TAC dispute applications

If that TAC makes a decision that you do not agree with primarily in relation to your no fault benefits, you can lodge what’s called a TAC dispute Application (provided you have engaged a lawyer to assist you).

If you’re not sure what you’re no fault benefits are, it’s the payment of medical and like expenses, income payments, and an impairment benefit lump sum.

They are called no fault benefits because, as the name suggests, you do not need to show that another party was at fault in order to claim these benefits.

So what exactly is a TAC dispute application?

A dispute application is a form that outlines the decision that you disagree with and the reasons why you disagree with the decision.

It also includes your contact information and TAC claim number.

A dispute application form initiates the organising of a dispute conference.

And on the bottom of the form, there are sections where you are to list when you want the conference to be conducted. There are different sections for you to enter alternative dates.

This dispute application form can be lodged online using the TAC’s online claim lodgement form or alternatively a paper copy can be completed and sent to the TAC.

Who completes a dispute application?

Your lawyer is responsible for completing the dispute application and submitting it to the TAC.

For this reason, if there is a decision The TAC has made that you disagree with and want to contest by way of a dispute application, you should obtain legal representation.

What happens once the dispute application has been lodged?

The TAC and their representative will get in touch with your lawyer and acknowledge receipt of the dispute application.

They will then work with your lawyer to organise a date for a conference to be held.

In most cases, the conference will be held via video link.

Your lawyer should speak to you in the days or weeks leading up to the conference and let you know whether they would like you to attend their office during the conference or whether you just need to be available by phone.

What happens at the dispute resolution conference?

The decision will be discussed and your lawyer will put forward reasons as to why the decision should be altered.

In most cases you will not be required to be on video and you will not be required to talk to the TAC (or their representatives).

The TAC will put forward their position.

There might be some backwards and forwards discussions which may involve offers and counter offers being made.

Your lawyer should seek your instructions to put offers and reject offers on your behalf.

Sometimes matters will resolve during the conference as an agreement will be reached between the parties.

Sometimes, an agreement will not be reached however discussions can continue in the days, weeks and sometimes months after a conference and matters can resolve by way of these further discussions.

If the matter does not resolve and your lawyer believes there is merit in proceeding further and you’re happy to do so, then the next step you can take is to pursue the matter to VCAT.

What happens if the matter resolves at conference?

The original decision will then be altered and you will receive correspondence from the TAC confirming this.

It is important to note that if you succeed with your application, that is, the TAC agrees to change their original decision, then the TAC will pay some costs to your lawyer.

Depending upon the nature of the dispute and the amount of work involved required by your lawyer, you may not receive a further bill from your lawyer for work done.

In some instances however you may and for this reason you should discuss this with your lawyer before commencing the dispute application.

If the issue in dispute related to the payment of income benefits, for example, that your payments were terminated or that you believed you were entitled to a greater amount, then you are entitled to be back paid any monies owed to you by way of a lump sum.

What types of decisions commonly go to dispute applications and conferences?

Here are some of the typical issues that may proceed to dispute conferences:

• Calculation of income support payment amounts
• Termination of income benefits
• Non-payment of medication or a particular type of medication
• Termination of entitlement to a particular type of medical treatment or all medical and like expenses
• Impairment benefit Issues such as rejection of liability for an injury or a dispute regarding the appropriate whole person impairment rating.

A dispute application or informal review?

If the TAC makes a decision that you disagree with and if you want to contest that decision you can either pursue a dispute application (which you need a lawyer for) or ask the TAC to perform an informal review (which you do not need a lawyer for and you can do yourself).

The benefit of a dispute application is that you will have a lawyer assisting you, which will help ensure you get the best result possible in relation to the dispute.

However, there is nothing stopping you from pursuing an internal review first and then if the matter doesn’t resolve favourably, you can pursue a dispute application.

Conclusion

If the TAC makes a decision that you disagree with in relation to one of your no fault entitlements, then one avenue to contest that decision is to pursue a dispute application.

This is something that you need to do with the assistance of a lawyer.

A dispute application initiates a dispute resolution conference which generally occurs over video conference with your lawyer and representatives from the TAC or their representatives.

If the matter doesn’t resolve following the conference further discussions can take place between the parties which can result in the matter resolving.

If not, if you still wish to pursue the matter and if there is merit in doing so according to your lawyer, you can proceed to VCAT.

Does TAC pay super?

Once you have an accepted TAC claim, if your ability to work has been impacted you will likely be entitled to the payment of income benefits.

Income benefits are payable for a total of three years post accident.

In some cases, income benefits can be paid beyond the three year mark, but in very limited cases.

For the first 18 months a person will be paid what’s called loss of earnings benefits.

Thereafter, from 18 months to 3 years, they will be entitled to claim loss of earning capacity benefits.

