Medicare and Private Health Refunds after a Motor Vehicle Accident

If you visit a doctor or specialist for treatment of injuries sustained in a motor vehicle, personal injury or public place accident, Medicare, or your Private Health Insurer may cover all or part of the costs associated with the treatment.

However, if you are successful in obtaining a motor vehicle accident compensation settlement, Medicare or your Private Health Insurer will want to recoup any funds they have paid for the treatment of your injuries from the accident. It is important to note that for settlements of less than $5,000.00 there is no refund applicable for Medicare.

In the process of a compensation claim, it is necessary to determine what, if any, refund is owing to each party. A Claims History Statement is requested which outlines all visits to doctors, specialists, radiographers etc you have attended since the date of your accident and for which you have used your Medicare card. You will need to identify which visits relate to your accident injuries, and which are unrelated.

Sinnamon Lawyers encourages all clients to keep a diary of their visits to doctors and treatment providers from the beginning of the claim. This will ensure that you can easily complete the Claims History Statement when the time comes, and only the relevant services are refunded to Medicare or the Private Health Insurer.

Sinnamon Lawyers assists you with this process by requesting the Claims History Statement and sending it to you as required throughout the claim. Once it has been completed, it is submitted to Medicare or the Private Health Insurer and they will issue a Notice of Charge which outlines the refund owing to them. For Medicare, this notice is valid for 6 months from the date of issue. For Private Health Insurers, they request that they are notified when the claim is about to settle so that they can issue an up to date Notice of Charge.

If there is no valid Medicare Notice of Charge at the date your claim settles, the Insurer will pay 10% of the total settlement amount to Medicare. Medicare will determine what is owing to them and then refund the balance back to you.

If a Claims History Statement is requested from Medicare and it is not returned within the specified timeframe, Medicare will issue a “Deemed” Notice of Charge whereby they consider that all services you have had since the date of your accident are applicable and they will want all charges refunded to them. This deemed notice is then valid for 6 months and accurate notice of charge cannot be obtained until the deemed notice has expired.

At the end of your claim, any refunds owing to Medicare are automatically paid by the Insurer prior to settlement funds being paid to Sinnamon Lawyers. For refunds to Private Health Insurers, your solicitor will obtain your authority to pay the refund owing to them from the settlement monies received on your behalf.

Understanding what costs may need to be refunded to outside parties when you are successful in a compensation claim can be confusing but we are here to ensure that our clients are fully informed throughout the claim process.

If you have any questions regarding your claim, or if you have been involved in an accident and would like to make a claim, please contact our office on 1800 007 277.

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