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Medicare's Involvement in Motor Vehicle and Workers Compensation Claims

Understanding How Medicare Affects Your Compensation Case

When you start a legal case for compensation after an injury or illness, you might be surprised to learn your lawyer needs your Medicare number. Here’s why: Medicare interacts with various compensation claims, including:

  • Statutory claims: Workers’ compensation and motor vehicle accidents
  • Common law claims: Work injury damages, public liability, and medical negligence

 

Why Does Medicare Get Involved?

Australia’s Medicare system provides healthcare to all citizens. However, if someone else is responsible for your medical expenses due to an injury or illness, Medicare shouldn’t bear those costs. The responsible party, like an insurance company, should cover them. Medicare acts to recover these funds from the responsible party to ensure taxpayers aren’t funding what should be a private liability.

What This Means for You and Your Lawyer’s Role

Throughout your claim, your lawyer will play an active role in coordinating with Medicare. They’ll check with Medicare to see if you’ve used their services for injury-related expenses. This is common, especially:

  • Early stages of Workers’ Compensation or Motor Accident claims: You might use Medicare initially as you can’t access immediate benefits from an insurer.
  • Public Liability claims: You might use Medicare before filing a claim or while waiting for approval.

Your lawyer will then obtain a list of all Medicare services you’ve used since your accident. This includes:

  • Routine immunizations
  • General treatment
  • Treatment related to your injury/illness

They’ll work with you to identify which services relate specifically to your claim. Medicare will then issue a charge payable after your case settles.

Navigating Potential Medicare Charges

There are three main scenarios depending on whether you’ve used Medicare and if the exact amount owed is known:

  1. No Outstanding Balance: If you haven’t used Medicare for your injury, your lawyer will simply notify them of your settlement and have you sign a declaration confirming this. Medicare’s involvement then ends.
  1. Known Outstanding Balance: If you and your lawyer know the exact amount owed to Medicare, the insurer will deduct it directly from your settlement and pay Medicare. This finalizes their involvement and ensures a smooth settlement process.
  1. Unknown Outstanding Balance: If you’re unsure of the amount owed, the insurer will make a 10% advance payment to Medicare. They’ll hold this in trust until you complete the list of services with your lawyer’s help.
  • Money Owed Confirmed: If you owe Medicare, they’ll deduct the amount from the trust and return any remaining funds to you. You’ll receive a breakdown of the advanced payment, deducted amount, and returned amount.
  • No Money Owed: If you don’t owe anything, Medicare will return the entire trust amount to you.

Reclaiming Deductions and Working with Your Lawyer

For claims like Workers’ Compensation or Motor Accident, you might be able to reclaim what Medicare deducted from your settlement through your lawyer. They can advise you on the possibility of recovery or if this cost will be deducted from your final compensation amount.

The Importance of Staying Informed

The best approach is to stay informed about any potential Medicare charges throughout your claim. This allows you and your lawyer to work together to factor them into your settlement negotiations and ensure you receive the maximum possible compensation. If unsure about outstanding amounts, the insurer can simply make a 10% advance payment to avoid delays.

Patience is Key and Legal Guidance is Available

Unfortunately, Medicare can take several months to process charges and service lists after your claim settles. Be prepared for some administrative lag after your case concludes.

When in Doubt, Consult Your Lawyer

If you have any questions or concerns throughout the process, always contact your lawyer or legal specialist. They can guide you through the intricacies of Medicare involvement in compensation claims, advise you on potential reimbursements you might be entitled to claim, and ensure your rights are protected.

We hope this clarifies Medicare’s involvement in compensation claims in Australia and empowers you to work effectively with your lawyer to achieve the best possible outcome for your case.

Contact Garling and Co Lawyers today on telephone (02) 8329 9500 or visit our website www.garlingandco.com.au for more information.

Professional woman typing on laptop at work.

