Acupuncture involves inserting fine needles into specific points on the skin or applying various other techniques to the acupuncture points to encourage the body to heal itself.

The TAC can pay the reasonable cost of acupuncture provided to TAC clients which is required as a result of transport accident injuries.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC will pay the reasonable cost of acupuncture services. This includes:

• acupuncture consultations, which may involve:
  • assessing injuries
  • providing manual therapy
  • developing treatment plans and reviewing progress
• completion an Allied Health Treatment and Recovery Plan when requested by the TAC.

The TAC will pay for treatment and services according to the Acupuncture fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

The TAC won't pay for:

• services that are not required for the treatment of transport accident-related injuries.
• services provided by individuals who do not meet the provider guideline requirements or comply with the Allied Health Policy
• services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• Acupuncture provided by students or by practitioners who are not registered with AHPRA.
• Chinese herbal medicine.
• Acupuncture when the client is receiving concurrent treatment from another allied health or medical professional, except in exceptional circumstances. See the Allied Health Policy for further information.

Further information can be found at What we cannot pay for.

Within the first 90 days of a client’s accident, the TAC can help pay for acupuncture services without the need for prior TAC approval. The TAC may contact clients or their service providers to discuss client progress and ensure that treatment is clinically justified and outcome focused.

If a client needs acupuncture beyond 90 days after their transport accident, the TAC must provide approval before TAC-funded treatment can be delivered. Prior approval is also needed if it has been more than 6 months since the client last received TAC-funded treatment.

To request further treatment, acupuncturists must complete an Allied Health Treatment and Recovery Plan. The TAC will use this information to consider if the client is receiving treatment that aligns with the Clinical Framework and continues to be reasonable, clinically justified and outcome focused. Based on this assessment, the TAC will inform the provider and client about what the TAC will help pay for and for how long.

To provide TAC-funded acupuncture, a practitioner must:

• Be registered:
  • As a Chinese medicine practitioner in the Division of Acupuncturists under the Health Practitioner Regulation National Law (AHPRA)
  • To practice as an acupuncturist under Section 97 of the Health Practitioner Regulation National Law. For example, allied health professionals who are endorsed by the Osteopathy or Physiotherapy Boards of Australia to practice as acupuncturists.
• Comply with the TAC Allied Health policy.
• Adhere to the principles of the Clinical Framework for the Delivery of Health Services.

Promoting independence and avoiding treatment dependence

In line with Principle 3 of the Clinical Framework, the TAC expects that providers of acupuncture promote independence from treatment through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies to empower the injured person to manage their injury and discourage overreliance on treatment should be incorporated in all phases of recovery. Further guidance on promoting injury self-management is available in the Clinical Framework.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

Allied Health Assistants work within a particular scope of practice and undertake tasks that are delegated to them by a treating Physiotherapist, Occupational Therapist or Speech Pathologist, who provide supervision and direction. The Allied Health Assistance service is provided by an Allied Health Assistant with the appropriate Victorian Government grade and is covered by or holds relevant insurances.

An Allied Health Assistant may work in clinics and the community to assist TAC clients with achieving rehabilitation and recovery goals and maintaining optimal function for those with disability and promoting independence by delivering quality, cost-effective support.

The TAC expects a treating Allied Health Professional to identify when a TAC client would benefit from clinical support from an Allied Health Assistant delivering these delegated services or when the support is more appropriately delivered by an Attendant Carer.

The TAC can pay the reasonable cost of Allied Health Assistance provided to TAC clients which is required as a result of transport accident injuries. The treating Allied Health Professional will recommend when to engage Allied Health Assistance to deliver quality, delegated treatment in a cost-effective manner.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

The TAC will pay the reasonable cost of Allied Health Assistance in line with the provider’s grading and the published TAC fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the paying for treatment and services page of this website.

The TAC can pay for provider travel when the client is medically unfit to travel or where treatment in the client’s functional environment is clinically justified. Prior written approval from the TAC is required before provider travel can be paid.

• services that are not required for the treatment of transport accident-related injuries
• services provided by individuals who do not meet the Provider Guideline requirements or comply with the Allied Health policy
• services that are not evidence based, reasonable, clinically justified and outcome focused
• non-clinical support including assistance with daily living and assisting the client with travel as these are considered Attendant Care services.
• Allied Health Assistance billed under an Allied Health Professional fee code

For further information see what the TAC cannot pay for.

