Over the last few years, COVID-19 has impacted our lives in ways we could have never expected. Vaccination against the virus, including regular booster shots, is one of the most effective ways to reduce the severity of the illness.
Most of us will undergo our vaccination and only experience minor side effects. But what happens if you suffer a moderate to a significant reaction that requires treatment?
What is the COVID-19 vaccine claims scheme?
The Australian Government has developed a claims scheme that can be accessed by people who have suffered a moderate to significant impact following an adverse reaction to vaccination for COVID-19.
The scheme currently only covers claims from the three vaccines that are approved for use in Australia by the Therapeutic Goods Administration (“TGA”):
- Vaxzevria (AstraZeneca);
- Comirnaty (Pfizer); and
- Spikevax (Moderna).
The vaccines covered by the scheme may change in the future.
One of the fantastic things about the scheme is that you can make a claim online seeking reimbursement for expenses or compensation for your injury without the need to involve a lawyer or commence formal legal proceedings.
What conditions can you claim for under the scheme?
To make a claim under the scheme, one of the first things you will need to do is receive treatment from a medical practitioner for the adverse reaction.
You will need to have a treating doctor diagnose your symptoms as one of the clinical conditions included in the approved product information for the specific vaccine you received.
They will be required to fill out a “COVID-10 vaccine claims scheme medical report”, which can be downloaded here.
The scheme covers the following adverse effects:
- Anaphylactic reaction;
- Capillary leak syndrome;
- Demyelinating disorders (including Guillain Barre Syndrome);
- Thrombosis with thrombocytopaenia syndrome; or
Only specified injuries related to the administration of a COVID-19 vaccine that have been clinically diagnosed, are covered under the scheme. So, if you aren’t sure about your reaction, the best thing you can do is speak to your treating doctor about it.
What conditions can’t you claim for under the scheme?
The scheme won’t cover you if you develop any of the following adverse effects after receiving a TGA approved COVID-19 vaccination:
- Abdominal Pain;
- Anxiety-related reactions such as hyperventilation or fainting;
- Decreased appetite;
- Influenza-like illness;
- Injection site reactions;
- Muscle or joint pain;
- Pain in extremity;
- Phycological or psychiatric conditions;
- Secondary injuries;
- Urticaria or rash; or
What sorts of things can you claim for?
If you meet the eligibility requirements under the scheme, you can claim for costs associated with the following:
- Deceased COVID-19 vaccine recipient payments and funeral costs;
- Gratuitous attendant care;
- Out of pocket expenses;
- Paid attendant care services;
- Pain and suffering costs;
- Loss of capacity to provide domestic services; and
- Lost earnings.
What compensation is payable?
The scheme has three tiers of compensation. Tiers 1 and 2 are if you have suffered injury yourself and tier 3 is for claims by an estate of someone who has died as a result of receiving a COVID-19 vaccine.
There is a “no-fault” claim which covers past and future losses and a further “pain and suffering” option related to the duration and severity of your condition.
The scheme covers losses of $1,000 and above (see list above of losses included), associated with injuries that are caused by an adverse effect from a TGA approved COVID-19 vaccination.
Tier 1 compensation claims are for losses between $1,000 and $16,000 if pain and suffering is also claimed, or for losses between $1,000 and $20,000 if pain and suffering is not claimed.
Tier 2 compensation claims are for losses of $16,000 or more if pain and suffering is also claimed, or for losses of $20,000 or more if pain and suffering is not claimed.
Tier 3 claims can result in a potential maximum compensation payment of $644,640 (to the estate of the deceased) plus additional sums if the deceased had more than one dependant at the time of death as a result of a COVID-19 vaccine.
The amounts listed above may change in the future and are only based on what is currently outlined in the COVID-19 Vaccine Claims Scheme Policy dated 21 December 2021.
If you are claiming $1,000 and $20,000, you will need to have been hospitalised for at least one night. You will need to provide the following evidence:
- Medical documentation that sets out your injury and confirms that it is likely due to a COVID-19 vaccination;
- Hospital documentation that you have been admitted because of a vaccine-related injury (this requirement can be waived if you were rural or remote without hospital access or you received outpatient treatment);
- Medical costs; and
- Lost wages.
What if the reaction you have suffered is not on the list of accepted conditions?
If the reaction you have suffered is not on the list of accepted conditions, there may be other options, outside the vaccine claims scheme, for you to seek compensation.
If you’ve suffered a reaction and are ineligible for compensation through this scheme, the best thing to do is to speak to a lawyer who has experience in medical negligence about your situation. They will be able to advise you on whether you would likely be successful in a claim outside of the scheme.
How do you claim?
Once you have all of your supporting documentation together, you can lodge a claim online at COVID-19 Vaccine Claims Scheme – Services Australia.
Services Australia will then review your claim and notify you of the outcome.
If you have any queries about your eligibility or your claim, you should email Services Australia here: [email protected]
Or alternate options for contacting them can be found at www.servicesaustralia.gov.au/contact-us