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Dispute Resolution for TAC claims in Victoria

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Please note that this post was written for Victorian audiences and the information within may not apply to other regions.

The Transport Accident Commission (TAC) supports Victorians who are injured on the road and assists with recovery.

Under the “No-Fault Scheme”, the TAC can provide entitlements such as medical and like expenses.

Medical and like expenses include but are not limited to:

  • GP consultations;
  • Specialist appointments;
  • Radiology (e.g. MRI, x-ray);
  • Physical therapies;
  • Psychology/Psychiatry treatment; and/or
  • Medication (original receipts are required).

However, there may be instances where a TAC claimant receives a denial letter or faces challenges when claiming entitlements such as medical and like expenses.

If you receive a letter from the TAC denying an entitlement, before you decide to dispute the decision, you should:

  1. Review the letter carefully. This will allow you to understand TAC’s reasoning and how you may be able to change their decision if you disagree with it.
  2. Request further clarification: If you have read the letter and require further clarification, contact your claims manager directly. If English is your second language, you may request that an Interpreter be dialed in to assist you in understanding TAC’s reasons.
  3. Discuss the denial letter with your General Practitioner and whether your treater disagrees with it.
  4. Contact your Lawyer!

Common Reasons for TAC’s denial:

Understanding common reasons as to why the TAC may reject a medical and like request assists claimants with addressing any potential issues proactively. The following are common examples:

Causation: TAC may deny a claim if they determine that the injury or medical condition is not directly related to the transport accident.

Pre-existing conditions: If the TAC believes that the claimed expenses are related to pre-existing conditions rather than injuries arising from the transport accident, they may deny liability or the medical request. However, if the accident exacerbates a pre-existing condition, it may still be compensable.

Lack of medical evidence: If the TAC does not have enough information from your treaters to approve a medical and like expense request, they may deny the request.

Dispute Resolution: Review Rights

If you are dissatisfied with the TAC’s decision, you can exercise your review rights in the following ways for Dispute Resolution:

  • Informal Review: it allows you to request a reconsideration of the decision. If you wish to initiate an informal review, you must submit a request to the TAC within 28 days of receiving the decision. A TAC review manager who was not involved in the original decision-making process will review the case. They will examine all the relevant information and may seek additional information if required. The reviewer will consider the client’s arguments and any new evidence provided;
  • TAC/LIV/ALA No Fault Dispute Resolution Protocols (“Protocols”): Under these protocols, clients must complete a pre issue review before they can issue an application for a VCAT review; and/or
  • Lodging an Application for Review at VCAT: VCAT is an independent body that deals with disputes. An individual who wishes to lodge an application for VCAT to review must do so within 12 months of being aware of the TAC’s original decision.  A tribunal may order a compulsory conference or mediation to take place between the TAC and the client’s solicitor before the dispute is heard by VCAT. If a decision is not made through these processes, then it will proceed to a hearing where VCAT will make a final verdict.

It is important to note you have 12 months after you have become aware of the decision to challenge TAC’s decision.

If you have received a letter from the TAC denying your rights to entitlements such as medical and like expenses, contact Zaparas Lawyers and speak to one of our experienced TAC lawyers who can help you with the Dispute Resolution.

You can read more blogs relating to TAC below: