COVID-19 Vaccination Information Distillation 3: COVID-19 vaccine claims scheme introduced for claims of $5,000 or more

The Federal Government has published further information about the COVID-19 vaccines claims scheme and is now taking registrations from individuals interested in making a claim.

Although initially described as an indemnity scheme designed to assure health professionals (including general practitioners, nurses, pharmacists) or other immunisation providers, further detail now published suggests the Scheme will provide an avenue for individuals to seek reimbursement or compensation where they:

• have suffered injuries due to administration of a TGA-approved COVID-19 vaccine or due to an adverse event (side effect) that is considered to be caused by a COVID-19 vaccination; and
• the costs of injuries are $5,000 or more (including for medical costs or lost wages).

Eligible claims under the Scheme

Although prior Government media releases have suggested the scheme will be backdated to 22 February 2021, that detail (and any other relevant exclusions or evidentiary pre-requisites) has not yet been published.

Online registration for individuals interested in making a claim under the Scheme opened at the beginning of this week through the Department of Health's website. These registrations demonstrate an individual's intention to make a claim and are not the claims process itself.

To qualify for claims between $5,000 and $20,000 a claimant will need to have been hospitalised for at least one night, nominate they are claiming less than $20,000 and provide evidence of:

• the nature of the injury and medical documentation evidencing its likely relationship to a COVID-19 vaccination;
• hospitalisation caused by the injury;
• medical costs; and
• lost wages.

Injuries with costs less than $5,000 or which did not involve hospitalisation are not covered under the Scheme.

At present, the evidence requirements for claims for $20,000 and over, including claims relating to death, have not been finalised. These evidence requirements will be advised as the Government releases more information about the Scheme. The Scheme website confirms, however, that claims relating to a death will not require evidence of hospitalisation. What sort of monetary claims may be eligible under the Scheme where a claim involves a death are yet to be addressed.

So far, no additional detail has been published about how claims will be assessed, other than that previous Ministerial press releases indicate assessment by a team of independent experts.

How the Scheme affects vaccination providers, including employers

Based on the information currently available, the Scheme provides limited comfort to GPs, nurses, health practitioners or other vaccination providers (including employers engaging with such providers for the purposes of administering the COVID-19 vaccines to workers) because, while it will provide a process for streamlined, no fault compensation it doesn't appear to preclude injured individuals pursuing litigation.

On the other hand, the Scheme provides a right of compensation in relation to known adverse events associated with the COVID-19 vaccines, which may ordinarily be difficult to pursue in litigation because they have been the subject of relevant warnings. In addition, any compensation payment made through the Scheme could not be claimed again in litigation.

Related Insights

• COVID-19 Vaccination Information Distillation: TGA's registration process for the COVID-19 vaccine and what to consider now
• COVID-19 Vaccination Information Distillation 2: New vaccines, regulation and a Commonwealth indemnity scheme