The treating Physiotherapy, Occupational Therapy or Speech Pathology Allied Health Professional must seek TAC approval before funded treatment can be delivered by an Allied Health Assistant. Prior approval is also needed if it has been more than 6 months since the client last received TAC-funded treatment.

The TAC will use information provided by the treating Allied Health Professional to consider if the treatment aligns with the Clinical Framework and is reasonable, clinically justified and outcome focused. Based on this assessment, the TAC will inform the provider and client about what the TAC can pay for and for how long.

Further treatment must be requested by the treating Allied Health Professional.

To provide TAC funded Allied Health Assistance, the Allied Health Assistant must:

• register with the TAC through an Allied Health Professional’s recommendation to provide Allied Health Assistance to an existing client
• comply with the Allied Health policy
• be covered by the appropriate insurances of the supervising Allied Health Professional or hold all relevant insurances in the case of an Allied Health Assistant external to the Allied Health Professional’s practice
• meet relevant worker screening requirements where applicable e.g. police check, Working with Children Check, Working with Vulnerable People check
• meet the Victorian Government Allied Health Assistance grading system requirements:

The treating Allied Health Professional may engage Allied Health Assistants at the rates approved by the TAC. Allied Health Assistance cannot bill at the same rate as an Allied Health Professional.

Allied Health Professionals must ensure their insurance policy covers employing an Allied Health Assistant. When engaging an Allied Health Assistant external to their practice, Allied Health Professionals must ensure the external Allied Health Assistant holds the appropriate insurances and where relevant a current police check, working with children check and/or working with vulnerable people check.

Allied Health Professionals are expected to:

• provide the TAC upon request with a written program of activity when delegating to a Grade 2 or 3 Allied Health Assistant, as part of the Allied Health Professionals reporting requirement
• recommend and delegate to appropriately experienced and qualified Allied Health Assistants
• ensure Allied Health Assistants are following the prescribed delegated program of activity while supporting the client to achieve their TAC approved goal
• identify when a TAC client requires clinical support from an Allied Health Assistant delivering rehabilitation services or when the support is more appropriately delivered by Attendant Care disability services such as disability maintenance and non-clinical support e.g. support with daily living

Allied Health Assistance Service Standards

An Allied Health Assistant must follow the professional standards of the delegating Allied Health Professional.

It is expected that Allied Health Assistance services:

Promote High Value Service

Allied Health Assistance aims to support and deliver the approved service to support best client outcomes under the supervision and delegation of the client’s treating Allied Health Professional. Providers should avoid client dependence, unnecessary or low-value services that do not promote best client outcomes.

Are delivered in an appropriate format by providers with necessary skills and specialised knowledge

The TAC recognises that providers who specialise in a specific area are more likely to achieve positive client outcomes. The Allied Health Assistant is expected to:

• be equipped with relevant or specialised skills and knowledge directly related to the client’s TAC approved goals
• work within a defined scope of practice, only undertaking tasks which they are competent to do
• ask the supervising Allied Health Professional for guidance if they feel they are not able or adequately prepared to carry out any aspect of their work, or if unsure how to safely and effectively complete a task.

The TAC uses the following principles to aid socially and economically responsible decision-making in line with the Transport Accident Act 1986:

The treating Allied Health Professional will recommend when to engage Allied Health Assistance to deliver quality, delegated treatment in a cost-effective manner.

1. Entitled

TAC clients are entitled to Allied Health Assistance if:

• the TAC has accepted liability for the accident-related injury that relates to the Allied Health Assistance service, and
• the treating Allied Health Professional has recommended Allied Health Assistance

2. Reasonable

When determining if Allied Health Assistance is reasonable, the TAC considers whether the cost of the service is an appropriate, cost-effective support for Allied Health Professional services under Occupational Therapy, Physiotherapy, or Speech Pathology.

When determining whether Allied Health Assistance is a reasonable cost, the TAC considers:

• if the Allied Health Assistance service is necessary as a quality, cost-effective support for approved Allied Health Professional services under Occupational Therapy, Physiotherapy, or Speech Pathology
• If the supports cannot be provided by an existing treatment/service provider (for example, the client’s existing attendant care provider)
• if the cost of the service is reasonable in relation to the service (refer to the TAC fee schedule).

