SIRA Logo

Standard 26 - arrangement for payments to Medicare Australia

Proactive engagement with Medicare Australia and correct attribution of medical costs helps to ensure prompt payment of entitlements and reduces the risk that a worker will be inadvertently subject to recovery action from Medicare.

Arrangement for payments to Medicare Australia

Principle: Due care will be given in the management of claims to mitigate risks arising from the interaction between Medicare and the workers compensation scheme.

 ExpectationsBenchmarks
S26.1 Insurers must request a notice of past benefits from Medicare when:
  • an application for dispute resolution has been lodged with the Workers Compensation Commission (excluding disputes that only relate to work capacity decisions)
  • accepting liability for a condition that is contracted or caused by gradual process or that may be an aggravation of a disease;
  • there is a retrospective entitlement to compensation (ie. when liability for medical expenses had been disputed but subsequently accepted six months or more after the liability dispute date); or
  • a settlement of a claim for compensation is initiated that will exceed $5,000.
Medicare notice of past benefits to be initiated within five working days of relevant event.