Circumstances in which high cost claim indemnity payable
30 Circumstances in which high cost claim indemnity payable
Basic payability rule
Subject to section 31, a high cost claim indemnity is payable to an MDO or insurer under this section if:
a claim is, or was, made against a person (the practitioner); and
the claim relates to:
an incident that occurs or occurred; or
a series of related incidents that occur or occurred;
in the course of, or in connection with, the practitioner’s practice as a medical practitioner; and
either:
the incident occurs or occurred; or
one or more of the incidents in the series occurs or occurred;
in Australia or in an external Territory; and
the MDO or insurer is first notified of:
the incident; or
the claim; or
an eligible related claim;
between 1 January 2003 and the date specified in the rules as the termination date for the high cost claim indemnity scheme; and
the MDO or insurer has a qualifying payment in relation to the claim, or qualifying payments in relation to:
the claim; or
the claim and one or more eligible related claims; and
the amount of the qualifying payment, or the sum of the amounts of the qualifying payments, exceeds what was the high cost claim threshold at the earliest of the following times:
when the MDO or insurer was first notified of the incident;
when the MDO or insurer was first notified of the claim;
when the MDO or insurer was first notified of an eligible related claim; and
any other requirements (however described) that are specified in the rules have been met.
The claim referred to in paragraph (a) may be one that was made before, or is made after, the commencement of this Act and an incident referred to in paragraph (b) may be one that occurred before, or occurs after, the commencement of this Act.
Rules made for the purposes of paragraph (1)(g) do not apply in relation to an incident if the claim relating to the incident was made before the rules in question commence.
Qualifying payments
The MDO or insurer has a qualifying payment in relation to a claim if:
the MDO or insurer:
pays an amount in relation to the claim; or
is liable to pay an amount in relation to a payment or payments that someone makes, or is liable to make, in relation to the claim under a written agreement between the parties to the claim; or
is liable to pay an amount in relation to a payment or payments that someone makes, or is liable to make, in relation to the claim under a judgment or order of a court that is not stayed and is not subject to appeal; or
is a Chapter 5 body corporate and is liable to pay a provable amount in relation to the claim; and
the MDO or insurer pays, or is liable to pay, the amount under an insurance contract or other indemnity arrangement between the MDO or insurer and the practitioner; and
the MDO or insurer:
pays, or becomes liable to pay, the amount in the ordinary course of the MDO’s or the insurer’s business; or
is a Chapter 5 body corporate and would be able to pay the amount in the ordinary course of the MDO’s or the insurer’s business if it were not a Chapter 5 body corporate.
The date specified in the rules for the purposes of paragraph (1)(d) must be at least 12 months after the day on which the rules in question are registered on the Federal Register of Legislation.
Indemnity to be paid on trust if MDO or insurer under external administration
If a high cost claim indemnity is paid to an MDO or insurer that is a Chapter 5 body corporate, the indemnity is, to the extent to which it is attributable to an amount that the MDO or insurer is liable to pay to a person, paid on trust for the benefit of that person.
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