3. Clinically Justified

When deciding if Allied Health Assistance is clinically justified, the TAC considers whether:

• Allied Health Assistance is clinically appropriate for the client’s transport accident injuries and presentation
• the treatment complies with the principles of the Clinical Framework
  • treatment should result in a measurable benefit to the injured person
  • the treatment adopts a biopsychosocial approach
  • the treatment empowers the client to self-manage their injury
  • the treater implements goals focused on optimising function, participation and return to work/health
  • the treatment is based on the best available research evidence.
• the duration and frequency of treatment is appropriate in relation to the client’s condition and their recovery. These factors are assessed on a case-by-case basis. Treatment sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• treatment should be discontinued, and the client discharged when:
  • the client can independently manage their recovery
  • the client reaches a phase of maintenance and further treatment is more appropriately supported by an Attendant Care disability service under the direction of the treating Allied Health Professional
  • there is no measurable benefit from continued treatment

4. Outcome Focused

The TAC assesses whether Allied Health Assistance services are outcome focused by monitoring progress toward approved individualised recovery or care goals.

For more information on TAC decision making, see the How we make decisions page.

Chiropractors are health professionals who diagnose neuro-musculoskeletal conditions and recommend appropriate evidence-based treatment. Chiropractic treatment may include manual therapy, exercise prescription, education and development of self-management strategies. Clients can find a chiropractor on the Chiropractic Australia website or Australian Chiropractors Association website.

The TAC can pay the reasonable cost of chiropractic services provided to TAC clients which are required as a result of transport accident injuries.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC will pay the reasonable cost of chiropractic services. This includes:

• chiropractic consultations, which may involve:
  • assessing and diagnosing injuries
  • developing treatment plans and reviewing progress using outcome measures
  • conducting psychosocial screening
  • providing education, manual therapy and exercise-based treatment
  • preparing Certificates of Capacity
  • monitoring & evaluating independent exercise programs
• x-rays and radiological services provided by licensed chiropractors in accordance with advice for chiropractors on the use of radiography (x-rays) from the Chiropractic Board of Australia
• provider travel when the client is medically unfit to travel or where treatment in the client’s functional environment is clinically justified (included as part of the out of rooms consultation fee)
• equipment in accordance with the Medical and rehabilitation equipment policy
• completion of an Allied Health Treatment and Recovery Plan when requested by the TAC.

The TAC will pay for treatment and services in accordance with the Chiropractic fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

The TAC won't pay for:

• services that are not required for the treatment of transport accident-related injuries
• services provided by individuals who do not meet the provider guideline requirements or comply with the Allied Health Policy
• services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• Chiropractic treatment provided by students or by practitioners who are not registered with AHPRA.
• X-rays and radiological services provided by chiropractors who do not hold a radiation use license.
• X-rays and radiological services requested by chiropractors which do not meet advice for chiropractors on the use of radiography (x-rays) from the Chiropractic Board of Australia.
• Full spine x-rays.
• More than two spinal radiological items (C1-C11) from the Chiropractic fee schedule for the same patient for the same injury.
• Exercise attire and footwear.
• Concurrent treatment where a client is receiving chiropractic treatment at the same time as physiotherapy or osteopathy for the same injury, except in exceptional circumstances. See the Allied Health Policy for further information.
• Concurrent chiropractic treatment and exercise physiology unless it is required for a brief handover period as part of a coordinated rehabilitation program. It is expected that chiropractic treatment will cease as exercise physiology treatment progresses. Concurrent chiropractic treatment and exercise physiology may be approved for clients with severe injury and permanent disability as part of their MyPlan if clinically justified.

Further information can be found at What we cannot pay for.

Within the first 90 days of a client’s accident, the TAC can help pay for chiropractic services without the need for prior TAC approval. The TAC may contact clients or their service providers to discuss client progress and ensure that treatment is clinically justified and outcome focused.

If a client needs chiropractic treatment beyond 90 days after their transport accident, the provider must seek TAC approval before funded treatment can be delivered. Prior approval is also needed if it has been more than 6 months since the client last received TAC-funded treatment.

Chiropractors must complete an Allied Health Treatment and Recovery Plan to request further treatment. The TAC will use this information to consider if the client is receiving treatment that aligns with the Clinical Framework and continues to be reasonable, clinically justified and outcome focused. Based on this assessment, the TAC will inform the provider and client about what the TAC will help pay for and for how long.

