All about TAC medical expenses

After a motor vehicle accident, if you have an accepted claim the TAC is liable to pay the reasonable costs of any medical expenses incurred that relate to the treatment of any injuries that you suffered in a transport accident.

In the first 90 days after the accident

The TAC is responsible for paying medical treatment services in the first 90 days after the accident without the need to obtain approval from the TAC.

The treatments and services must be recommended by your doctor or other health practitioner and must be related to the treatment of any injuries that you sustained in the accident.

These treatment and services are;

• Physiotherapy
• Occupational therapy
• Chiropractic treatment
• Osteopathy
• Podiatry
• Exercise physiology
• Ambulance services
• Medication prescribed or recommended by your doctor and bought from a pharmacy
• Hospital treatment at either a public private or rehabilitation hospital
• Scans which includes MRI, CT and ultrasound scans to diagnose your injury
• Doctors appointments to see your GP and other practitioners
• Rehabilitation services at home or in hospital
• Travel and accommodation
• Basic equipment and medical aid
• Mental health and well-being services
• Community nursing

Where you will need to ask the TAC for approval to pay for a treatment or medical service

If is more than 90 days since your accident and the TAC haven’t already approved treatment or services, or it has been six months or more since you’ve had any treatment or service paid for by the TAC.

Other treatment and services will need approval regardless as to whether they are claimed within 90 days post accident or not.

These are;

• Modifications to a vehicle
• Applications to your home to help improve your independence. An example of this would be a handrail in a bathroom.
• Surgery that occurs three more months after the accident
• Gym or swim program which will enable you to do exercise based rehabilitation on your own in a pool or in a gym
• Pain management program
• Massage therapy
• Assisted living accommodation if it is hard for you to live independently because of your injury
• Taxi travel/ridesharing transport
• Home help such as cleaning and gardening services
• Specialised equipment and medical related aids such as wheelchairs, adjustable beds and adjustable lounge chairs.

The medical excess

The TAC in some cases will ask that you meet a medical excess before they pay for any medical expenses.

This means that you will need to pay for your medical expenses until they amount to a total dollar amount.

Currently, this dollar amount is $651 if your accident occurred on or after 1 July 2017.

If your accident occurred before this date then you will be required to pay a medical excess, but it will be slightly less than this amount.

If the medical excess applies to you, you should ensure to keep receipts and invoices for all medical treatment that you have obtained and you should forward them to the TAC.

You should keep a record as to how much you have spent by way of medical treatment.

You do not have to worry about the medical excess if the date of your accident was after the date referred to above.

If your accident occurred on or after this date, the TAC is responsible for paying all of your medical treatment from the date of accident.

If a person dies as a result of injuries suffered in a transport accident, then the TAC is liable for all of the reasonable costs of medical services that were received by that person because of their injuries.

Also, if more than one person is injured and they’re from the same immediate family, the TAC will treat any claim by a member of that family as one claim.

Therefore, only one medical excess is payable in such circumstances and is able to be reached through the combined value of medical services received by a number of family members.

Specific circumstances

Modification to a motor vehicle or a home

If an injured person requires a car or a motor vehicle to be modified as a result of his or her injuries, the TAC is responsible for paying the reasonable costs of modification. 

If the car is not able to be modified suitably, the TAC is required to contribute a reasonable amount to the purchase of a suitable modified vehicle.

It’s similar if modifications are needed to a home.

If the home is not capable of being suitably modified, than the TAC is required to contribute t towards the purchase cost of a semi detachable portable unit or the cost of relocating the person to another home that is suitable and capable of being modified.

Household help

The TAC is liable to pay for the reasonable costs of hiring an authorised person to provide home services during the first five years after an injury.

For example, say because of your injury that you are not able to perform housework to an adequate standard.

The TAC, provided there is support from your treating doctor, will be required to pay for the cost of a cleaner to attend your home.

Keep in mind that the TAC cannot pay for more than a total of 40 hours per week of such services or support.

If however you have a severe injury, the five year time limit does not apply.

The TAC will have regard to the capacity of the members of your household to carry out such services before approving such a request.

How do I claim payment for a medical expense?

In general, you can claim an expense in one of two ways.

You can obtain the medical treatment and pay for it yourself and then submit the expense to the TAC for payment.

The second way is that you can give the person that is providing the service to you with your TAC claim number and ask them to send the expense off to the TAC directly.

Keep in mind however that some providers will be reluctant to do this and will insist that you pay their bill and recover the money from the TAC yourself.

What if the TAC refuse to pay for a particular medical treatment or service?

There are a few options open to you in this instance.

The first is that you can ask the TAC to do an internal review.

This involves someone from the TAC who did not make the original decisions, reviewing the decision.

If necessary, they will request further medical material from any relevant health practitioners.

The second option is to pursue a dispute application.

This is generally done if you have a lawyer to assist you.

The lawyer will lodge a dispute application on your behalf on the TAC.

This will initiate a conference that will occur between your lawyer and the TAC (or their nominated representatives) where the matter will be negotiated.

The conference will generally happen over the telephone or via a video conference and will usually occur within a couple of months after the dispute application has been lodged.

Your lawyer will usually obtain medical material in support of your position prior to the conference and exchange this with the TAC.

Generally speaking, dispute applications are a more affective way then internal review having decisions overturned.

The final option is to pursue the matter to VCAT.

This would involve a formal hearing where the tribunal member would be required to make a decision as to whether you should be provided with the medical treatment.

It can take several months before your matter is reached at VCAT.

Do I have to ask the TAC to pay for medical expenses?

You do not need to use the TAC to pay for medical expenses if you do not want to, however we recommend that you do.

Even if you have private health insurance, you may as well utilise the TAC if you need them.

You have paid for TAC insurance coverage in your car registration every year, whether you aware of this or not.

What is the time limit for applying to the TAC to pay for my medical expenses?

The TAC is able to pay for medical expenses incurred if an application for payment of the relevant medical expenses is made within three years of the date of the accident or two years of the date of incurring the expense in any other case.

How long will the TAC pay for my medical expenses?

The TAC will pay for medical expenses provided the expenses are ‘reasonable’.

This is largely based on medical opinion.

What are your doctors what are the health practitioners saying about the need for a particular medical service?

Even then, in the event that your doctor supports the need for a medical service, you may find that the TAC refuse to pay for a medical expense.

In this instance, you have appeal rights as mentioned above.

If the expense you were claiming involves a physical therapy such as physiotherapy, chiropractic treatment or osteopathy, keep in mind that at some point during the life of your claim, it is quite possible that the TAC will seek to reduce your entitlement to the service with a view to progressing you to a home based treatment regime.

Also keep in mind that the TAC will generally not pay for the cost of multiple physical therapies at once.

An example of multiple physical treatments would be if you were trying to claim physiotherapy and chiropractic treatment at the same time.