How does TAC compensation work?
If you are injured in a motor vehicle accident in Victoria, you may be entitled to claim TAC compensation.
This page will explore how TAC compensation works.
TAC is insurance
Whenever you renew your motor vehicle registration, a portion of the total fee is for TAC insurance.
By paying the TAC component, this means that in the event of a motor vehicle accident, you may be covered by the TAC for any injuries that you suffer.
Even if you were riding a bicycle you may be covered by the TAC if the accident involved a motor vehicle. This is because the driver of the vehicle will likely have paid their registration and therefore they are covered by the TAC.
Note that TAC will only compensate people for injuries. They will not provide compensation if you damage your motor vehicle.
Fault is not required to claim
If you are involved in a motor vehicle accident in Victoria, fault is not a requirement to pursue and obtain TAC compensation.
This is because Victoria has both a no fault at fault scheme.
This means that some entitlements are no fault based, while one of the entitlements is fault based.
The no fault entitlements are: weekly payments, medical and like expenses and an impairment benefit lump sum.
You do not need to show that someone else was at fault for the accident to claim these entitlements.
The fault based entitlement is called a common-law claim for damages.
In order to claim this entitlement you will need to show that someone else was at fault for the accident.
However – and this is important – in order to make a TAC claim and have it accepted, you do not need to show that anyone else was at fault for the accident.
There are also no claim thresholds that need to be met in terms of the severity of injury.
The first step is lodging a TAC claim
The first step to claiming TAC compensation is to lodge a TAC claim.
You can read about how to do that here.
In a nutshell however, you can make a claim by telephoning the TAC or using their online claim lodgement form.
Once the claim has been lodged, the TAC will then process the claim and make a decision to accept or reject it.
If the claim is accepted, then you are entitled to the payment of medical and like expenses and if your ability to work has been impacted because of an injury or injuries sustained in the accident, you are entitled to claim loss of earnings benefits.
If you wish to pursue an impairment lump sum claim common law claim, you’ll need to make separate applications for these two lump sum claims and just because you have an accepted TAC claim does not mean that you will succeed in either or both of these lump sum claims.
If the the initial TAC claim is rejected, and if you disagree with the decision to reject, then you can appeal the decision.
You can ask the TAC to perform an internal review which means that a member of the TAC team who is not responsible for making the decision, reviews the decision.
You can also pursue a dispute application which is an application that initiate a conference between the parties.
You should have legal representation if you decide to pursue a dispute application.
If the matter does not resolve either by way internal review or by way of a dispute application, then you can go to VCAT.
Again, it’s recommended that you have legal representation in relation.
Assuming your claim gets accepted, then you are entitled as mentioned above to the payment of medical and like expenses and potentially income payments if your ability to work is impacted.
You are entitled to be back paid to the date of accident if your claim is rejected initially and then later accepted.
Claiming medical and like expenses
If you wish to claim medical expenses from the TAC in general there are two ways that you can do so.
The first is to pay for the expense yourself and then seek reimbursement from the TAC by submitting receipts.
The second way is for you to provide your TAC claim number to a particular provider, for example to your general practitioner or a physio or chiro or to a chemist and ask them to send their bill to the TAC directly.
You can read more about this here.
TAC will only pay certain amount for particular types of medical treatment so keep in mind that you may be required to pay gap costs, in a similar way to how Medicare works.
The TAC may also refuse to pay for a particular type of medical treatment and if this occurs you have appeal rights.
As mentioned above in relation to the rejection of a TAC claim, if the TAC reject payment for a particular medical expense you can dispute the decision via internal review, a dispute application or through VCAT.
Claiming income benefits
If your ability to work has been impacted because of an injury you can claim income benefits for up to 3 years post accident (in limited cases beyond three years).
You must obtain certificates of capacity from your general practitioner or other health provider that covers the incapacity periods which you will then need to provide to the TAC.
If you are certified as having a capacity to return to your full pre injury duties, then you will not be entitled to obtain income benefits.
Claiming an impairment benefit
As mentioned above, just because you have an accepted TAC claim, doesn’t mean that you are entitled to a impairment lump sum.
In order to claim an impairment benefit lump sum, you need to make a further claim in addition to the original TAC claim.
And it is not just a matter of having an injury in a car accident and proving that.