To provide TAC-funded chiropractic services, a chiropractor must:

• be registered under the Health Practitioner Regulation National Law (AHPRA) to practice in the chiropractic profession (other than as a student)
• comply with the TAC Allied Health policy
• adhere to the principles of the Clinical Framework for the Delivery of Health Services.

Promoting independence and avoiding treatment dependence

In line with Principle 3 of the Clinical Framework, the TAC expects that chiropractors promote independence from treatment through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies to empower the injured person to manage their injury and discourage overreliance on treatment should be incorporated in all phases of recovery. Further guidance on promoting injury self-management is available in the Clinical Framework.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

Exercise physiology treatment involves the development and application of specialised exercise programs and interventions to aid recovery and independence after injury or surgery. Exercise physiologists provide information and advice about exercise and develop and monitor individualised exercise programs that are safe, effective and appropriate for the person.

Exercise physiologists aim to equip clients with the necessary skills and knowledge to progress their own exercise program independently. Exercise physiologists do not diagnose injuries or provide hands on treatment. Clients can find an accredited exercise physiologist on the Exercise and Sports Science Australia website.

The TAC can pay the reasonable cost of exercise physiology services provided to TAC clients which are:

• required as a result of transport accident injuries
• for treatment of a condition that has been diagnosed by a medical or allied health professional.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC will pay for exercise physiology treatment. This includes:

• exercise physiology consultations, which may involve:
  • developing treatment plans for a diagnosed transport accident injury
  • reviewing progress using outcome measures
  • conducting psychosocial screening
  • supervising individual exercise programs
  • developing, monitoring and evaluating a gym or pool program
  • transitioning clients from provider-led treatment to self-management
• group consultations (between two and six patients being treated in the same treatment session) led by an accredited exercise physiologist
• basic exercise equipment prescribed by an accredited exercise physiologist, such as hand weights, therabands and exercise balls
• completion of an Allied Health Treatment and Recovery Plan when requested by the TAC.

The TAC will pay for treatment and services according to the Exercise physiology fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

The TAC won't pay for:

• services that are not required for the treatment of transport accident-related injuries.
• services provided by individuals who do not meet the provider guideline requirements or comply with the Allied Health Policy
• services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• Exercise physiology provided by a person who is not accredited by ESSA as an exercise physiologist (for example, personal trainers).
• Exercise attire, swimwear and footwear.
• The cost incurred by the exercise physiologist for admission to a gym or aquatic centre.
• Travel time to attend a gym or aquatic centre, as this cost is included in the scheduled fee.
• Specialised equipment prescribed / requested by an exercise physiologist.
• Concurrent exercise physiology at the same time as physiotherapy, osteopathy or chiropractic treatment unless it is clinically justified in the acute recovery phase or required for a brief handover period as part of a coordinated rehabilitation program. It is expected that physiotherapy, osteopathy or chiropractic treatment will cease as exercise physiology treatment progresses. Concurrent treatment may be approved for clients with severe injury and permanent disability as part of their MyPlan. See the Allied Health policy for further information.

Further information can be found at What we cannot pay for.

Within the first 90 days of a client’s accident, the TAC can help pay for exercise physiology services without the need for prior TAC approval. The TAC may contact clients or their service providers to discuss client progress and ensure that treatment is clinically justified and outcome focused.

If a client needs exercise physiology beyond 90 days after their transport accident, the provider must seek TAC approval before funded treatment can be delivered. Prior approval is also needed if it has been more than 6 months since the client last received TAC-funded treatment.

Exercise physiologists must complete an Allied Health Treatment and Recovery Plan for further treatment. The TAC will use this information to consider if the client is receiving treatment that aligns with the Clinical Framework and continues to be reasonable, clinically justified and outcome focused.  Based on this assessment, the TAC will inform the provider and client about what the TAC will help pay for and for how long.

To provide TAC-funded exercise physiology services, an exercise physiologist must:

• be accredited by Exercise and Sports Science Australia (ESSA) as an exercise physiologist
• comply with the TAC Allied Health policy
• adhere to the principles of the Clinical Framework for the Delivery of Health Services.

