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Joint Medical Examination policy

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POLICY

The TAC can pay the reasonable costs of joint medical examinations (JMEs) requested by the TAC,  a client or the client's legal representative to determine impairment, initial or ongoing entitlement under the Transport Accident Act 1986 (the Act).

This policy refers to medico-legal reports and examinations conducted by an independent examiner. For information about reports written by a client's treating health practitioner, including any treatment notes or medical treatment reports refer to the Treating Health Practitioner (Medical) Reports requested by the TAC Policy.

A request from a solicitor for a JME will only be considered if:

  • the request is received at least 28 days before the examination service date
  • the request is submitted on the published TAC JME  Request form
  • the request is submitted via the TAC JME Requests email inbox

This policy must be read in conjunction with the following:

BACKGROUND

As a result of legislative changes, from 1 July 2014 the TAC is no longer liable to reimburse a solicitor for a medico-legal report obtained for a TAC matter, unless it is requested jointly by the TAC and the person who is injured.
 
The medical examiner will prepare one joint medical report to address questions from both the TAC and the client's legal representative.

A collaborative and transparent approach must be undertaken between the TAC, the client or their legal representative (referring parties) and the examiner.  The medical examiner should not contact either party separately or vice versa.

The TAC and client or their legal representative should use their best endeavours to reduce waiting times for clients and to improve client experience.

DEFINITIONS

In this policy:

  • Medical Examination is an examination and report completed by a non-aligned medical practitioner to assist in determining a client's entitlements under the Act.  This includes medico-legal reports
  • Impairment Assessment is an examination and report completed by an accredited Impairment Assessor to assist in determining a client's level of impairment under the Act.

GUIDELINES

What can the TAC pay for in relation to JMEs?

The TAC can pay the reasonable costs of authorised JMEs that are:

  • required as a result of the transport accident injury
  • reasonable, necessary or appropriate in the circumstances
  • prepared for the purposes of determining a client's degree of impairment under sections 46A, 47(7), 47(7A), 54 & 55 of the Act
  • prepared for the purposes of Part 6 or division 1 of Part 10 of the Act
  • prepared in order to respond to a decision of the commission under Parts 3 and 4 of the Act
  • prepared for the purposes of an application under s77 of the Act for the review of a decision of the Commission
  • prepared by a suitably qualified medical examiner or an impairment assessor.

The TAC can pay the reasonable travel, accommodation and interpreter costs for a client attending a JME or impairment examination.
 
A JME request may not be authorised:

  • if a medico-legal report has been obtained from the same discipline in the previous 12 months
  • if a medico-legal report has been obtained to assess the same injury by a different discipline in the previous 12 months
  • to assess injuries the TAC has no record of at the time the request is received
  • for the purpose of disputing a decision (s 60 or Originating Motion) unless a new issue is articulated
  • where the TAC has assessed a client as not likely to be eligible for an impairment entitlement at the time a joint request is received
  • if a client is not stable for the purposes of impairment at the time a joint request is received
  • where a TAC decision is not required
  • for the Course of Employment Transport Accident matters
  • for interstate Common Law unless the injured person has a TAC no-fault claim and is pursuing those entitlements.

A JME request will not be authorised:

  • if the client does not have an accepted claim where the request for a JME relates to treatment and there is no outstanding request for treatment on file
  • if a client is excluded from impairment in accordance with the Act

JME Supplementary reports 
The TAC can pay the reasonable cost of a JME supplementary report if agreed to by both parties. The published JME supplementary report fee will apply.

If agreement for a supplementary report cannot be reached, either party can obtain a supplementary report at their own expense.

Non-attendance at a JME appointment  
The TAC can pay the reasonable cost of non-attendance where a patient cannot attend or cancellation is not received within 72 hours of the appointment. 

How is a JME arranged?

A JME request initiated by the client or their legal representative must be submitted to the TAC via email using the JME Request Form.  The TAC will provide a written response to the client and their legal representative within 21 days from receipt of the request, advising of the TAC's decision; accepted, denied or pended (additional information required). Reasons for denial of a request will be outlined in the TAC response letter.

If insufficient information has been provided by the client or their legal representative to enable the TAC to make a decision then the client or their legal representative must re-submit a new request with the required information. The TAC will provide a written response within 21 days of receipt of the new request.

If the TAC does not respond within 21 days of receipt of a request then the JME request will be deemed to be accepted.

A JME requested by the client or their legal representative where no appointment has been arranged
If a client's legal representative submits a request for a JME without pre-booking the appointment and the request is approved by the TAC, the client's legal representative will be required to submit a new Joint Medical Examination Request form providing the appointment details at least 28 days prior to the booked appointment.

A JME arranged by the TAC
Where a JME has been arranged by the TAC with an examiner the TAC will provide a copy of the client's booking letter to the clients' legal representative. The TAC must advise the client's legal representative of any cancellations or reschedules in writing as soon as practicable.

What documents will be sent to the medical examiner prior to the appointment?

The referring party must send a copy of their instruction letter outlining their questions and a list of attached inclusions and documents to the other party no later than 28 days prior to the appointment date.

The non-referring party will then send their instruction letter including any additional questions and documents to the examiner ensuring that there is no duplication with the other party's original instructions or documents. Instruction letters including questions and documentation must be sent to the examiner at least 14 days prior to the appointment. Any correspondence to the examiner must be easily identifiable as joint documentation.

Both parties must include each other on all correspondence to the examiner and take all reasonable steps to avoid unnecessary duplication of questions and documents sent to the examiner.

Who can provide JMEs?

JMEs can only be provided by:

  • medical practitioners nominated by the TAC who have agreed to provide joint medical reports
  • impairment assessors who have relevant impairment assessment training as prescribed by the Act.

The TAC will agree to examinations with any appropriately qualified medical examiner nominated.

What information does the TAC require to consider paying for a JME?

The medical examiner should always submit a copy of their report and invoice with the JME item code to the TAC for payment.

What information does the TAC require in the report?

Examiners must put their concerns or comments in writing in the report negating the need to contact either party individually. The process must be collaborative and the report must be independent. The same rationale applies when a client's presentation does not correlate with the examination findings. Such observations must be captured in the examiner's report.

The report should be submitted to the TAC and the client or their legal representative within 10 working days of the examination occurring. If this time frame is unable to be met, the medical examiner should contact both the TAC and the client or their legal representative.

Joint medical examiners must send their completed report simultaneously to the TAC and the client's legal representative by mail.

What are the TAC's invoice requirements?

The TAC will only accept and process invoices from joint medical examiners. The TAC will not accept invoices for JMEs submitted by the client or their legal representative.

Refer to the:

What fees are payable for JMEs?

Refer to the relevant JME Fee Schedule.

In relation to JMEs, what won't the TAC pay for?

The TAC will not pay for:

  • the same JME provided more than once, for example a reissue of a previous report or multiple copies
  • services provided by telephone or other non face to face mediums
  • telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals.