Accidents involving motor vehicles are a major source of injuries requiring medical attention. In Victoria, the cost of treating injuries linked to road accidents is covered by the Transport Accident Commission (TAC). Covered costs include not only the medical care you need following an accident but also the cost of other necessary services to help you recover from your injuries (known as “like services” or “like benefits”).
If you are injured in a transport accident, you are entitled to compensation for medical and like services. Unfortunately, sometimes the TAC unjustly denies coverage of benefits.
Henry Carus + Associates offer a Medical + Like Services Guarantee to all TAC clients. If the TAC has refused to pay for your medical expenses or the cost of like services, our lawyers can get these benefits paid free of charge.
Keep reading for more information on why your TAC claim may have been denied and what to do next, or contact Henry Carus + Associates today for a free, no-obligation consultation.
When Will I Find Out If TAC Will Pay for My Medical Care + Like Services?
In the 90 days following a transport accident, approved medical treatment and like services do not require prior TAC authorisation so long as they are (a) related to your injuries from the accident and (b) recommended by a medical practitioner. However, many accident victims require subsequent or ongoing treatment(s) and services. Many TAC disputes originate at this juncture.
After an accident claim is lodged, the TAC must approve or deny the claim within 21 days. If more information is required before a decision can be made, the client has 28 days to comply with this request. Once the additional information is received, a decision will be made by the TAC within 14 days.
It is important to act quickly if you receive a request for more information. Although you can contact your medical provider on your own, it is generally in your best interest to entrust the matter to an experienced TAC accident lawyer. Medical records by themselves often don’t contain the types of information necessary to establish your right to compensation.
Your lawyer can work with your doctors and other practitioners to collect the information the TAC needs to make a decision in your favour. Hiring a lawyer sooner than later can reduce the likelihood of your claim being denied.
Why Was My TAC Claim Denied?
The TAC may cite a number of reasons for denying your request for a medical or related benefit after a transport accident. Justification for the adverse decision should be provided to you in writing.
Some of the reasons for denial are relatively straightforward, including:
- The treatment or service is not covered by the TAC
- Prior approval is required before the TAC will cover the cost
- What the provider charges exceeds the payment rate established by the TAC
- The TAC requires more information before it will cover the expense
- A claim is made more than 6 months from the date of the last TAC service
- The request for reimbursement of a benefit is made more than 2 years from “the date of incurring the expense”
In some instances, the TAC may approve medical care and like services if you and/or a medical practitioner can provide information describing (a) why the treatment or service is necessary and (b) how it is related to your injuries from the transport accident. The type of information required varies depending on the reason the TAC cites for denying your claim.
However, in other cases the reason for denial is more difficult to discern. Unfortunately, this often seems to be the case when clients need it the most, such as paying for a surgical procedure, ongoing physiotherapy and psychiatric counselling, or attendant care and other kinds of support and services. The TAC may also try to argue that your injury represents a pre-existing condition; the TAC is not obligated to cover medical and like benefits for injuries that existed prior to the accident.
Without TAC accident benefits, you may be forced to pay some or all of the expenses for medical care and like services on your own. It is always worth speaking to a lawyer about your options if your TAC claim is denied or your benefits are suddenly reduced or terminated.
Can I Dispute Denial or Underpayment of My Medical Care + Like Services?
The TAC is essentially a government-created insurance agency. As such, what the TAC considers reasonable and necessary treatments and services after a road accident may differ significantly from what your doctor tells you.
If a claim for medical care and like services that can improve your life or aid in your recovery is denied, you should seek legal advice as soon as possible. Your lawyer can lodge a dispute application or request a review of the decision by the Victorian Civil and Administrative Tribunal (VCAT) on your behalf.
A VCAT review is a specialised legal proceeding with strict deadlines (for example: you must request a review of your claim within 12 months of being denied). It is critically important to have a qualified lawyer who can assist you with every step of the process.
The aftermath of an accident is an uncertain time. Getting medical treatment for your injuries is often just the beginning of a long and difficult recovery. Working with the TAC is frequently one of the biggest hurdles after an accident.
If the TAC refuses to cover the cost of medical care and like services, you have the right to dispute the decision. Henry Carus + Associates can help.
We have unparalleled experience navigating the complexities of TAC legislation and the challenges of recovering the full benefits and other compensation our clients deserve. Our philosophy is You Deserve More, and we embody this attitude through a compassionate and individualised approach to representing our clients paired with aggressive pursuit of the best results.
Learn more about the Henry Carus + Associates Medical + Like Services Guarantee for TAC clients by calling 03 9001 1318 today for a free, no-obligation consultation. Our transport accident lawyers serve clients in Melbourne and throughout VIC.