Authority to access a claim - Medicare Compensation Recovery 011-15040120

Record details from the caller in a case note on MCRS:

• name of person calling
• relationship to the deceased
• contact telephone number

Is the caller registered as a claimant, or are they an authorised third party?

• Yes, request acceptable documentation (if not on file) to confirm who the claimant is. Tell the caller, that as the injured person is now deceased:
• any previous third party authorisations are now invalid
• a new authorisation will need to be signed by the appointed executor, executrix or administrator of the estate
• no information about the claim can be disclosed until official documents are received, go to Step 3
• No,
• thank the caller for the information. Tell the caller that the claimant will need to contact Medicare Compensation Recovery to provide the acceptable documentation
• go to Step 4 to add a case note

Check if there is a date of death recorded on the customer’s record.

• Select Restricted Claim Actions
• Enter the customer’s name and date of birth into the relevant fields, select Search
• Confirm the correct customer has been provided on the Results screen, check the:
• name
• date of birth, and
• address
• Select the Medicare card number hyperlink to open the View consumer details screen

Is there a date of death recorded on MCRS?

• Yes, go to Step 4
• No,
• request a copy of the death certificate
• add a case note

Note: the consumer details check performed by using the Medicare card hyperlink shows the information held on the Medicare consumer database. If the claim was registered prior to the date of death the information will not have updated. Service Officers will need to add the detail during an update. See Claim management - Medicare Compensation Recovery

Advise the caller of the below acceptable documentation:

• Last Will and Testament of the deceased injured person
• Documents from the Public Trustee appointing an administrator
• Letters of Administration from the applicable state’s Supreme Court that includes the deceased person's name and name of the person appointed as administrator
• Probate from the court

Program Management accepts Commonwealth of Australia Statutory Declarations signed by the person responsible for the estate if:

• there are no official legal documents, or
• the injured person has died intestate and documents have not been issued yet

Service Officers must add a case note documenting the interaction and advice given

If case notes indicate that supporting documents from the executor, executrix or administrator have been received, and the claim details need to be updated:

• read all case notes, and
• check all Medicare Compensation Recovery documents

• Yes, update the claimant record:
• Select the claim/work item number (WIN)
• From the Enquiry screen, select Other - all other documents from the dropdown menu as the document type
• Select the Does the Medicare customer selected match the injured Person named in the document? button
• Select the Does the claim selected match the details in the documents? button
• Select the Is update to existing details required? button
• Select Continue
• Select Yes to the question: Are you sure you want to update the claim?
• From the Injured person details screen, add Date of death using the date provided in the evidence, and select Continue. Note: once a date of death is added to a claim record, the Claimant’s given name automatically updates to include the 'Estate of' on outgoing correspondence when referencing the injured person
• From the Claimant details screen, add the details of the executor, executrix or administrator, select Continue
• Update notifiable person details if required, select Continue
• Review all details entered, select Submit
• Select Yes to the question: Are you sure you want to update the claim?
• If MCRS determines that a new notice to claimant is required, this can be actioned from the Issue correspondence screen
• add a case note
• No,
• do not process the claim
• request the required documents
• add a case note

Is the injured person a minor under 14 years of age?

• Yes, go to Step 2
• No,
• the minor is under 18 years of age
• go to Step 4

Are claimant details provided on the form or other supporting documents received with the claimant details provided?, and is the minor on the same Medicare card as the parent or guardian who is listed on the form(s)?

• Yes, go to Step 3
• No, go to Step 7

Is the minor on the same Medicare card as the parent or guardian, as well as their own Medicare card?

• Yes,
• a minor under the child protection agency will remain on their existing Medicare card and will also be issued with their own Medicare card
• go to Step 7
• No, go to Step 6

• Yes, go to Step 5
• No, go to Step 7

Is there a valid third party authority giving the parent or guardian authorisation to act as claimant on behalf of the minor?

• Yes, go to Step 8
• No, go to Step 7

Does the parent or guardians names on the Medicare card match the claimant name/s?

• Yes, go to Step 9
• No,
• do not complete the case as the correct claimant must be confirmed
• go to Step 7

Is there a signed Third Party Authority (MO021) Form, legal documentation received such as a Commonwealth of Australia Statutory Declaration, or a Guardianship or Court order to verify a claimant is acting on behalf of the minor?

• Yes, go to Step 8
• No, do not provisionally register a claim, call the sender of the correspondence., if:
• successful contact is made, request the required documents (for example, a form with claimant details provided that match a parent/carer on the same Medicare card, guardianship order)
• unsuccessful making contact on the first attempt, hold the claim to user and make further contact attempts within 24 hours. If the Service Officer is not available the following day to make further attempts, transfer the work item through Work Load Manger (WLM) to a team leader for allocation
• On subsequent contact attempts, if:
• successful, request the required documents (for example, form with claimant details provided that match a parent/carer on the same Medicare card, guardianship order). See Table 2 on Resource page
• unable to contact the sender after multiple attempts, add a case note to NCRI screen on minor’s record describing all actions taken and invalidate case. Procedure ends here

When the minor has an authorised representative, all Medicare Compensation Recovery claim documents (including the notice to claimant) may be sent to that party.

• Make sure the claimant name and address details are correctly listed
• Process the claim
• Issue documents to the claimant

When the minor is listed on a parent or guardian’s Medicare card only, and they are not listed on a separate Medicare card, all Medicare Compensation Recovery claim documents (including the notice to claimant) may be sent to the parent or guardian.

