Post Hospital Support Payments

This policy applies to TAC clients discharged from hospital on or after 1 March 2005.

Policy

The TAC can pay the reasonable post hospital support payments, under section 60A of the Transport Accident Act 1986 (the Act), for an injury resulting from a transport accident if:

a person receives hospital services as an inpatient or for day surgery
the hospital services were received at least three years after the transport accident occurred
while in hospital, or while recovering from the treatment he or she received in the hospital, the person
- suffers a loss of wages
- needs assistance with child care, home services or post acute support.

Background

Post hospital support payments should only be accessed once all other entitlements under the Act have expired, such as home services and post acute support under section 60(2)(d) and loss of wages under sections 44, 45, 49 or 50.

The TAC will assess a client's entitlement to services or benefits under the other provisions of the Act first to preserve post hospital support for the client's future use. Post hospital support payments are limited because a maximum statutory cap is placed on the amount that can be paid.

Post hospital support payments will be made as a reimbursement to the client or client's employer once the TAC has received the required information as outlined in this policy.

This policy must be read in conjunction with the following:

Definitions

In this policy:

Post acute support is the provision of assistance to, or for, a person who requires support in personal care, mobility, transfers, banking or shopping after being discharged from a hospital.
Post hospital support payments include a singular support or a combination of multiple supports that may be required after receiving hospital services. These include wage support, child care support, home support and post acute support. Post hospital support payments for loss of wages and services required due to a hospital admission are unique to this policy and do not reflect equivalent services and benefits of a like nature funded under the other provisions of the Transport Accident Act 1986.
Hospital services are services a client receives while in hospital as an in-patient, or for day surgery as the consequence of their transport accident injuries, but excludes any outpatient or casualty visit.
Home support includes home services and household help.

Guidelines

What can the TAC pay for in relation to post hospital support payments?

The TAC can consider reimbursing the following services to an eligible client:

child care services
home services
post acute support
loss of wages.

Sick leave or annual leave

Where an employer has already paid the client sick leave or annual leave, the TAC can reimburse the employer the client's post hospital support loss of wages entitlement under s.126(1A) of the Act. This will allow the client's sick or other leave entitlements to be reinstated.

When requesting a reimbursement to the employer a client must complete and return the Authority to pay entitlement: employer form.

Client's who have received a common law settlement

A TAC client who has received a common law settlement may be eligible to receive post hospital support. However, a client will not be entitled to post hospital support in the form of lost wages if the settlement included a future pecuniary loss component. Refer to s.93(18A) of the Act.

Maximum statutory amount

The maximum statutory amount that will apply to each client's claim is the maximum statutory amount that was in place at the time of the hospital admission when the client first received post hospital support payments. If the amount is not fully used after the client's first hospital admission, the remaining amount will be carried forward for any future hospital admission.

Calculation of post hospital support loss of wages payments

For an employee, the TAC will obtain the total gross loss of wages, then work out the daily loss and multiply this figure by the number of days the employee was absent from work (as supported by a certificate of capacity).

For a Self-Employed person, determining the actual loss of wages may require a more detailed review. The TAC’s Specialist income team can provide assistance in determining this.

However, the TAC cannot pay a gross amount for loss of wages for a daily loss that exceeds one-fifth of the current statutory maximum amount for loss of earnings. For the current statutory maximum amount refer to Indexed Statutory Amounts.

Are post hospital support loss of wages payments taxed and does the TAC issue an annual payment summary or income statement?

If paid directly to the client, loss of wages through post hospital support is a taxable payment and the TAC will issue a payment summary at the end of each financial year it has been paid.

If paid as a reimbursement to an employer to reinstate leave entitlements, loss of wages through post hospital support will not have tax withheld by TAC as this is taxable when entitlements are paid by the employer. A payment summary will not be issued if a reimbursement to employer is made.

Who can provide post hospital support services?

The TAC can only reimburse a client for child care, post acute support or home support services when provided by a person authorised by the TAC. See below

Post acute support - must be provided by an attendant care agency that is a signatory to the Disability Services Agreement or that meets service provider eligibility criteria for attendant care agencies. Refer to the Schedule 2 Authorised Disability Services and the Attendant Care policy
Child care – must be provided by a provider of Approved Child Care. Refer to the Support at Home policy
Home support services - must be provided by an agency or an individual who has been authorised by the TAC.

