The entitlement to ‘Medical and Like Expenses’ in TAC and WorkCover claimsAnna Vadaketh | |
The entitlement to ‘Medical and Like Expenses’ in TAC and WorkCover claims
- 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.
- 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.
- 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.
- A treater’s opinion is also important when an Authority is looking to terminate entitlements.
- 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.
- 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.