HEALTH DEPARTMENT OF WESTERN AUSTRALIA
Applicable to:ALL HOSPITALS
Enquiries to:Administrative Services
Date:5 October 1984
Subject:MOTOR VEHICLE THIRD PARTY INSURANCE PATIENTS' FEES
Under the provisions of the Commonwealth/State Medicare Agreement and the Hospitals (Services Charges) Regulations a compensable patient is not eligible to elect to be a public patient or a private patient. A motor vehicle accident patient must be classified as a
"compensable patient" if in respect of the injury for which he is being treated he has received or established a right to receive payment by way of compensation or damages, including a payment in settlement of a claim for compensation or damages.
Public hospitals classify as "compensable" those motor vehicle accident patients who have a current claim on the Western Australian Motor Vehicle Insurance Trust (or similar authorities in other States) but do not classify as compensable those patients who have received an award or out-of-court settlement to meet the cost of future hospitalisation for their compensable injury. In future, compensable charges should be raised against such patients until award or settlement moneys have been utilised from which time the person will cease to be a compensable patient and will be eligible to be a public patient or a private patient.
To ensure all motor vehicle accident patients are correctly classified as compensable, public or private, it is important that they be asked whether they are being admitted because of a motor vehicle accident and, if so, they should complete the attached revised form HA22B (redesigned for use by patients entitled to compensation and by those who have received awards or out-of-court settlements). In determining the inpatient classification, total reliance should be placed on information supplied by the patient.
If a patient who has received an award or a settlement following a motor vehicle accident is unable to complete part B of Form HA22B because he is unsure that any money was included in the award/settlement to meet future hospital expenses the hospital may assist in determining this matter by studying the court award judgement or the out-of-court settlement details which may possibly be obtained through the Department (for non-teaching hospitals) if the patient does not hold a copy of such documents. The Departmental contact officer is the Clerk in Charge, Clerical Section. The following guidelines are given to assist in determining whether to classify the patient as compensable:-
(i) If no costs for future hospitalisation are provided the patient should not be classified as compensable and may elect to be admitted as a public patient or as a private patient.
- 2 -
(ii) If an amount for future hospital costs is provided, the patient should be charged the appropriate compensable rate until such moneys have been expended. Patients should certify in writing when their award/settlement funds become exhausted from which time they will cease to be compensable and may elect to be a private patient or a public patient.
(iii) If the award/settlement includes an amount for future medical costs it should be regarded as including required hospitalisation costs unless the patient can establish that hospitalisation costs have not been included. The Department should be contacted for advice about patients with this type of award or settlement.
(iv) If the award/settlement provided for a lump sum amount for general damages making no reference to future hospital or medical costs the patient should not be classified as compensable and may elect to be admitted as a public patient or as a private patient.
(v) If a lump sum is provided and stated to include but does not specify an amount for future hospitalisation, charge the patient as a compensable patient until he can demonstrate that the total amount charged for hospital treatment has reached a reasonable assessment of the amount included in his lump sum settlement for hospital treatment. The patient should cease to be a compensable patient from the date the assessed amount has been used. The Department should be contacted for advice about patients with this type of award or settlement.
Where a patient is classified as "compensable" new Form HA22C should be completed indicating the elected inpatient status if award/settlement moneys become exhausted or the compensation claim is rejected. This election classification should be agreed at the time by the patient's doctor.
Fees charging and statistical recording arrangements for motor vehicle insurance accident patients are:-
1. Patients who have lodged claims or who intend to lodge claims against the Western Australian Motor Vehicle Insurance Trust:-
Classify as "Motor Vehicle Insurance Trust" but do not raise any fees because special payment arrangements exist with the Trust. (Department submits a claim on behalf of hospitals.)
2. Patients who have received awards/settlements for hospital costs:-
Classify as "Motor Vehicle Insurance Other" and charge compensable patient rates until award/settlement funds are exhausted and then classify and charge or treat without charge in accordance with the patient's election on Form HA22C.
3. Patients who have lodged claims or who intend to lodge claims against other States' Motor Vehicle Third Party Insurance Authorities:-
Classify as "Motor Vehicle Insurance Other" and charge compensable patient rates and send accounts to the patients or to the authorities (if known).
