The TAC claim process
This page details the TAC claim process.
It will explain the claim process relating to the lodgement of an initial TAC claim, what you’re entitled to once your claim has been accepted and what the process is if your claim gets rejected.
It will also explain the claim process relating to impairment benefit lump sums and common law lump sums.
The initial TAC claim process
There are a few different ways that a TAC claim can be made by a person who has been involved in an accident.
The first is to call the TAC.
Let the operator know that you’ve been involved in an accident and wish to lodge a new TAC claim.
They will ask you a series of questions relating to the accident and they will also ask for your information.
At the end of the call, you’ll be provided with a TAC claim number which you should write down somewhere.
The TAC will also send you some information after the call.
If you would like to lodge a claim over the phone but you have a disability that makes communicating over the phone difficult, then a person can contact the TAC on your behalf and discuss an alternative arrangement for lodging a claim on your behalf.
Another way that you can lodge TAC claim is via the TAC’s online claim lodgement page.
It’s important to note however that if you choose to lodge a TAC claim online that you will need most of the information listed on the page for the claim to be submitted.
If you do not have relevant information you may not be able to submit the claim online and you may be better off calling the TAC and lodging a claim that way.
Another way that TAC claim can be lodged as if a person sustained an injury or injuries in an accident and is hospitalised after the accident, it is common for hospitals to lodge a claim on a persons behalf.
Hospitals do this to ensure that any relevant medical expenses related to your treatment are paid for.
Many times, people have had a claim lodged by a hospital but will not be aware of it.
If you have been hospitalised after an accident you should telephone the TAC and ask whether a claim has been lodged on your behalf.
You can read more about how to make a TAC claim on this page.
Once a claim has been lodged
Once the initial claim has been lodged, the TAC will then process and determine the claim.
They will need to make a decision as to whether to accept or reject the claim or alternatively, to seek further information.
The TAC must do this within 21 days of receiving the claim.
If the TAC request further information either from you or from another party, which includes medical material, then they have 14 days after receipt of that material to make a decision.
If the TAC request further information from you following the lodgement of a claim, then you have 28 days to respond to the TAC‘s request and to provide them with this information.
If you require more than 28 days, then you can reach an agreement with the TAC in this regard.
If you do not respond to the TAC within 28 days (or the period that was agreed to) then the claim that was lodged will lapse and you will need to lodge a new claim.
What documents might the TAC send me after lodging a claim?
Authority to release information form – this authorises the TAC to obtain information in relation to your injuries and the accident.
Third-party representative form – this form allows a third party to act on your behalf in relation to the TAC matter (eg: a lawyer).
If your claim has been accepted
If your claim gets accepted by the TAC then you will receive correspondence from them confirming this.
You’ll be entitled to claim reasonable medical and like expenses, which you can read about here.
You’ll also be entitled to claim income payments from the TAC if your ability to work has been impacted as a result of the accident.
In relation to medical and like expenses, there are two ways that you can go about claiming the cost of medical treatment from the TAC.
The first way is to pay for the expense of yourself and then submit proof of payment to the TAC who will then need to reimburse you.
The second way is to provide your TAC claim number to the provider and ask them to bill the TAC directly.
It’s important to be aware that in the first 90 days, many expenses do not need approval from the TAC.
It’s also important to note that the TAC has set fees that they will pay for different types of medical treatment and if the provider that you see wishes to bill over and above that then you’ll need to cover the extra amount.
For example, say the TAC will pay $50 for a particular type of medical treatment, but the provider bills you $70, you’ll need to pay the $20.
In relation to income payments, you’ll be entitled to these if you can only work at a reduced capacity following the accident, or if you cannot work at all.
You can read about claiming income payments on this page.
In order to claim income payments you’ll need to obtain certificates of capacity from a medical practitioner. Sometimes people don’t sign certificates and they get rejected by the TAC, so ensure that you sign each certificate of capacity before submitting it to the TAC.
Income payments are payable for up to 3 years post accident. In a very limited number of cases payment can be made in addition to 3 years (if a person has been assessed as having a 50% or greater whole person impairment rating).
In relation to income payments, it’s important to note that you will not be paid at 100% of your lost wages.
Interim payments and income payments
Also, once your claim has been accepted if you are claiming income payments there will be a period where the TAC needs to establish your pre-injury average weekly earnings (referred to as PIAWE).
This is the figure that your income payments will be based on.
It is an average of your earnings 12 months prior to the accident occurring (or if you haven’t been employed for 12 months, the period of time that you have been employed with a particular employer).
During this period while the TAC is determining the appropriate amounts to pay you, It’s possible to ask the TAC to pay you interim payments.
