Medical Establishments Insurance

About This Policy

This policy insures healthcare establishments (general practices and medical centres, allied health clinics, day surgeries and procedure centres, private hospitals, and aged care and community health facilities) for the civil liability of the establishment arising from the provision of healthcare services.

It covers:

• the company's own civil liability for bodily injury or property damage arising from its healthcare operations;
• the company's vicarious liability for the acts, errors and omissions of its employees, allied health practitioners, volunteers, students and locum tenens;
• the company's vicarious liability for the acts, errors and omissions of medical practitioners, including visiting medical officers, practising at or for the company;
• premises liability while healthcare services are being provided;
• administrative and system errors: care-plan failures, medication management and dispensing errors, inadequate supervision, and triage and referral failures; and
• the costs of responding to inquiries, investigations, and disciplinary and regulatory proceedings.

Medical practitioners. This policy never covers the personal civil liability of a medical practitioner. We will not pay the civil liability of a medical practitioner for any act, error or omission in the provision of healthcare services in their capacity as a medical practitioner. Every medical practitioner practising at or for the company must hold their own medical indemnity insurance that complies with the Medical Indemnity (Prudential Supervision and Product Standards) Act 2003 (Cth). What this policy does cover is the company's own liability, including its vicarious liability and its non-delegable duty of care, arising from a medical practitioner's conduct. See the Civil Liability for Healthcare Operations clause and the Vicarious Liability for Employees, Practitioners and Contracted Doctors clause.

Allied health practitioners. This policy covers an allied health practitioner only while acting for or on behalf of the company. It is not written to be, and does not claim to be, the professional indemnity insurance that the Health Practitioner Regulation National Law and a National Board's registration standard require of a registered practitioner for their own practice. It has no unlimited retroactive cover, and its run-off cover belongs to the company, not to the practitioner. Each practitioner should check with their National Board whether this policy satisfies the standard that applies to them. [WP REVIEW: confirm this statement against the insurance requirement in the Health Practitioner Regulation National Law and the National Boards' registration standards.]

Claims made and notified. This policy covers only claims first made against you during the policy period and notified to us during the policy period. It does not cover claims first made after the policy period ends, even if the treatment or incident occurred during the policy period, subject to your statutory rights under s.40(3) of the Insurance Contracts Act 1984 (Cth), which the Notification of Circumstances clause explains. Before you enter into this contract, your insurer or its distributor must give you written notice of the effect of s.40(3), as s.40(1) of that Act requires.

This policy, together with your schedule and any endorsements, forms your contract of insurance with us. Please read all documents together and tell us if anything is incorrect. We enter into this contract, and each of us must act towards the other, with the utmost good faith, as the Insurance Contracts Act 1984 (Cth) requires. Words with special meanings are listed in the Definitions section.

This wording is written for businesses and professionals. Some buyers, such as small businesses, may be retail clients under the Corporations Act 2001 (Cth). Where a buyer is a retail client, the issuer must give a Product Disclosure Statement and make a Target Market Determination available. This wording is not itself a Product Disclosure Statement. [WP REVIEW: confirm the retail-client posture for medical establishments.]

Version and Document History

This document is version-controlled. The version and date shown on the cover page and in the footer of each page govern this text. The version stated in your schedule as current at inception applies for the life of your policy period, unless your schedule or an endorsement states otherwise.

Schedule

(Completed separately for each policy. It contains your specific details.)

The schedule shows:

• The named insured, ABN or ACN, and any subsidiary
• The facilities covered, by category: general practice or medical centre; allied health clinic; day surgery or procedure centre; private hospital; aged care or community health facility
• The healthcare services covered, being the establishment's operations as described
• The policy period, start and end dates
• The retroactive date
• The limit of liability, the aggregate for all claims and defence costs combined, and whether defence costs are inclusive (the default) or in addition
• Sub-limits that differ from the defaults in the Sub-limits provision
• The excess, the amount you pay first on each claim
• The geographical limits, if different from the default in the definition of Geographical Limits
• The declared gross revenue used to rate the policy
• The premium, including stamp duty and GST
• The state or territory whose law governs this policy (see the Governing Law condition)
• The claims and complaints contact details of the insurer
• The endorsements that change the standard terms, by code, with their variables

Definitions

These words have the meanings below wherever they appear in this policy, the schedule or an endorsement. The singular includes the plural and the plural includes the singular. Headings are for convenience only.

What Is Covered

Civil Liability for Healthcare Operations

If a claim is first made against you during the policy period and notified to us during the policy period, and the claim arises from your healthcare operations conducted on or after the retroactive date within the geographical limits, we will pay the loss you become legally liable to pay, and your defence costs, for any actual or alleged:

• (i) death, bodily injury, mental injury, illness or disease of any person arising from the provision of, or failure to provide, healthcare services;
• (ii) physical loss of or damage to tangible property (including resulting loss of use) arising from your healthcare operations;
• (iii) breach of a duty of care, including a non-delegable duty of care, owed by the company in connection with healthcare services;
• (iv) administrative or system error in the conduct of healthcare operations, including failures of care planning, clinical handover, triage, referral, recall, test-result follow-up, patient identification, credentialing, rostering or supervision, and errors in the storage, management, prescribing systems or dispensing of medication;
• (v) liability of the company as occupier of a facility for bodily injury or property damage occurring while healthcare services are being provided or in connection with the conduct of healthcare operations;
• (vi) breach of privacy or confidentiality in connection with healthcare services (see also the Privacy Complaints and Data Breach Notification Costs extension and the Serious Invasion of Privacy extension);
• (vii) unintentional defamation committed in the course of providing healthcare services; and
• (viii) any other civil liability arising from your healthcare operations,

unless excluded under the What Is Not Covered section.

Vicarious Liability for Employees, Practitioners and Contracted Doctors

Cover under the Civil Liability for Healthcare Operations clause includes the company's vicarious liability, and its liability for breach of a non-delegable duty of care, arising from the acts, errors and omissions of:

• (a) any employee, including nurses, allied health practitioners, care workers and administrative staff;
• (b) any allied health practitioner, volunteer, student or locum tenens acting for the company; and
• (c) any medical practitioner, including a visiting medical officer or contracted doctor, while providing healthcare services at or for the company.

We will not pay the civil liability of a medical practitioner for any act, error or omission in the provision of healthcare services in their capacity as a medical practitioner. The cover in this clause is for the company's liability only. A medical practitioner is never an insured under this policy, has no rights under this policy, and must maintain their own compliant medical indemnity insurance.

Where the company is liable, vicariously or for breach of a non-delegable duty of care, for the conduct of a medical practitioner, we pay the company's whole liability for that conduct, even if the medical practitioner is also liable for the same loss. After we pay, we may seek contribution or recovery from the medical practitioner or their insurer (see the Preserve Our Recovery Rights obligation).

Inquiry and Regulatory Defence Costs

If, during the policy period, you are first notified in writing that you are required to attend, produce documents to, or respond to an inquiry, and you notify us during the policy period, we will pay the defence costs of your representation at, and response to, the inquiry, provided the subject matter of the inquiry arises from your healthcare operations conducted on or after the retroactive date. This includes, without limitation:

• (a) coronial inquests and inquiries;
• (b) Ahpra and National Board notifications, investigations, performance assessments, panel hearings and tribunal proceedings concerning the company or an insured person;
• (c) proceedings before the Health Care Complaints Commission (NSW), the Office of the Health Ombudsman (Qld), or any equivalent health complaints entity;
• (d) Aged Care Quality and Safety Commission investigations, audits, compliance monitoring, enforcement proceedings, and Serious Incident Response Scheme (SIRS) investigations;
• (e) Medicare, Professional Services Review, PBS and NDIS Quality and Safeguards Commission audits and investigations (see also the Medicare, NDIS and PBS Audits and Employee Fraud extension); and
• (f) Royal Commissions and boards of inquiry, to the extent your involvement arises from your healthcare operations; and
• (g) the legal costs of advice about, making or responding to a mandatory notification under the Health Practitioner Regulation National Law, including a notification the company or an insured person is legally required to make about a registered practitioner, and a notification made about the company or an insured person, where the obligation to notify arises, or you first receive notice of the notification, during the policy period.