- 3 -
4. Patients classified as "Motor Vehicle Insurance Other" (2 and 3 above) should be shown in the appropriate MVIT days column of the inpatients' fees journal, the days circled (for identification purposes) and a suitable comment made in the remarks column. Care must be taken not to include these days in the monthly returns sent to the Motor Vehicle Insurance Trust or in the annual return of MVIT days sent to the Department.
Hospitals should implement this policy for all new admissions. Patients presently in hospital who are known to have received an award or a settlement to meet future hospital expenses should be informed of the change in policy and a social worker's assessment made of their ability to pay compensable rates from the date of their current admission.
Any motor vehicle accident outpatients who have received awards/settlements for future hospital costs should be charged and compensable outpatient fee as set out in the Determination made by the Minister (currently $33 in teaching hospitals and $28 in non-teaching hospitals).
This circular covers patients regarded as compensable because they have received an award/settlement under Motor Vehicle Third Party Insurance and does not relate to Workers Compensation Act patients or Merchant Seamen who have received compensation or damages because under the appropriate legislation such payments would not include money for future hospital costs. Such persons admitted after receiving settlements are not compensable patients and may elect to be treated as public or private patients. Prior to settlements they are regarded as compensable, as at present, and should complete Form HA22C to cover a situation of a claim for compensation being rejected.
If hospitals have any queries about any aspect of this circular the Department should be contacted for advice. The matter will receive immediate attention.
W D Roberts
COMMISSIONER OF HEALTH
HA 22 C COMPENSABLE PATIENT DECLARATION
(full name of patient) Tick one box:
¨have received an award/out-of-court settlement under Motor Vehicle Third Party Insurance to cover the cost of this hospital treatment.
¨believe I am eligible to claim compensation/damages under Workers’
Compensation, Motor Vehicle Third Party Insurance or as a Merchant Seaman for the cost of this hospital treatment.
When my award or settlement moneys are used up or if my compensation/damages claim is unsucessful (for whatever reason), I elect to be a:
¨Public (Non-chargeable) patient, in which case I will not be charged for hospital accommodation or medical or other services provided during my hospitalisation.
¨Private (Chargeable) patient, in which case I will be:
(1) the private patient of the doctor under whose care I have been admitted.
(2) responsible for fees for medical services.
(3) responsible for the hospital’s accommodation charge.
Signature of Patient _________________________________
If the patient is a minor or is unable to sign, the next of kin or the person responsible for the patient should sign hereunder and print his/her full name (for identification purposes).
Full name of person signing
HA 22 B HEALTH DEPARTMENT OF WESTERN AUSTRALIA
VEHICLE ACCIDENT PATIENT DECLARATION
PART “A” (COMPLETE IF YOU BELIEVE YOU ARE ENTITLED TO COMPENSATION/DAMAGES
believe I am entitled to compensation or damages under Motor Vehicle Third Party Insurance and submit the following details about the accident:- (1) Date of Accident:
(2) If a Police Officer attended the accident scene what was his name:-
(3) Please give a brief description of the accident:-
(4) Was more than one vehicle involved? Yes/No (5) Were you the Driver? Yes/NO
(6) were all of the vehicles:-
(a) Commonwealth Government vehicles? Yes/No
(b) Vehicles registered in the Eastern States? Yes/No
(c) Unregisterable vehicles, eg. off road vehicles? Yes/No
(d) A combination of (a), (b) and (c)? Yes/No
(7) Details of vehicles involved:-
Vehicle I was in Second Vehicle Third Vehicle (if any) Type of vehicle
Registration Number Owner’s Name
Driver’s Name and address
If you were the driver in a one vehicle accident or if all vehicles in the accident were CommonweaIth Government vehicles or vehicles registered in the Eastern States your hospital costs are not the responsibility of the Australian Vehicle Insurance Trust. If hospitalisation costs are the responsibility of another authority please advise:-
(a) Name of Authority: ____________________________________________________________________________________________
(b) Address of Authority: __________________________________________________________________________________________
PART "B" (COMPLETE IF YOU HAVE RECEIVED COMPENSATION OR DAMAGES FOR THE ACCIDENT)
(FULL ADDRESS) do/do not have money specifically awarded or paid to me for the costs of this hospital treatment.
PART "C" (SIGN AFTER COMPLETING PART "A" OR PART "B"
SIGNATURE OF PATIENT _________________________________________________________ DATE ___________________
(or person responsible for patient)
SIGNATURE OF HOSPITAL OFFICER RECEIVING PATIENT _____________________________________________________________