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The entitlement to ‘Medical and Like Expenses’ in TAC and WorkCover claims

Anna Vadaketh | | Injury Law, Motor Vehicle Accidents, Workers' Compensation

The entitlement to ‘Medical and Like Expenses’ in TAC and WorkCover claims

 

  1. With accepted claims, both the Transport Accident Commission (‘TAC’) and the Victorian WorkCover Authority (‘WorkCover’) will fund the reasonable costs of a broad range of what are termed ‘medical and like expenses’. This refers to the costs of the associated treatment and/or support services required as a result of an accident or injury.

 

  1. These entitlements are available irrespective of who is to blame for the accident /injury and continue for as long as a person needs treatment for the injury. They include:
    • Ambulance and hospital services;
    • Medical consultations from Specialists and GPs, and nursing services;
    • Allied health therapies like as physiotherapy, gym and hydrotherapy, psychology and counselling;
    • Pharmaceuticals and pain management;
    • Home and community care like cleaning and gardening;
    • Rehabilitation and disability services including return-to-work programs; home and vehicle modifications and respite care.

 

  1. Active involvement in the management of such services by a treater is crucial. A request for approval of medical and like expenses usually requires a short letter to the insurer from a treater advising of the claimant’s name, claim number and date of injury; service required including duration and frequency; relation to the client's injury, and reason why the services or treatment would assist the patient. A clear and concise request linking the request to the injury leaves less room for rejection of the services.

 

  1. A treater’s opinion is also important when an Authority is looking to terminate entitlements.

 

  1. The relevant Authority is required to provide a written decision either approving or denying the request. Delays in providing a response or decision are common which then delays the patient getting the service. Unfavourable decisions can be challenged, however, a challenge can’t be mounted until a decision is made. Challenges must then be made within 60 days of the decision date for WorkCover claims and 12 months with TAC claims.

 

  1. Injury lawyers are familiar with these processes and can assist initially to expedite the making of a decision and/or by triggering the relevant dispute process with the relevant Authority.
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