Appendix 3: Run-Off Cover Scheme claims
A.3.1 The legislation defines claims broadly. Claims need not involve legal proceedings. Claims may include civil claims for negligence, administrative proceedings, disciplinary proceedings (including those performed by a professional body) and inquiries or investigations into conduct (subsection 5(1) of the Act).
A.3.2 A ROC claim is payable to an insurer under section 32 if:
- it relates to incident(s) that occurred on or after 1 July 2010;
- it relates to a person eligible under section 31(2) (see Appendix 2);
- it relates to incident(s) occurring in connection with the person’s practice as an eligible midwife;
- the person has midwife professional indemnity run-off cover that indemnifies the person in relation to the claim; and
- the claim would be paid in the ordinary course of the insurer’s business.
A.3.3 Where these criteria are met, the Commonwealth is liable to pay run-off cover indemnities regardless of whether the insurer has sought private reinsurance (section 71).
A.3.4 Applications for ROC Commonwealth contributions must be made to DHS (section 58 of the Act). They are paid by the Chief Executive Medicare before the end of the month that immediately follows the month in which the eligible insurer applies for the indemnity (section 59).
A.3.5 If a Level 1 or Level 2 Commonwealth contribution is payable in respect of that payment, the amount of the run-off cover Commonwealth contribution is reduced by the amount of the Level 1 or Level 2 Commonwealth contribution (section 35(2)).