We do not pay under this clause: fines or penalties (except as provided by the Statutory Liability extension); any compensation ordered by the inquiring body (which may instead be covered under the Civil Liability for Healthcare Operations clause); or your internal costs. This clause pays for the company and for insured persons. It does not pay for the own representation of a visiting medical officer or any other medical practitioner. The sub-limit for this clause in the Sub-limits provision applies.

Notification of Circumstances

If during the policy period you become aware of any fact, matter or circumstance that might reasonably be expected to give rise to a claim against you or an inquiry involving you, and you notify us of it in writing during the policy period, then any claim or inquiry that later arises from those facts, whenever it is made or commenced, will be treated as a claim or inquiry first made during this policy period and notified under this policy.

Your written notice should include: why you think a claim or inquiry might arise; details of the act, error, omission or incident involved; the identity of any potential claimant, patient or resident (if known); and an estimate of the potential value (if possible).

This clause reflects, and does not limit, your rights under s.40(3) of the Insurance Contracts Act 1984 (Cth), which provides that where the insured gave notice in writing to the insurer of facts that might give rise to a claim, as soon as was reasonably practicable after becoming aware of them and before the insurance cover expired, the insurer is not relieved of liability in respect of the claim, when made, by reason only that it was made after the cover expired.

Extensions of Cover

The following extensions are included automatically. Each is subject to the terms, conditions and exclusions of this policy and to the limit of liability. Where an extension refers to a sub-limit, the sub-limit in the Sub-limits provision applies unless the schedule states a different amount. Sub-limits are part of, not in addition to, the limit of liability.

Consumer Protection Legislation

We will cover your civil liability for loss and defence costs arising from a claim alleging a breach of the Competition and Consumer Act 2010 (Cth) (including the Australian Consumer Law), the Australian Securities and Investments Commission Act 2001 (Cth), or any state or territory fair trading legislation, committed in connection with your healthcare services, including allegations of misleading or deceptive conduct and breach of consumer guarantees. We do not cover criminal liability, or pecuniary penalties except as provided by the Statutory Liability extension.

Privacy Complaints and Data Breach Notification Costs

We will cover:

• (a) your civil liability for loss and defence costs arising from a claim alleging breach of privacy legislation, breach of confidence, or unauthorised use or disclosure of personal or health information, in connection with your healthcare operations;
• (b) your defence costs in responding to a complaint, investigation or determination by the Office of the Australian Information Commissioner or a state or territory privacy or health records regulator; and
• (c) your reasonable first-party costs, incurred with our prior written consent, of assessing and notifying an eligible data breach as required by Part IIIC of the Privacy Act 1988 (Cth), including forensic investigation, legal advice on notification obligations, preparation of statements to the Commissioner, and notification to affected individuals. Because the Privacy Act requires you to complete your assessment within 30 days, our consent under this paragraph is deemed given for reasonable costs necessarily incurred to meet that statutory deadline, provided you notify us as soon as reasonably practicable.

Penalties under privacy legislation are covered only to the extent permitted by law and only under the Statutory Liability extension, subject to its sub-limit. The sub-limit for this extension applies.

Serious Invasion of Privacy

We will cover the company's civil liability for loss and defence costs arising from a claim under Schedule 2 of the Privacy Act 1988 (Cth) (the statutory cause of action for serious invasions of privacy, inserted by the Privacy and Other Legislation Amendment Act 2024 (Cth) and in force from 10 June 2025), including the company's vicarious liability for the conduct of an insured person.

We will also cover an insured person (other than a medical practitioner) for such a claim, but only where the invasion of privacy is alleged to have been reckless rather than intentional, and only where the insured person was acting in the course of their duties for the company. We do not cover any person who is found by a court, or who admits, to have intentionally committed a serious invasion of privacy, and if defence costs have been advanced to that person, they must be repaid.

Good Samaritan Acts

We will cover the company's liability, and the liability of any insured person (other than a medical practitioner), arising from emergency medical treatment, first aid or assistance rendered in good faith and without expectation of payment to a person in urgent need at or near the scene of an accident, emergency or sudden illness, including outside a facility. This extension applies even though the treatment falls outside the healthcare services described in the schedule.

Medicare, NDIS and PBS Audits and Employee Fraud

We will pay:

• (a) your defence costs in responding to an audit, investigation or review by Medicare, Services Australia, the Chief Executive Medicare, the Professional Services Review, the Department of Health and Aged Care, or the NDIS Quality and Safeguards Commission, concerning claiming, billing or payments in connection with your healthcare services; and
• (b) your defence costs where such an audit or investigation involves alleged fraud or dishonesty by an employee, but only for the benefit of the company and any insured person who did not commit, condone, participate in, or wilfully ignore the fraudulent or dishonest conduct.

We do not pay: repayments of benefits, rebates or payments incorrectly claimed or received; fines or penalties (except as provided by the Statutory Liability extension); or the defence costs of any person who committed or condoned the fraud or dishonesty (and any defence costs advanced to such a person must be repaid). The sub-limit for this extension applies.

Statutory Liability

We will pay your defence costs in defending a prosecution, civil-penalty proceeding or formal enforcement proceeding first brought against the company or an insured person during the policy period and notified to us during the policy period, under any Australian statute in connection with your healthcare operations, including proceedings under work health and safety legislation, privacy legislation, the Aged Care Act (including civil-penalty proceedings brought by the Aged Care Quality and Safety Commission), and food safety, radiation safety, and drugs and poisons legislation.

We will also pay fines and civil pecuniary penalties imposed on the company or an insured person in such a proceeding, but only to the extent the law allows them to be insured, and never a criminal fine.

We do not pay any fine or penalty that the law does not allow to be insured. In particular, we do not pay a penalty imposed under work health and safety law in a State or Territory whose law prohibits insurance of it (including New South Wales, Victoria and Queensland), and we do not pay a criminal fine. In those jurisdictions this extension provides defence costs only for work health and safety proceedings.

[WP REVIEW: confirm the list of jurisdictions that prohibit insurance of WHS penalties; library sources differ on WA and Victoria.]

Penalties are also not covered where the conduct was deliberate, dishonest, fraudulent or reckless, or where payment would be against public policy. Certain penalties, including penalties at the quantum available under the Aged Care Act and privacy legislation, may be uninsurable at law in whole or in part, and we pay only what the law permits.

The Corporations Act 2001 (Cth), sections 199A and 199B condition applies to this extension for an insured person. Where we advance defence costs in a civil-penalty or criminal proceeding against an insured person, we advance them as they are incurred, and the insured person must repay them if a Final adjudication, or a court's finding, establishes conduct that this policy or the law does not allow to be covered.

[WP REVIEW: confirm what public policy and s 199B of the Corporations Act 2001 (Cth) allow for civil-penalty and criminal proceedings against insured persons, including directors and officers of the company.]

The sub-limit for this extension applies. This extension does not cover medical practitioners.

Molestation Defence Costs

Despite the Molestation exclusion, we will pay the defence costs of the company, and of any insured person who is not the alleged perpetrator, in defending a claim alleging molestation committed by an employee in connection with your healthcare operations, provided that:

• (a) no member of the control group knew of, condoned or wilfully ignored the alleged conduct or any propensity of the alleged perpetrator;
• (b) cover under this extension is limited to defence costs only: we will not pay any loss, compensation, settlement or damages in respect of molestation;
• (c) the most we will pay under this extension for all claims combined during the policy period is the molestation defence costs sub-limit; and
• (d) if it is established by judgment, adverse admission or other final adjudication that the molestation occurred and was committed, condoned or wilfully ignored by the person for whose benefit defence costs were paid, that person must repay to us all defence costs we advanced on their behalf.

This extension never covers the alleged perpetrator where the allegation is established, and never covers a medical practitioner.

Newly Acquired Subsidiaries and Facilities

If during the policy period the company acquires or creates a new subsidiary, or acquires or opens a new healthcare facility, the new entity or facility is automatically covered for 60 days from the date of acquisition or opening, provided that:

• (a) its healthcare activities are the same as or similar to the healthcare services shown in the schedule;
• (b) its annual revenue does not exceed 20% of the company's annual revenue;
• (c) it does not provide obstetrics services, cosmetic procedures, or services in the United States of America or Canada; and
• (d) cover applies only to acts, errors, omissions and incidents occurring after the acquisition or opening.

You must give us written details within 60 days; we may then adjust the premium or terms. If you do not, cover for the new entity or facility ends at the expiry of the 60 days.

