Case History and Your Premiums

You can download a copy of your case history by logging into our Member Online Service using your email or Member Number or by contacting us on 1800 011 255 or via email at peaceofmind@mdanational.com.au.

For calculating your premium we consider solicitors’ letters and writs that have an estimated cost of $5,000 or more and have occurred in the last ten years. The recency of claims and factors relevant to your risk is also considered when you have had two or more claims in the last 10 years.

Patient complaints or any other types of claims other than those outlined above do not attract a case rating factor.

For the purposes of calculating your premium we consider the following occurring in the last 10 years:

• investigations by Ahpra, or
• inquiries by a health services authority, medical tribunal, Royal Commission, criminal court, hospital, consumer protection agency, Information Commissioner, Privacy Commissioner, Police or Anti-Discrimination Board

We do not consider Medicare or Coronial inquiries for the purpose of calculating your premiums.

The degree to which the case history risk rating factor impacts on premium is influenced by the number and severity of investigations a Member has had.

Seeking medico-legal advice does not contribute to your premium.

We encourage you to seek the support of our medico-legal advisers, who can provide you with expert advice and support when you need it most.

Our national team of industry-leading doctors, lawyers and medical defence experts are just a click or phone call away, and available 24/7 (in emergencies).

Notification of an adverse incident does not have an impact on your premium. If that incident eventuates into a litigated claim or an investigation that meet the criteria for the CRF then it may contribute to future premiums however that would depend on the criteria at the time.

It is important that you continue to notify any matters that could lead to a claim under your Policy as that is a requirement under the terms and conditions of the Professional Indemnity Policy and forms part of your obligations under the Policy. Timely notification is crucial to ensure that you can get the best possible assistance/defence and failure to notify could have broader consequences on the cover under your Policy.

We recognise that practitioners can be unlucky and may be subject to claims and/or investigations at some point during their career. However, our statistical analysis clearly indicates that a Member who has had previous claims and/or investigations has a higher likelihood of a future claim.

Like most insurers, our pricing approach reflects that those with a higher likelihood of a future claim pay a higher premium contribution to the overall insurance premium collected by MDA National.

It is important to highlight that the increase in claims is not necessarily a reflection of a Member’s quality of practice.

If the costs pertaining to an eligible claim (Solicitors letter/Writ) is greater than $5000 then it will meet the criteria for the case rating factor (CRF). Other than this the quantum of the claims settlement has no impact on the CRF. The CRF is not intended to recover costs of a claim or be a punitive measure. It is to accurately price for the heightened risk of a future claim.

Your case history for the last 10 years is considered when applying a claims rating factor. While you are currently employer indemnified for civil claims arising from your work in a hospital setting the claims rating factor considers the potential likelihood of future cases arising which can result in claims under the Policy for investigations and inquiries and other aspects of cover apart from a civil liability claim.

If you have undertaken private work in the past MDA will continue to be liable for new claims or investigations arising from that practice that may be notified in the future arise in the future. On that basis the case rating factor has been applied to your Policy. If you are no longer undertaking any remunerated private practice and working in the public system, you may be eligible for the Federal government’s Run-off Cover Scheme (ROCS).

Our Cases Committee members have provided tips on ways to reduce your risk of receiving a claim against you here .

If your premium exceeds 7.5% of your private gross annual billings, you may be eligible for the Australian Government's Premium Support Scheme (PSS) which has been established to assist eligible medical practitioners to meet the costs of their medical indemnity insurance.

Additionally, we offer a range of payment options including quarterly and monthly instalments. All payment options will be outlined in your Renewal Notice.

If you wish to know if you are eligible, or have any other questions regarding the PSS, please contact our Member Services team on 1800 011 255 or at peaceofmind@mdanational.com.au . You can also check your eligibility by using the PSS Calculator once you receive your Renewal Notice.

We will also consider requests for broader financial assistance in meeting premium payments on a case-by-case basis.

We consider charging different premiums based on a Member’s risk rating very much in the spirit of mutuality. It is only fair and equitable that those doctors with a higher risk of a future risk claim based on their case history (and therefore future projected claims risk) pay a higher contribution to the overall premium pool, as they are more likely to need to access the premium pool to cover the cost of claims.