Document ID: chunk:federal_register_of_legislation:C2004A01206:clause:2_34l:p1
Version: federal_register_of_legislation:C2004A01206
Segment Type: clause
Provision Reference: sch 2 cl 34L (pt 1/2)
Character Range: 32771–35409

34L  When is an exceptional claims indemnity payable?

Criteria for payment of indemnity

 (1) The HIC may decide that an exceptional claims indemnity is payable in relation to a liability of a person (the practitioner) if:
 (a) a claim for compensation or damages (the current claim) is, or was, made against the practitioner by another person; and
 (b) a qualifying claim certificate is in force in relation to the current claim; and
 (c) the liability is a qualifying liability of the practitioner in relation to the current claim (see section 34M); and
 (d) because of the practitioner's contract limit in relation to the contract of insurance identified in the qualifying claim certificate, the contract does not cover, or does not fully cover, the liability; and
 (e) the amount that, if the practitioner's contract limit had been high enough to cover the whole of the liability, the insurer would (subject to the other terms and conditions of the contract) have been liable to pay under the contract of insurance in relation to the liability exceeds the actual amount (if any) that the insurer has paid or is liable to pay under the contract in relation to the liability; and
 (f) the aggregate of:
 (i) the amount (if any) the insurer has paid, or is liable to pay, in relation to the liability under the contract of insurance; and
 (ii) the other amounts (if any) already paid by the insurer under the contract in relation to the current claim; and
 (iii) the amounts (if any) already paid by the insurer under the contract in relation to other claims against the practitioner;
  equals or exceeds the relevant threshold identified in the qualifying claim certificate; and
 (g) a person has applied for the indemnity in accordance with section 37A.

Note 1: For how paragraphs (e) and (f) apply if there are deductibles, see section 34C.

Note 2: For how paragraphs (e) and (f) interact with the high cost claim indemnity scheme, see section 34D.

Note 3: For the purpose of subparagraphs (f)(i) and (ii), payments and liabilities to pay must meet the ordinary course of business requirement set out in subsection (3).

Note 4: For how paragraphs (e) and (f) apply if the insurer is an externally‑administered body corporate, see subsection (4).

Note 5: For how paragraphs (e) and (f) apply if the claim relates to a series of incidents some, but not all, of which occurred in the course of the provision of treatment to a public patient in a public hospital, see section 34N.

Note 6: For how paragraphs (e) and (f) apply if the claim relates to a series of incidents some, but not all, of which occurred after the termination