Loss of Documents

If during the policy period you discover that any documents (including patient records) necessary for your healthcare operations have been physically lost, damaged or destroyed while in your possession or in the possession of a person to whom you entrusted them, we will pay the reasonable costs of replacing or restoring them, incurred with our prior written consent, and your civil liability arising from the loss. We do not pay for loss caused by wear, tear, vermin or gradual deterioration, or for electronic data loss arising from a cyber event of the kind excluded by the Cyber Events exclusion except as covered by the Privacy Complaints and Data Breach Notification Costs extension. The sub-limit for this extension applies.

Public Relations and Crisis Costs

Following a claim or inquiry covered by this policy, or an incident notified under the Notification of Circumstances clause that has attracted or is reasonably likely to attract adverse publicity, we will pay the reasonable costs of engaging a public relations or crisis management consultant, with our prior written consent, to protect or restore the reputation of the company. The sub-limit for this extension applies.

Court Attendance

If any insured person attends a court, tribunal, arbitration, coronial inquest or inquiry as a witness in connection with a claim or inquiry covered by this policy, at our request or with our agreement, we will pay the company $500 for each day or part-day of attendance. This payment does not erode the excess. The sub-limit for this extension in the Sub-limits provision applies.

Advance Claim Protection

If you notify us of a claim or inquiry and urgent legal representation is required before we have confirmed coverage, we will appoint and pay a lawyer from our panel to protect your position immediately, including responding to procedural deadlines, coronial notices, regulatory information demands and SIRS timeframes, pending our coverage decision. If we subsequently and properly decline cover, you must repay the amounts we advanced for the matters declined; if we confirm cover, the amounts form part of your defence costs. Payments under this extension are capped at its sub-limit.

Continuous Cover

If a claim is first made against you during the policy period and:

• (a) it arises from a fact, matter or circumstance you first became aware of during an earlier policy period, and should have notified under an earlier medical malpractice or civil liability policy issued by us;
• (b) you did not notify it earlier through error or oversight and not through fraud;
• (c) you have held continuous equivalent cover with us from the date you first became aware of the fact, matter or circumstance until this policy period; and
• (d) the claim would have been covered under the earlier policy had it been notified,

then we will cover the claim under this policy, on the terms, conditions, exclusions and limits of the earlier policy or this policy, whichever are narrower and lower, and reduced by any amount that fairly represents the prejudice we have suffered from the late notification.

Run-off Cover

If during the policy period the company permanently ceases its healthcare operations, or is merged into or acquired by another entity, this policy automatically continues to cover claims and inquiries first made against you and notified to us during the 84 months following the cessation, merger or acquisition, but only for healthcare operations conducted before the cessation, merger or acquisition and on or after the retroactive date. All terms, conditions, exclusions and the remaining limit of liability continue to apply. No additional premium is payable for the first 12 months. For the balance of the run-off period, the additional premium is the amount shown in the schedule or, if none is shown, 200% of the annual premium for the last policy period. We will notify you of the amount before the first 12 months end. If you do not pay it within 30 days of our notice, run-off cover ends at the end of the first 12 months. [WP REVIEW: confirm the premium rule and the off-ramp for the balance of the run-off period.]

Extended Reporting Period

If we cancel or refuse to renew this policy (other than for non-payment of premium or fraud), or you do not renew it, you may purchase an extended reporting period of 365 days from the end of the policy period, for the additional premium shown in the schedule (or, if none is shown, a premium we set acting reasonably, not exceeding 100% of the expiring annual premium). During the extended reporting period, claims and inquiries first made and notified are covered, but only for healthcare operations conducted before the end of the original policy period. You must elect and pay within 30 days after the policy period ends. The extended reporting period does not increase or reinstate the limit of liability and does not apply if run-off cover under the Run-off Cover extension responds.

Aged Care Act Statutory Compensation

Where the company operates an aged care or community health facility, cover under the Civil Liability for Healthcare Operations clause extends to claims for statutory compensation under the Aged Care Act, including an application, claim or proceeding for compensation for loss or damage suffered by an individual as a result of a contravention of the statutory duty under the Aged Care Act, and a compensation order sought in, or in connection with, a civil-penalty proceeding. Civil penalties themselves are addressed, and limited, by the Statutory Liability extension. A claim alleging molestation remains subject to the Molestation exclusion and the Molestation Defence Costs extension.

SIRS and Commission Proceedings

For the avoidance of doubt, the cover under the Inquiry and Regulatory Defence Costs clause includes your defence costs in responding to: a Serious Incident Response Scheme investigation; a request, notice or requirement of the Aged Care Quality and Safety Commission (including audits, assessment contacts and compliance monitoring where legal representation is reasonably necessary); and enforcement or civil-penalty proceedings brought by the Commission. Nothing in this policy prevents, penalises or discourages you from making a report or notification required by the Serious Incident Response Scheme: see the Do Not Admit Liability, With Important Exceptions obligation.

Students and Placements

We will cover the company's liability, and the personal liability of any student, arising from healthcare services performed by the student under the supervision of the company or its staff, in accordance with the company's protocols. This extension does not cover a student who is a registered medical practitioner acting in that capacity.

Volunteers

We will cover the company's liability, and the personal liability of any volunteer, arising from duties performed for the company with its consent. Volunteers may also have statutory protection under civil liability legislation and the Volunteers Protection Act 2003 (Cth); this extension supplements and does not displace that protection.

Locum Tenens

We will cover the company's vicarious liability arising from healthcare services performed by a locum tenens. Where the locum tenens is not a medical practitioner, we will also cover their personal liability as an insured person. Where the locum tenens is a medical practitioner, this extension covers the company's liability only: we will not pay the civil liability of a medical practitioner for any act, error or omission in the provision of healthcare services in their capacity as a medical practitioner.

Estates, Heirs and Spouses

If an insured person dies, becomes legally incapacitated or becomes insolvent, we will cover their estate, heirs or legal representatives for a claim arising from the insured person's conduct that would have been covered under this policy. We will also cover the lawful spouse or domestic partner of an insured person for a claim made against them solely because of their spousal relationship or their joint ownership of property, but not for any act, error or omission of the spouse or partner themselves.

Telehealth and Remote Care

For the avoidance of doubt, healthcare services include services provided by telehealth and remote patient monitoring, wherever the patient is located within the geographical limits, provided the service is lawful both where it is provided from and where the patient is located. This extension does not cover claims made in, or governed by the law of, the United States of America or Canada, or services provided to patients located there.

What Is Not Covered

We do not cover any claim, inquiry, loss or liability:

Medical Practitioners' Own Liability

of any medical practitioner for their own act, error or omission. We will not pay the civil liability of a medical practitioner for any act, error or omission in the provision of healthcare services in their capacity as a medical practitioner.

This exclusion does not apply to, and nothing in it limits, the company's own civil liability (including vicarious liability and liability for breach of a non-delegable duty of care) arising from the conduct of a medical practitioner, which is covered under the Civil Liability for Healthcare Operations clause and the Vicarious Liability for Employees, Practitioners and Contracted Doctors clause. Medical practitioners must hold their own medical indemnity insurance. This policy is not, and must not be represented as, medical indemnity cover for any doctor.

Employer's Liability

arising from: the death, bodily injury, illness or disease of any employee or other worker arising out of or in the course of their employment or engagement by you; any liability under workers compensation, accident compensation or industrial legislation; or any employment-related claim, including wrongful dismissal, discrimination, harassment, bullying, underpayment or breach of employment law. These exposures are designed to be covered under workers compensation and employment practices liability insurance.

Directors' and Officers' Liability

made against a director, officer or committee member of the company for a wrongful act in their capacity as a director or officer, that is in the management or governance of the company as distinct from the conduct of healthcare operations, or arising from the company's or an insured person's capacity as trustee of a superannuation fund.

However, this exclusion does not apply to defence costs covered under the Inquiry and Regulatory Defence Costs clause or the Statutory Liability extension for an inquiry or statutory proceeding arising from your healthcare operations, including a proceeding against a person who is a responsible person of the company within the meaning of the Aged Care Act, to the extent those costs relate to the healthcare operations rather than to the person's management of the company's corporate affairs. Broader directors' and officers' cover is designed to be provided under a management liability policy.