Promoting independence and avoiding treatment dependence

In line with Principle 3 of the Clinical Framework, the TAC expects that exercise physiologists promote independence from treatment through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies to empower the injured person to manage their condition and discourage overreliance on treatment should be incorporated in all phases of recovery. Further guidance on promoting injury self-management is available in the Clinical Framework.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

Gym and pool memberships enable clients to access gym or pool facilities to carry out independent exercise-based rehabilitation programs that are developed and monitored by an allied health professional. The aim of a gym or pool membership is to empower the client to manage their injury through independent exercise without the need for regular treatment from their allied health provider.

To be considered for approval, the gym or pool membership must be required as a result of transport accident injuries and:

• The membership is recommended and monitored by a registered medical practitioner, physiotherapist, osteopath, chiropractor or accredited exercise physiologist.
• The prescribed exercise cannot be performed in the client’s usual settings, such as their home or workplace, and requires access to specialised facilities.
• The membership will assist the client in the transition from provider-based treatment to a self-managed program where appropriate.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider the extent to which the transport accident has exacerbated the pre-existing injury when making a decision about paying for the membership.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC may pay the reasonable cost of an initial 3-month gym or pool membership for eligible clients. The reasonable cost should reflect costs charged to the general public which may include the joining fee and membership fee. Subsequent memberships will only be approved where clinical justification is provided by a treating medical professional, physiotherapist, osteopath, chiropractor or exercise physiologist. Clients will be responsible for the cost if they wish to continue with a gym or pool membership beyond the TAC approved membership period.

The TAC may consider paying for memberships of a longer duration for clients with severe injury as part of their MyPlan.

The TAC will pay for travel to and from a gym or pool for eligible clients in line with the TAC Travel and accommodation policy. The facility must be in a practical location, within a reasonable distance from the client’s home or work.

The TAC won’t pay for:

• services that are not required for the treatment of transport accident-related injuries
• services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• Personal training.
• Memberships for general health, fitness or wellbeing purposes.
• Memberships for general health and fitness group classes, such as pilates, yoga and spin classes. The TAC may pay for group exercise when provided by a registered allied health practitioner when clinically justified as part of an approved treatment plan.
• Exercise clothing, footwear or swimming equipment.
• Swimming lessons.
• Hire of equipment for at-home gyms unless clinically justified and approved as part of a MyPlan for clients with severe injury and permanent disability.

Further information can be found at What we cannot pay for.

An initial gym or pool membership must be requested by a registered medical practitioner, physiotherapist, osteopath, chiropractor or accredited exercise physiologist by submitting the TAC Gym and Pool Membership Request and Evaluation Form for approval.

Gym and Pool memberships must be undertaken at one the following types of commercial facilities designed for public use:

• a gymnasium equipped for various modalities of exercise
• a swimming pool or aquatic centre.

The facilities must:

• hold current public liability insurance
• have a privacy policy
• employ staff who:
  • hold a minimum Certificate III / IV in Fitness or are accredited by AUSactive
  • hold a current first aid certificate.

To request a subsequent membership, supervising health professionals are expected to report on client progress using valid outcome measures on the Gym and Pool Membership Request and Evaluation Form. The TAC will use this information to consider if the membership continues to be reasonable, clinically justified and outcome focused.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a gym or pool membership if the TAC has accepted liability for the accident-related injury that relates to the gym or pool membership.

2. Reasonable

When determining whether a gym or pool membership is a reasonable cost in the circumstances, the TAC considers whether:

• the exercise program can only be performed in a gym or pool facility
• is a reasonable cost.

3. Clinical justification

When deciding if a gym or pool membership is clinically justified, the TAC considers whether:

• The membership has been recommended by a medical practitioner, physiotherapist, osteopath, chiropractor or exercise physiologist.
• Clinical benefit is evidenced by improved scores on validated outcome measures.
• The membership promotes self-management, participation and return to work/health.
• The duration of the program is appropriate in relation to the client’s condition. These factors are assessed on a case-by-case basis. The TAC expects that most clients will not require a gym/swim service beyond the initial 3-month membership. Some clients with severe injury and permanent disability may require longer term memberships in order to maintain function and independence.
• The membership will support the client to transition from provider-led treatment to independent exercise and injury self-management. The TAC expects that the frequency of provider-led treatment will reduce as the client engages with a gym or pool membership.

4. Outcome focused

When deciding if a gym or pool membership is outcome focused, the TAC considers whether the membership is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

For more information on TAC decision making see the How we make decisions page.