• Make sure the claimant's name and address details match the parent/guardian details
• Process the claim
• Issue documents to the authorised claimant
• Add a case note

View documents and case notes to determine if there is an existing authorised third party. To release information to a third party, a completed Third party authority (MO021) form must be provided by the injured person or claimant.

Is there an existing valid third party authority already on file?

• Yes, go to Step 2
• No, go to Step 5

Note: all existing third party authorities are valid even after the claim is closed, unless otherwise revoked verbally or in writing by the injured person, claimant or authorised third party, or unless the claimant has passed away.

Is the existing third party authority form being revoked because:

the injured person, claimant has advised the agency that they:

• no longer want the existing third party, and/or
• want to authorise a different third party, or
• the authorised third party has advised that they no longer represent the injured person or claimant, or
• the injured person has passed away

Do any of the above apply?

• Yes, see Claim management - Medicare Compensation Recovery to update claimant details
• No, a Third party authority (MO021) form has been received, go to Step 3

Are there any changes to the existing authorised third party, for example, a change of solicitor or change of solicitor address?

• Yes, go to Step 4
• No,
• attach the document to the claim, see Claim management - Medicare Compensation Recovery
• procedure ends here

Has all the mandatory information been included in the MO021 form?

• Yes, see Claim management - Medicare Compensation Recovery to update claimant details
• No,
• complete except for claimant signature, get verbal consent, go to Step 5
• incomplete, go to Step 6

Note: the form must have already been signed by the third party to be authorised.

Has the injured person or claimant provided verbal consent for the otherwise complete and current MO021 form?

• Yes, see Claim management - Medicare Compensation Recovery to update claimant details
• No, the authority is invalid, go to Step 8

Confirm if the third party authority form is for this claim.

Is the date of injury correct?

• Yes, go to Step 7
• No, date is missing, or a different date to what is recorded on this compensation claim:
• Contact the injured person or claimant, and
• Verbally get the correct date of injury or illness over the phone
• If contact is successful and the correct date is confirmed, go to Step 7
• If contact is unsuccessful, go to Step 8

Note: the authority may relate to a different claim for the same person. If so, get the correct claim details.

Is there other missing mandatory information?

• Yes, form is invalid, go to Step 8
• No, form is valid, see Claim management - Medicare Compensation Recovery to update authorised third party details

Issue a We are unable to process Z2802 letter.

From the Evaluate screen:

• select the Does the Medicare customer selected match the injured Person named in the document? button
• select the Does the claim selected match the details in the documents? button
• select the Are the documents received incomplete? button
• Select Continue
• Select Yes at the Are you sure you want to send correspondence & close Enquiry? button

From the Set Correspondence screen:

• select the form that is unable to be processed and the relevant reason
• select the correct recipient and select Preview to view the letter content
• select Submit to issue the letter

Note: make sure a phone call is made to the party that submitted the incomplete form.

Are the documents for a new claim registration?, Go to Step 9.

Issue the We need more information to register a compensation claim (Z2798) letter

From the Evaluate screen:

• Select the document type
• Select the Does the Medicare customer selected match the injured Person named in the document? button
• Select the relevant buttons for provided information on the New claim checklist
  Note: if mandatory information is missing from the provided document leave the signature button unselected
• Complete all provided details for injured person on the injured person and claim screen, leaving the Declaration signed and dated button deselected
• Proceed through to the Capture notifiable person details screen
• Enter provided details
• Select Continue
• Review all information entered, making sure that declaration date is not entered. If incorrect detail identified, select Edit link on right hand side of each section and update information
• Select Submit
• Provisional record pop up will present. Have you entered all information provided? Select Yes
• Is the case notifiable?
• No, go to Table 3, Step 10 in Claim management - Medicare Compensation Recovery
• Yes, select the reason/s the claim was unable to be registered
• Select the recipient for correspondence
• Select Submit
• Procedure ends here

View documents and case notes to determine if the claimant is authorised to act on behalf of the injured person.

Is there a claimant already recorded on the claim?

• Yes, go to Step 2
• No, go to Step 4

Is the existing claimant still authorised to act on behalf of the injured person?

• Yes,
• If updates to details are required see Claim management - Medicare Compensation Recovery to update claimant details
• If no updates to details are required procedure ends here
• No, go to Step 3

If the existing claimant is no longer authorised to act on behalf of the injured person the authorisation end date must be entered to stop any correspondence or information being provided to the incorrect party.

Have supporting documents been received for a new claimant?

• Yes, go to Step 4
• No, see Claim management - Medicare Compensation Recovery to end date the claimant authorisation

Have supporting documents been provided to confirm the claimant can act on behalf of the injured person?

• Yes, see Claim management - Medicare Compensation Recovery to add a claimant
• No, see Table 3, Step 8 to issue a We are unable to process (Z2802) letter requesting supporting documents

Note: all Power of Attorney documents received by the agency before the death of the injured person become invalid once the injured person dies.

If a subpoena is received:

• attempt one contact with the sender to advise that the subpoena has been sent to the incorrect address:
• See Request information using subpoenas and other court orders on Services Australia website
• If the contact is unsuccessful, contact a Program Support Officer
• request for a Team Leader to access the MCRS mailbox and locate the original email
• Team Leader must forward the email to the Subpoena team making certain that the 'From’ field is assigned as the MCR mailbox address
• Service Officer to invalidate the work item in MCRS

See Resources page for link to Subpoena team email