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Notifiable and not notifiable claims - Medicare Compensation Recovery 011-15020000

This document outlines the types of compensation claims that are notifiable and not notifiable for the purposes of Medicare Compensation Recovery.

Determine if a claim is notifiable or not notifiable

Includes how to search for and return payments if needed.

Table 1

Step	Action
1	For Transport Accident Commission (TAC) claims only + Read more ... Note: all non-TAC related claims go to Step 2. Was a Medicare history statement requested for TAC for: a common law claim by an injured person who lives in Victoria, or non Victorian resident injured in an interstate accident involving a motor vehicle that was registered in Victoria (interstate claim)? Yes, go to Step 2 No, this claim is not notifiable under the Health and Other Services (Compensation) Act 1995 (HOSC Act), go to Step 9
2	Check if compensation is notifiable under the HOSC Act + Read more ... Is the compensation: a payment for damages a payment under an insurance scheme or compensation under law a payment (with or without admission of liability) resulting from judgment or settlement of a claim for damages, or a claim under an insurance scheme any other compensation or damages payment, other than a payment under a scheme where the recipient has contributed. For example, life insurance or superannuation Do any of the above apply? Yes, go to Step 3 No, this claim is not notifiable, go to Step 9 Unsure, go to Step 10
3	Check if notifiable person has insurance + Read more ... Is the notifiable person a company, registered business or medical practitioner? Yes, go to Step 4 No, proceed Is the notifiable person an individual? Yes, call the person who submitted the request to get further details. Are they insured or required by law to be insured? Yes, go to Step 4 No, the claim is not notifiable, go to Step 9 Unsure, go to Step 10
4	Check if compensation is for legal costs only + Read more ... Was the compensation amount for legal costs only? Yes: evidence must be provided to the agency to confirm this, such as the Terms of settlement, Deed of release or the legal costs invoice. Escalate these claims to Program Management the claim is not notifiable, go to Step 8 No, go to Step 5 Unsure, if: no evidence on file, go to Step 9 evidence received but still unsure if notifiable or not, go to Step 10
5	Check the claim amount or time period + Read more ... Was a compensation amount fixed by judgment or settlement for more than $5,000?, or was a reimbursement arrangement made more than 6 months after the compensation claim was made to the notifiable person? Yes, go to Step 6 No, if the claim is in progress or resolved, go to Step 9 Note: legal costs are included in the fixed amount for settlements, but not for judgments. Court documents may be needed to determine the amount of damages, excluding costs, for some judgments. Escalate these claims to Program Management.
6	Check if claim is for a personal injury + Read more ... Was the claim made for an injury/illness to a person? Yes, go to Step 7 No, this claim is not notifiable, go to Step 9 Unsure, go to Step 10
7	Register a Standard Active claim in MCRS + Read more ... Assess the submitted form for required information to register a claim. For process steps see Process Correspondence - Medicare Compensation Recovery Procedure ends here
8	Check for an advance payment or ad hoc payment + Read more ... Check SAP for payments that may relate to this claim banked against an 87 number. Did the agency get any payments for the claim? Yes, a refund of the payment must be issued to the payer, normally the compensation payer: Complete a Referring a case to Compensation Finance email template with the instruction to pay the payer Add a case note Procedure ends here No: Add a case note to advise the claim is not notifiable and include the reason why Terminate claim and issue You do not need to tell us about the compensation claim/reimbursement arrangement Z2797 letter Procedure ends here
9	Terminate active standard and provisional claims in MCRS + Read more ... If claim has previously been registered: go to Close, terminate or reopen a claim - Medicare Compensation Recovery to terminate the claim, and send a You do not need to tell us about a compensation claim/reimbursement arrangement (Z2797) letter Register a Provisional claim in MCRS If no claim is registered, create a provisional record in MCRS and: call the insurer and request evidence of a settlement amount for legal costs only. This can be provided on a copy of the Terms of settlement, Deed of release or the legal costs invoice determine the amount of damages excluding costs for some judgments, call the insurer and request a copy of the terms of settlement advise that a claim is not notifiable, send a You do not need to tell us about a compensation claim/reimbursement arrangement (Z2797) letter add a case note, Save Go to Search for or update an existing claim or register a new claim - Medicare Compensation Recovery for information on registering a provisional claim.
10	Escalate claim to Program Management + Read more ... Contact a Program Support Officer (PSO) for help in determining if the claim is notifiable. If unable to determine if the claim is notifiable, escalate the claim to Program Management. Create a provisional record in MCRS, and escalate to Program Management. Go to Search for or update an existing claim or register a new claim - Medicare Compensation Recovery. Add a case note confirming: background, all actions taken, information requested and from whom reason/s for escalation and recommendations for a decision whether the injured person has other active claims and if this claim has been escalated before Operational Blueprint procedures reviewed before escalating the claim