Medicare Compensation Recovery

About

As part of your support from WorkSafe as you recover, you may receive a settlement payment. If that payment is more than $5,000, you may need to repay Medicare for the treatment costs it covered related to your injury. This is called Medicare Compensation Recovery.

Medicare Compensation Recovery often applies to lump sum payments including impairment benefits.

Your agent will let you know if this applies to your settlement.

How repayment works

If you are required to repay Medicare, your agent will notify Medicare of your settlement and pay an amount of it to them.

The amount depends on whether there is a current Medicare Notice of Past Benefits or Notice of Charge at the time of your settlement.

A Medicare Notice of Past Benefits or Notice of Charge is a notice from Medicare listing the medical services and treatments it paid for related to your injury.

It shows what Medicare has covered and the total amount that needs to be repaid from your settlement.

A Notice of Past Benefits is valid for 6 months and can be provided to your agent prior to settlement. You or your legal representative can request a Notice of Past Benefits by completing Medicare’s MO026 form.

If there is a current Medicare Notice of Past Benefits or Notice of Charge

• Your agent will deduct this amount from your settlement and pay Medicare
• You will then receive the remaining balance of your settlement
• If no amount is owed to Medicare, nothing will be deducted

If there is no current Medicare Notice of Past Benefits or Notice of Charge

• Your agent will pay 10% of your settlement to Medicare as an advance payment
• You will receive the rest of your settlement straight away

Medicare will then contact you directly to confirm the final amount owed.

• If you owe less than the 10% of your settlement already paid by your agent, Medicare will refund the difference
• If you owe more than 10%, you may need to pay the additional amount

Medicare will only recover costs related to your work-related injury or illness.

Reimbursement of expenses

After your settlement, you may be able to claim reimbursement of all or part of the amount specified in the Notice of Past Benefits or Notice of Charge.

If you are seeking reimbursement, you must provide a written request to your agent including your Notice of Charge with the list of compensation related medical benefits and/or care services.

Only services considered reasonable and necessary for your work-related injury or illness can be considered for reimbursement.

Notifiable reimbursement arrangements

Agents are required to notify Medicare of some claim decisions, including if your claim is accepted more than 6 months after it was lodged.

If this happens, Medicare may contact you directly to confirm any amount owing.

What you need to do

If required, your agent may ask for:

• your Medicare card number and
• your Medicare reference number

More information

Visit the Services Australia website for more information and forms.

If you have a legal practitioner or representative supporting you with your claim, you may wish to discuss this process with them.