Pre-existing and non-accident related injuries

We cannot pay for pre-existing and non-accident related injuries. We can only pay for treatments and services that are required as a result of a transport accident injury and not for a pre-existing condition.

When a patient is being treated for non-accident related injuries at the same time as accident related injuries, you may only invoice us for the treatment relating to the patient’s accident related injury.

Subsequent injuries

For an injury sustained after the transport accident, we will only accept liability if it is established that the subsequent injury is a direct result of the injury or injuries originally sustained in the transport accident.

Notify us if your patient has sustained a subsequent injury.

Exacerbation of a pre-existing injury

For a pre-existing injury aggravated as a result of a transport accident, we can help fund treatment for the exacerbation of that injury.

Notify us if your patient has sustained an exacerbation of an existing injury.

Treatment by an immediate family member

We cannot pay for treatment or services provided by a member of a client’s immediate family, unless exceptional circumstances exist such as:

• Treatment was provided in an emergency situation.
• A client resides in a remote area and the distance to access an alternative healthcare professional is excessive.

When the TAC client has been treated by a family member, care should be transferred to another suitably qualified healthcare professional as soon as practicable.

Services

We cannot pay for:

• Services for a person other than the client (except for family counselling where applicable).
• Services not related to the client’s transport accident injuries.
• Services subcontracted to, or provided by, a non-registered provider.
• Services provided outside the Commonwealth of Australia.
• Services where there is no National Health and Medical Research Council level 1 or 2 evidence that they are safe and effective. See: Non-established, new or emerging treatments and services policy.
• Fees associated with cancellation and non-attendance (unless the fee schedule for your occupation has specific items and rates for these items). If you have cancellation charges that the TAC does not cover, please advise clients of this in advance.

Expenses and travel

We cannot pay for:

• The cost of telephone calls and telephone consultations between two providers, a provider and a hospital and providers who have not been approved to provide telehealth services.
• Downtime between appointments or travel expenses unrelated to a consultation.

Invoices

We cannot pay for:

• Invoices submitted after two years from the date of service, or three years from the date of transport accident. See Time limit to apply for the payment of medical and like expenses policy.

Reports

We cannot pay for:

• The same medical report provided more than once – for example, a re-issue of a previous report or multiple copies.
• A consultation used for the purposes of preparing a medical report. When we request a report, please complete it using your existing clinical notes.
• Completion of a Certificate of Capacity as a separate invoice. This should be included as part of a consultation.
• Medical reports in advance of submission to the TAC.

For more information

Access specifics related to your profession in our provider guidelines.