You can read about interim payments here.
Also, you should be aware that even if you were not working at the time of employment, you may still be entitled to income payments and you can read more about that here.
If the claim is rejected
Sometimes a TAC claim will be rejected.
To summarise, if your claim has been rejected then you’ll be notified by the TAC in writing as to the reasons why.
If you disagree with the reasons why (you should obtain legal advice) then you can ask that the TAC perform an internal review which involves a member of the TAC team who was not involved in the making of the original decision, reviewing the decision to reject your claim.
Another option, and the option we recommend, is to lodge a dispute application and initiate a dispute resolution conference.
This is something that should be done with a lawyer.
The dispute conference involves your lawyer and the TAC (or their representatives) and will likely be a video conference where the parties each put forward their respective arguments.
If the matter does not resolve either by way of internal review or a dispute resolution conference then you can potentially pursue the matter to VCAT.
If you want to go down this road then we’d recommend you have legal representation.
If you go through and appeal the TAC’s decision to reject your claim and the claim is later accepted, you’ll be entitled to be back paid the cost of any reasonable medical and like expenses and income payments that you would’ve received had your claim initially been accepted.
Impairment claim process
What we’ve described above is the initial TAC claim process.
Lodgement of the initial TAC claim and acceptance of that claim entitles a person to obtain payment for reasonable medical and like expenses and if their ability to work has been impacted by the accident, income payments.
However there are two lump sum claims under the TAC system that a person can pursue but a person is not automatically entitled to them just because they have an accepted initial claim.
The first is an impairment claim which you can read about in detail here.
There are two scenarios in relation to pursuing an impairment claim.
The first is that you’ve lodged and had accepted an initial TAC claim and you do not have a lawyer representing you.
The second is that you have lodged and had accepted an initial TAC claim and you do have a lawyer that is representing you.
If you do not have a lawyer
If you do not have legal representation, the TAC will send you some correspondence in relation to your entitlement to pursue an impairment claim.
An impairment claim can only be pursued once all the injuries that you suffered in the accident have stabilised, and after a minimum of 12 months of passed since the accident.
If you do not have a lawyer, then you should let the TAC know that you wish to pursue an impairment benefit claim.
They will need medical material from you’re treating medical practitioners that addresses the diagnosis of your injury or injuries, prognosis and the issue of stability.
You can read about stability here.
What the TAC will then do is organise medical assessments for you to see doctors of their choosing.
They will organise for you to see doctors of specific specialities to assess each of your injuries.
So if you suffered a musculoskeletal injury, they may organise an appointment for you to see orthopaedic surgeon.
If suffered injury to your nose they may organise an appointment for you to see an ear nose and throat doctor and so on.
The TAC will cover the cost of these doctors, and will also pay for travel to the appointments.
Each of the doctors will be required to put a percentage figure on the injuries that they assess.
These percentage figures will then get combined into one overall figure called your whole person impairment rating.
The TAC will then, once you’ve undergone all assessments, send you a written offer to resolve the matter.
You can either elect to accept or dispute the offer.
This is one of the key reasons why we recommend that you should have a lawyer if you want to pursue an impairment claim.
It can be very difficult for an injured person, who likely has no experience with impairment claims and impairment ratings, to determine what is appropriate.
Yes, you can simply accept the offer that the TAC put to you and the claim can be finalised. But in some instances, you will be resolving the matter for less than what you could have obtained had you been legally represented.
If you are happy to accept the offer from the TAC, they will ask you to sign a document confirming the settlement. This is called a release.
This document will prevent you from reopening the matter in the future.
You will then generally speaking be paid the settlement monies within a couple of weeks, sometimes a little bit longer.
If you have a lawyer
If you have a lawyer, once your injuries have stabilised, your lawyer will request medical material from your treating medical practitioners.
Your lawyer will then organise appropriate medical assessments.
Unlike the above situation where you do not have a lawyer, your lawyer will choose the doctors who will assess your injuries.
They will likely select doctors that they have experience with.
The TAC will in most cases be responsible for the full payment of any of the medical assessments that have been arranged by your lawyer.
Once all medical assessments have been completed and your lawyer has been provided with medical reports from each of the doctors that assessed you, they will likely discuss your whole person impairment rating.
Your lawyer will then complete an impairment claim form which will be submitted to the TAC, along with what’s called a TAC application statement.
Once the material has been submitted to the TAC, the TAC will then determine the claim.
They may accept all of the assessments performed by the doctors.
Or they may dispute certain parts of the claim.
For example, a doctor may have awarded you 10% for a spinal injury suffered in the accident.