Obstetrics

arising from the provision of, or failure to provide, obstetrics services, unless the schedule or Endorsement E01 states that obstetrics cover is included. This exclusion does not apply to emergency treatment covered by the Good Samaritan Acts extension where no obstetric care could reasonably have been referred or transferred in time.

Cosmetic and Aesthetic Procedures

arising from any procedure, treatment or service performed wholly or predominantly to alter or enhance appearance rather than to treat illness, injury or disease, including cosmetic injectables (such as botulinum toxin and dermal fillers), liposuction, breast or other augmentation, cosmetic surgery, laser and light-based aesthetic treatments, and hair transplantation. This exclusion does not apply to reconstructive procedures performed to address the consequences of illness, injury, congenital condition or medical treatment.

Unregistered or Unlicensed Practice

arising from healthcare services performed by any person who, at the time of the relevant act, error or omission: was not registered, endorsed, licensed or accredited as required by law for that service; was practising while their registration was suspended, cancelled or lapsed; or was practising in breach of a condition, undertaking or restriction on their registration that is material to the claim, where the company knew, or ought reasonably to have known through its credentialing processes, of the deficiency. This exclusion does not apply to a student acting under supervision in accordance with the Students and Placements extension, or to an insured person whose registration deficiency was concealed from the company despite reasonable credentialing checks.

Prescription-only Medicines

arising from the supply, dispensing or administration of any medication that may lawfully be supplied only on the prescription of an authorised prescriber, where no such prescription (or lawful standing order, or lawful emergency authority) existed.

Clinical Trials and Experimental Procedures

arising from any clinical trial, medical research study, or investigational use of any drug, device or procedure; or from any procedure or treatment that is experimental in nature and not approved or recognised by the relevant professional colleges, the Therapeutic Goods Administration, or the Medical Services Advisory Committee. Cover for clinical trials is available under Endorsement E04.

Molestation

arising from molestation, except as expressly provided by the Molestation Defence Costs extension (defence costs only).

Intoxicants and Drugs

arising from healthcare services performed by any person while under the influence of alcohol or of a drug not prescribed for them (or prescribed but taken contrary to medical direction), but only where the company, through a member of the control group, knew of or connived at the person performing healthcare services in that state. The knowledge or conduct of the impaired person is not imputed to the company or to any other innocent insured person, and cover for the innocent company and innocent insured persons is preserved.

Prior Known Circumstances and Retroactive Date

arising from: (a) any fact, matter, circumstance or incident that you knew about, or ought reasonably to have known about, before the start of the policy period (or before we first agreed to insure you on continuous terms, if earlier) and that you knew or ought reasonably to have known might give rise to a claim or inquiry; (b) any claim, inquiry or circumstance notified, or that ought to have been notified, under any earlier policy (subject to the Continuous Cover extension); or (c) any act, error, omission or incident occurring before the retroactive date. Knowledge under paragraph (a) is assessed as the Severability and Non-imputation condition provides: for the company, by what a member of the control group knew or ought reasonably to have known; for an insured person, by what that person knew or ought reasonably to have known.

Contractual Liability

assumed by you under any contract, agreement, warranty or guarantee, to the extent the liability is greater than the liability you would have had at law in the absence of the contract, including liability arising because a contract excludes or modifies the operation of proportionate liability legislation. However, this exclusion does not reduce cover for the share of any loss for which you would have been liable at law in the absence of the contract, including your proportionate share as it would have been determined under applicable proportionate liability legislation.

Goods Sold or Supplied

arising from the manufacture, sale, supply, storage, installation, repair or recall of any goods or products, unless the liability arises directly from the provision of healthcare services (for example, the supply, fitting or administration of medication, prostheses, aids or appliances as part of treatment).

Trading Debts and Fee Disputes

for: (a) any trading debt or personal debt; (b) the refund, return, remission or offset of fees, charges, subsidies or payments (including Medicare, PBS, NDIS, or aged care subsidies or accommodation payments); (c) liquidated damages or amounts payable only because a contract fixes them; (d) your lost profit, mark-up or overheads; or (e) your liability for any tax.

Fines, Penalties and Punitive Damages

for fines; civil or criminal penalties; punitive, exemplary or multiple damages; or aggravated damages to the extent they are uninsurable at law, except where, and only to the extent that, cover for fines and penalties is expressly provided by the Statutory Liability extension and is permitted by law, and never for a criminal fine.

WHS Monetary Penalties

for any monetary penalty imposed under work health and safety legislation, to the extent the law prohibits insurance or indemnity for it. Defence costs for WHS proceedings remain covered under the Statutory Liability extension.

Related Parties

brought by or on behalf of: (a) the company or any insured person; (b) any entity that controls the company, is controlled by the company, or is under common control with the company; or (c) any person or entity that holds a financial, executive or managerial interest of 20% or more in the company together with the right to appoint or occupy a seat on its board, or any entity in which the company holds such an interest.

However, this exclusion does not apply to: a claim for bodily injury brought by a natural person (including a relative of an insured person) in their capacity as a patient, resident or recipient of healthcare services; or a claim brought by an independent third party for which a related party seeks contribution or indemnity from you.

Radioactivity and Nuclear

arising from ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste, or from the radioactive, toxic, explosive or other hazardous properties of any nuclear assembly or component. However, this exclusion does not apply to liability arising from the possession, storage, transport or clinical use of radioactive isotopes, radiopharmaceuticals or radiation-emitting equipment for diagnostic, imaging or therapeutic purposes in the ordinary course of your healthcare services.

Asbestos

arising from or in connection with asbestos in any form, including its mining, manufacture, distribution, installation, presence, removal or disposal. However, this exclusion does not apply to your liability arising from the medical treatment, care, diagnosis or advice you provide to patients suffering from, or being investigated for, asbestos-related injury or disease.

War and Terrorism

arising from: (a) war (whether declared or not), invasion, civil war, rebellion, revolution, or military or usurped power; or (b) any act of terrorism, or any action taken in controlling, preventing or suppressing terrorism. However, paragraph (b) does not apply to your liability arising from the healthcare services you provide to victims of an act of terrorism.

Pollution

arising from pollution, unless the discharge, release, escape or dispersal is sudden, accidental, unintended and unexpected, and arises directly from your healthcare operations (including the handling of clinical waste).

Cyber Events

arising from unauthorised access to or interference with your computer systems, ransomware, malware, denial-of-service attacks, or failure of your computer system security, unless, and only to the extent that, the liability arises from a breach of privacy or confidentiality covered by the Privacy Complaints and Data Breach Notification Costs extension or the Serious Invasion of Privacy extension, or from bodily injury caused by a failure of clinical care. Broader cover is designed to be provided under a cyber insurance policy.

United States of America and Canada

made, brought or maintained in the United States of America or Canada or their territories or protectorates; arising from healthcare services provided in, or to a patient located in, the United States of America or Canada; or based on a judgment, order or settlement of a court of the United States of America or Canada, including proceedings to enforce such a judgment elsewhere. This exclusion is absolute and cannot be varied except by express endorsement.

How Much We Will Pay

Limit of Liability

The most we will pay under this policy for all loss and defence costs combined, for all claims and inquiries during the policy period, is the limit of liability shown in the schedule. This is an aggregate limit: it applies to all claims and inquiries combined, regardless of how many are made, how many insured persons are involved, or how many facilities are affected.

Sub-limits

Where a sub-limit applies, it is the most we will pay for that type of cover for all claims and inquiries combined during the policy period. Sub-limits are included within, not in addition to, the limit of liability, unless the schedule states otherwise. Unless the schedule states a different amount, the sub-limits are:

[WP REVIEW: these default sub-limits are new in this version; version 1.0.0 left every sub-limit to the schedule. Confirm with the capacity provider.]

Defence Costs

Defence costs are included within the limit of liability and reduce the amount available to pay compensation, unless the schedule states that defence costs are payable in addition to the limit of liability, in which case the schedule will show the separate defence costs limit that applies.

We will advance defence costs as they are incurred, before final resolution. If it is finally established that a claim or inquiry, or part of it, is not covered, you must repay the defence costs advanced for the uncovered portion.

Excess

You must pay the excess shown in the schedule as the first part of each claim or inquiry, applied to loss and defence costs combined unless the schedule states otherwise. The excess applies even where a matter involves only defence costs. Where multiple claims are treated as a single claim under this policy, only one excess applies.

