This information applies to transport accidents between 27 November 2007 and 13 February 2018. For any queries about the medical excess for earlier accidents, please contact the TAC policy team.
What is the medical excess?
The medical excess is the cost that a client may have to pay for medical treatment outside of hospital, such as visits to the doctor or physiotherapist
You are not responsible for paying the cost of other services such as ambulance and hospital treatment, because the medical excess does not apply to these services. This means the TAC can pay the reasonable cost of these services from the beginning of your claim.
To find out which treatments can be used to reach the excess and which are not subject to the excess, please refer to 'What services outside of hospital can be used to reach the excess?' in this policy.
The current medical excess amount is:
- $0 for accidents on 14 February 2018 or later
- $651 (applies to accidents on or after 1 July 2017)
- $629 for accidents between 1 July 2016 and 30 June 2017, or
- $623 for accidents between 1 July 2014 and 30 June 2016, or
- $599 for accidents between 1 July 2013 and 30 June 2014, or
- $584 for accidents between 1 July 2012 and 30 June 2013, or
- $564 for accident between 1 July 2004 and 30 June 2012.
Contact the TAC policy team for medical excess amounts for transport accidents before 1 July 2004.
Transport Accident Act 1986 references: s.3 'medical service' and s.43
You don't have to reach the medical excess if:
- Your accident date was on 14 February 2018 or later, or
- You or an immediate family member was admitted to hospital as an inpatient. The TAC will instead pay for the reasonable costs of your accident-related treatment from the time of your admission to hospital.
- An immediate family member dies as a result of the transport accident.
Immediate family members are partners, parents, children or siblings.
Please note: the TAC cannot waive the medical excess because you are experiencing financial hardship.
How to reach the medical excess
Each time you have treatment outside of a hospital, the total cost of that treatment will be considered towards the medical excess.
If Medicare or private health insurance covers part or all of your treatment, this refund will also be considered towards the medical excess. For example, if you visit the doctor and are bulk-billed for the treatment, the cost of that consultation (although not paid for by you) will still contribute to the medical excess.
A statement can be obtained from Medicare or your private health insurer which outlines expenses they have covered for your accident injuries.
Transport Accident Act 1986 reference: s.3'medical service' and s.43
How does the medical excess apply to your immediate family members in the same accident?
Where immediate family members have been injured in the same accident, only one medical excess amount will apply. Immediate family members are partners, parents, children or siblings.
Only one medical excess declaration form needs to be completed per family.
Transport Accident Act 1986 reference: s.3 'member of the immediate family'.
How does the 2-year time limit apply when it takes more than 2 years to reach the medical excess?
There is no time limit on the services that can be used to reach the medical excess. However, the TAC is unable to reimburse any medical services after the medical excess has been reached where the application for payment of those services is received more than 3 years after the date of accident or more than 2 years after the date of service. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.
What are hospital services?
A 'hospital service' includes medical treatment provided to you:
- as an in-patient in a hospital, or
- by the emergency, casualty, or outpatient department of a hospital
Investigative services (e.g. radiology and/or pathology) performed by private organisations upon referral by a hospital are also a hospital service, as long as they are directly related to the hospital visit.
Transport Accident Act 1986 reference: s.3'hospital service'
- Doctor (GP or specialist)
- Elective surgery not performed in a hospital
- Replacement of medical equipment damaged in the accident, e.g. prescription spectacles, mobility scooters
- Equipment required because of the accident injuries, e.g crutches, bandages, splints, et
- Hyperbaric oxygen therapy
- Medical reports not requested by the TAC
- Medication and chemist/pharmacy items, e.g. Prescription, Panadol, bandages, crutches, etc.
- Nutritional supplements/Special Food/Formula
- Pathology, e.g. bloodtests (when not referred by a hospital)
- Prosthetic services and prosthetics, e.g. shoe inserts
- Radiology, e.g. MRI or x-rays (when not referred by a hospital)