Emma Perkins

Joining Garling and Co in 2019, Emma brings to the team a deep knowledge and understanding of Personal Injury Law. Since her admission in 2009, she has specialised in the fields of workers' compensation, victims' compensation, public liability, motor...
Lisa L.
05:18 13 Jul 24
Outstanding service and commitment to my case was delivered from the first point of contact right until the end of my successful case.Highest recommendations to the team at Garling and Co. Matthew... got me an excellent result and was available and informative throughout the entire foreign process of legal proceedings. He was wonderful and so was his team.If i could rate higher than 5 stars i would!read more
J B
07:12 02 Jul 24
Matthew Garling and all of the team were extremely professional and supportive throughout what was a very long and arduous CTP battle. I am happy with the result and feel that their fees were fair... and well deserved.read more
Nelson B.
02:11 30 Jun 24
Professional, prompt & honest service
Brad M.
02:19 28 Jun 24
I worked with Garling & Co for 3+ years, the team has been incredible and I could not have been happier with Kerry's support and the results produced!I highly recommend choosing them as your... representatives!!read more
Ray H.
07:33 13 Jun 24
Matthew Garling and Team are kind, patient, polite, professional, empathetic and efficient. I was treated terribly by the at fault insurer. Garling and Co. had my back. Matthew gently and patiently... kept me up to speed on all the steps to go through. From my personal experience I recommend these guys. They are safe hands. Thank you team.read more
Jo L.
05:58 07 May 24
So very impressed with the professional team who looked after me throughout the last 4 and 1/2 years. A special mention to Kerry and Nathan who navigated each request to fight for my right to gain... access to further treatments and physio and to ensure medical treatment would be covered moving forward. I was so grateful I could hand it all over to you and not have to go through this very challenging time without your support.I thank you for the compassion you have provided to me, from the first contact with Matthew and Natasha, to finalisation with Kerry and Nathan.I highly recommend the team at Garling and Co for any third party compensation claims. You are in good hands with them all.read more
Linda O.
21:53 06 May 24
Emma, Rebecca and the team at Garling and Co have worked diligently throughout my workers compensation claim. The level of professionalism, support and communication has been faultless. Of particular... note has been the sensitivity displayed to me throughout the lengthy process. Worker’s compensation claims are complex and not easy to navigate, particularly when you are unwell. I do not hesitate to recommend Garling and Co to help you find a way through this otherwise unfathomable system.read more
Keith H.
20:51 23 Apr 24
After my case stalled with another firm, I decided to give Matthew Garling a call. He took my case and not only won, but achieved an outcome that far exceeded my expectations. This firm is the best... in the business in my opinion and I wouldn't hesitate to recommend them to anyone.read more
Anthony T.
00:50 16 Apr 24
Thank you Matthew and his team who guided me through the legal process, a truly positive experience with total professionalism.
Mikaele N.
03:01 15 Apr 24
Garling &Co Lawyers were awesome, I called every compensation law firm and was told that I couldn't claim for compensation.The whole experience and process was simple and stress free.Mr Matthew... Garling and Allison deserve an accolades for the very best in client service. I would highly recommend their service to anyone.read more
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Lisa L.
05:18 13 Jul 24
Outstanding service and commitment to my case was delivered from the first point of contact right until the end of my successful case.Highest recommendations to the team at Garling and Co. Matthew... got me an excellent result and was available and informative throughout the entire foreign process of legal proceedings. He was wonderful and so was his team.If i could rate higher than 5 stars i would!read more
J B
07:12 02 Jul 24
Matthew Garling and all of the team were extremely professional and supportive throughout what was a very long and arduous CTP battle. I am happy with the result and feel that their fees were fair... and well deserved.read more
Nelson B.
02:11 30 Jun 24
Professional, prompt & honest service
Brad M.
02:19 28 Jun 24
I worked with Garling & Co for 3+ years, the team has been incredible and I could not have been happier with Kerry's support and the results produced!I highly recommend choosing them as your... representatives!!read more
Ray H.
07:33 13 Jun 24
Matthew Garling and Team are kind, patient, polite, professional, empathetic and efficient. I was treated terribly by the at fault insurer. Garling and Co. had my back. Matthew gently and patiently... kept me up to speed on all the steps to go through. From my personal experience I recommend these guys. They are safe hands. Thank you team.read more
Jo L.
05:58 07 May 24
So very impressed with the professional team who looked after me throughout the last 4 and 1/2 years. A special mention to Kerry and Nathan who navigated each request to fight for my right to gain... access to further treatments and physio and to ensure medical treatment would be covered moving forward. I was so grateful I could hand it all over to you and not have to go through this very challenging time without your support.I thank you for the compassion you have provided to me, from the first contact with Matthew and Natasha, to finalisation with Kerry and Nathan.I highly recommend the team at Garling and Co for any third party compensation claims. You are in good hands with them all.read more
Linda O.
21:53 06 May 24
Emma, Rebecca and the team at Garling and Co have worked diligently throughout my workers compensation claim. The level of professionalism, support and communication has been faultless. Of particular... note has been the sensitivity displayed to me throughout the lengthy process. Worker’s compensation claims are complex and not easy to navigate, particularly when you are unwell. I do not hesitate to recommend Garling and Co to help you find a way through this otherwise unfathomable system.read more
Keith H.
20:51 23 Apr 24
After my case stalled with another firm, I decided to give Matthew Garling a call. He took my case and not only won, but achieved an outcome that far exceeded my expectations. This firm is the best... in the business in my opinion and I wouldn't hesitate to recommend them to anyone.read more
Anthony T.
00:50 16 Apr 24
Thank you Matthew and his team who guided me through the legal process, a truly positive experience with total professionalism.
Mikaele N.
03:01 15 Apr 24
Garling &Co Lawyers were awesome, I called every compensation law firm and was told that I couldn't claim for compensation.The whole experience and process was simple and stress free.Mr Matthew... Garling and Allison deserve an accolades for the very best in client service. I would highly recommend their service to anyone.read more
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
University of Technology, Sydney
Member of Law Society of New South Wales
Law Society of NSW Specialist Accreditation
University of Sydney
Legal Profession Admission Board of New South Wales
The law society of nsw professional standards scheme logo.
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