TAC surgery service charter

We understand that having surgery is an important part of your health and recovery.  We will be transparent and timely when we make a decision about paying for your surgery.

We are here to:

• support your recovery from your transport accident-related injuries, and
• make sure your surgery is in line with what we can pay for under the Transport Accident Act 1986.

Information we need from your surgeon

For us to make a decision about whether we can pay for your surgery, we need a request from your surgeon, which includes:

• a description of the surgery,
• why you need the surgery,
• how the surgery relates to your transport accident injuries,
• how the surgery will help you with your recovery, and
• any relevant diagnostic findings (like x-rays and pathology results).

Your surgeon can use the surgery request form to provide this information.

What you can expect from us

We will contact you within 10 business days to let you know we have received a request for your surgery.

Then, we will follow the steps below to make a decision about whether we can pay for your surgery.

If we have all the information we need to make a decision

We will review the information and let you and your surgeon know our decision within 20 business days of receiving the surgery request.

If we need more information to make a decision

1. We will contact you within 20 business days of receiving the surgery request to explain:
   1. what further information we need,
   2. what we are doing to get that information,
   3. if we have questions about the information already provided
2. Sometimes we need to ask for recommendations from a member of the TAC Clinical Panel, or an Independent Medical Examiner. This helps us make a decision in line with the Transport Accident Act. It ensures that the surgery request is reasonable and related to your transport accident.  If we need to do this, we will contact you within 20 business days of receiving the request to give you:
   1. an estimate of how long we think it will take to get information from the Clinical Panel. This can take up to 8 weeks.
   2. the details of any appointments made with an Independent Medical Examiner. These appointments can have a wait time of up to 6 months.
      
      In these cases, if you have a lawyer, or someone else helping you with your claim, we will also contact them to explain what we are doing. They might be able to help us get the information we need, as soon as possible.

3. We will make a decision about whether we can pay for your surgery within 20 business days of receiving the information and recommendations we need. We will write to you and your surgeon to let you know our decision.

We will keep you up to date

We will let you know when:

• we request more information, and from whom
• we send your request to the TAC Clinical Panel or an Independent Medical Examiner
• we make a decision.

If we can’t pay for your surgery, we will explain why

• We will explain your rights for review or appeal of our decision.
• There may be other ways to pay for your surgery. Talk with your surgeon or doctor about what is available through private health insurance or the public hospital system.

How to contact us about your request

If you need help with your surgery request or have any questions about your TAC claim, we're here to help. You can reach out to your TAC claims manager, who will be more than happy to assist you with any concerns or questions you have. Simply call their usual number.

Or, if you don't have your claims manager's number or would like to speak with someone else, call us on 1300 654 329. Our friendly and knowledgeable team is available Monday to Friday, 8.30am to 5.30pm to answer your call and help you with any questions or concerns.