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

This document outlines how Services Australia releases information for Medicare Compensation Recovery claims. Includes how information can be released to third party authorities, claimants and notifiable persons, legal representatives, minors, and deceased estates.

Step	Action
1	Notification received via telephone advising the injured person is deceased + Read more ... Record details from the caller in a case note on MCRS: name of person calling relationship to the deceased contact telephone number
2	Identify the caller + Read more ... Was the caller previously 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 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 provide the acceptable documentation for examples of acceptable documentation, go to Step 4
3	Verify death + Read more ... Check if there is a date of death recorded on the customer’s Medicare 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 CDMS or MCRS? Yes, go to Step 4 No, request a copy of the death certificate add a case note Note: the Medicare card hyperlink shows the information held on the Medicare consumer database (CDMS). If the claim was registered prior to the date of death the information will not update automatically. Service Officers will need to add the detail during an update. See Claim management - Medicare Compensation Recovery
4	Acceptable documentation to establish the claimant for deceased estates + Read more ... 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 interstate and documents have not been issued yet Service Officers must add a case note documenting the interaction and advice given

Action documents for a deceased person

Table 2

Step	Action
1	Review case notes and documents + Read more ... If case notes indicate that supporting documents from the executor or administrator have been received, and the claim details need to be updated: read all case notes, and check all Medicare Compensation Recovery documents
2	Are documents acceptable to verify the claimant for a deceased estate? + Read more ... 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 Select Continue From the Claimant details screen, select the dropdown menu under ‘Relationship to inured person’ Select Legal Representative Add legal representatives name, address and contact details to the relevant fields 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, go to Step 3
3	Injured person is deceased + Read more ... Did the injured person pass away before the date of a judgment, settlement or reimbursement arrangement? Yes, make two reasonable attempts to call the sender to request required legal documentation to verify claimant: successful contact is made, request the required documents and escalate the claim to Program Management. Clearly case note what actions were taken, what was discussed on the call and what is required from Program Management. unsuccessful making contact after two reasonable attempts, escalate the claim to Program Management. Clearly case note what actions were taken and what is required from Program Management. No, go to Step 4
4	Injured person is deceased after date of judgment, settlement or reimbursement arrangement + Read more ... Clearly case note the reason for the escalation and what is required from Program Management Escalate the claim to Program Management

Action a claim for a minor

Table 3

Step	Action
1	Check injured person is a minor under 14 years of age + Read more ... Is the injured person a minor under 14 years of age? Yes, go to Step 2 No, the minor is 14 years of age or older, but under 18 years of age, go to Step 4, or the injured person can act on their own behalf, see Claim management - Medicare Compensation Recovery
2	Check if the minor is on the same Medicare card as the parent/guardian listed as the claimant + Read more ... Open Consumer Directory Maintenance System (CDMS) Select Inquire on Consumer Details The following fields will appear: Program select ‘Medicare’ ID Number enter Injured persons Medicare card number ID Number Type select ‘Medicare Card Number’ Select the Personal button to enter record Consumers lists the people recorded on the Medicare Card. Make sure the correct minor record has been selected and check the minor and parent/guardian are listed on the same Medicare Card. See Consumer Directory Maintenance System (CDMS) for Medicare for more details about the CDMS system. Note: this process is only needed to confirm that the minor is on same Medicare card as the parent/guardian. The View consumer details screen when selecting Medicare card hyperlink in MCRS does not show this information. Are claimant details provided on the form or other supporting documents received with claimant details listed? And is the minor on the same Medicare card as the parent or guardian listed as the claimant who is listed on the form(s)? Yes, go to Step 3 No, go to Step 7
3	Check if the minor has their own Medicare card + Read more ... 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 6 No, go to Step 8
4	Is the minor under 18 years of age on the same Medicare card as a parent/guardian? + Read more ... Yes, go to Step 5 No, go to Step 8
5	Check if the parent or guardian is authorised to act as claimant for the minor + Read more ... Is there a valid Third party authority (MO021) form giving the parent or guardian authorisation to act as claimant on behalf of the minor? Yes, go to Step 8 No, go to Step 6
6	Review legal documentation to determine claimant + Read more ... Is there a signed Third party authority (MO021) form, legal documentation received such as a Guardianship or Court order, or a Commonwealth of Australia Statutory Declaration, to verify a claimant is acting on behalf of the minor? Yes, go to Step 7 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 where claimant details provided match a parent/carer on the same Medicare card or a Guardianship order). See Table 2 on the Resources page. Tell the sender that the current form is invalid and action will be taken when new form/s are received with supporting documents. Invalidate the work item 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, re-categorise the work item through Work Load Manager (WLM) to a team leader for allocation On subsequent contact attempts, if: successful, request the required documents (for example, a form where claimant details provided match a parent/carer on the same Medicare card or a Guardianship order). See Table 2 on Resource page. Advise current form is invalid and action will be taken when new form/s are received with supporting documents and invalidate work item 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 work item. Procedure ends here
7	Make sure claimant details are correct and process the claim + Read more ... 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’s name and address details are correctly listed Process the claim Issue documents to the claimant Add a case note
8	Update claimant’s name to parent or guardian and process the claim + Read more ... 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

