Compensation Payments: Why Do I have to Repay Medicare?

21 August, 2017


When an individual suffers an injury, they are usually entitled to claim Medicare benefits when seeking medical treatment. This can include doctors and physiotherapists bills and even residential care subsidies.

But what if the injury is the subject of a compensation claim?

And what if the compensation settlement covers the full cost of your treatment?

To make sure no “double dipping” occurs, Medicare is entitled to recover the cost of benefits and subsidies it has paid to an individual that has since been covered via a compensation settlement.

What does Medicare Recover?

It is important to note Medicare will ONLY recover accident-related medical expenses claimed on the settlement of an injury compensation case.

AND only if the compensation claim is settled for more than $5,000

How do you know how much Medicare will Recover?

Once a compensation claim nears settlement, your personal injury lawyer will request a claims history statement from Medicare. This will list all the benefits that have been paid by Medicare since the date of the injury.

From this list you will identify the injury related services and Medicare will determine the amount, if any, that is require to be repaid to the Australian Government. Medicare will then send a Notice of Past Benefits assessment to both the individual claimant AND the compensation payer. It is valid for 6 months.

What happens when your compensation claim reaches settlement?

If the claim is finalised during this 6 month period, the compensation payer will:

  • Send the amount to be repaid direct to Medicare (from the compensation amount)
  • Send the balance to the claimant

If the claim is finalised outside the 6 month period, the Notice of Past Benefits has to be renewed.

At Peninsula Personal Injury Lawyers, we endeavour to obtain a current Notice of Past Benefits at the time of your settlement so you receive the total of your settlement funds as swiftly as possible.

You can read more about the Medicare Recovery Program here

If you have any further questions, please contact our office on (08) 9581 4339. We provide an initial consultation at no cost to discuss your current claim and possible entitlements.  We also act on a no win no fee basis if we are able to assist with your claim.