How we make decisions
In the first 90 days after your accident:
- there are some treatments and services the TAC can help pay for
- you don't need to contact us for approval for these treatments and services.
We can do this because we have a good understanding of the types of treatments and services most people need after an accident.
You can see a list of these treatments and services here.
90 days after your accident, if you need more treatments and services, we will ask you and your providers for information. This helps us understand more about your injuries and the treatment and support you need. We also use this information to make decisions about what we can help pay for, and for how long.
Decision-making principles
The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:
1. Entitled
A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.
2. Reasonable
When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.
3. Clinical justification
When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:
- The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
- The treatment or service complies with the principles of the Clinical Framework in that it:
- results in a measurable benefit to the injured person
- reflects the adoption of a biopsychosocial approach
- empowers the client to self-manage their injury
- has goals focused on optimising function, participation and return to work and health
- is based on the best available research evidence.
- The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis. Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
- The treatment or service should be discontinued and the client discharged when either:
- the client can independently manage their recovery,
- the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
- there is no measurable benefit on outcome measure scores from continued treatments or services.
4. Outcome focused
When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.
Understanding a TAC decision
We will always communicate our decisions in writing to you. This written communication will clearly outline the following:
- what the decision is
- what information we considered in making the decision
- how you can ask for a review of the decision.
If you are unclear about why or how the TAC made a decision on your claim, then you should contact us for clarification.
You also have the right to any information that we considered when we made our decision. Find out more about how to get a copy of your TAC documentation.
If you disagree with a TAC decision
TAC clients have several options if they disagree with a TAC decision. You can learn more about our review process here.
