Medico-legal notification
If you believe a medico-legal issue will or might lead to a claim on your indemnity policy, you must notify us as soon as possible.
Depending on your notification, you may need to provide the following information. It’s easier to have this ready before starting.
- Member ID
- Correspondence you’ve received (format: doc, .docx, .pdf, .png, .jpg, .xls, .xlsx)
- Patient name and DOB
- Key dates relevant to the issue
Disclaimer: Please be aware that Avant Insurance Limited ABN 82 003 707 471 may be compelled to produce this document and any attachments as required by law in the course of any legal action or proceedings. Avant may be required to provide this form to investigators, complainants or other authorities.
Avant Mutual Group Limited and its related entities collect your personal information included in this form for the purpose of providing our services, conducting our business, communicating with you and complying with the law. If you don’t provide this information this may affect our ability to provide the requested information and our services to you. We may disclose your personal information to contracted service providers as reasonably necessary to assist us in core functions and help us deliver services to you. For more information on our related entities, how we collect, use and disclose this information, how to access or correct your personal information held by us or to make a complaint, please read our Privacy Policy or contact our Privacy Officer at privacy@avant.org.au. By [providing your details/clicking ‘submit’], you consent to your information being collected, used and disclosed as outlined above.
Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765