COVID-19 Vaccine Claims Scheme now open

Anastasia Tsirtsakis

15/12/2021 3:46:58 PM

GPs will play a leading role by providing a medical report for potential claimants under the scheme.

A nurse filling out a form.
The Federal Government’s Scheme will cover the cost of injuries or adverse events caused by a TGA approved COVID-19 vaccine for $1000 and above.

Australians who receive a COVID-19 vaccine and experience a moderate or significant adverse event or injury can now claim compensation under the Federal Government’s no-fault vaccine claims scheme.
The scheme, which officially opened on Monday 13 December, enables people who have received one of three COVID-19 vaccines approved by the Therapeutic Goods Administration (TGA) – AstraZeneca, Pfizer or Moderna – to claim for compensation for any associated costs incurred of $1000 or more.
After strong RACGP advocacy, college President Dr Karen Price welcomed the scheme as an important move for both GPs and patients.
‘This was a long and hard battle, and it was a collaborative one, to get a scheme that made doctors’ lives and patients’ outcomes centred because it was becoming a bit of a roadblock,’ Dr Price told newsGP.
‘The college put in a lot of consistent work, and vociferously and firmly spoke to the need for a rational outcome that benefited patients.
‘It also removes some of the small claims and so forth from GPs themselves when we are actually pushing out a public health initiative, which is clearly in the nation’s benefit.’
The compensation threshold was reduced from $5000 to $1000 last month to give more people access to the scheme.
For claims to be eligible, the claimant must have experienced one of the following eligible clinical conditions or injuries:

  • Anaphylactic reaction – AstraZeneca, Pfizer, Moderna
  • Thrombosis with Thrombocytopenia Syndrome (TTS) – AstraZeneca
  • Myocarditis – Pfizer, Moderna
  • Pericarditis – Pfizer, Moderna
  • Capillary leak syndrome – AstraZeneca
  • Demyelinating disorders including Guillain-Barré Syndrome (GBS) – AstraZeneca
  • Thrombocytopenia including Immune Thrombocytopenia, where this represents a final diagnosis – AstraZeneca
  • A shoulder injury following receipt of a COVID-19 vaccine
  • Other moderate-to-significant administration injuries that caused permanent impairment or the need for an extended period of medical treatment
To support their claim, the claimant is required to provide proof that they were admitted to hospital for at least one night, and also be able to show how the amount being claimed was calculated with accompanying evidence.
The claim must also include evidence that the harm has been caused by the vaccine, including a 10-page medical report completed by either the patient’s treating doctor or a hospital physician indicating:
  • the nature of the harm suffered by the patient post-vaccination
  • the duration of that condition
  • the causative link to the TGA approved COVID-19 vaccine.
Claims can be lodged either through myGov using a Medicare online account or through the Express Plus Medicare mobile app. Alternatively, a COVID-19 Vaccine Claims Scheme application can be completed via the Services Australia website.
Claims for compensation between $1000–$19,999.99 will be assessed by Services Australia, who will then make a recommendation to an authorised delegate. Complex claims may, however, be referred for assessment by a panel of independent experts, as will all claims for $20,000 and above.
Dr Price said while there is some uncertainty regarding how many claims will be made and what the compensation process will look like in practice, patients must be advised to have all their documentation ready to ensure a smooth process, given how detailed the medical report is.  
‘I understand the form … is 10 pages, so quite onerous,’ she said.
‘GPs will undoubtedly be involved in helping people fill out these forms, and the GPs themselves are going to be asked whether or not they are of the opinion that this adverse outcome is related to the vaccine, and so all of those things will need to be clearly documented.’
According to the TGA’s latest safety report, the regulator had received 88,549 adverse event reports from more than 39.6 million doses administered up to 5 December, a reporting rate of 2.2 per 1000 doses.
Last month it was reported that more than 10,000 Australians had already registered their interest to make a claim on the DoH’s website.
However, adverse events and injuries that do not require hospitalisation and that do not meet the $1000 loss threshold are excluded from the scheme, as are cases of COVID-19 infection post COVID-19 vaccination and psychological distress.
People who were not admitted to hospital, but should have been, can seek a waiver if they experienced one of the seven accepted clinical conditions.
While the RACGP has welcomed the scheme, the college has also been calling for a no-fault vaccine injury compensation scheme (VICS) to be extended to all vaccines listed on the National Immunisation schedule.
‘My understanding is that it’s commonly applied overseas, and it would be a positive step forward as a vote of confidence,’ Dr Price said.
‘As we’ve seen from COVID, vaccines aren’t just for the patient’s benefit, they’re also for the community benefit and so we’d be in support of that.’
The following resources on the COVID-19 Vaccine Claims Scheme are available: Log in below to join the conversation.

AstraZeneca COVID-19 Moderna no-fault indemnity Pfizer vaccine compensation scheme vaccine injury vaccine rollout

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