When the TAC calculates a persons loss of earnings payment rate, the TAC will not include the employers compulsory superannuation contribution.

They will only consider a persons gross earnings prior to a persons salary being structured into a mix of salary and non salary benefits.

Likewise, when it comes to loss of earning capacity benefits, periodic superannuation payments are not taken into account by the TAC.

So in short, the TAC will not pay superannuation payments to you following an accident if you are not able to work.

What if I can partially work following an accident?

If you are partially able to work following an accident, then your employer will be required to make superannuation contributions based on your earnings from employment.

The period of time that you are not able to work that you would have worked pre-injury, is not able to be covered by the TAC.

There are also no other mechanisms that will allow you to make up for lost superannuation payments in this instance, unfortunately.

Common law claim

You can read about common law claims here.

The person succeeded in a common law claim, one thing they may be entitled to claim is lost earnings.

That is, any loss of income from the date of accident to the date of settlement and ongoing into the future.

What their loss of earnings is likely to be will depend upon medical material that addresses what their work capacity is likely to be moving forward.

It is possible to factor in to those calculations superannuation payments that a person may have obtained but for the accident.

So for example, if a person is no longer able to work following an accident, any superannuation payments that they might have received into the future had they continued to work can be taken into account as part of a loss of earnings claim under a common law claim.

You can still make your own contributions

Notwithstanding the fact that you will not be getting paid super by the TAC if you can’t work, you can still make your own contributions to your superannuation fund.

If no super contributions will be made for an extended period of time

Also, if it’s likely that there aren’t going to be any contributions made to your super for an extended period of time, it’s a good idea to review your super and any insurance arrangements connected to your superannuation account to ensure they don’t lapse due to non contribution.

The super fund should contact you in this regard if there is a chance your insurance connected to your superannuation account may cease.

Conclusion

TAC will not pay superannuation contributions after an accident if your ability to work has been impacted.

However, if you pursue a common law claim you may be able to factor in any lost superannuation related to the accident as part of a loss of earnings claim.

Can you claim for trauma from a car accident?

If you’ve been involved in a car accident that entitles you to TAC assistance, you might be wondering whether you can claim for trauma from that accident.

This page will explore this issue further.

What is trauma?

Trauma can be defined as severe and lasting emotional shock and pain caused by an extremely upsetting experience. Also, physical injury, usually caused by an accident.

For the purposes of an initial TAC claim, the answer in general is that yes you can claim for trauma.

The injury or condition itself that was sustained in the accident is not a relevant consideration when it comes to having a TAC claim accepted.

You just need to have an injury or condition.

The act that covers TAC claims, the Transport Accident Act, defines an injury as either a physical or mental injury, which includes nervous shock suffered by person who is directly involved in an accident.

In addition to this, it also involves a person who might have witnessed an accident or the aftermath of an accident.

Whether a person suffered a physical injury in an accident, or a mental injury or a combination of both, it does not matter for the purposes of lodging and having a TAC claim accepted.

The other thing worth mentioning in relation to the acceptance of an initial TAC claim and claiming for trauma is that a person does not need to show that another party was at fault for the accident to have a TAC claim accepted.

Trauma and medial and like expenses

Once a TAC claim has been accepted, one entitlement that a person can access is the payment of medical and like expenses.

If they have suffered trauma in the form of a physical injury, then they are able to obtain payment for medical expenses to treat that physical injury (or injuries).

Whether that means GP attendances, physiotherapist treatment, orthopaedic surgeon attendances or surgery, chiropractic treatment, or a range of other treatments.

Also, if you’ve suffered a mental type injury the TAC will cover such things as psychologist or psychiatrist treatment, counselling expenses, medication etc.

To read about the payment of medical and like expenses you can do so in detail here.

Trauma and income payments

Another entitlement once you have an accepted TAC claim is the payment of income payments.

If your ability to work has been impacted, whether you can’t work at all or whether you can only work in a restricted capacity, you may be entitled to claim income payments from the TAC.

If you’ve suffered trauma in an accident, again whether that be physical, mental or a combination of the two, you are entitled potentially to the payment of income payments.

You’ll just to obtain certificates of capacity certifying you as either having no work capacity for employment, or a capacity for modified/suitable duties.

There just needs to be an impact on your ability to work.

To read about income payments we can do so here.

Trauma and an impairment lump sum

A further entitlement once you have an accepted TAC claim is an impairment benefit lump sum which you you read about here.

This is a lump sum where a person can be compensated for permanent impairment following an accident.

All of the injuries and conditions that you suffered in the accident should be assessed by appropriate doctors who put percentage figures on each of the injuries or conditions and the percentage figures then get combined into one overall whole person impairment rating figure called your whole person impairment rating.