Other Insurance

If a loss covered by this policy is also covered by another insurance policy, we will not refuse or reduce our payment because of that other insurance. We may seek contribution from the other insurer as the law allows. This does not apply where the schedule or an endorsement states that this policy is excess of a specified underlying policy, in which case this policy pays only after the limit of that specified policy is exhausted.

Tell us promptly about other insurance that may cover the same loss or defence costs, and give us reasonable assistance to seek contribution.

Allocation

If a claim or inquiry involves both covered and uncovered matters, or covered and uncovered parties (for example, a claim brought against both the company and a medical practitioner; the company's liability for the practitioner's conduct is not allocated away, see the Vicarious Liability for Employees, Practitioners and Contracted Doctors clause), you and we will use our best endeavours to agree a fair and reasonable allocation of loss and defence costs between the covered and uncovered portions, taking into account the relative legal and financial exposures. If we cannot agree within 30 days, the allocation will be determined by senior counsel, whose determination is binding on both of us and whose costs form part of defence costs. Pending agreement or determination, we will advance the defence costs we consider fair and reasonable.

Paying Out the Limit

At any time we may pay you the limit of liability (or what remains of it after earlier payments), less any applicable excess, and our obligations to defend or make further payments will end. Before doing so, we will give you reasonable written notice and the opportunity to take over the conduct of any defence at your own cost.

Your Obligations

Each obligation in this section is a term of the contract, not a condition precedent to our liability. If you do not comply with an obligation, we may reduce our liability for the relevant claim or inquiry by the amount that fairly represents the prejudice we suffer as a result, and we may refuse the claim only where the Insurance Contracts Act 1984 (Cth), including s.54, permits.

Tell Us About Claims and Inquiries

Tell us in writing as soon as reasonably practicable after you become aware that a claim has been made against you or that you are required to respond to an inquiry. Include: who is making the claim or conducting the inquiry, and what is alleged; when you first became aware; details of the act, error, omission or incident involved; and your estimate of the potential value, if you can. This policy only covers claims and inquiries first made and notified during the policy period, so notify promptly and before the policy period ends.

Tell Us About Circumstances

Tell us in writing during the policy period about any fact, matter or circumstance you first become aware of that might reasonably be expected to give rise to a claim or inquiry. This protects you: see the Notification of Circumstances clause. Examples: a patient or resident has suffered an unexpected adverse outcome; a serious incident has been reported under SIRS; a family has expressed an intention to seek compensation; Ahpra has notified you of a complaint touching your systems or supervision; a coroner has requested records; a regulator has signalled a formal investigation.

Do Not Admit Liability, With Important Exceptions

Do not admit liability for, make an offer or promise to pay, or settle any claim, or waive any right of recovery, without our prior written consent. We will not unreasonably withhold or delay consent.

This obligation never prevents, and is not breached by, any of the following:

• (a) an apology or expression of regret, sorrow or sympathy made in accordance with applicable civil liability legislation (including s.69 of the Civil Liability Act 2002 (NSW), Part IIC of the Wrongs Act 1958 (Vic), ss.71 and 72 of the Civil Liability Act 2003 (Qld), and their equivalents), which by law does not constitute an admission of liability;
• (b) open disclosure communications;
• (c) a mandatory notification to Ahpra or a National Board under the mandatory notification provisions of the Health Practitioner Regulation National Law, or any other notification a registered practitioner or the company is legally required to make;
• (d) a report of a reportable incident under the Serious Incident Response Scheme, or any other report or notification required by the Aged Care Act or the National Disability Insurance Scheme Act 2013 (Cth);
• (e) a data breach assessment, statement or notification required by Part IIIC of the Privacy Act 1988 (Cth); and
• (f) any other disclosure, report or notification you are required by law to make.

Making a legally required disclosure, or communicating with patients and families in accordance with open disclosure, is not an admission of liability for the purposes of this policy and will never of itself prejudice your cover. Where practicable, tell us before or promptly after making such a disclosure so we can help you manage it.

[WP REVIEW: add the National Law section references for mandatory notifications; the previous draft cited ss.140 to 143, which have not been verified.]

Cooperate With Us

Give us all information, documents and assistance we reasonably request to investigate, defend or settle a claim or respond to an inquiry. Attend meetings, conferences, examinations and proceedings we reasonably require. Nothing in this obligation requires you to waive legal professional privilege otherwise than to us, or to breach any law, including privacy legislation.

Conduct of the Defence

We have the right, and at your request the duty, to take over and conduct in your name the investigation, defence and settlement of any claim, and to appoint lawyers to represent you at an inquiry. We will:

• (a) consult you and keep you reasonably informed;
• (b) take account of the professional reputation and clinical accreditation interests of the company and insured persons in conducting the defence; and
• (c) if an actual conflict of interest arises between you and us, or between insured persons we are defending, notify you and arrange separate legal representation for the conflicted parties at our expense (as part of defence costs), with lawyers reasonably acceptable to both of us. Common facts alone, or a mere reservation of rights, do not of themselves create a conflict.

Senior Counsel Clause

Neither you nor we are required to contest any claim, or appeal any judgment, unless senior counsel advises that the proceeding or appeal has reasonable prospects of success, taking into account the interests of both you and us, including damage to your professional reputation and the prospect of an award exceeding any available settlement. The costs of obtaining senior counsel's advice form part of defence costs.

Settlement Opportunities

If we recommend that a claim be settled for an amount within the limit of liability that the claimant is willing to accept, and senior counsel (instructed under the Senior Counsel Clause obligation at the request of either of us) advises that the settlement is reasonable, but you do not consent to the settlement, then our total liability for that claim will not exceed the amount for which it could have been settled, plus the defence costs incurred up to the date your consent was requested, less the excess. You may then continue the defence at your own cost and risk.

Mitigate

Take all reasonable steps to prevent or reduce any loss that might be covered by this policy, including complying with your clinical governance, credentialing and incident-management systems.

Tell Us About Material Changes

Tell us as soon as reasonably practicable about any material change to your healthcare operations during the policy period, for example: commencing a new category of healthcare services (including obstetrics services or cosmetic procedures); opening, acquiring or closing a facility; a merger or acquisition; loss or suspension of an accreditation, approval or licence material to your operations; or the appointment of an administrator or liquidator. We may adjust the premium or terms for the changed risk. Under the Insurance Contracts Act 1984 (Cth), we cannot refuse a claim solely because you failed to tell us about a change, except to the extent we are prejudiced.

Tell Us About Other Insurance

Tell us about any other insurance that might cover the same loss or defence costs: see the Other Insurance provision.

Preserve Our Recovery Rights

Do not do anything after a claim is made, or after you become aware of a circumstance, that might prejudice our right to recover from any third party, including a medical practitioner or their insurer. If we pay, we may exercise your rights of recovery in your name; you must give us reasonable assistance. We will not exercise recovery rights against an insured person unless the Intoxicants and Drugs exclusion, the fraud carve-outs in the Medicare, NDIS and PBS Audits and Employee Fraud extension, or paragraph (d) of the Molestation Defence Costs extension applies to that person. Any recovery (less our costs of recovery) will be applied first to reduce your uninsured loss, then ours.

General Conditions

Insurance Contracts Act

Nothing in this policy excludes, restricts or modifies the operation of the Insurance Contracts Act 1984 (Cth). Where this policy is inconsistent with the Act, the Act prevails.

If this policy would otherwise let us refuse to pay a claim, in whole or in part, because of something you did or did not do after this policy was entered into, section 54 of the Act applies. We may not refuse to pay the claim only because of that act or omission. Our liability is reduced by the amount that fairly represents the extent to which our interests were prejudiced. Where the act or omission could reasonably be regarded as capable of causing or contributing to the loss, we may refuse to pay only the part of the claim that the act or omission caused or contributed to. We may not refuse any part that you prove the act or omission did not cause. This applies to every condition, exclusion, limit and obligation in this policy, not only to the claims conditions.

Corporations Act 2001 (Cth), sections 199A and 199B

Section 199A of the Corporations Act 2001 (Cth) limits the liabilities and legal costs for which a company may indemnify its officers. Section 199B prevents a company from paying a premium for insurance that covers an officer against a liability, other than one for legal costs, arising out of conduct involving a wilful breach of duty in relation to the company, or a contravention of section 182 or 183 of that Act.

