Healthcare Providers - Adviceline Injury Lawyers
Transport & Vehicle Injuries – The TAC System
Is my patient entitled to have their treatment costs covered?
Yes, if he or she has been injured in a motor vehicle accident or on public transport in Victoria. Claims need to be made to the Transport Accident Commission (TAC).
TAC is a no-fault system, covering people who are injured in transport accidents regardless of how it occurs. Injuries can be both physical and psychological.
If your patient is unsure of their rights, they can get free, obligation-free advice by calling our lawyers directly. TAC processes can take time, so the earlier they find out their rights, the better.
What benefits can the TAC provide?
- Payment of ‘reasonable’ medical and like expenses
- Weekly payments of income compensation
- A once-off ‘impairment benefit’ lump sum if the injury is considered permanent
- If your client has a serious injury, they may be able to bring a claim for lost earnings, and pain and suffering damages.
What medical expenses will the TAC pay for?
The TAC will pay for the “reasonable medical and like expenses” needed as a result of a transport accident. This can include hospital care, GP visits, surgery and medication, as well as a range of approved services including dentistry, massage, hydrotherapy, physiotherapy and even gym memberships.
In addition, upon request from a medical practitioner, personal and household services can be provided by the TAC, including household help, orthopaedic aids, home modifications and even gardening services.
If your patient reasonably requires treatment or care that the TAC has declined to pay for, we may be able to assist in disputing this decision either internally through the TAC’s dispute resolution process or at VCAT.
How can my patient access TAC compensation?
The injured person needs to contact the TAC by telephone where they will complete a claim form over the telephone and be assigned a claim number. The Claim form will then be sent out to them in the post to be signed before an authorised witness such as a member of the police, a pharmacist or a lawyer.
All transport accident claims must be reported to the police. Advise your patient to report the accident to the police if they have not already done so.
He or she needs to submit the claim form to the TAC, along with:
- An initial Medical Certificate completed by his/her treating doctor, usually the GP. These Medical Certificates can be obtained from the TAC by calling them on 1300 654 329. Otherwise they can be downloaded from the TAC website (http://www.tac.vic.gov.au/upload/MCF1.doc) – Initial Medical Certificate or http://www.tac.vic.gov.au/upload/MCF2.doc - Subsequent Medical Certificate.
Where it is not possible for a medical provider to use the TAC Medical Certificate, a provider can submit a medical certificate to the TAC which will be accepted provided it contains the following details:
- The patient’s name, other personal details and the claim number.
- The patient’s transport accident related injuries.
- Periods the patient is considered unfit to work, and any restrictions or conditions on employment, including to and from dates (only applicable if the patient is claiming loss of income benefits from the TAC).
- Assistance the patient requires such as home help or taxi transport. This should specify:
- The number of days per week,
- The hours per day, and
- The to and from dates
- the assistance is required.
How should I fill out the Medical Certificate?
A Medical Certificate in TAC matters is relevant to the patients capacity to work and therefore to claim benefits for loss or earnings. It is generally valid for 1 month, unless the patient needs review more often. The TAC generally will not accept backdated Medical Certificates unless you can provide a reasonable explanation to them.
A section of the TAC Medical Certificates refers to capacity for work. Your patient may have an entitlement to some Loss of Earning benefits even if they have a partial capacity for work. It is important therefore to specify precisely what the patient’s capacity for work is. If you believe that the patient is fit for modified duties and can work reduced hours or can work but with restrictions such as no heavy lifting, then it is important to specify what those restrictions are.
Patients have an entitlement to Loss of Earnings or Loss of Earning Capacity benefits for a period of three years following the transport accident where they are unable to earn the same amount through their personal exertion as they were prior to the accident. However, if they are deemed to have suffered a permanent impairment (see section on Impairment) of 50 % or above they will be entitled to make a claim for lost earnings until the age of 65.
What is permanent impairment?
Permanent impairment benefits are paid by the TAC to patients who meet certain criteria regarding their injuries under the ‘no-fault’ side of the TAC scheme. Permanent impairment benefits are akin to financial compensation to patients injured in transport accidents regardless of who was responsible for the transport accident.
You may be asked for a report and/or your patient’s medical records from the TAC and/or your patient’s solicitors to assist in determining your patient’s injuries.
The TAC and/or your patient’s solicitors will send your patient to be assessed by independent medical practitioners who have the appropriate qualifications to conduct ‘impairment assessments’. An impairment assessment can only be made once your patient’s injuries have been found to have substantially stabilised. The TAC can determine interim impairment and make a payment when the injuries are substantially stable. They can then make a final determination at a later stage.