Occupational therapists are trained to help people take part in everyday activities and live a more independent life after injury or illness. Services provided by an occupational therapist may include:

• Assessing and reporting on a person’s daily living support needs.
• Working out what the person can do and identifying areas where support may be needed.
• Developing goals, strategies or a treatment program to improve functional ability including supporting the use of assistive technology, retraining techniques and other environmental modifications to support independence.

Occupational therapists can complete assessments and make recommendations in relation to:

• Support to manage personal, domestic and community activities of daily living, such as attendant care
• Assistive technology
• Home services
• Home modifications
• Vehicle modifications
• Driving assessment
• Driving programs/lessons
• Vocational and return to work plans
• Transport and travel training
• Support and monitoring for clients engaged in community group programs or a supported employment service.

The TAC can pay the reasonable cost of occupational therapy provided to TAC clients which is required as a result of transport accident injuries.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

Clients with a severe injury

If the client has a severe injury, the discussion, referral and approval of services may form part of the client planning process between the client, the client's treating team and the TAC.

If the client already has an individualised funding package, occupational therapy services may be included as part of that.

The TAC will pay for the reasonable cost of occupational therapy. This includes intervention, assessment and recommendations to:

• establish what supports and services a TAC client may require because of their injury/illness.
• prescribe adaptive and/or alternative techniques to make it easier for a TAC client to perform activities, e.g. breaking strenuous tasks into smaller more manageable tasks.
• prescribe assistive technology that will facilitate and/or maximise a TAC client's independence and participation, e.g. installing a rail in a bathroom.
• prescribe exercises to maximise a TAC client's function and promote the recovery or rehabilitation from their injury
• attend multidisciplinary consultations and team meetings
• complete and issue Certificates of Capacity for TAC clients.

The TAC can pay for an occupational therapist’s travel to and from a client, where reasonable and clinically justified. This must be pre-approved by the TAC. Travel time is paid between the occupational therapist’s practice address and client's residence.

The TAC will pay for treatment and services according to the Occupational therapy fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

• Directly to the service provider, when the client has given the service their TAC claim number.
• The client can pay for the service and then using myTAC, send a copy of their receipt to TAC for reimbursement.

• services that are not required for the treatment of transport accident-related injuries.
• services provided by individuals who do not meet the occupational therapy provider registration requirements or comply with the Allied Health Policy
• services that are not evidence based, reasonable, clinically justified and outcome focused, and in line with the TAC’s occupational therapy service expectations.

This includes:

• Occupational therapy provided by students or by practitioners who are not registered with AHPRA.

Within the first 90 days of a client’s accident, the TAC can help pay for the reasonable costs of an initial occupational therapy assessment and report without the need for the occupational therapist or the client to contact the TAC for approval first. A client may access services independently or following a referral from a medical practitioner or on discharge from hospital.

Following the initial assessment and report, the TAC may help pay for the reasonable costs of the further occupational therapy services. If an occupational therapist intends to continue treating a TAC client beyond 90 days after their transport accident, they will need to send a request in writing using the relevant TAC template. The TAC will review a client’s treatment to ensure it’s reasonable, clinically justified, outcome focused and in line with the Clinical Framework. The TAC will assess the request and let the occupational therapist and the client know the decision about what the TAC can help pay for and for how long.

If a client has not received treatment in 6 months they will need to seek approval from the TAC before the TAC will pay for further treatment. Occupational therapists should ask their client for a copy of their approval if they haven’t seen the client in 6 months.

To provide TAC-funded occupational therapy, an occupational therapist must:

• be registered under the Health Practitioner Regulation National Law (AHPRA) to practice in the occupational therapy profession (other than as a student),
• comply with the TAC Allied Health policy, and
• adhere to the principles of the Clinical Framework for the Delivery of Health Services.

TAC provider registration

Occupational therapists have the option to apply for registration on the TAC's Occupational Therapy Access Registry. Providers registered on the Occupational Therapy Access Registry are eligible for service arrangements that include access to enhanced fee rates and preferential referrals coordinated by TAC.   For information on the Occupational Therapy Access Registry and registration requirements, visit the Registration information page.

Occupational therapists who are not registered on the Access Registry can continue to provide services to TAC clients under standard arrangements.

Specific requirements apply to each occupational therapy service type. All occupational therapists must ensure they are familiar with and meet the service-specific requirements. These requirements must be read in conjunction with the occupational therapy policy, registration requirements and other relevant TAC policies and guidelines.

