Notice of past benefits request and Notice to claimant (NTC) - Medicare Compensation Recovery 011-15030050

A Notice of past benefits request is a document that results in a notice produced by Medicare Compensation Recovery, Notice of past benefits (NOPB). This notice provides the amount of recoverable Medicare benefits and care costs owing to the Australian Government. This is in relation to a notifiable compensation claim.

The Notice of past benefits request prompts the issue of a NTC. Once the NTC is completed and returned, this results in a:

• NOPB
• Notice of past benefits – advance payment (NOPB-AP), or
• Notice of charge (NOC)

When and how to make a request

A NOBP can be requested before or after:

• a judgment/settlement, or
• entering into a reimbursement arrangement

If a NOPB is requested before judgment/settlement, the request must be made on a current Medicare Compensation Recovery Notice of past benefits request form (MO026).

A NTC is automatically sent if:

• a Medicare Compensation Recovery Notice of Judgment or Settlement form (MO022) or Medicare Compensation Recovery Notice of reimbursement arrangement form (MO027) is received by the agency, and
• a NOPB does not exist, or has expired, or a received Medicare Compensation Recovery Section 23A statement form (MO023) is not accepted when an MO022 is received
  Note: a MO026 is not required in these situations.

The Resources page contains links to forms.

Who can make a request

The request can be made by:

• an injured person
• claimant, authorised third party or legal representative. For example:
• power of attorney
• legal guardian
• executor, or
• administrator of a deceased estate
• a notifiable person (compensation payer or insurer), or their delegate or agent

Note: an agent or delegate is another business, such as another insurer or solicitor, who has been contracted to manage the claim. For example, a state Worker's Compensation authority may contract work to an insurer.

Go to Table 7 in the Process correspondence - Medicare Compensation Recovery for the MO026 information requirements.

Processing the request

When the valid MO026 form is processed in MCRS, an NTC is issued.

A NTC is issued to the injured person/claimant or the authorised third party if a valid Medicare Compensation Recovery Third party authority form (MO021) is held on the claim:

• in response to a valid Medicare Compensation Recovery Notice of past benefits request form (MO026), or
• if a valid Medicare Compensation Recovery Notice of Judgment or Settlement form (MO022) is received without a valid Medicare Compensation Recovery Section 23A statement form (MO023), and:
• there is not a valid NOPB at date of judgment or settlement
• a NTC has not already been issued, or
• a statement by claimant (SBC) is not awaiting processing
• if a reimbursement arrangement was entered into before a NOPB was issued

A NTC has 2 parts:

• Identify related Medicare history and care services letter (Z2800)
• Medicare history statement, care services statement and declaration (Z2801)

A NTC:

• will not include a Medicare history statement if:
• no Medicare services were received between date of injury and date of statement issue
• the claim is for an injured person not entitled to Medicare, however Services Australia has been advised that care services were received in relation to the compensable injury/illness
• will become an SBC when returned (Z2801)
• will result in the issue of a:
• NOPB, or
• Notice of past benefits – advance payment (NOPB-AP), or
• Notice of charge (NOC)
• may be issued more than once for the same compensation claim. Each subsequent notice will include services (ticked items) that were identified on the last statement (known as verified services)
• may be re-issued (for MCRS or CCMS generated NTC, if a copy was requested). Go to Medicare Compensation Recovery

Return statement by the due date on the notice

The completed SBC must be returned on or before the due date printed on the ‘Identify related Medicare history and care services’ Z2800 letter, sent with the statements and declaration.

The due date is 37 days from the date the statement is printed. This is the legislated 28 days plus up to 9 days allowance for receipt by regular mail (post).

Go to Statement by claimant (SBC) and care costs - Medicare Compensation Recovery for the contents of a valid SBC.

If the completed SBC is not returned, all items on the Medicare history statement:

• will be taken as related to the compensated injury/illness,
• will be included in the total recoverable amount, and
• must be paid to the Australian Government if the NOPB is valid when the claim is finalised by:
• judgment
• settlement, or
• reimbursement arrangement

Note: previously identified care costs on an expired NOPB will be carried forward and added to the notice with all services included.

An extension of time to return the completed Medicare history and care services statement/s and declaration (Z2801) may be requested on or before the due date. For more details, go to Extensions, not substantially correct, decisions and reviews.

When the agency will not issue a NTC

If the time period in which a NOPB or NOC must be issued has passed. For example, if it is 3 months or more after the agency received a notice of judgment or settlement or valid advance payment (whichever is later):

• MCRS will not give the option to send a NTC, and
• the agency will not be eligible to recover benefits and subsidies for the claim, unless an extension was granted for the return of the SBC

Go to:

• Extensions, decisions and reviews – Medicare Compensation Recovery
• Notice of judgment or settlement (NOJS)