What information does the TAC/Agent require to consider paying for post hospital support services?

If a client requires support services (child care, home services or post acute support), a detailed request from the client's treating medical practitioner which contains the following information is required:

The client's name, date of accident and claim number
The transport accident injury or injuries
The date the client was admitted to hospital as an in-patient or day surgery patient and the relationship this has to the transport accident injury
The type of assistance the client requires, such as child care, home support services or post acute support services
How many times or hours per week the assistance is required and the expected duration of the service.

If a client requires support for loss of wages, they should also provide the TAC with a certificate of capacity outlining the period of time the client is expected to be unfit for work and the following documentation:

For an employee - current pay slips and a letter from the employer confirming sick leave or other leave will not be paid
For a self-employed client - relevant taxation returns and verification of any substitute labour employed.
To ensure the correct amount of tax is deducted we also require a completed Tax File Number declaration form. If you choose not to provide this form we will deduct tax at the highest marginal rate.

The client is expected to obtain written prior approval from the TAC before starting services. The TAC's approval letter will outline the:

type of service(s) approved
period/duration of the services approved
amount the TAC agrees to pay.

When will the TAC respond to a request?

The TAC will respond to written treatment and service requests as set out in the TAC Service Charter.

What fees are payable for post hospital support services?

Refer to the following:

In relation to post hospital support services, what won't the TAC reimburse?

The TAC will not reimburse:

treatment or services for a person other than the client (except for child care)
payment for services that exceed the maximum statutory amount
lost wages for a client if their common law settlement included a future pecuniary loss component
treatment or services subcontracted to, or provided by a non-registered provider
fees associated with cancellation or non attendance
treatment or services provided outside the Commonwealth of Australia
the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
treatment or services provided more than two years prior to the request for funding except where the request for payment is made within three years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.