To the extent the company pays the premium, this policy does not cover an insured person for a liability, other than legal costs, that section 199B prevents the company from insuring. This does not reduce cover for any other liability, or for legal costs.

[WP REVIEW: confirm this statement of ss 199A and 199B, and whether cover for a liability within s 199B can be provided where the insured person pays the relevant part of the premium.]

Your Duty of Disclosure

Before you enter into, renew, extend, vary or reinstate this policy, you have a duty under the Insurance Contracts Act 1984 (Cth) to tell us anything you know, or could reasonably be expected to know, that is relevant to our decision whether to insure you and on what terms. You do not need to tell us about matters that reduce the risk, are common knowledge, we know or should know as an insurer, or we have told you we do not need to know.

If you do not comply with the duty, we may reduce or refuse a claim, or cancel the policy, and if the non-disclosure is fraudulent we may treat the policy as if it never existed, in each case only as the Insurance Contracts Act 1984 (Cth) permits. As between us and each insured person, the consequences of non-disclosure are assessed individually: see the Severability and Non-imputation condition.

Utmost Good Faith

This contract is governed by the duty of utmost good faith under s.13 of the Insurance Contracts Act 1984 (Cth). The duty binds both of us: we must act towards you, and you must act towards us, with the utmost good faith in all matters arising under or in relation to this policy, including claims handling.

Cancellation

You may cancel this policy at any time by telling us. We refund the premium for the unexpired period of insurance on a pro-rata basis, less any non-refundable government charges.

We may cancel this policy only as the Insurance Contracts Act 1984 (Cth) allows, by giving you written notice as that Act requires. We refund the premium for the unexpired period on a pro-rata basis.

Cancellation does not affect cover for a claim first made, or a circumstance notified, before the cancellation takes effect.

Severability and Non-imputation

The proposal and all information supplied to us are treated as a separate application by each insured person. No fact known to, statement by, or conduct of one insured person will be imputed to any other insured person, or to the company, except that the knowledge and conduct of a member of the control group is the company's knowledge and conduct. Cover for each innocent insured person continues unaffected by another's non-disclosure, misrepresentation or breach.

Insured Persons as Third-party Beneficiaries

Each insured person who is not a contracting party (including employees, allied health practitioners, volunteers, students, and locum tenens other than medical practitioners) has the benefit of this policy as a third-party beneficiary under s.48 of the Insurance Contracts Act 1984 (Cth) and may claim directly under it, subject to its terms. Only the named insured may agree to vary or cancel the policy or an endorsement.

Governing Law

This policy is governed by the law of the state or territory of Australia shown in the schedule for this purpose. If none is shown, it is governed by the law of the state or territory in which the named insured had its principal place of business at the start of the policy period.

Jurisdiction

You and we submit to the non-exclusive jurisdiction of the courts of the state or territory whose law governs this policy under the Governing Law condition, and the courts that hear appeals from those courts.

Complaints and AFCA

If you are unhappy with any decision or with our service, please contact us first, using the complaints contact details shown in the schedule. We will follow our internal dispute resolution process and respond within 30 days.

If you are not satisfied with the outcome, you may refer the matter to the Australian Financial Complaints Authority (AFCA): www.afca.org.au, info@afca.org.au, 1800 931 678, GPO Box 3, Melbourne VIC 3001. AFCA provides a free and independent external dispute resolution service. Time limits apply to AFCA complaints.

General Insurance Code of Practice

We are committed to the General Insurance Code of Practice, which sets standards for the fair handling of policies, claims, complaints, and customers experiencing vulnerability or financial hardship. A copy is available at codeofpractice.com.au.

GST and Input Tax Credits

Tell us the extent of any input tax credit you are entitled to claim for the premium. If you do not, we will assume you are entitled to a full input tax credit. When we pay a claim, we will reduce the payment by any input tax credit you are entitled to claim for the repair, replacement or supply concerned, in accordance with A New Tax System (Goods and Services Tax) Act 1999 (Cth).

Australian Currency

All premiums, limits, sub-limits, excesses and claim payments under this policy are in Australian dollars. Where a loss is incurred in another currency, it will be converted at the Reserve Bank of Australia rate on the date the payment obligation is quantified.

Premium Payment

The premium is due by the date shown in the schedule or invoice. If the premium (or an agreed instalment) remains unpaid after that date, we may cancel the policy for non-payment in accordance with ss.59 and 60 of the Insurance Contracts Act 1984 (Cth), by written notice.

Multiple Claims Aggregation

All claims and inquiries arising from, based upon, or attributable to the same act, error, omission or incident, or a series of acts, errors, omissions or incidents that are similar or related, causally connected or interrelated, or that arise from the same clinical, administrative or systemic cause, are treated together as a single claim first made when the earliest of them was first made, and a single limit of liability and a single excess apply.

Assignment

You cannot assign this policy or any right under it without our prior written consent, which we will not unreasonably withhold.

Entire Agreement and Variation

This policy, the schedule and any endorsements form the entire agreement between you and us about this insurance. A variation is effective only if recorded in an endorsement issued by us. Nothing in this condition limits the operation of the Insurance Contracts Act 1984 (Cth).

Sanctions

We do not provide cover, pay any claim or provide any benefit under this policy to the extent that doing so would expose us to any sanction, prohibition or restriction under:

• the Autonomous Sanctions Act 2011 (Cth), the Charter of the United Nations Act 1945 (Cth), or regulations made under either Act; or
• the trade or economic sanctions laws of the United Kingdom, the United States of America or the European Union, to the extent they apply to us.

[WP REVIEW: confirm that naming the UK, US and EU regimes is appropriate for Australian capacity; this is a deliberate library-wide scope choice.]

Privacy

We collect personal information (including, where necessary for claims, health information) to assess applications, administer the policy and handle claims, in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. We may disclose it to reinsurers, claims professionals, lawyers and regulators as reasonably required, some of whom may be overseas. Our privacy policy, including how to access or correct information and how to complain, is available on request.

How to Make a Claim

1. Contact your broker, or contact us directly at the claims contact details shown in the schedule, as soon as reasonably practicable, and always before the policy period ends.
2. Provide written details of the claim, inquiry or circumstance: see the Tell Us About Claims and Inquiries obligation and the Tell Us About Circumstances obligation for what to include. For urgent matters (coronial notices, SIRS deadlines, regulatory demands), tell us by telephone first; the Advance Claim Protection extension lets us appoint a panel lawyer immediately.
3. We will acknowledge your notification, assign a claims manager experienced in healthcare liability, and confirm the next steps.
4. We will work with you to investigate, defend and manage the matter, and keep you informed of progress. Continue your open disclosure and legally required notifications: they do not prejudice your cover (see the Do Not Admit Liability, With Important Exceptions obligation).
5. Do not admit liability or agree to any settlement without our written consent, subject to the exceptions in the Do Not Admit Liability, With Important Exceptions obligation. We will not unreasonably withhold or delay consent.

Endorsement Library

An endorsement applies only if its code is shown in the schedule. Each endorsement changes this policy only as it states, and is read together with the variables shown for it in the schedule. No endorsement is available, and none will be issued, that provides direct cover for the civil liability of a medical practitioner in their capacity as a medical practitioner.

E01 Obstetrics Buy-back

The Obstetrics exclusion is deleted, in whole or in part, for the obstetrics services and facilities described in the schedule, subject to the sub-limit, additional excess and clinical governance conditions stated there. For a private hospital, Endorsement E15 states further conditions that apply.

Schedule variables: obstetrics services and facilities; sub-limit; additional excess; clinical governance conditions.

E02 Defence Costs in Addition

The Defence Costs provision is amended so that defence costs are payable in addition to the limit of liability, up to the separate defence costs limit shown in the schedule.

Schedule variables: defence costs limit.

E03 Cosmetic Procedures Buy-back

The Cosmetic and Aesthetic Procedures exclusion does not apply to the specific procedures listed in the schedule, subject to the practitioner-qualification, facility-accreditation and sub-limit conditions stated there.

Schedule variables: procedures; practitioner qualifications; facility accreditation; sub-limit.

E04 Clinical Trials

The Clinical Trials and Experimental Procedures exclusion does not apply to the company's liability arising from the specific trials or studies listed in the schedule, provided each has current human research ethics committee approval and the sponsor indemnity stated in the schedule is in place.

Schedule variables: trials or studies; sponsor indemnity; sub-limit (optional).

