Forms for Clients

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Coronavirus update

The TAC is unable to send or receive hard copy documents at this time. We have some different options for you to send us forms, documents or receipts for reimbursement.

Reimbursements

  • myTAC
    Please use our app or web portal, myTAC to ask for reimbursements. Go to upload documents > reimbursement form and send us a photo of your receipt or proof of payment and a description of what you've paid for.
  • Email
    If you can't use myTAC to send your receipts, please take a photo and email it to us at info@tac.vic.gov.au. Include your claim number in the subject line of your email so we can process your request.

Forms and documents

  • myTAC
    Please use our app or web portal, myTAC to send forms or documents. Go to upload documents > submit documents and send us a photo of your form or document.
  • Email
    If you can't use myTAC to send your forms or documents, please take a photo and email it to us at info@tac.vic.gov.au. Include your claim number in the subject line of your email so we can process your request.

Forms used by TAC clients

Authority to pay entitlement: employer form

Use this form to have your sick or annual leave reimbursed for time off work because of your accident injuries.

Authority to release information (client representatives)

This form is for clients to provide the TAC with permission to obtain information and documents from medical practitioners, government agencies, employers and other relevant parties regarding claim, health and employment details.

Complete the Authority to release information - client representative form online

Authority to release information (general)

This authority allows the Transport Accident Commission (TAC) to obtain any records or information which may affect your claim.  If you do not complete this form upon request, the TAC may not be able to assess your entitlements.

Complete the Authority to release information - general form online

Authority to release information (medical practitioner)

This authority allows the Transport Accident Commission (TAC) to obtain any records or information from the nominated medical practitioner which may affect your claim.  If you do not complete this form upon request, the TAC may not be able to assess your entitlements.

Complete the Authority to release information - medical practitioner form online

Bank details form for TAC clients

You can use this form to have your TAC payments deposited into your bank account by EFT.

You can also use this form to change your bank account details with us.

Certificate of Capacity form

The Certificate of Capacity form is for authorised providers to provide information about their TAC patient’s transport accident conditions and to assess and certify their capacity for work as a result of these injuries.

IMPORTANT NOTICE:
It is an offence under the legislation to provide false or misleading information. A person who provides a false or misleading certificate of capacity could be liable to prosecution.

Please provide feedback about the Certificate of Capacity to medicalcertificatefeedback@tac.vic.gov.au

Changes in family circumstances

Use this form if you are on LOEC and there is a change to your family circumstances.

Any changes to the number of dependants you have can effect your LOEC benefit.

Freedom of information (FOI) application form

This form can be used to make requests to the TAC to view or obtain copies of documents under Freedom of Information laws. It also details the application fees.

Freedom of information (FOI) application form - represented client

This form can be used by a client's representative to make requests to the TAC to view or obtain copies of documents under Freedom of Information laws. It also details the application fees.

Funeral and dependency benefits claim form

This form needs for be completed and returned to the TAC to claim funeral expenses and/or dependency benefits after a person has died as a result of a transport accident. The introduction section sets out what information and official documents need to be provided regarding the deceased person's spouse, partner and dependant children.

General reimbursement form

You can use this form to claim general reimbursements from the TAC.

Household support services declaration form

This form can be used to claim payment or reimbursement for household support services (required as a result of your accident injuries). Details that need to be completed include dates when services were provided, start/finish times, hourly rate and total cost.

Informal review request form

This form needs to be completed by clients (or their representative) to request an informal review of a claim decision or funding denial. It also outlines the TAC's process for acknowledging and assessing informal review requests.

This can be completed using the Online Informal Review form

Medical excess declaration form

If the medical excess applies to you, you are responsible for the first $651 of your treatment costs outside of hospital.  The medical excess declaration form needs to be completed when you have reached this amount.

Pharmacy (Chemist) declaration form

Use this form to claim pharmacy purchases. This includes prescription and over-the-counter medications that you need as a result of your accident injuries. You need to attach itemised, original receipts to the completed form.

Pharmacy Expenses Information Sheet (for TAC clients) This information sheet outlines the types of Pharmacy expenses the TAC can pay for, and what information is required to pay your pharmacy accounts.
Statement of earnings

If you are on LOEC, use this form to tell us about all your income, earnings and losses each year.

Under the Transport Accident Act 1986, all TAC clients receiving LOEC benefits need to complete this form each year.

Travel and Accommodation expenses for family members attending the funeral service of a TAC client

This form can be used by immediate family members of deceased clients to claim travel and accommodation expenses associated with attending their loved one's funeral.  Please note, to be eligible for reimbursement, immediate family members must reside more than 100km away from the place where the funeral, burial or cremation service was held.

Travel and accommodation expenses for family members visting an injured client admitted to hospital

This form can be used by immediate family members of hospitalised clients to claim travel and accommodation expenses associated with visiting their loved one/s. Please note, to be eligible for reimbursement, immediate family members must reside more than 100km away from the hospital.

Travel expense declaration form

This form is to be used when claiming reimbursement for travel (i.e. private vehicle, public transport and/or taxi) expenses to attend: medical treatment for accident injuries; medical examinations arranged by the TAC; approved rehabilitation or disability services; or work, if you are participating in a formal Return to Work program.

Travel to work declaration form

This form is for claiming expenses related to travel (by private car, public transport and/or taxi) to work. (Claims for travel expenses to attend medical treatment and/or rehabilitation need to be made using a separate form titled Travel Expenses: Declaration).