Appealing a decision made by the TAC
If the TAC makes a decision that you do not agree with, there are a number of avenues open to you to contest their decision;
- Ask the TAC to review the decision (internal review)
- Lodge a dispute application
- Pursue the matter to VCAT
Common decisions you may want to contest are:
- Rejection of claim
- Not paying for a particular type of medical expense
- Not paying for income benefits or incorrect calculation of benefits
- Calculation of impairment (relating to an impairment claim).
Ask the TAC to review the decision – internal/informal review
It is possible to have your decision reviewed by a someone at the TAC who was not involved in making the original decision.
This is called internal/informal review.
This person is someone who works independently of the area where the original decision was made.
The person who conducts the review is required to consider all of the relevant information and material.
If you are able to provide new information or material, then they will need to consider that material as well.
Once the review has been completed, they will provide you with a letter that outlines whether the original decision will be altered or maintained.
You have 12 months from the date the original decision was made in order to ask for an informal review.
The TAC states that they aim to complete all informal reviews within 60 days from when you request a review.
However, please note that if the decision is complex or further in information is required it may take longer than this.
How do you initiate an internal review request?
You can find an informal TAC review form on their website or you can call the TAC on 1300 654 329
TAC Dispute application
The second option is to lodge what’s called a dispute application.
This is usually the option that your lawyer will recommend if you have one.
The process is designed to resolve disputes without needing to proceed to court in a way that is faster and simpler for all involved.
Your lawyer will handle the lodgement of the dispute application.
The dispute application will include the decision that you want reviewed and it will outline any reasons as to why you disagree with the dispute.
Material in support will need to be provided.
Relevant material may include medical reports, clinical notes, accounts/invoices/receipts.
How is a dispute application lodged?
Dispute applications must be lodged within 12 months from the date of the decision you are seeking to appeal.
Dispute applications can be sent via post to the TAC or alternatively, can be electronically lodged online.
What happens after the application is lodged?
Once the application is lodged the TAC will then provide your lawyer with all of the material that it relied upon in making the decision.
Your lawyer is then invited to provide any further material that they may wish to rely upon.
The matter is then set down for a conference which generally occurs over the phone or via a video conference.
Your lawyer may or may not want you to be present with him or her during the conference.
If the TAC agrees to alter their decision during the conference then the matter is finalised.
If the TAC does not agree to change their decision during the conference, then if you wish to appeal further there is one final step.
VCAT review of a TAC decision
You are able to pursue a VCAT application within 12 months from the date of the original decision.
In our opinion it is best that you are legally represented if you elect to pursue the matter to VCAT.
A fee must be paid in order to initiate VCAT proceedings.
A decision will be made by a VCAT member in relation to the dispute.
However sometimes matters resolve before reaching the hearing stage.
Conclusion
If you disagree with a TAC decision, there are a number of ways you can appeal that decision.
Asking for an internal review is something that you can do yourself. However if pursuing a dispute application of a VCAT application we recommend that you have a lawyer to assist you.
You should also keep in mind the time limits referred to on this page.