Accept or revoke a third party authority

Table 4

Step	Action
1	Check MCRS + Read more ... View claim details, 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 authorised third parties 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 injured person has passed away.
2	Revoking an existing third party authority + Read more ... Is the existing authorised third party authority 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 a minor aged over 14 years of age did not provide a MO021 prior to turning 18 years of age 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
3	Changes to the existing third party authority + Read more ... 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
4	Valid Third party authority form (MO021) + Read more ... Has all the mandatory information as outlined in Document Assessment been included in the MO021 form? Yes, see Claim management - Medicare Compensation Recovery to update claimant details No, the form is: complete except for claimant signature, go to Step 5 complete except for missing date of injury or illness, or a different date to what is recorded on this compensation claim, go to Step 6 incomplete, go to Step 9
5	Verbal consent for an unsigned form + Read more ... Note: the form must have already been signed by the third party to be authorised. Make an outbound call to the injured person and complete authentication checks Ask the injured person: Do you authorise (insert name from Third Party Authority form) to act on your behalf regarding the Medicare compensation recovery claim that includes your personal information? Include a case note such as: ‘Verbal consent has been provided by [Injured person/claimant] for [authorised third party name] to act on their behalf as per the [document type] received on [date]' 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, add a case note go to Step 9
6	Date of injury or illness + Read more ... Confirm if the third party authority form is for this claim. Does the date of injury match the date recorded in MCRS? Yes, go to Step 8 No, the date is missing, or a different date to what is recorded on this compensation claim: If the injury description is indicative of an historical abuse or historical psychological claim, go to Step 7 Contact the injured person or claimant by phone to verbally confirm the correct date of injury or illness If contact is successful and the correct date is confirmed, go to Step 9 If contact is unsuccessful, go to Step 9 Note: the authority may relate to a different claim for the same person. If so, get the correct claim details.
7	Indicative of an historical abuse or historical psychological claim + Read more ... Date of injury or illness is often unclear due to the historical nature of these claims. Review all details provided such as involved parties, reference numbers and any supporting documentation listing a solicitor. If the date of injury does not match but it is clear that the authority is for this claim, get advice on retaining the authority. See Escalations - Medicare Compensation Recovery. Is the authority being retained? Yes, go to Step 8 No, go to Step 9
8	Missing information + Read more ... Is there other missing mandatory information? Yes, form is invalid, go to Step 9 No, form is valid, see Claim management - Medicare Compensation Recovery to update authorised third party details
9	Check claim registration status + Read more ... Is a claim registered that matches the details on the MO021? Yes, a claim exists, go to Step 11 No, claim has not been registered, go to Step 10
10	Other documents received + Read more ... Have other documents been received to register a claim, such as a valid MO026, MO022 or MO027? Yes, see Claim management - Medicare Compensation Recovery to register a new claim go to Step 12 No, other documents are invalid or have not been received, go to Step 11
11	Documents invalid/not received + Read more ... 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 add case note Procedure ends here Note: a courtesy call is required to the party that submitted the incomplete form, to advise that a letter has been sent to the injured person or claimant and no correspondence or information about the compensation claim will be proved until a valid MO021 is received.
12	Register provisional claim - issue correspondence - Z2798 letter + Read more ... Register a provisional claim and issue the We need more information to register a compensation claim (Z2798) letter. From the Evaluate screen: Select the document type, MO026. A provisional claim will not be recorded if only MO021 is selected 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. The checklist on Evaluate screen will not change the claim status, to make sure the provisional WIN is created the Date of declaration field in MCRS will also need to remain 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 message will display. Have you entered all information provided? Select Yes Is the case notifiable? See Notifiable and not notifiable claims - Medicare Compensation Recovery 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 correct recipient and select Preview to view the letter content Select Submit Record case note Procedure ends here Note: a courtesy call is required to the party that submitted the incomplete form, to advise that a letter has been sent to the injured person or claimant and no correspondence or information about the compensation claim will be provided until a valid MO021 and MO026 (if applicable) is received.

Accept or revoke an authority for a party other than an authorised third party

Table 5

Step	Action
1	Check MCRS + Read more ... View claim details, 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
2	Authority for an existing claimant + Read more ... Is the existing claimant still authorised to act on behalf of the injured person? Yes, If updates to details are needed see Claim management - Medicare Compensation Recovery to update claimant details If no updates to details are needed procedure ends here No, go to Step 3
3	Removing authority for an existing claimant + Read more ... 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 Note: Power of Attorney documents received by the agency before the death of the injured person become invalid once the injured person dies.
4	Supporting documentation + Read more ... Has a Third party authority (MO021) form signed by the injured person been received for an individual to act as an authorised third party on behalf of the injured person? For example, a friend or family member. Yes, contact with the injured person is required to confirm that the injured person has fully understood that: submitting a MO021 for an individual will not revoke an existing authorisation for a solicitor. It gives the nominated party the ability to contact the agency and discuss the claim on behalf of the injured person information will be released to the third party, and the injured person is bound by the third party’s actions Note: if contact is successful, clearly case note the call with the injured person, including the name of the person being authorised to act on behalf of the injured person. If the injured person is unable to provide verbal consent, for example if they have severe psychological damage, escalate the claim to Program Management for advice. If contact is unsuccessful, clearly case note call attempts. Do not add the individual’s name into case notes until the injured person has been advised of the points above No, see Table 8, Step 2 to issue a We are unable to process (Z2802) letter requesting supporting documents

Subpoenas

Table 6

Step

Action

Correspondence requiring further action + Read more ...

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

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

Operational Information