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Medical indemnity DSS 2012-14

Identifying and definitional attributes

Metadata item type:Help on this termData Set Specification
METeOR identifier:Help on this term329638
Registration status:Help on this termHealth, Superseded 21/11/2013
DSS type:Help on this termData Set Specification (DSS)
Scope:Help on this term

The Medical indemnity data set specification (DSS) describes the data items and standardised data outputs for medical indemnity claims for the Medical Indemnity National Collection (MINC).

The MINC contains information on medical indemnity claims against health providers. These are claims for compensation for harm or other loss allegedly due to the delivery of health care. This health care may occur in settings such as hospitals, outpatient clinics, general practitioner surgeries, community health centres, residential aged care or mental health care establishments or during the delivery of ambulatory care. Adverse events or harm due to medical treatment, which do not result in a medical indemnity claim, are not included in the MINC.

In 2002, Australia's Health Ministers decided that a 'national database for medical negligence claims' should be established. In 2003 the Medical Indemnity Data Working Group (MIDWG) came into existence with its membership drawn from health authorities, the Department of Health and Ageing and the Australian Institute of Health and Welfare (AIHW). The MIDWG collaborated on establishing a Medical Indemnity National Collection (Public Sector), comprising data from the jurisdictions. In 2006 private medical indemnity insurers agreed to have their data on medical indemnity claims included in the MINC. In 2008 the Australian Health Ministers' Advisory Council approved funding for data development work. The data items and recording specifications proposed for DSS development are based on those endorsed by the MIDWG for the 2009-10 data transmission period.

Medical indemnity claims fit into two categories, i.e. actual claims (on which legal activity has commenced via a letter of demand, the issue of a writ or a court proceeding) and potential claims (where the health authority or private medical indemnity insurer has placed a reserve against a health-care incident in the expectation that it may eventuate to an actual medical indemnity claim). Information in the MINC relates to actual and potential medical indemnity claims and the alleged or reported health-care incidents leading to medical indemnity claims.

The MINC includes basic demographic information on the patient at the centre of the alleged health-care incident; related information such as the type of incident or allegation and the clinical specialties involved; the reserve amount set against the likely cost of settling the medical indemnity claim; the time between setting the reserve and closing the medical indemnity claim; and the cost of closing the medical indemnity claim and the nature of any compensatory payments.

Compensatory payments may be made to the patient and/or to an other party claiming collateral loss as a result of the loss or harm experienced by the patient.

As a general guide, the main steps in the management of public sector medical indemnity claims are:

1. An incident that could lead to a medical indemnity claim is notified to the relevant claims management body. In some jurisdictions medical indemnity claims are managed by the relevant state or territory health authority; however, in others, most of the claims management process is handled by a body external to the health authority. Occasionally, some of the legal work may be outsourced to private law firms.

2. If the likelihood of a medical indemnity claim eventuating is considered sufficiently high, a reserve is placed, based on an estimate of the likely cost of the claim when closed.

3. Various events can signal the start of a medical indemnity claim, for example, a writ or letter of demand may be issued by the claimant’s solicitor (this can occur before an incident has been notified) or the defendant may make an offer to the claimant to settle the matter before a writ or letter has been issued. In some cases no action is taken by the claimant or the defendant.

4. The medical indemnity claim is investigated. This can involve liaising with clinical risk management staff within the health facility concerned and seeking expert medical advice.

5. As the medical indemnity claim progresses the reserve is monitored and adjusted if necessary.

6. A medical indemnity claim is closed when, in the opinion of the health authority, there will be no future unforeseen costs associated with the claim's investigation, litigation or a payment to a claimant. If a claim is closed and the possibility of future costs arises, the claim may be reopened.

7. A medical indemnity claim may be finalised through several processes—through state/territory-based complaints processes, court-based alternative dispute resolution processes, or in court. In some jurisdictions settlement via statutorily mandated conference processes must be attempted before a medical indemnity claim can go to court. In some cases settlement is agreed between claimant and defendant, independent of any formal process. A medical indemnity claim file that has remained inactive for a long time may be finalised through discontinuation.