The level of permanent impairment is assessed in accordance with ‘The Guides to the Evaluation of Permanent Impairment’ produced by the American Medical Association. The Guides deal with all the different parts of the body and work out precise impairment levels based on factors such as loss of range of movement and sensory loss. Psychiatric impairment is only determined on the primary effects of the transport accident on the patient such as nightmares and flashbacks. Eventually, once all of the various body parts affected have been assessed they are combined to give a ‘whole person impairment’ using a formula contained in the Guides.
In order to qualify for a payment from the TAC a patient must have a whole person impairment greater than 10%. The Guides provide for conservative ratings. For example, if your patient has their leg amputated below the knee, it would only amount to a whole person impairment of 28%. The formula for financial payments is also conservative, with an impairment level of 11% attracting a benefit of $5,270 and an impairment level of 20% attracting a benefit of $17,570.
Adviceline Injury Lawyers have a wealth of experience in helping our clients to maximise their entitlements through the Permanent Impairment Process.
How do I write a report for the TAC? And how do I charge my fee?
From time to time, the TAC will request medical reports from patient’s treating practitioners.
The legal criteria for compensation are complex, and what you say in your report may be applied in ways that you do not necessarily intend. For example, if your treatment goal is to get your patient back to work, but the likely outcome is that they will not be able to return, be careful to make that distinction.
Take the time to read the letter of instruction from the TAC carefully. Should you have any questions in relation to the letter of instruction, bring them to the attention of the TAC.
Your tax invoice can generally be sent to the TAC once you have prepared the report for pre-payment.
See our checklist How do I write a report for solicitors? And how do I charge my fee?
To investigate our clients’ potential entitlements, Adviceline Injury Lawyers often write to doctors and health care providers directly to request reports.
We will usually ask specific questions in our letter – and it is important for your patient’s claim that you address each separate question. If you have any queries at all in relation to a report request that you have received, we invite you to contact our office directly.
We are happy to pre-pay for the report if a tax invoice is provided to our office. We understand that medical practitioners are busy, and greatly appreciate the time and effort that you spend in preparing these reports.
Why does my patient have to see ‘Independent Medical Examiners’?
The TAC and your patient’s solicitors will periodically have your patient examined by independent specialists (Independent Medical Examiners – IMEs) to assess the seriousness of their injuries, whether they can return to work, and what treatment is reasonable.
An IME may have an opinion which is different from yours. While the IME may be a specialist in their field, as a treating doctor or medical practitioner, you may have better knowledge or understanding of your patient. If you disagree with the report of an IME, it is helpful to clearly state your opinion and reasoning in your own medical reports.
Although these appointments can be very stressful, it is important that your patient attends appointments with IMEs, because the TAC can cut off his/her compensation payments if he or she does not cooperate.
Problems with TAC benefits – what can I do to help my patient?
Dealing
with the legal system can be frustrating. If your patient disagrees with a TAC
decision, they can request to have that decision reviewed within a period of 12
months of the decision through a review process agreed between the TAC and
Victorian lawyers. If that process is
unsuccessful in resolving the dispute then the patient has the option of taking
the matter to VCAT.
Should your patient experience difficulties with the TAC and assessing their
entitlements under the TAC scheme, you should encourage them to seek legal
advice so that the particular decision can be challenged.
Do I have to provide my patient records?
What should I expect if I am asked to give evidence in court?
What does AdviceLine Injury Lawyers do for my patient?
We assist people who have been injured in a transport accident with:
- Having their injury recognised by TAC as work-related
- Claiming medical and like expenses
- Claiming weekly payments while they cannot perform their pre-injury duties
- If the injuries your patient suffers from the transport accident were the result of criminal actions of others such as where your patient’s transport accident was caused by somebody else’s drink driving then we can assist them in claiming compensation from the Victim’s of Crime Assistance Tribunal.
- Claiming lump sum compensation in the form of a claim for Permanent Impairment benefits through the TAC no-fault scheme. Where your patient has suffered a serious injury through the actions of another, we can assist them to claim compensation through the common law of negligence.
- Advise them on superannuation and pension implications if they suffer a total and permanent disability
- Our work involves running court proceedings, obtaining and assessing medical and other evidence, instructing barristers, negotiating settlements, and fully advising our clients so that they can make informed decisions about their injury claim.
- We act No Win, No Fee in most cases and abide by strict regulation on legal services fees in Victoria.
- We are specialised personal injury lawyers, and many of our Partners are Law Institute Accredited Personal Injury Specialists.
