Commonwealth Consolidated Acts Commonwealth Consolidated ActsCriteria for certification
(1) The Chief Executive Medicare may issue a certificate stating that a claim is a qualifying allied health claim if the Chief Executive Medicare is satisfied that:
(a) the claim is a claim that is or was made against a person (the practitioner ); and
(b) the claim relates to:
(i) an incident that occurs or occurred; or
(ii) a series of related incidents that occur or occurred;
in the course of, or in connection with, the practice by the practitioner of an allied health profession; and
(c) if the allied health profession is midwifery--the practitioner is not:
(i) an eligible midwife for whom a contract of insurance with a midwife insurer provides midwife professional indemnity cover in relation to the claim; or
(ii) an eligible midwife who has a contract of insurance that names the eligible midwife as the only person to whom the insurance cover provided by the contract extends, and that indemnifies the eligible midwife (subject to the terms and conditions of the contract) in relation to claims that may be made against the eligible midwife in relation to incidents that occur or occurred in the course of, or in connection with, the practice by the eligible midwife of the profession of midwifery; and
(d) except in the circumstances specified in rules made for the purposes of this paragraph, either:
(i) the incident occurs or occurred; or
(ii) one or more of the incidents in the series occurs or occurred;
in Australia or an external Territory; and
(e) either:
(i) the incident occurs or occurred; or
(ii) all of the incidents in the series occur or occurred;
on or after 1 July 2020; and
(f) the incident did not occur, or the incidents did not all occur, in the course of the provision of treatment to a public patient in a public hospital; and
(g) there is a contract of insurance in relation to which the following requirements are satisfied:
(i) the contract provides medical indemnity cover for the practitioner in relation to the claim, or would, but for the practitioner's contract limit, provide such cover for the practitioner in relation to the claim;
(ii) the practitioner's contract limit equals or exceeds the relevant allied health threshold (see section 34ZZL);
(iii) the insurer is an eligible insurer;
(iv) the insurer entered into the contract in the ordinary course of the insurer's business; and
(h) if a termination date for the allied health exceptional claims indemnity scheme is set (see section 34ZZM), the incident, or one or more of the incidents, to which the claim relates occurred before the allied health termination date; and
(i) the claim is not a claim specified in rules made for the purposes of this paragraph; and
(j) the contract of insurance is not a contract specified in rules made for the purposes of this paragraph; and
(k) a person has applied for the certificate in accordance with section 34ZZN; and
(l) the Chief Executive Medicare could not issue a qualifying claim certificate in relation to the claim if an application for the certificate were made in accordance with section 34H.
Note 1: Paragraph (f)--for what happens if some, but not all, of the incidents in a series occur in the course of the provision of treatment to a public patient in a public hospital, see section 34ZZT.
Note 2: Paragraph (h)--for what happens if some, but not all, of the incidents in a series occur after the allied health termination date, see section 34ZZU.
When a certificate is in force
(3) The certificate comes into force when it is issued and remains in force until it is revoked.
Matters to be identified or specified in certificate
(4) The certificate must:
(a) identify:
(i) the practitioner; and
(ii) the claim; and
(iii) the contract of insurance in relation to which paragraph (1)(g) is satisfied; and
(b) specify the relevant allied health threshold.
The certificate may also contain other material.
ART review of decision to refuse
(5) Applications may be made to the Administrative Review Tribunal for review of decisions of the Chief Executive Medicare to refuse to issue a qualifying allied health claim certificate.
Note: Section 266 of the Administrative Review Tribunal Act 2024 requires notification of a decision that is reviewable.
Chief Executive Medicare to give applicant copy of certificate
(6) If the Chief Executive Medicare decides to issue a qualifying allied health claim certificate, the Chief Executive Medicare must, within 28 days of making the decision, give the applicant a copy of the certificate. However, a failure to comply does not affect the validity of the decision.