Has TAC rejected your claim, stopped your benefits or reduced your benefits?

If you’re injured as a result of a transport accident in Victoria, you can lodge a claim for TAC benefits like medical expenses, loss of income and lump sum compensation. While the TAC does a lot to support people who have been injured in motor vehicle accidents, just like any other insurer the TAC makes decisions with one eye on saving money, and sometimes this means that people who need treatment and support are missing out.

As a result, at Polaris more and more of our clients are asking “what can I do to protect my TAC medical and income benefits?”

• Medical expenses: the TAC has an obligation to pay for medical and like expenses for as long as the request is reasonable and related to the accident injuries.
• Income support: unless a person has suffered a severe injury, the TAC can pay for loss of income benefits (which are capped) for up to 3 years after an accident.

Recently though, we’ve seen a spate of decisions from the TAC reducing or rejecting entitlements and benefits for our injured clients. Below are just a few examples of scenarios this is happening in.

1. Clients whose surgeons have requested surgery are having that request denied because a TAC internal consultant doesn’t think the treatment will help.
2. Doctors and other health professionals are being pressured to report to TAC that no more treatment is needed.
3. Income payments are being miscalculated or stopped for seriously and severely injured people.
4. Physiotherapy treatment is being stopped, with clients told that the injuries should have resolved by now.
5. Gardening and home help support is being cut off for injured clients, without reasons being given.
6. Psychological and psychiatric treatment support is being stopped for people continuing to experience trauma from accidents.

If you’re unhappy with a decision from TAC, for example rejecting your claim, terminating your benefits or reducing your benefits, there are a few things you need to do:

1. Ask for the decision in writing;
2. Speak to your treating doctors about the decision, particularly if the decision involves denying a request for treatment;
3. Seek advice from a personal injury lawyer experienced in TAC claims immediately.

When you engage Polaris to help you challenge a decision made by the TAC, we can help you dispute that decision.

You can also find out more information in our article “How do I challenge a TAC decision?”

When we help someone to challenge a decision, there are a number of steps which we need to go through. Usually, this will mean that it can take 2-4 months to:

1. investigate and analyse the medical material in your case;
2. ask your treating doctors for more information in support of your need for support or treatment;
3. provide TAC with reasons as to why the decision they made was wrong; and
4. engage with the TAC in an informal process called “Dispute Resolution Protocols” to try and resolve the dispute without you having to go anywhere near a court or a tribunal.

If the TAC makes a decision that you believe is incorrect, you have 12 months from the date of the TAC’s decision to dispute it.

No, your other TAC benefits and entitlements should not be affected by challenging the TAC’s decision.

For instance, if the TAC is paying you $600 per week in loss of earnings benefits and should be paying you $800 – they should continue to pay $600 until the decision has been successfully challenged.

If you challenge a decision rejecting a request for surgery, your entitlement to other medical treatment and support such as physiotherapy and medication should not be affected by your decision to challenge the TAC’s surgery rejection.

Getting your benefits back on track shouldn’t leave you out of pocket.

Generally, engaging Polaris to help you challenge the decision will be free of charge.

This is because when we successfully dispute a decision made by the TAC on your behalf, the costs will be paid by the TAC.

Sometimes, there will be bills which need to be paid in order to get extra medical information in support of the dispute. If we need this in your case, we will speak to you first and can offer to have those bills paid on your behalf and reimbursed when you win your claim, so that you aren’t required to make any up-front payment.

If you’ve had an adverse decision from TAC, acting fast is imperative.

We offer an obligation-free and cost-free consultation to give you a stress free opportunity to find out about your entitlements.

And if you have difficulty coming to our CBD office, we can speak with you over the phone or arrange to meet with you at a mutually convenient location, including in hospital.