Medical and Like Expenses from the TAC
Following an accident, one of the most important things for our clients is to know who will be funding their medical expenses. Naturally, these occur immediately after an accident and can be quite expensive, well beyond what the average person might be able to fund. It is often reassuring to know that, by law, the Transport Accident Commission has a responsibility to fund a client’s medical treatment that is related to their transport accident for the rest of their life. This requirement, however, is not unlimited. The treatment or services requested must meet the test of being ‘reasonable and related’ to the transport accident injuries. If the treatment fails either of those tests, then the Commission is within its rights to deny the treatment. However, what is reasonable and related is a subjective test and so there is plenty of scope of negotiation.
The most common type of treatment that people request is fairly standard – appointments with their general practitioner, physiotherapy, hydrotherapy, medications and so on. This particular category of benefit is often referred to as ‘medical and like’ expenses. Often, clients don’t realise that this means that a whole range of other benefits can be claimed under this category. For example, someone who has a hip injury and can no longer maintain the garden, could reasonably request assistance from the Commission to fund the services of a gardener to come and help with the gardening. Other examples of items the TAC can fund include home services, taxi trips if you are unable to drive, walking sticks, babysitting and new mattresses. It is important to note here that each request is assessed on its merits, and that the same test of being reasonable and related to the transport accident injuries. In this regard, the Commission will assess the whole circumstances of the request in accordance with the particular injuries. Different injuries will mean different physical and psychiatric limitations, and what may be required in one instance, may not be in another. If you are unsure whether something should be funded by the Commission, we recommend that you seek legal advice to guide you.
In order to make a request for a particular service or treatment, your doctor will need to send a written request to the Commission to ask it to fund the treatment. We recommend putting in the medical justification for the treatment, and, if there has been a gap in treatment, explain the reasons for that gap as well. This will hopefully help the Commission in its consideration of the request and prevent unnecessary delays. Once the Commission has received the material, it will make a decision on the merits of the request. If the decision is to approve the treatment, then you can arrange with your treatment provider to undergo the treatment, or with a service provider to the assistance. If the decision is to deny funding, we recommend that you seek legal advice to help you determine whether this a decision that should be challenged. Strict time limits apply, so we recommend seeking advice as soon as possible. A lawyer will be able to help you through this process and negotiate on your behalf. At Zaparas Lawyers, we advocate for our clients in regard to these types of disputes every day, and are pleased to do it as part of the service we provide at no extra cost to our clients.