However, the TAC might argue that a more appropriate assessment would have been 5% as the doctor did not properly take into account your pre existing back injury.
If there is a disagreement between the parties, then your lawyer will negotiate with the TAC on your behalf.
If an agreement can’t be reached, your lawyer may seek your instructions to pursue a dispute resolution application.
If agreement is reached to resolve the matter, either with or without the need to pursue a dispute application, then the TAC will send to your lawyer a document for you to sign that confirms resolution of the matter.
This is a release document, and when you sign it will prevent you from reopening the matter in the future. You should discuss this with your lawyer.
Also, upon successful resolution of this claim, the TAC will pay costs to your lawyer.
These are called protocol costs.
Some lawyers may not bill you over and above these protocol costs while others will.
So it’s not a bad idea before you pursue an impairment claim to ask your lawyer whether they intend to bill over and above the protocol costs payable by the TAC if your claim is successful.
You will likely have been provided with a cost agreement document which should address this.
Common law claim process
This is the second potential lump sum claim open to a person to pursue.
As with an impairment benefit claim, it a claim that you are not automatically entitled to just because you have an accepted TAC claim.
If you wish to pursue a common law lump sum claim, you should have a lawyer.
A common law claim requires legal experience and knowledge and it is not something you should attempt to pursue yourself.
You can read about common law claims here.
Assuming you have a lawyer, the process is that the lawyer would request medical material from your treating medical practitioners once your injuries are stabilised.
You may also need to undergo further medical assessments, arranged by your lawyer.
Other material will likely be requested as well in relation to the issue of negligence.
You may be asked to see a barrister who will draft relevant claim documentation.
Your lawyer will then need to lodge what’s called a TAC serious injury application.
You can read about serious injury applications here.
A serious injury application is the initiating step to pursuing a common law lump sum claim.
The TAC then need to determine whether you have a serious injury or not as a result of the accident.
During this determination period, they may request further material from your treating doctors, a hospital you attended, or they may ask you to undergo an assessment by a doctor of their choosing.
If they determine that you do have a serious injury, then what will happen is the parties will conference the matter.
This settlement conference usually occurs within a few weeks after you’ve been provided with a serious injury certificate.
In most instances the settlement conference will involve you and your lawyer and probably a barrister.
If the matter resolves at the conference, you’ll need to sign a document confirming settlement of the matter and then you will generally be paid your settlement monies within four to six weeks after settlement.
Out of the gross settlement monies, your lawyer will deduct their fees (assuming you entered into a no-win no fee agreement with a lawyer). The TAC will also pay some fees to your lawyer.
If the TAC do not provide you with a serious injury certificate for whatever reason, then it is possible that the matter will go to a conference involving the TAC, your lawyer and probably a barrister where the issue of serious injury will be negotiated.
Not all matters will be conferenced in relation to the serious injury aspect however.
If you get provided with a serious injury certificate at this point then you will go to the settlement conference referred to above.
If you do not obtain a serious injury certificate then if you still wish to pursue the matter you will need to (or more specifically, your lawyer will need to) issue County Court proceedings to have the matter determined by a Judge.
Once proceedings have been issued it can take six to twelve months before your matter reaches hearing before a Judge.
The Judge will need to make a decision as to whether you have a serious injury or not.
Keep in mind however that any time the parties are able to negotiate the issue of serious injury and also to potentially negotiate a total settlement of the matter.
Assuming that your matter does go before a Judge and you obtain a serious injury certificate then you will go to the settlement conference as referred to above.
If the matter does not resolve at the settlement conference, then there can be some further negotiations between the parties but if the matter fails to resolve then proceedings will need to be issued in either the County Court or Supreme Court
Prior to any hearing of the matter, it will need to be mediated.
As you can see, the common law claim process is quite involved and to be able to successfully navigate your way through the system you should have a lawyer that knows who knows the system and what they’re doing.
If the accident involved a death
You should read this page which goes into detail about the TAC dependency claim process and how the TAC can assist.
Conclusion
The TAC claim process begins with the lodgement of an initial TAC claim which can be done either by calling the TAC or using the TAC’s online claim form.
If you were hospitalised after the accident it’s possible that the hospital lodged a TAC claim on your behalf.
Once your claim has been accepted you’ll be entitled to the payment of medical and like expenses and potentially income payments.
You may also be entitled to an impairment lump sum claim and a common law claim for damages which are claims that you are not automatically entitled to after the lodgement of an initial TAC claim.
The claim process for an impairment lump sum involves getting medically assessed by doctors who will determine your whole person impairment rating. This rating is used to calculate the compensation payable to you.
The claim process for a common law lump sum claim is initiated by the lodgement of a serious injury application.
