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MEDICAL INDEMNITY (PRUDENTIAL SUPERVISION AND PRODUCT STANDARDS) ACT 2003 No. 37, 2003 - SECT 4

Definitions

General

(1)
In this Act:

"APRA" means the Australian Prudential Regulation Authority.

"arrangement" includes a contract of insurance.

"ASIC" means the Australian Securities and Investments Commission.

"breach the minimum cover rules" has the meaning given by subsection (8).

"claim":

(a) means a claim or demand of any kind (whether or not involving legal proceedings); and
(b) includes proceedings of any kind including:
(i) proceedings before an administrative tribunal or of an administrative nature; and
(ii) disciplinary proceedings (including disciplinary proceedings conducted by or on behalf of a professional body); and
(iii) an inquiry or investigation;

and claim against a person includes an inquiry into, or an investigation of, the person's conduct.

"claims-made based cover" has the meaning given by subsections 6(2) and (3).

"claims period", in relation to a regulated insurance contract, has the meaning given by subsection 21(3).

"client", in relation to a regulated insurance contract, has the meaning given by subsection 21(2).

"come into effect", in relation to an arrangement, has the meaning given by subsection (4).

"compensation claim" means a claim for compensation or damages that is made against a health care professional in relation to a health care incident.

"complying offer" has the meaning given by section 24.

"compulsory new contract offer", in relation to a new regulated insurance contract, means an offer under section 22.

"compulsory offer period", in relation to an offer made under section 23, means the period referred to in paragraph 24(2)(b) in relation to the offer.

"constitutional corporation" means a corporation to which paragraph 51(xx) of the Constitution applies.

"enter into", in relation to certain arrangements, has a meaning affected by section 7.

"entity" means:

(a) a body corporate; or
(b) a partnership; or
(c) any other unincorporated association or body of persons; or
(d) a trust.

"general insurer" has the same meaning as in the Insurance Act 1973 .

"health care" means any care, treatment, advice, service or goods provided in respect of the physical or mental health of a person.

"health care incident", in relation to a health care professional, means an incident that occurs in the course of, or in connection with, the provision of health care by the health care professional.

"health care professional":

(a) means an individual who provides health care (whether for reward or not and whether as an employee, as part of a business or on some other basis); and
(b) includes:
(i) a medical practitioner; and
(ii) a registered health professional.

"incident" includes:

(a) any act, omission or circumstance; and
(b) an incident that is claimed to have occurred.

"incident-occurring based cover" has the meaning given by subsection 6(4).

"indemnify" has a meaning affected by subsection (2).

"medical practitioner" means an individual registered or licensed as a medical practitioner under a State or Territory law that provides for the registration or licensing of medical practitioners.

"minimum cover amount" has the meaning given by section 16.

"new regulated insurance contract" means a regulated insurance contract to which section 22 applies.

"otherwise uncovered prior incidents" for a health care professional has the meaning given by subsection 21(4).

"payable", in relation to a compensation claim, has the meaning given by subsection (7).

"provide a financial service" has the meaning given by section 766A of the Corporations Act 2001 .

"provide medical indemnity cover" has the meaning given by section 5.

"prudential standard "means a standard determined by APRA under section 32 of the Insurance Act 1973 .

"registered health professional": an individual is a registered health professional if:

(a) the individual practises a health care related vocation; and
(b) the individual must be registered under a State or Territory law to practise that vocation.

"regulated insurance contract" has the meaning given by subsection 21(1).

"relevant constitutional connection" has the meaning given by subsection (6).

"renew" has the meaning given by subsection (5).

"without medical indemnity cover" has the meaning given by subsection (3).

Indemnify

(2)
To avoid doubt, a person may, for the purposes of this Act, indemnify someone else by either:

(a) making a payment; or
(b) agreeing to make a payment.

Note: A person may indemnify someone else by making a payment even if the payment was not preceded by an agreement to pay.

Without medical indemnity cover for a health care incident

(3)
For the purposes of this Act, a health care professional is without medical indemnity cover for a health care incident if:

(a) the health care incident occurs during a particular period; and
(b) there is no arrangement under which the health care professional will, or may, be indemnified for compensation claims made against the health care professional in relation to health care incidents occurring during that period.

When arrangement comes into effect

(4)
For the purposes of this Act, an arrangement under which a person provides medical indemnity cover for a health care professional comes into effect on the first day on which, under the arrangement, a claim against the person providing the cover may be made.

Renewal of arrangement

(5)
For the purposes of this Act, an arrangement is renewed if:

(a) the arrangement is renewed; or
(b) the period of the arrangement is extended;

whether this happens:

(c) because of action taken, or not taken, by a party or parties to the arrangement; or
(d) automatically; or
(e) by force of law.

Note: For example, if renewable insurance cover is provided under a contract of insurance (the original contract ), a further contract of insurance may exist between the parties to the original contract by force of subsection 58(3) of the Insurance Contracts Act 1984 .

Relevant constitutional connection

(6)
For the purposes of this Act, an arrangement has a relevant constitutional connection if:

(a) the arrangement provides for insurance with respect to which the Commonwealth Parliament has power to make laws under paragraph 51(xiv) of the Constitution; or
(b) the arrangement is entered into in the course of trade and commerce:
(i) with other countries; or
(ii) among the States; or
(iii) between a State and a Territory; or
(c) the arrangement is entered into in, or is governed by the laws of, a Territory.

Amount payable in relation to compensation claim

(7)
For the purposes of this Act, the amount that is payable in relation to a compensation claim includes an amount that would be paid to meet legal and other expenses that are directly attributable to any negotiations, arbitration or proceedings in relation to the compensation claim.

Breaching the minimum cover rules

(8)
For the purposes of this Act, a regulated insurance contract breaches the minimum cover rules if subsection 17(2), 18(3) or 19(3) applies to the regulated insurance contract.

Claim against health care professional during particular period

(9)
A reference in this Act, in relation to:

(a) a contract of insurance under which the insurer provides medical indemnity cover for a health care professional; or
(b) an offer by an insurer to provide medical indemnity cover for a health care professional;

to a compensation claim against the health care professional being made, or having to be made, during a particular period is a reference to any one or more of the following happening, or having to happen, during that period:

(c) the compensation claim being made against the health care professional;
(d) the compensation claim being notified to the insurer;
(e) the health care incident to which the compensation claim relates being notified to the insurer;
(f) a claim being made against the insurer in relation to the compensation claim;
(g) an event prescribed by the regulations.

References to health care professional

(10)
A reference in this Act to a health care professional includes a reference to an individual who has been a health care professional at any time.

References to medical practitioner

(11)
A reference in this Act to a medical practitioner includes a reference to an individual who has been a medical practitioner at any time.

References to registered health professional

(12)
A reference in this Act to a registered health professional includes a reference to an individual who has been a registered health professional at any time.


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