Of all of the financial burdens in the wake of a transport accident, the cost of medical care tends to make up a significant portion of the expenses faced by those injured. Although the Transport Accident Commission (TAC) pays for a variety of medical expenses and supports after an accident, many injured persons have difficulty obtaining all of the benefits to which they are entitled. These difficulties arise due to a number of factors, some contained within the legislation and others not.
Many of the guidelines used by the TAC in deciding whether to meet the costs of medical and related expenses are based on internal policies created by TAC and published on its website. These policies are not law, but are applied by TAC as though they were law.
Those injured do not know that these policies can be challenged on an individual basis, to ensure each injured person receives the support that person requires.
Furthermore, many decisions made by TAC in relation to payment of treatment and services are based on opinions provided by TAC from its internal “Medical Panel”. Who is on that panel to make a decision and their experience is oftentimes not known to the injured person when they are told that TAC is going to rely on the Medical Panel decision.
When carefully considered, many of these panel decisions are simply not based on opinions from medical practitioners with relevant medical experience. For instance, a sports rehab doctor commenting on the need for surgery.
Given these challenges, it is crucial to know what the TAC will and will not cover after an accident. If the TAC fails to pay for medical expenses and like services, it is also important to understand how a transport accident lawyer can help get your benefits paid.
Treatments and Services Paid For by TAC
In the first 90 days after a transport accident, TAC approval is not required for treatments and services that are (a) related to the injuries you sustained in the accident and (b) recommended by a medical provider (such as a doctor, nurse, physiotherapist, etc.). Approval by the TAC is required if:
- “It is close to or more than 90 days since your accident and we haven’t already approved further treatments or services, or
- “It has been more than 6 months since you’ve had any treatment or service paid for by the TAC” or
- The treatment or service is not specifically listed by the TAC.
Treatments and services that are automatically approved by the TAC within 90 days of a road accident include:
Medical Services and Doctor Appointments
In addition to appointments with your doctor, you may be referred to one or more medical specialists for assessment and treatment of your injuries after the accident. The TAC pays for these appointments.
Allied Health and Physiotherapy
“Allied health” is an umbrella term used by the TAC to encompass treatments that improve mobility and function and aid with pain management. Treatments and services recognised by the TAC in this category include:
- Physiotherapy: Sessions with a physical therapist can help accident victims recover range of motion in injured areas.
- Chiropractic: Adjustments performed by a chiropractor can alleviate pain in the neck and back (both commonplace after car accidents).
- Occupational therapy: If your accident-related injuries make it difficult for you to return to everyday activities, sessions with an occupational therapist can help you overcome physical and cognitive challenges.
- Osteopathy: Osteopathic doctors combine conventional medicine with a whole-body approach that, like chiropractic, emphasises the health and function of bones and muscles.
- Exercise physiology: Similar to physiotherapy, exercise physiologists can help you develop a fitness regimen that facilitates healing and reduces the risk of re-injury.
- Orthotic and prosthetic: An orthotic device provides support for an injured body part. A prosthetic replaces a body part that is lost as a result of trauma. Both devices must be custom-fitted by a medical professional for maximum effectiveness.
- Podiatry: If you suffered an injury to your foot or feet in a transport accident, the TAC will pay for appointments with a podiatrist.
- Dieticians and weight management: Your doctor may recommend seeing a dietician or weight loss specialist if he/she believes that losing weight or changing how you eat may improve your recovery after an accident.
- Audiology: The inner ear may be damaged in a motor vehicle accident. If this is the case, your doctor could refer you to an audiologist for examination and treatment.
- Optometry and orthoptic services: Specialist eye doctors (such as optometrists, orthoptists, and ophthalmologists) can assess your vision in the event of a head injury or eye injury in a road accident and prescribe correction, surgery, and other treatment.
- Speech pathology: Accident victims who suffer damage to the mouth, jaw, and/or voice box may be referred to a speech pathologist to help them recover the ability to speak.
Remember: These treatments are approved by the TAC in the 90 days after an accident, provided your doctor or another practitioner recommends them. After 90 days, however, you will need to apply to the TAC for approval.
The TAC will pay for you to be taken to hospital from the scene of a transport accident. In the event that you need to be transported to another medical facility, TAC benefits cover the costs as well.
Surgical procedures performed within 90 days of a road accident are approved by the TAC. If you require surgery more than 3 months after the accident, you will need to complete the approval process.
During the first 90 days, the TAC will cover expenses related to hospitalisation without prior approval. You have the option of receiving treatment in a public or private hospital.
X-Rays and Scans
X-rays, MRIs, CT scans, and other medical imaging are used to assess the nature and severity of injuries after an auto accident. Scans ordered by a medical provider are approved for the initial 90 days. After the 90-day period or if you haven’t received a service paid for by the TAC in more than 6 months, further imaging will require approval.
Your healthcare provider may prescribe medication or recommend certain over-the-counter meds. The cost of medication is covered by the TAC for 90 days, after which approval will be required.
Medical Aids and Equipment
The TAC covers the cost of basic medical supplies (such as crutches, bandages, braces, etc.) as well as equipment that helps you dress yourself, prepare food, and use the bathroom. Benefits also cover the replacement of eyeglasses or dentures that were damaged in the accident.
Meanwhile, the cost of more specialised equipment and aids requires TAC approval. These include wheelchairs, handrails, medical-grade beds, and more.
A dentist can diagnose and treat accident-related injuries to the teeth, gums, tongue, and/or jaw. Dental services are covered by the TAC during the initial 90-day period after the accident, with treatment after this date subject to approval.
The TAC pays for rehabilitation services related to your accident injuries. These services can be performed on an outpatient basis (at home) or in a hospital or community centre.
Mental Health Counseling
Being involved in or witnessing an accident can have a significant impact on your mental and emotional health. The TAC’s mental health services cover appointments with a psychiatrist, psychologist, social worker, and other professionals.
Other Treatments and Services
TAC benefits also cover a range of additional treatments and services related to your medical care and recovery. Some of these are approved in the 90 days following a transport accident, such as reimbursement for travel to and from medical appointments and the services of an interpreter.
Other services, however, require TAC approval regardless of timing. These include:
- Travel by taxi or rideshare service for medical care
- Modifications to your home and/or vehicle
- Home- and community-based services
- Massage therapy
- Pain management
Some treatments and services are subject to payment limits. It is important to be aware of these limits so you don’t have to pay out of your pocket.
What If TAC Won’t Cover My Medical Expenses?
Despite the medical benefits guaranteed to the injured by the Transport Accident Commission, it is an unfortunate reality that the TAC sometimes unfairly disputes or denies coverage of the expenses incurred by accident victims. Recovering from a motor vehicle accident is difficult enough without having to worry whether the TAC will cover your medical bills and other costs.
If the TAC is refusing to pay for your medical care and other like services, you should speak to a lawyer as soon as possible. At Henry Carus + Associates, we are proud to offer TAC clients a Medical + Like Services Guarantee.
With our Medical + Like Services Guarantee, our lawyers can help you get the benefits you are owed. This service is available FREE to all TAC clients, with no upfront cost and no legal fees.
Henry Carus + Associates have unparalleled experience with TAC legislation and accident claims. Our extensive knowledge of the system enables us to resolve disputes quickly and fairly on behalf of our clients. You Deserve More, and our team will aggressively advocate for you to ensure you get the benefits and compensation you are due.
Please call 03 9001 1318 today for a free, no-obligation consultation. Henry Carus + Associates serve clients in Melbourne and throughout Victoria.