Call Us Today
Medical + Like Services Guarantee
What Medical + Like Services Does the TAC Cover?
Medical and like services encompass the treatments and other care the Transport Accident Commission (TAC) will pay for following a road accident. Covered costs include not only the medical care you need following an accident, but 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 for life. Unfortunately, sometimes the TAC unjustly denies coverage of benefits.
Henry Carus + Associates offer a Medical + Like Services Guarantee to all TAC clients, regardless of past representation. That being, 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. We can also provide assistance if you are a client of the TAC and your benefits have been suddenly reduced or terminated.
The Medical + Like Services Guarantee is available at NO COST TO YOU. Call Henry Carus + Associates today at 03 9001 1318 for immediate assistance. Our firm serves clients in Melbourne and all of VIC.
Treatments and Services Paid For by the 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 [the TAC hasn’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.
Medical and like services that are automatically approved by the TAC within 90 days of a transport 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.
- Acupuncture: The TAC will pay for acupuncture treatment if it is recommended by a health care professional for your injuries from the transport accident.
- 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 if you sustained 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.
Ambulance Services
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 of this transportation as well.
Surgery
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 get a referral from your doctor. After meeting with you, the surgeon can submit a surgery request form for the TAC to review.
Read More: Does TAC Pay for Surgery After a Transport Accident?
Hospital Care
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.
Medications
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.
Dental Services
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.
Rehabilitation Services
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 Counselling
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.
When Will I Find Out If the TAC Will Pay for My Medical and Like Services?
In the 90 days following a transport accident, approved medical 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.
What If the TAC Won’t Cover My Medical and Like 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.
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 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 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 and 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 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 Administration 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.
Medical + Like Services Guarantee: Our Unique Service for TAC Clients
Henry Carus + Associates have detailed knowledge of Victoria’s road accident legislation and the Transport Accident Commission’s policies. We recognise how daunting it is for the average person to go up against an insurance company or government agency. In an effort to better serve injured people, we provide a one-of-a-kind Medical + Like Services Guarantee.
This guarantee is for people who:
- Have had a claim for medical and like services denied or underpaid by the TAC.
OR - Require additional medical treatment and/or related services for their injuries from a transport accident that the TAC is refusing to cover.
OR - Have had their TAC benefits suddenly terminated.
If you are experiencing any of these situations, contact Henry Carus + Associates or call 03 9001 1318 as soon as possible. Our extensive knowledge of the system enables us to resolve disputes quickly and fairly on behalf of our clients. The Medical + Like Service Guarantee is available FREE, with no upfront cost and no legal fees.
We guarantee 100% privacy.
Your information will not be shared.