Claims under the Exceptional Claims Scheme (ECS)

If an eligible claim is made against an eligible practitioner, they (or their representative or insurer) can apply for an ECS payment.

Eligible claims

A claim must meet certain criteria to be eligible for an ECS payment.

The claim

The claim (or a group of related claims) must:

  • be against a doctor or allied health professional who is eligible
  • exceed the cover of their professional indemnity insurance contract – see amount covered.

If the claim does not exceed their cover, the insurer may be able to access the High Cost Claims Scheme.

The incident the claim is about

The incident must:

  • be within the scope of the practitioner’s indemnity insurance contract
  • have occurred in Australia or its territories or under certain circumstances (such as aid work) overseas
  • have occurred, in part or in full, during the treatment of a private patient.

Public patient treatment is the responsibility of state and territory governments.

Timing of the incident or notification

One of the following must have occurred while the ECS is in operation:

  • The insurer receives notice of the incident.
  • The incident itself.

For allied health professionals, the incident must also have occurred before 1 July 2020.

The ECS will respond to claims about eligible incidents even if they are not made until after the ECS ends.

The ECS started on 1 January 2003 and does not currently have an end date.

If a claim is made

If an eligible practitioner becomes aware of a claim made against them:

  • the practitioner should contact their indemnity insurer
  • the insurer should assess if the claim will be above the practitioner’s level of cover
  • they should agree on who will apply for an ECS payment.

Apply for an ECS payment

The practitioner, someone acting on their behalf, or their insurer can apply for an ECS payment.

The first step is to contact Services Australia.

The medical indemnity team in Services Australia administers the ECS. They will confirm:

  • if the claim is eligible
  • what needs to be submitted
  • how to apply.

The applicant must contact Services Australia if any claim details change.

Who manages the claim

The indemnity insurer manages the claim.

Who pays for the claim

The practitioner must pay for any deductible or excess they agreed to in their insurance contract.

Once they have done this, their insurer and the ECS will make payments for the remaining claim costs.


In their insurance contract, a practitioner has agreed to pay an excess of $100,000 for each claim. They have cover of up to $20 million.

A patient makes a claim against the practitioner. The total claim costs add up to $50 million. The practitioner must pay the first $100,000 before:

  • their indemnity insurer will pay $19.9 million – the remaining amount up to the cover limit
  • the ECS will pay $30 million – the remaining amount above the cover limit.

How claims will be paid

Services Australia will make the ECS payment to the person who applied for it.

The person must forward the payment on to discharge the practitioner's liability. They would usually do this by paying the claimant’s solicitor.

If needed, Services Australia will seek to recover from the person:

  • any overpayments
  • any amount the person failed to forward on.
Date last updated:

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