In relation to trauma in an accident, under an impairment you can take into account both physical trauma and psychological trauma.

That is, any physical injuries that you suffered in the accident and any psychological injuries or conditions that you suffered in the accident.

One thing to note in relation to psychological injuries is the distinction between primary psychiatric injury and secondary psychiatric injury.

With an impairment claim, primary psychological injury can be taken into account but secondary psychological injury cannot.

An example of primary psychological injury would be if you were involved in the car accident and as a consequence you suffered post traumatic stress disorder as a consequence of the accident.

An example of secondary psychological injury would be if you suffered a physical injury in the car accident, and that as a consequence and secondary to that physical injury, you developed depression.

Trauma and common law claims

The final entitlement under a under the TAC scheme is a common law claim.

You can read about common law claims here.

You are entitled to be compensated for trauma by way of a common law claim.

Again, you can be compensated for physical trauma and you can be compensated for psychological trauma.

Conclusion

If you’ve suffered trauma from a car accident, you are able to claim compensation via a number of TAC entitlements.

This is the case whether the trauma that you suffered in the accident is physical, mental, or a combination of the two.

TAC informal review process

Once you have a TAC claim accepted, you might find the TAC make a decision in relation to your claim that you disagree with.

If so, there are a few options open to you to contest the decision.

You can ask the TAC to perform an internal review, if you have legal representation then you can lodge a dispute application and pursue a dispute conference, or you can pursue the matter to VCAT.

This page will look specifically at the informal review option.

What is informal review?

Basically, a TAC informal review involves a decision of the TAC being reviewed by a TAC employee.

The TAC employee is required to be someone who works independently of the area where the original decision was made.

What decisions can I asked to be informally reviewed by the TAC?

Most decisions that the TAC make in relation to your no fault entitlements can be reviewed by way of informal review:

Some common decisions you might seek to have reviewed are;

• Rejection of your TAC claim
• Rejection of payment for a medical related expense, such as a particular type of medical treatment or medication.
• Non-payment of income benefits.
• Incorrect calculation of income benefits.

What is the informal review process?

To initiate an informal review, you need to complete the informal review form which you can find on the TAC website.

The form will ask you for your name, address, claim number, date of birth, date of accident and phone number.

Another person is able to complete this form on your behalf and there is a section on the form where they need to provide their details and list their relationship to you.

On page two of the form you need to list the decision or decisions that you want the TAC to informally review.

You will need to outline the reasons as to why you would like the decision reviewed and explain why you believe the TAC’s decision is incorrect.

Once you have completed the form you need to either post it back to the TAC or email it back to them.

Alternatively, the TAC has an online form that you can use to lodge an informal review.

Once you have lodged the informal review application, then someone from the TAC should contact you to discuss your application within a few days.

They will then review the decision.

They are able to take into account any new information that you provide so if there is any further information that the TAC didn’t have when they made their original decision that you think they would benefit from, then you should provide this to the TAC.

An informal review can take weeks or months, depending upon the matter that the TAC is reviewing.

They do say that they aim to complete all inform reviews within 60 days. However, whether this occurs or not can depend upon the issue in dispute.

Once the review has been completed then you’ll be contacted by the TAC and informed of the decision.

The decision will either be to maintain, overturn or alter the original decision.

Is there a cost for internal review?

There is no cost for an informal review.

If you have a lawyer assist you, then that lawyer may bill you for work done in relation to the informal review however.

Is an informal review the correct option?

As mentioned above, you’re able to also pursue a dispute application if you have legal representation.

Generally speaking, we recommend that people pursue a dispute application first as opposed to an informal review in most cases.

This is because when you have a lawyer representing you in relation to a TAC matter, they will will understand the TAC system and how things work.

Generally speaking, you are more likely to get a better result with a lawyer then handling things yourself.

Also, if you pursue a dispute application and you succeed, then the TAC will pay protocol costs to your lawyer and because of this it is quite possible that you will not receive a bill from your lawyer for work done.

So you will essentially get, in many cases, a better result in a comparative amount of time to an informal review, at no cost.

Although, if you do have a lawyer you should discuss costs with them before pursuing a dispute application so you are clear as to what costs may need to be paid if you succeed and what costs might be payable if you don’t succeed.

What if the TAC don’t change their decision following informal review?

Then you can either speak to a lawyer and ask them to consider lodging a dispute application and pursue the matter to a dispute conference.

Or alternatively, you can pursue the matter to VCAT either with or without legal representation.

Conclusion

A TAC informal review is one option open to people that may wish to dispute a decision made by the TAC.

An informal review involves a TAC employee reviewing the original decision and either maintaining the original decision, or altering it.

Decisions in relation to informal reviews should be made within 60 days however in some instances it can take longer than this depending upon the nature of the dispute.