The TAC expects that occupational therapy services promote independence and support TAC clients to achieve the best possible outcomes. This includes:

• Making recommendations that support clients to experience improved quality of life through a focus on independence and social and community participation.
• Delivering services that are individualised and outcomes focused.
• Recommending the least restrictive practices and only when necessary and as a last resort to protect the client and/or others from harm.
• Collaborating with the TAC, treating teams and relevant community services.
• If requested, actively participating in the TAC client planning process.
• Proactively identifying any changes to a client’s circumstances, needs or behaviour and notify the TAC if these may impact on the nature or frequency of the services recommended.

Promoting independence and avoiding treatment dependence

In line with Principle 3 of the Clinical Framework, the TAC expects that occupational therapists promote independence from treatment and services through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies that empower the injured client to manage their injury and discourage overreliance on treatment and services should be incorporated into all phases of recovery. Further guidance on promoting injury self-management is available in the TAC Clinical Framework.

Allied health assistance

The treating occupational therapist may recommend allied health assistance to help a client with achieving rehabilitation or recovery goals. This is to be charged as per the allied health assistant fee schedule and cannot be charged at the same rate as an occupational therapist.

Certificates of capacity

As part of the client’s treatment, occupational therapists can complete Certificates of Capacity to assess and certify a client’s capacity for work.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:

• results in a measurable benefit to the injured person
• reflects the adoption of a biopsychosocial approach
• empowers the client to self-manage their injury
• has goals focused on optimising function, participation and return to work and health
• is based on the best available research evidence.

• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:

• the client can independently manage their recovery,
• the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
• there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

Osteopaths are health professionals who diagnose neuro-musculoskeletal conditions and recommend appropriate evidence-based treatment. Osteopathy treatment may include manual therapy, exercise prescription, education and development of self-management strategies. Clients can find an osteopath on the Osteopathy Australia website.

The TAC can pay the reasonable cost of osteopathy services provided to TAC clients which required as a result of transport accident injuries.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC will pay the reasonable cost of osteopathy. This includes:

• osteopathy consultations, which may involve:
  • assessing and diagnosing injuries
  • developing treatment plans and reviewing progress using outcome measures
  • conducting psychosocial screening
  • providing education, manual therapy and exercise-based treatment
  • working with the client to identify and achieve activity goals such as return to work, social or domestic activities
  • preparing Certificates of Capacity
  • monitoring & evaluating independent exercise programs
• equipment in accordance with the Medical and rehabilitation equipment policy
• completion of an Allied Health Treatment and Recovery Plan when requested by the TAC.

The TAC will pay for treatment and services in accordance with the Osteopathy fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page on the TAC website.

The TAC won't pay for:

• services that are not required for the treatment of transport accident-related injuries
• services provided by individuals who do not meet the provider guideline requirements or comply with the Allied Health Policy
  services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• Osteopathy provided by students or by practitioners who are not registered with AHPRA.
• Exercise attire and footwear.
• Concurrent treatment where a client is receiving osteopathy at the same time as physiotherapy or chiropractic treatment for the same injury, except in exceptional circumstances. See the Allied Health Policy for further information.
• Concurrent osteopathy and exercise physiology unless it is required for a brief handover period as part of a coordinated rehabilitation program. It is expected that osteopathy will cease as exercise physiology treatment progresses. Concurrent osteopathy and exercise physiology may be approved for clients with severe injury and permanent disability as part of their MyPlan if clinically justified.

Further information can be found at What we cannot pay for.

Within the first 90 days of a client’s accident, the TAC can help pay for osteopathy services without the need for prior TAC approval. The TAC may contact clients or their service providers to discuss client progress and ensure that treatment is clinically justified and outcome focused.
If a client needs osteopathy beyond 90 days after their transport accident, the provider must seek TAC approval before funded treatment can be delivered. Prior approval is also needed if it has been more than 6 months since the client last received TAC-funded treatment.

Osteopaths must complete an Allied Health Treatment and Recovery Plan to request further treatment. The TAC will use this information to consider if the client is receiving treatment that aligns with the Clinical Framework and continues to be reasonable, clinically justified and outcome focused. Based on this assessment, the TAC will inform the provider and client about what the TAC will help pay for and for how long.