E05 Additional Extended Reporting Period

The reporting period under the Extended Reporting Period extension is extended beyond 365 days for the further period and premium stated in the schedule.

Schedule variables: further period; premium.

E06 Increased Molestation Defence Sub-limit

The sub-limit for the Molestation Defence Costs extension is increased to the amount shown in the schedule. All other terms of that extension, including that it covers defence costs only and the repayment obligation, continue to apply.

Schedule variables: molestation defence costs sub-limit.

E07 Increased Sub-limits

One or more of the sub-limits in the Sub-limits provision are increased to the amounts shown in the schedule.

Schedule variables: sub-limits and amounts.

E08 Aggregate Limit Reinstatement

The limit of liability is reinstated once, in full, for claims wholly unrelated to any claim already paid or notified, first made and notified later in the same policy period. Sub-limits are not reinstated.

Schedule variables: none.

E09 Additional Facilities

The facilities named in the schedule are added as facilities from the date shown, outside the automatic cover in the Newly Acquired Subsidiaries and Facilities extension.

Schedule variables: facilities and dates.

E10 Contractual Liability Buy-back

The Contractual Liability exclusion does not apply to liability assumed under the specific contracts listed in the schedule, to the extent stated there.

Schedule variables: contracts; extent.

E11 Excess Layer

This wording applies in excess of the underlying insurance stated in the schedule, and follows its terms only as the schedule states. Our liability attaches only after the underlying limits have been exhausted by payment of covered claims.

Schedule variables: underlying insurer, policy and limit.

E12 Prior and Pending Litigation Date

We do not cover any claim or inquiry arising from any litigation, proceeding or inquiry commenced or pending before the prior and pending litigation date shown in the schedule, or from the facts alleged in it. This endorsement is used for run-off or takeover placements.

Schedule variables: prior and pending litigation date.

E13 GP Medical Centre and Primary Care

This endorsement applies where the company operates one or more facilities shown in the schedule in the category general practice or medical centre, including general practices, GP medical centres, GP super clinics, urgent care clinics and other primary care establishments, and allied health clinics. The Medical Practitioners' Own Liability exclusion continues to apply: this policy never covers the personal civil liability of a medical practitioner.

GP credentialing. The company must establish and maintain a documented credentialing system for every medical practitioner (employed, contracted or visiting) who provides healthcare services at or for the company, which must include: verification of the practitioner's current registration under the Health Practitioner Regulation National Law, including any conditions, undertakings or notations; verification that the practitioner holds current individual medical indemnity insurance that complies with the Medical Indemnity (Prudential Supervision and Product Standards) Act 2003 (Cth) and applicable minimum cover requirements; and an annual re-verification cycle, with records retained for at least seven years. This is an obligation under the Your Obligations section.

Telehealth compliance. Where the company provides or facilitates telehealth services, those services must be provided in compliance with the Medicare Benefits Schedule telehealth requirements current at the time of the service where the service is billed to Medicare, and the applicable Ahpra or National Board telehealth guidelines for the profession of the person providing the service. This is an obligation under the Your Obligations section and supplements, and does not narrow, the Telehealth and Remote Care extension.

Pathology collection. Cover under the Civil Liability for Healthcare Operations clause and the Vicarious Liability for Employees, Practitioners and Contracted Doctors clause extends to the company's vicarious liability, and its liability for breach of a non-delegable duty of care, arising from the acts, errors and omissions of pathology collection staff operating at a facility under a contractor or licence arrangement with a pathology provider, including specimen collection, labelling and handling errors occurring at the facility. This covers the company's liability only. It does not cover the liability of the pathology provider itself; the personal liability of the collection staff (who are not insured persons unless they are employees); or any liability of the requesting or reporting medical practitioner.

Cosmetic injection clinics. The Cosmetic and Aesthetic Procedures exclusion continues to apply. A cosmetic injection or aesthetic clinic operated as a discrete business unit (identified by separate branding, separate billing, or separate premises or a clearly demarcated section of a facility) is not covered under this endorsement; it must be declared to us separately and cover, if any, arranged under Endorsement E03 or a separate policy. Cosmetic injectables provided incidentally within the general practice, as a minor proportion of the company's revenue, must be declared to us and are covered only where, and on the terms on which, the schedule or Endorsement E03 states they are covered.

After-hours and locum arrangements. Consistent with the Locum Tenens extension, cover extends to the company's vicarious liability arising from healthcare services provided at or for the company by an after-hours, deputising or locum medical practitioner, provided that at the time of the service the practitioner held current registration and current individual medical indemnity insurance, verified through the company's credentialing system. The practitioner's own liability is never covered.

System and administrative errors. For the avoidance of doubt, administrative and system error under the Civil Liability for Healthcare Operations clause includes failures of the company's recall and reminder systems, test-result follow-up systems, triage protocols and referral tracking in the primary care setting.

Schedule variables: facilities in this category.

E14 Day Surgery and Procedure Centre

This endorsement applies where the company operates one or more facilities shown in the schedule in the category day surgery or procedure centre: facilities licensed for same-day surgical or procedural care, including endoscopy centres, ophthalmic and dermatological surgery centres, and other day procedure centres. The Medical Practitioners' Own Liability exclusion continues to apply.

Additional obligations. These are added to the Your Obligations section and operate on the same basis:

• (a) Hospital transfer plan. The company must maintain, and review at least annually, a documented hospital transfer plan for the management of patient deterioration and unexpected complications at each facility, including escalation and resuscitation protocols, arrangements with a receiving hospital capable of accepting the facility's patients within a reasonable transfer time, and ambulance and transfer logistics, and provide evidence of the current plan and its last review to us on request.
• (b) Infection control and reprocessing. The company must comply with AS/NZS 4187:2014 (Reprocessing of Reusable Medical Devices in Health Service Organisations), or its successor standard as applicable to the facility. Current accreditation under the National Safety and Quality Health Service (NSQHS) Standards is accepted as evidence of compliance.
• (c) State and territory licensing. The company must hold and maintain a current licence, approval or registration to operate each facility as a day surgery or day procedure centre under the applicable health facility legislation, including the Private Health Facilities Act 2007 (NSW), the Health Services Act 1988 (Vic) and the Private Health Facilities Act 1999 (Qld), provide evidence of it on request, and tell us as soon as reasonably practicable if a licence is suspended, cancelled or made subject to material conditions.

Additional exclusions. We do not cover any claim, inquiry, loss or liability arising from:

• (a) Obstetrics services. The Obstetrics exclusion applies without the availability of Endorsement E01: obstetrics cover is not available for day surgery and procedure centres. The carve-out for emergency treatment under the Good Samaritan Acts extension continues to apply.
• (b) Overnight inpatient care. The care of a patient retained at a facility overnight, where the retention was neither required by a clinical emergency (including a deterioration managed under the hospital transfer plan pending transfer) nor pre-approved by us in writing. A facility operating as a hospital requires Endorsement E15. Cover for the same-day elements of an episode of care is not affected.

Anaesthetic services. Cover under the Civil Liability for Healthcare Operations clause and the Vicarious Liability for Employees, Practitioners and Contracted Doctors clause extends to the company's vicarious liability, and its liability for breach of a non-delegable duty of care, arising from anaesthetic services provided at a facility by a visiting anaesthetist (a visiting medical officer), including the company's own system failures in anaesthetic booking, pre-admission screening, equipment, monitoring and recovery staffing. The anaesthetist's own liability is never covered: every anaesthetist must hold their own medical indemnity insurance, verified through the company's credentialing processes.

Same-day discharge systems. Administrative and system error under the Civil Liability for Healthcare Operations clause includes failures of the company's pre-admission assessment, discharge criteria, post-discharge instruction and follow-up contact systems for same-day patients.

Schedule variables: facilities in this category.

E15 Private Hospital

This endorsement applies where the company operates one or more facilities shown in the schedule in the category private hospital: facilities licensed as private hospitals under the health facility legislation of the relevant State or Territory, including overnight surgical, medical, rehabilitation and mental health hospitals. The Medical Practitioners' Own Liability exclusion continues to apply.

VMO credentialing register. The company must maintain a current credentialing register for every visiting medical officer practising at a facility, recording for each: current registration, including any conditions, undertakings or notations; evidence of current individual medical indemnity insurance complying with the Medical Indemnity (Prudential Supervision and Product Standards) Act 2003 (Cth); the scope of clinical practice approved by the company's credentialing (or medical advisory) committee; and the date of the last annual review. This is an obligation under the Your Obligations section.

