Before taking action based on the information provided on this page, you need to consider your own situation and the relevant laws. You should seek advice that takes account of your particular set of circumstances. Check with your medical indemnity insurer if they have additional requirements which may not be covered here.
The Department of Health makes reasonable efforts to ensure that the information provided on this page is accurate. However, before relying on any information on this page, you should always check that the information is accurate, current and complete. The Department does not guarantee the accuracy, currency or completeness of the information on this page. The Department accepts no legal liability for the information on this page.
The High Cost Claims Scheme (HCCS)
What is the HCCS?
How will the HCCS reduce doctors' premiums?
How will the HCCS reduce practitioner' premiums?
Are claims against me covered by the HCCS if it is more than the level of insurance?
Allied Health High Cost Claim Scheme (AHHCCS)
What is the HCCS?
Under this Scheme, the Australian Government will reimburse medical indemnity insurers 50% of the insurance payout over a threshold of $300,000 up to the limit of the practitioner's cover, for claims notified on or after 1 January 2004.
Your claim will only be covered by this scheme if you are insured. The HCCS minimises the impact that large claims may have on the ability of medical indemnity insurers to continue to provide affordable indemnity cover for practitioners.
From 1 July 2020, the HCCS will be limited to medical practitioners and a separate scheme will be available for allied health professionals.
How will the HCCS reduce practitioners' premiums?
This scheme helps to produce downward pressure on premiums, particularly for practitioners in high-risk specialties by:
- lowering the amount medical indemnity insurers have to pay out; and
- reducing the amount of reinsurance medical indemnity insurers need to buy to fund large claims.
Why is there only a 50% payment for the excess of high cost claims?
The subsidy has been restricted to 50% (of the insured amount) to ensure that medical indemnity insurers bear some of the risk of high payouts for medical negligence.
Are claims against me covered by the HCCS if it is more than the level of insurance?
Your claim will only be covered by the HCCS up to the limit of your medical indemnity insurance coverage. The Scheme will not cover your claim for any amounts due over that limit.
However, the Australian Government's Exceptional Claims Scheme (ECS) can help practitioners where claims exceed their contract limits. If the claim is over the specified threshold limit (currently $20 million) then the Australian Government will cover 100% of costs over the contract's limit. This means practitioners will not be personally liable for very large claims (see:
Exceptional Claims Scheme).
Allied Health High Cost Claim Scheme (AHHCCS)
This new scheme takes effect from 1 July 2020. As per the HCCS, the AHHCCS will cover 50% of the cost of eligible medical indemnity insurance payouts for eligible claims relating to privately practising allied health professionals (including midwives indemnified under their employer’s professional indemnity insurance policy) registered by the Australian Health Practitioner Regulation Agency (AHPRA). A claim must be greater than the threshold amount (currently $500,000), up to the limit of the allied health professional’s insurance cover.
To be eligible under this scheme, the incident or series of related incidents need to have occurred on or after 1 July 2020 and the allied health professional needs to be registered with AHPRA. This scheme will be open to insurers providing professional indemnity insurance to registered medical practitioners (or their employers) at the date of the scheme’s commencement.
The AHHCCS is largely consistent with the circumstances described in the HCCS. The difference is that the incident, or series of incidents, must have occurred on or after 1 July 2020. However, if the incident occurred before 1 July 2020, allied health practitioners will continue be eligible under the HCCS.
