Car accident medical claims
If you’ve been involved in a motor vehicle accident in Victoria and you’ve suffered injury, there are some ways that you can go about ensuring you get your medical treatment paid for.
This page will look at the different options open to you.
Lodging a TAC claim
The first option is to lodge TAC claim to get your medical expenses paid.
Even if you were only involved in a minor vehicle accident and suffered minor injuries and therefore may only need, for example, the occasion GP visit or physiotherapy session, you should consider lodging a claim.
There is no real downside to lodging a TAC claim.
Keep in mind that every year you pay your vehicle registration, a part of that is called the TAC charge.
This amount is an insurance component that is designed to cover you if you’ve been involved in a motor vehicle accident and if you’ve suffered injuries.
So you’ve essentially paid for insurance coverage so you should use it.
Another thing to keep in mind is that you can lodge a TAC claim and have your medical expenses paid even if no one else was at fault for the accident.
Even if you were 100% to blame for the accident, you can lodge a TAC claim and have your medical expenses paid for.
Some people might think that lodging a TAC claim will be a huge headache, but this is generally not the case.
Once the claim has been lodged after a short period of time in most cases it will be accepted by the TAC.
You can then send your accounts to the TAC directly or you can have the providers that are treating you send the accounts off to the TAC for payment.
One thing to keep in mind is that the TAC has set fees for what they will pay.
Some providers may charge over and above the TAC’s set amount which will mean you’ll need to cover the gap costs, in a similar way to how Medicare works.
If you wish to claim medical expenses from the TAC, the first step is to lodge a TAC claim.
You can see this page for a full breakdown as to how to do that.
In a nutshell however, there are three ways to lodge a TAC claim.
The first is by telephoning the TAC and lodging a claim over the phone.
The second way is by using the TAC’s online lodgement form.
The third way is some hospitals will lodge a TAC claim on a person’s behalfif they’ve been admitted to hospital after an accident.
This is because hospital wants to make sure they get paid for the treatment they’ve provided and so you’re not out of pocket.
Sometimes they do not tell a person that a TAC claim has been lodged so if you’ve been admitted to hospital, there is the possibility that you’ve already got a claim lodged.
Once your claim has been accepted, then you’re entitled to claim medical expenses right away.
Some services can be claimed without having to get approval from the TAC.
Others will need approval.
Some of the common medical expenses people might claim are: physiotherapy expenses, chiropractic treatment, osteopathy treatment, surgery, ambulance services, medication, travel expenses and accommodation, scans such as MRI and CT, and hospital treatment at either a private or public hospital or rehabilitation hospital.
If your injury occurred prior to 14 February 2018, then something called the medical excess may apply.
Basically this means that if you are to claim medical expenses from the TAC, you must pay the first $651 before the TAC will start paying your medical expenses.
If this applies to you then you should keep all receipts and invoices for the medical treatment that you’ve paid for and send them off to the TAC once you’ve hit the excess amount.
If your injury occurred after 14 February 2018 the medical excess will not apply to you so you don’t have to worry about this and the TAC will pay medical expenses for you immediately.
If you want to claim medical expenses from the TAC once you have an accepted claim, you can pay for the treatment yourself and then send the receipt to the TAC for reimbursement.
You can read about how long it takes for the TAC to reimburse you on this page.
Or, you can provide the service provider with your TAC claim number and asked them to send the expense off to the TAC on your behalf.
Private health insurance
Some people have private health insurance policies which covers injuries sustained in accidents
Generally speaking however, claiming medical expenses under private health insurance policies will be more restrictive compared to claiming via a TAC claim.
For example, some private health insurance policies may not cover the aggravation of an existing medical condition that occurred in a motor vehicle accident whereas under a TAC claim this is likely to be covered.
Some policies may also restrict the time period during which you can claim medical expenses after an accident (e.g. you may be only able to claim for 90 or 180 days after an accident).
The TAC is much more flexible and does not have the same time limits on how long you can claim medical expenses for.
The TAC may terminate or reduce your entitlement to certain medical expenses, but generally speaking you should be able to obtain the payment of a wider variety of medical expenses and for a longer period of time via a TAC than claiming under most private health funds.
Also, if you attend an emergency department for treatment as an outpatient, most private health insurance policies will not cover these costs.
Some private health policies will also not cover the cost of an ambulance.
In fact, some health insurers may refer you to the TAC after a road accident because they believe claiming from the TAC will be the best thing for you.
Some health insurance funds may pay provisional benefits and then recover the cost of these benefits from the TAC.
This could be related to medical services, hospital services or nursing services.
It may be a good idea however to request payment from your health insurance fund in the following circumstances;
- If the TAC has rejected or denied approval for a medical treatment which you urgently need
- If you do not have an accepted TAC claim at the time the medical treatment or service is required
- If a particular provider, such as a physiotherapist or doctor will not accept the TAC’s fee schedule (refer to above) for a given service and so claiming under your health insurance will ensure you’re not out of pocket or less out of pocket than if you were to rely completely on the TAC.
What if I don’t want to pursue a TAC claim and don’t have private health insurance?
You can see a GP that bulk bills to ensure that GP attendances do not cost you.
If you are prescribed medication, if you have a concession or healthcare card you may be able to obtain medication for cheaper.
Likewise, if you have a seniors health card or are on the pension you should be able to obtain medication cheaper.
If you need surgery, you can go on the public waiting list.
When you ask the TAC or a private health insurer to pay for the cost of surgery and any associated costs, you’ll be on the private waiting list and generally speaking will get in to have the surgery much quicker.
If you wish to obtain counselling or psychological treatment, you could see your GP and they can organise a treatment plan under which you can get a limited number of sessions with a counsellor or psychologist at no cost to you.
Even if you have suffered minor injuries in a car accident it is recommended that you lodge a TAC claim and claim all of the expenses that you can under the claim because that’s what it’s for.
Whether you are aware of it or not, you have been paying for this insurance coverage for as long as you’ve been registering your vehicle. So you may as well use it.
Getting a TAC claim lodged and accepted in most cases is not too difficult as it’s really just a matter of a phone call and filling out some forms or completing a form online. Or in some instances a hospital may have lodged a claim for you.
If you don’t want to lodge a TAC claim then you should look at claiming medical expenses from your private health insurance if you have a policy. Keep in mind though that the expenses that you can claim will be restricted.
Finally, if you don’t want to pursue a TAC claim or claim via your private health insurance, there are free options open to you to ensure that you can get some of the medical treatment you need.