Forms for Clients

Start Navigation [Current Level] End Navigation [Current Level]

Forms used by TAC clients

Authority to pay entitlement: employer form

It is strongly recommended that you speak with a TAC claims manager or income officer prior to completing this form as it will have an effect on your income entitlement and tax obligations. Additionally, changes to future payments will not commence until contact has been made.

This form is for clients to authorise the TAC to make payments directly to their employer.

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.

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 

Complaints form

This form can be used to register complaints or dissatisfaction with the TAC. It also explains the process that will taken to investigate complaints. Alternatively, the TAC Complaints form as available online.

Electronic Funds Transfer (EFT) Authority Form

Please complete and return this form to the TAC to have your TAC payments directly deposited into your bank account by EFT.   This form can also be used if you wish to change the bank account the TAC is currently using.

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

This form can be used to claim general expenses. Itemised, original receipts must accompany the completed form.  Please note there are separate forms for claiming costs related to travel, accommodation, pharmacy, home services and medical excess.

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.

Medical excess declaration form

If the medical excess applies to you, you are responsible for the first $629 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

This form can be used for claiming pharmacy purchases, including prescription and over-the-counter medications, that you need as a result of your accident injuries. Itemised, original receipts need to be attached to the completed form.

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).

Visiting expenses form for family members of an injured client admitted to hospital

This form can be used by immediate family members of hospitalised clients to claim travel 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.