You need to have an injury or injuries from the motor vehicle accident that are permanent.
You need to have some sort of permanent incapacity from the accident.
Any injuries also need to be stable – in that they are not getting any better and not getting any worse. Generally speaking, this is a minimum of 12 months post accident.
And the combination of the injuries, or a single injury, need to reach a particular threshold.
What happens is that you’ll be sent off to a medical assessment or assessments, depending upon the injuries or injuries and your injuries will be graded by doctors. They will put percentage figures on your injuries.
In order to successfully claim a TAC impairment benefit, you need to have a total whole person impairment of greater than 10%.
For every percentage point you are over the 10%, the amount that you are entitled to by way of an impairment benefit increases.
If you don’t reach the threshold, or you’re not happy with the offer made by the TAC, then you can appeal.
An impairment claim is for the most part not one that requires a person to go to court.
If you do intend to pursue an impairment claim, it is advisable to have legal representation to help ensure you get the best result possible.
If you do you have legal representation, and you succeed in an impairment benefit, the TAC will pay some costs to your lawyers called protocol costs. Some lawyers may bill you over and above the costs they receive from the TAC, but others won’t so just be mindful of this.
Before commencing the claim the lawyer should give you an idea as to what costs are likely payable to them for work done.
Claiming common law damages
In order to claim common law damages following a motor vehicle accident, your injury needs to be stabilised in that it’s not getting any better and not getting any worse.
The reason that an injury needs to be stabilised before pursuing a common law claim is because you are getting compensated for permanent impairment and the impact that an injury has on your life.
The only way that this can be determined is for your injury to have played out, that is stabilised.
As mentioned above, a general guideline as to when injuries have stabilised is 12 months from the date of accident.
Pursuing a common law claim following a road accident accident is not a simple process and you should have legal representation.
Medical material will need to be obtained in support.
This medical material is usually obtained from medical practitioners that have treated you following the accident and those that continue to treat you.
It is also obtained from medicolegal assessors. These doctors that might see you on one occasion and provide an assessment but will not provide you with treatment.
Specific documentation will need to be drafted.
The most important of which is called an affidavit.
This affidavit basically paints a before and after picture as to how you were before the accident and compares that to how you are now.
What then happens is a serious injury application is lodged. This gets sent off to the TAC.
The TAC then have to make a decision and that decision is whether to provide you with a serious injury certificate or not.
They need to determine whether your injury is a serious injury or not.
If they determine that you do have a serious injury, then the next step is to go to a settlement conference where the parties will discuss the matter and attempt to resolve it.
Many matters will resolve at these conferences but some don’t and they will need to push on.
Further negotiations can take place after these conferences.
If the matter fails to resolve by way further negotiations, then court proceedings will need to be issued.
Many matters resolve without the need to go to court but those that cannot will need to go to hearing.
If the TAC say that you do not have a serious injury and you wish to continue to pursue the matter then you’ll need to issue court proceedings to have the matter heard before a judge. It will then be their job to decide whether you have a serious injury or not.
If you succeed and obtain a serious injury certificate then you will follow the process described above. That is, your matter will go to a settlement conference and if the matter doesn’t resolve court proceedings will need to be issued.
I terms of compensation under a common law claim, you can get compensated for pain and suffering, that is the pain and suffering that you have gone through and will go through as a consequence of the injury or injuries.
You can also be compensated if you lost earnings as a consequence of the accident taking into account your loss of earnings into the future, potentially up until retirement age.
If you have suffered an injury in a motor vehicle accident in Victoria, then you may be entitled to pursue compensation via a TAC claim.
Once you have an accepted TAC claim, this entitles you to clean medical and like expenses from the TAC and if your ability to work is impacted as a consequence of the accident, income replacement benefits for up to three years post accident (in some cases after more than three years).
In order to initiate a TAC claim, you will need to complete the TAC claim form documentation and lodge it on the TAC.
It is important to keep in mind that there does not need to be fault on behalf of another party in order to lodge and have accepted a TAC claim.
Victoria has both a fault and no fault based compensation scheme.
This means that in order to claim some entitlements, you do not need to show fault on behalf of another party. These entitlements are medical and like expenses, weekly payments and an impairment benefit lump sum.
In order to claim common law damages you need to show fault on behalf of another party relating to the accident.