Post Hospital Support Payments This policy applies to TAC clients discharged from hospital on or after 1 March 2005. Policy The TAC can pay the reasonable post hospital support payments, under section 60A of the Transport Accident Act 1986 (the Act), for an injury resulting from a transport accident if: a person receives hospital services as an inpatient or for day surgery the hospital services were received at least three years after the transport accident occurred while in hospital, or while recovering from the treatment he or she received in the hospital, the person suffers a loss of wages needs assistance with child care, home services or post acute support. Background Post hospital support payments should only be accessed once all other entitlements under the Act have expired, such as home services and post acute support under section 60(2)(d) and loss of wages under sections 44, 45, 49 or 50. The TAC will assess a client's entitlement to services or benefits under the other provisions of the Act first to preserve post hospital support for the client's future use. Post hospital support payments are limited because a maximum statutory cap is placed on the amount that can be paid. Post hospital support payments will be made as a reimbursement to the client or client's employer once the TAC has received the required information as outlined in this policy. This policy must be read in conjunction with the following: Attendant Care policy Schedule 2 Authorised Disability Services Support at Home policy Loss of Earning Capacity Benefits policy. Definitions In this policy: Post acute support is the provision of assistance to, or for, a person who requires support in personal care, mobility, transfers, banking or shopping after being discharged from a hospital. Post hospital support payments include a singular support or a combination of multiple supports that may be required after receiving hospital services. These include wage support, child care support, home support and post acute support. Post hospital support payments for loss of wages and services required due to a hospital admission are unique to this policy and do not reflect equivalent services and benefits of a like nature funded under the other provisions of the Transport Accident Act 1986. Hospital services are services a client receives while in hospital as an in-patient, or for day surgery as the consequence of their transport accident injuries, but excludes any outpatient or casualty visit. Home support includes home services and household help. Guidelines What can the TAC pay for in relation to post hospital support payments? The TAC can consider reimbursing the following services to an eligible client: child care services home services post acute support loss of wages. Sick leave or annual leave Where an employer has already paid the client sick leave or annual leave, the TAC can reimburse the employer the client's post hospital support loss of wages entitlement under s.126(1A) of the Act. This will allow the client's sick or other leave entitlements to be reinstated. When requesting a reimbursement to the employer a client must complete and return the Authority to pay entitlement: employer form. Client's who have received a common law settlement A TAC client who has received a common law settlement may be eligible to receive post hospital support. However, a client will not be entitled to post hospital support in the form of lost wages if the settlement included a future pecuniary loss component. Refer to s.93(18A) of the Act. Maximum statutory amount The maximum statutory amount that will apply to each client's claim is the maximum statutory amount that was in place at the time of the hospital admission when the client first received post hospital support payments. If the amount is not fully used after the client's first hospital admission, the remaining amount will be carried forward for any future hospital admission. Calculation of post hospital support loss of wages payments For an employee, the TAC will obtain the total gross loss of wages, then work out the daily loss and multiply this figure by the number of days the employee was absent from work (as supported by a certificate of capacity). For a Self-Employed person, determining the actual loss of wages may require a more detailed review. The TAC’s Specialist income team can provide assistance in determining this. However, the TAC cannot pay a gross amount for loss of wages for a daily loss that exceeds one-fifth of the current statutory maximum amount for loss of earnings. For the current statutory maximum amount refer to Indexed Statutory Amounts. Are post hospital support loss of wages payments taxed and does the TAC issue an annual payment summary or income statement? If paid directly to the client, loss of wages through post hospital support is a taxable payment and the TAC will issue a payment summary at the end of each financial year it has been paid. If paid as a reimbursement to an employer to reinstate leave entitlements, loss of wages through post hospital support will not have tax withheld by TAC as this is taxable when entitlements are paid by the employer. A payment summary will not be issued if a reimbursement to employer is made. Who can provide post hospital support services? The TAC can only reimburse a client for child care, post acute support or home support services when provided by a person authorised by the TAC. See below Post acute support - must be provided by an attendant care agency that is a signatory to the Disability Services Agreement or that meets service provider eligibility criteria for attendant care agencies. Refer to the Schedule 2 Authorised Disability Services and the Attendant Care policy Child care – must be provided by a provider of Approved Child Care. Refer to the Support at Home policy Home support services - must be provided by an agency or an individual who has been authorised by the TAC. What information does the TAC/Agent require to consider paying for post hospital support services? If a client requires support services (child care, home services or post acute support), a detailed request from the client's treating medical practitioner which contains the following information is required: The client's name, date of accident and claim number The transport accident injury or injuries The date the client was admitted to hospital as an in-patient or day surgery patient and the relationship this has to the transport accident injury The type of assistance the client requires, such as child care, home support services or post acute support services How many times or hours per week the assistance is required and the expected duration of the service. If a client requires support for loss of wages, they should also provide the TAC with a certificate of capacity outlining the period of time the client is expected to be unfit for work and the following documentation: For an employee - current pay slips and a letter from the employer confirming sick leave or other leave will not be paid For a self-employed client - relevant taxation returns and verification of any substitute labour employed. To ensure the correct amount of tax is deducted we also require a completed Tax File Number declaration form. If you choose not to provide this form we will deduct tax at the highest marginal rate. The client is expected to obtain written prior approval from the TAC before starting services. The TAC's approval letter will outline the: type of service(s) approved period/duration of the services approved amount the TAC agrees to pay. When will the TAC respond to a request? The TAC will respond to written treatment and service requests as set out in the TAC Service Charter. What fees are payable for post hospital support services? Refer to the following: Home Services - Non Preferred Providers Fee Schedule Home Services – Preferred Providers Fee Schedule Attendant Care Fee Schedule In relation to post hospital support services, what won't the TAC reimburse? The TAC will not reimburse: treatment or services for a person other than the client (except for child care) payment for services that exceed the maximum statutory amount lost wages for a client if their common law settlement included a future pecuniary loss component treatment or services subcontracted to, or provided by a non-registered provider fees associated with cancellation or non attendance treatment or services provided outside the Commonwealth of Australia the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals treatment or services provided more than two years prior to the request for funding except where the request for payment is made within three years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.