Hi there. Mistaken payments made via electronic transfers are regulated by the ePayments Code – a set of national guidelines that virtually all banks are required to follow. Under the Code, your health insurer’s bank (i.e. the bank that holds the account from which the money was originally paid) may be required to retrieve the mistakenly paid money. The bank’s responsibilities under the Code will depend on how quickly the mistake was reported to them.

If the mistaken payment was reported within 10 business days, the funds must be returned to the original account. If the mistake was reported between 10 business days and 7 months, the unintended recipient’s bank must freeze the funds. The recipient then has 10 business days to show they are entitled to the funds. If they cannot prove this, the funds will be returned. If the mistake was reported after 7 months, the funds can only be returned if the unintended recipient agrees to return the money.

The above rules only apply if the recipient has enough money in their account to repay the funds. If they do not have enough money, the recipient’s bank must make a reasonable attempt to get the money back. For example, the bank may negotiate a repayment plan with the account holder.

You will need to speak to your health insurer who, in turn, will need to contact their bank about the mistaken payment. The bank should then follow the above rules, depending on how quickly the mistake was reported. You may need to speak to your health insurer’s disputes or legal department, as their general customer service team may not be aware of the ePayments Code.

If you are dissatisfied with your health insurer’s response, you can lodge a formal complaint with the Financial Ombudsman Service (www.fos.org.au) or the Private Health Insurance Ombudsman, which is part of a larger organisation known as the Commonwealth Ombudsman (www.ombudsman.gov.au). Both of these organisations independently investigate complaints relevant to specific industries and, where appropriate, recommend a resolution to a dispute.

Suggested way forward

Start by speaking to your health insurer about their bank’s responsibilities under the ePayments Code. Then consider lodging a formal complaint with an ombudsman service. You may also want to speak to a lawyer who can advise you of your legal rights and the best course of action. By pressing the “Consult a Lawyer” button, LawAdvisor can help you search for experienced lawyers and obtain fee proposals for their services. Costs for legal advice and representation will vary between providers based on experience and the scope of services.