TAC claims – eligibility and benefits

Who claim eligibility - who can make a claim?

The Transport Accident Act 1985 provides that you can lodge a claim with the Transport Accident Commission (TAC) if you have sustained an injury through an incident directly caused by the driving of a motor vehicle, train or tram.

This includes:

• If you were the driver or passenger of a motor vehicle and have sustained injury;
• If you have been injured through the driving of a train or tram;
• If you are a cyclist who has sustained an injury because of colliding with a motor vehicle, a stationary motor vehicle or the door of a motor vehicle; and
• If you have witnessed a transport accident and have sustained a psychological injury.

Claims can be lodged for both physical and psychological injuries, including nervous shock, if you have witnessed a transport accident and developed a psychological injury.  

Claims can also be lodged if you have sustained an injury, regardless of whether you were at fault. If someone else is found to be at fault, you may also be eligible to lodge a common law claim for further damages.

If you are a dependent (adult or child) of a person killed as a result of a motor vehicle accident, you will be eligible to make a dependent’s death benefit claim.

What do I need to make a claim?

Before you make a claim, it is important that you have as much of the necessary information as possible. This will enhance the likelihood of a successful claim and also avert any delays in your claim.

Information to gather includes:

• Details of the accident such as where it happened, how it happened and any injuries you have sustained;
• Details of any vehicles involved, including their registration number and the names of any drivers or passengers involved;
• Details of any police officers who attended and whether or not a statement was made;
• The name of any health professionals you have attended as a result of the injuries arising from the transport vehicle accident. This should include general practitioners, hospitals, physiotherapists and rehabilitation centers;
• Pre-injury employment details, including how much you earnt per week before the accident occurred; and
• If the accident involved a train or tram, details of the public transport operator, who the accident was reported to and accident details including the vehicle number, location, and route of travel.

How to make a claim

If you have sustained an injury as a result of a motor vehicle accident, you should lodge TAC claim as soon as possible after the accident or becoming aware of your injuries.

TAC claims can be lodged in three different ways.

1. You can lodge your claim by completing the TAC’s online lodgment form which you can download here.
2. You can also lodge your claim over the phone by contacting the TAC on 1300 654 329; or
3. If you were admitted to hospital after your accident, the hospital may have lodged a claim on your behalf. You should check with the hospital or the TAC to confirm that the claim has been lodged.

Time limits for TAC claims

Strict time limits apply to lodging claims with the TAC.

If you have sustained an injury arising from a transport accident, you have 12 months from the date of the injury, or the date of becoming aware of the injury, to lodge a claim with the TAC.

For children injured in a transport accident, they have 12 months from the date of the injury, or date of becoming aware of the injury, along with an additional three years from the date they turned 18 years of age to lodge a claim.

In certain circumstances, the TAC has the discretion to accept claims up to three years from the date of the accident if there are reasonable grounds for the delay.

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If you have not lodged a claim with the TAC and believe you have grounds to do so, you should obtain advice from Guardian Injury Law to ensure your rights and entitlements are protected.

What benefits are available from the TAC

1.  Medical and like expenses

Once your claim is accepted with the TAC, you are entitled to reasonable medical and like expenses for your accepted injuries.

In the first 90 days following the accident, you do not need to seek approval from the TAC for approved treatments, so long as they are recommended by your GP and are for the claimed injuries.

These include:

• Allied health treatment such as physiotherapy, chiropractic, occupational therapy, acupuncture, exercise physiology and orthotic and prosthetics;
• Ambulance services;
• X-rays and scans;
• GP appointments;
• Medication;
• Mental health and wellbeing services;
• Surgery in the first 3 months;
• Rehabilitation services; and
• Travel and accommodation.

Once the 90-day period has passed, your treating doctors will need to seek approval from the TAC for any treatment that is considered necessary and reasonable for the claimed injuries. Your doctors can also request home help, gardening assistance and swim/gym membership if required.

In order to claim any “out of pocket” expenses for treatment incurred as a result of your accident, receipts for expenses must be sent to the TAC within 2 years of incurring the expense. The TAC will not reimburse expenses outside of this two-year window.

2.  Loss of earnings (for lost wages)

If you are unable to work due to the injuries you have sustained in the transport accident, you will be entitled to lost wages from the TAC. To access these entitlements, you should obtain the required TAC Certificate of Capacity from your treating GP and provide a copy to the TAC and your employer. Note, this certificate is not simply a “sick certificate” – it is a specific TAC document that your GP will need to complete.

The TAC will pay 80% of your pre accident wages for the first 18 months of incapacity. This is called a loss of earnings benefit (LOE). If you are able to make a partial return to work during the first 18 months, the TAC will provide an 80% top up of the remaining lost wages.

The TAC will continue to pay lost wages at the rate of 80% for a further 18 months if you have no current work capacity – so, to a total of 36 months after your accident. These benefits are known as loss of earning capacity benefits (LOEC benefits).

LOEC benefits will cease after 18 months unless you have been assessed as having no current work capacity and your injuries have been assessed as having a greater than 50% whole person impairment in accordance with the 4^th edition of the American Medical Association Guides.  

3.  Impairment benefit – lump sum compensation

If you have sustained an injury which becomes permanent, you may be entitled to lump sum compensation called an impairment benefit (IB).

IB claims can be lodged 18 months after sustaining the injury and when the injury is stable.

To be successful with an IB claim, your injuries must be assessed as having a greater than 10% whole person impairment in accordance with the 4^th edition of the American Medical Association Guides.

Guardian Injury Law are experts in preparing IB claims to ensure that all of your injuries are assessed in order to maximise your entitlements.

Appealing decisions by the TAC

Sometimes the TAC may make a decision that you don’t agree with or a decision that seems unfair and unreasonable in the circumstances. This could be a decision to deny a treatment, refuse to pay an expense related to the injury or to deny your claim.

If this occurs, it is essential that you seek legal advice from Guardian Injury Law as soon as possible as you only have 12 months in which to appeal the decision.

Guardian Injury Law will provide you with clear advice regarding the decision, any grounds for appeal, the process and expected outcomes. We will guide you through the process, every step of the way.