Obstetrics. Cover for obstetrics services is not available unless the schedule expressly shows obstetrics cover as operative for a named facility under Endorsement E01. Where it does, the following obligations apply: the facility must hold a current licence or approval as an obstetric unit; every obstetrician holding delivery privileges must hold current individual medical indemnity insurance, verified through the credentialing register; and the company must provide us at each renewal with the facility's annual obstetrics statistics, including delivery numbers, caesarean section rate, and any serious adverse neonatal or maternal outcomes reported to the relevant perinatal data collection. The carve-out for emergency treatment under the Good Samaritan Acts extension continues to apply.

Employed medical practitioners: cover is secondary. Where the company employs a medical practitioner directly under a contract of employment (as distinct from a VMO or contractor arrangement), cover for the company's liability arising from that practitioner's clinical acts, errors or omissions is in excess of the medical indemnity insurance policy identified in the schedule for that practitioner (the specified underlying policy). We will not pay any part of such a claim until the limit of the specified underlying policy is exhausted, and then only for the company's own liability. If the schedule does not identify an underlying policy for a practitioner, this paragraph does not apply to that practitioner and the Other Insurance provision applies. Nothing in this paragraph covers the practitioner personally. [WP REVIEW: confirm this excess-of-MDO clause operates as a true excess layer for s.45 purposes.]

NSQHS accreditation. The company must hold and maintain accreditation under the National Safety and Quality Health Service (NSQHS) Standards for each facility required to be accredited. If accreditation for any facility is conditioned, suspended, withdrawn or lapses, the company must tell us in writing within 30 days, and we may review the terms of this endorsement prospectively for the changed risk. A change to terms operates prospectively only and does not affect cover for healthcare operations already conducted.

Mental health inpatient units. Where the company operates a licensed mental health inpatient unit, cover under the Civil Liability for Healthcare Operations clause and the Vicarious Liability for Employees, Practitioners and Contracted Doctors clause extends to the company's civil liability arising from the detention, restraint, seclusion or involuntary treatment of a patient that was authorised by the mental health legislation of the relevant State or Territory, including the Mental Health Act 2007 (NSW), the Mental Health and Wellbeing Act 2022 (Vic) and the Mental Health Act 2016 (Qld). That is a limit on the cover, not an obligation. The company must also comply with that legislation and its instruments in doing so. That is an obligation under the Your Obligations section and operates on the s.54 prejudice basis. Nothing in this paragraph covers liability arising from an act intended to cause harm, and the Molestation exclusion and the Fines, Penalties and Punitive Damages exclusion continue to apply.

Intensive and critical care. Healthcare services include intensive care, high dependency and other critical care services provided within a facility's standard operations as described in the schedule. The company's liability arising from critical care staffing, equipment, escalation and transfer systems is covered as administrative and system error under the Civil Liability for Healthcare Operations clause.

Schedule variables: facilities in this category; licensed beds; the underlying medical indemnity policy for each employed medical practitioner.

E16 Aged Care and Residential Care

This endorsement applies where the company operates one or more facilities shown in the schedule in the category aged care or community health facility, including residential aged care facilities, memory care and dementia-specific units, respite facilities, and community and home care aged services. The Medical Practitioners' Own Liability exclusion continues to apply.

Aged Care Act 2024. This endorsement is drafted against the Aged Care Act 2024 (Cth), which commenced on 1 November 2025 and replaced the Aged Care Act 1997 (Cth). Conduct occurring before 1 November 2025 is assessed against the corresponding provisions of the Aged Care Act 1997 (Cth) then in force.

SIRS procedures and notification.

• (a) The company must maintain documented procedures complying with the Serious Incident Response Scheme (SIRS) under the Aged Care Act, including procedures for notifying the Aged Care Quality and Safety Commission (ACQSC) of a reportable incident within the Priority 1 and Priority 2 timeframes that apply from time to time.
• (b) Where the company makes a SIRS notification to the ACQSC and the incident notified has given rise to, or may give rise to, a claim, the company must notify us in writing of that incident within 14 days of the SIRS notification. A notification under this paragraph is treated as notification of a circumstance under the Notification of Circumstances clause.
• (c) A failure by the company to meet the ACQSC notification timelines that results in regulatory sanction does not of itself avoid cover; we may reduce our liability by the amount that fairly represents the prejudice we suffer.

Each of these is an obligation under the Your Obligations section and operates on the s.54 prejudice basis. [WP REVIEW: version 1.0.0 made the 14-day notification a condition precedent; this version makes it an obligation subject to s.54, which s.54 would in any case impose on a post-contract omission.] Nothing in this policy prevents, penalises or discourages the making of a SIRS report, and making one is never treated by us as an admission of liability.

Worker screening. Every worker of the company (employee or contractor) who has face-to-face contact with aged care residents must hold a current NDIS Worker Screening Clearance, an equivalent State or Territory clearance where applicable, or otherwise satisfy the aged care worker screening requirements under the Aged Care Act from time to time. The company must keep records of clearances and produce them on request. This is an obligation under the Your Obligations section.

Restrictive practices. Cover under the Civil Liability for Healthcare Operations clause and the Vicarious Liability for Employees, Practitioners and Contracted Doctors clause extends to the company's civil liability arising from the use of a restrictive practice on a resident. This paragraph does not cover a restrictive practice that the Aged Care Act, or its regulations or rules, prohibit. That is a limit on the cover, not an obligation. At the time of use, the practice must also have been approved under the company's documented behaviour support framework, including a behaviour support plan for the resident where required, and the consent requirements under the Aged Care Act and the guardianship, medical treatment decision or equivalent legislation of the relevant State or Territory must have been met. Those are obligations under the Your Obligations section and operate on the s.54 prejudice basis. The Molestation exclusion continues to apply.

Communicable disease outbreaks. Cover under the Civil Liability for Healthcare Operations clause extends to the company's civil liability arising from the transmission of COVID-19 or another communicable disease within a facility. During the relevant outbreak period the company must comply with the public health orders, directions and official guidance applicable to the facility, and maintain documented infection prevention and control procedures, including outbreak management plans, consistent with the Aged Care Act and ACQSC guidance. Those are obligations under the Your Obligations section and operate on the s.54 prejudice basis. Where the company was in material breach of an applicable public health requirement during the period in which the transmission occurred, we may exclude the resulting claim to the extent the breach caused or contributed to the transmission.

ACQSC inquiry costs. The cover under the Inquiry and Regulatory Defence Costs clause and the SIRS and Commission Proceedings extension applies to ACQSC-initiated investigations and SIRS-related proceedings concerning the company's aged care services, including any show-cause process, sanctions or enforceable-undertaking proceeding, compliance notice response, and any proceeding relating to a banning order against the company or a person acting for it. Fines and civil penalties are addressed only by the Statutory Liability extension; compensation orders are addressed by the Aged Care Act Statutory Compensation extension.

Dementia and cognitive impairment care. Healthcare services include dementia care, memory support and the care of residents with cognitive impairment as part of the company's standard residential aged care operations, including secure memory support units, subject to the restrictive practices terms above.

Schedule variables: facilities in this category; operational beds.

Licence and Trademark Notice

This wording's text is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). The licence applies to the wording text only. It does not extend to, and no licence is granted in, the "Meridian" name, the Cuttleflow Systems name, logo, bearing mark, or any other trademark, trade dress, or brand asset, all of which remain the property of their respective owners and may not be used without separate permission.

An adopting agency's own schedule, endorsements, and other materials prepared for use with this wording are not required to be released under CC BY 4.0 merely because they are used together with this wording; CC BY 4.0 requires only that you attribute the wording text you use.

This wording is provided for general use and adaptation. Adopting agencies and their advisers are responsible for obtaining their own legal, regulatory, and reinsurance advice before use, and use of this wording requires the approval of the relevant capacity provider. Any Wording Partner review and sign-off letter issued in respect of this wording runs to Cuttleflow Pty Ltd t/a Cuttleflow Systems only and does not constitute legal advice to any adopting agency or insured.

Designed for the Australian market. Assumes application of the Insurance Contracts Act 1984 (Cth). Users are responsible for their own legal review, regulatory compliance, and reinsurance alignment.