Claims incident notification

The earlier we know of a potential issue, the better placed we are to offer timely, professional advice.

To notify MIPS of an incident:

  • enter the details in the form below and one of our expert medico-legal advisers will contact you
  • or print out the claims incident notification form and fax or mail it to MIPS.

If you have any questions, please contact our clinico-legal advisers on 1800 021 223, or

Privacy: The information requested in this form is required by MIPS for its business operations. By completing this form you consent to the collection, use, storage and disclosure of any personal information as outlined in our Privacy Statement. These policies are consistent with the requirements of the Privacy Act and Australian Privacy Principles.

PART A:  your details

PART B: Patient details

Is a solicitor acting?

Attach any relevant documents

Attachments must be under 10Mb to be received.

Public or private patient
Is the patient deceased?*required
If deceased, is an inquest likely?

PART C: Incident details

PART D: Incident circumstances

Mandatory field(s) marked with *