Eligibility for the Exceptional Claims Scheme (ECS)

Doctors and allied health professionals may be eligible if they are in private practice and have medical indemnity insurance cover of at least $20 million.

Eligibility criteria

To be eligible for the ECS, practitioners must:

ECS threshold

The ECS threshold is currently $20 million. We set the threshold through legislation.

Changes to the threshold only apply to contracts that are signed after we register the updated legislation.

Indemnity insurers will have time to reflect any threshold changes in their insurance contracts:

  • Increases take effect 3 months before the start of a policy year.
  • Decreases take effect at least 3 months after we register the updated legislation.

ECS and other schemes

The ECS will cover a claim that is also eligible for the Run-Off Cover Scheme if the:

  • claim is against a doctor
  • doctor’s run-off cover is at or above the ECS threshold
  • claim costs exceed the doctor’s run-off cover limit.

Leaving ECS

Stopping private practice

If a practitioner stops private practice, they are no longer eligible for the ECS.

Doctors who have stopped private practice may become eligible for the Run-Off Cover Scheme. This scheme provides cover for incidents that occurred while they were working.

Reducing indemnity cover

If an eligible practitioner reduces their level of cover to below the ECS threshold, they will no longer be able to access the ECS.

They can still apply for an ECS payment for a claim made against them if the incident occurred while they were eligible.

Date last updated:

Help us improve health.gov.au

If you would like a response please use the enquiries form instead.