TAC Claim - What medical treatment will the TAC pay for?

What medical treatment will the TAC pay for?

After a transport accident, medical treatment is central to your recovery, but our clients can be concerned about the cost of such treatment and how they will pay for it. The TAC scheme means that the TAC pays for the reasonable cost of medical treatment required because of any injuries sustained in a transport accident.  Understanding what's covered, how to access pre-approval, and which services are funded helps you navigate your rehabilitation effectively. 

Reasonable and necessary treatment

TAC is required to fund treatment that is reasonable, clinically appropriate, and required because of the transport accident injury. In assessing whether treatment will be paid for, TAC may consider:

• whether the treatment is related to the accident injury;

• whether it is supported by medical or allied health evidence;

• whether it is likely to assist recovery, maintain function, or manage symptoms;

• whether it is being provided by an appropriately qualified and recognised practitioner; and

• whether the cost is reasonable.

Examples of treatment TAC may cover

Depending on the circumstances, TAC may pay for:

• GP consultations;

• ambulance and emergency treatment;

• hospital treatment and surgery;

• specialist consultations;

• physiotherapy;

• occupational therapy;

• psychology and other mental health treatment;

• speech pathology;

• podiatry where clinically relevant;

• some chiropractic or similar allied health treatment, subject to TAC requirements;

• prescribed medication;

• imaging such as X-rays, CT scans, and MRIs;

• rehabilitation services;

• aids, equipment, and some other treatment-related supports.

Approval requirements

Some treatment can be accessed without prior approval, particularly in the early stages of recovery. Other treatment requires prior TAC approval, a treatment plan, or compliance with TAC policy settings, session limits, or provider requirements. Before commencing surgery, high-cost treatment, extended rehabilitation, or non-standard therapy, it is sensible to confirm TAC’s approval position.

What TAC may not pay for

TAC may decline to pay for treatment that:

• is not related to the transport accident;

• is not clinically justified;

• is excessive, inappropriate, or outside accepted practice;

• is provided by a practitioner who is not appropriately registered, recognised, or acting within scope;

• is not approved where prior approval is required; or

• is not considered reasonable in cost.

Cosmetic treatment is generally not funded unless it is medically justified as part of treatment for accident-related injury, including disfigurement.

Ongoing treatment and rehabilitation

TAC may fund ongoing treatment where it is reasonably required to support recovery, maintain function, prevent deterioration, assist independence, or facilitate return to work and daily activities. Ongoing treatment is not automatically funded indefinitely and may be reviewed from time to time.

Complementary or alternative therapies

Complementary or non-standard therapies are not automatically covered. Whether TAC will pay depends on the nature of the treatment, the provider, the supporting clinical evidence, and TAC policy. Approval should be checked before incurring expense.

If TAC refuses treatment

If TAC declines to pay for treatment, that decision can be reviewed. The outcome usually turns on the quality of the medical evidence and whether the treatment can be shown to be accident-related, reasonable, and clinically justified.

How Grainger Legal can help 

We can assist with accessing treatment by advising what information the TAC is likely to require, helping gather medical reports and treatment plans, and dealing with the TAC about approval and payment issues.  If a treatment request is refused or limited, we will explain the decision to you, advise whether it should be reviewed or challenged, and help obtain the medical evidence needed to support reconsideration.

If the TAC has refused or limited your medical treatment, contact our team to discuss your options.

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