The detail of this process varies between jurisdictions, and in some jurisdictions there are different processes for small and large medical indemnity claims. Private medical indemnity insurers follow a similar process in managing claims reported to them that are covered by the insurance they provide to private medical practitioners.

Collection and usage attributes

Guide for use:Help on this term

The following terminology is used in the Medical indemnity DSS:

  • Claim refers to a medical indemnity claim
  • Claimant could be another party/parties alleging loss due to the incident, rather than or in addition to the patient.
Collection methods:Help on this term

State and territory health authorities provide data on medical indemnity claims to the AIHW for national collation, annually. Data is for the financial year ending 30 June. Private medical indemnity insurers provide data on the same annual basis for a subset of the data items provided by public sector health authorities.

Implementation start date:Help on this term01/07/2012
Implementation end date:Help on this term30/06/2014
Comments:Help on this term

The Medical indemnity DSS has been developed by the AIHW in conjunction with the MIDWG.

Source and reference attributes

Submitting organisation:Help on this termAustralian Institute of Health and Welfare
Steward:Help on this termAustralian Institute of Health and Welfare

Relational attributes

Related metadata references:Help on this term

Has been superseded by Medical indemnity NBPDS 2014- Health, Standard 21/11/2013

Metadata items in this Data Set SpecificationHelp on this term

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Seq No.Help on this termMetadata itemHelp on this term ObligationHelp on this term Max occursHelp on this term
1Medical indemnity claim management episode—Australian state/territory identifier, code NMandatory1
2Medical indemnity claim—medical indemnity claim identifier, XXXXXX[X(14)]Mandatory1
3Medical indemnity claim—type of compensatory payment to patient, code N[N]Mandatory1
4Medical indemnity claim—type of compensatory payment to other party, code N[N]Mandatory1
5Person—date of birth, DDMMYYYYMandatory1
6Person—sex, code NMandatory1
7Person—Indigenous status, code NMandatory1
8Medical indemnity claim—primary incident or allegation type, health-care code NN[N]Mandatory1
9Medical indemnity claim—additional incident or allegation type, health-care code NN[N]Conditional3
10Health-care incident—clinical service context, code N[N]Mandatory1
11Health-care incident—clinical service context, text X[X(39)]Conditional1
12Patient—primary body function or structure affected, body function or structure code N[N]Mandatory1
13Patient—additional body function or structure affected, body function or structure code N[N]Conditional3
14Patient—extent of harm from a health-care incident, code N[N]Mandatory1
15Health-care incident—date health-care incident occurred, DDMMYYYYMandatory1
16Health-care incident—geographic remoteness, remoteness classification (ASGC-RA) NMandatory1
17Health-care incident—service delivery setting, health service setting code N[N]Mandatory1
18Patient—relationship to health-care service provider, code NMandatory1
19Health-care incident—principal clinician specialty involved in health-care incident, clinical specialties code N[N]Mandatory1
20Health-care incident—additional clinician specialty involved in health-care incident, clinical specialties code N[N]Conditional3
21Medical indemnity claim management episode—reserve placement date, DDMMYYYYMandatory1
22Medical indemnity claim management episode—reserve size, range code N[N]Mandatory1
23Medical indemnity claim—medical indemnity claim commencement date, DDMMYYYYConditional1
24Medical indemnity claim management episode—medical indemnity claim finalisation date, DDMMYYYYConditional1
25Medical indemnity claim—medical indemnity claim finalisation mode, code N[N]Mandatory1
26Medical indemnity claim—medical indemnity claim size, code N[N]Mandatory1
27Medical indemnity claim—medical indemnity claim status, code NNMandatory1
28Medical indemnity claim management episode—medical indemnity payment recipient type, code NMandatory1
29Medical indemnity claim management episode—class action indicator, yes/no code NMandatory1
-Date—accuracy indicator, code AAAMandatory5
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