To provide TAC-funded osteopathy, an osteopath must:

• be registered under the Health Practitioner Regulation National Law (AHPRA) to practice in the osteopathy profession (other than as a student)
• comply with the TAC Allied Health policy
• adhere to the principles of the Clinical Framework for the Delivery of Health Services.

Promoting independence and avoiding treatment dependence

In line with Principle 3 of the Clinical Framework, the TAC expects that osteopaths promote independence from treatment through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies to empower the injured person to manage their injury and discourage overreliance on treatment should be incorporated in all phases of recovery. Further guidance on promoting injury self-management is available in the Clinical Framework.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

Physiotherapists are health professionals who diagnose neuro-musculoskeletal conditions and deliver appropriate evidence-based treatment. Physiotherapy treatment may include manual therapy, exercise prescription, education and development of self-management strategies. Physiotherapists can also prescribe equipment and train disability support providers to implement therapy support. Clients can find a physiotherapist on the Australian Physiotherapy Association website.

The TAC can pay the reasonable cost of physiotherapy provided to TAC clients which is required as a result of transport accident injuries.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC will pay the reasonable cost of physiotherapy. This includes:

• Physiotherapy consultations, which may involve:
  • assessing and diagnosing injuries
  • developing treatment plans
  • reviewing progress using outcome measures
  • conducting psychosocial screening
  • providing education, manual therapy and exercise-based treatment
  • working with the client to identify and achieve activity goals such as return to work, social or domestic activities
  • advising on non-pharmaceutical pain management options
  • advising on the use of botulinum toxin (Botox/Dysport)
  • preparing Certificates of Capacity
  • monitoring and evaluating independent exercise programs (see the Gym and pool memberships policy)
  • training support providers
  • prescribing equipment.
• Group consultations of a minimum of two and maximum of six patients in a class or group session that is led by a physiotherapist. Constant overall supervision and intermittent individual attention to each participant in the group is expected from the physiotherapist​. Clinical notes are required for all patients.
• Extended consultations for treatment that cannot be adequately addressed in a standard consultation for a client who has either:
  • complex injuries, such as a significant acquired brain injury or spinal cord injury
  • multisite injuries
  • two or more entirely separate injuries.
• Provider travel when the client is medically unfit to travel or where treatment in the client’s functional environment is clinically justified.
• Meeting attendance, at the request of the TAC, where the TAC client is present.
• Workplace/Home assessments and reports conducted by physiotherapists when requested by the TAC.
• Equipment prescription in accordance with the Medical and rehabilitation equipment policy.
• Completion of an Allied Health Treatment and Recovery Plan when requested by the TAC.

The TAC will pay for treatment and services in accordance with the Physiotherapy fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

The TAC won't pay for:

• services that are not required for the treatment of transport accident-related injuries
• services provided by individuals who do not meet the provider guideline requirements or comply with the Allied Health Policy
• services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• Physiotherapy provided by students or by practitioners who are not registered with AHPRA.
• Physiotherapy that is already included as part of a hospital inpatient bed fee or outpatient program.
• Exercise attire, swimwear and footwear.
• Vitamins and supplements recommended by a physiotherapist.
• Costs incurred by the physiotherapist for admission to a gym or aquatic centre.
• Concurrent treatment where a client is receiving physiotherapy at the same time as osteopathy or chiropractic treatment for the same injury site, except in exceptional circumstances. See the Allied Health Policy for further information.
• Concurrent physiotherapy treatment if the client is also accessing a multi-disciplinary treatment program which includes physiotherapy, for example a Network Pain Management Program.
• Concurrent exercise physiology and physiotherapy treatment unless it is required for a brief handover period as part of a coordinated rehabilitation program. It is expected that physiotherapy will cease as exercise physiology treatment progresses. Concurrent physiotherapy and exercise physiology may be approved for clients with severe injury and permanent disability as part of their MyPlan if clinically justified.
• Massage when it is performed by a masseur or myotherapist. The TAC can only pay for massage when it is performed by a registered physiotherapist, osteopath or chiropractor.

Further information can be found at What we cannot pay for.

Within the first 90 days of a client’s accident, the TAC can help pay for physiotherapy services without the need for prior TAC approval. The TAC may contact clients or their service providers to discuss client progress and ensure that treatment is clinically justified, and outcome focused.

If a client needs physiotherapy beyond 90 days after their transport accident, the provider must seek TAC approval before funded treatment can be delivered. Prior approval is also needed if it has been more than 6 months since the client last received TAC-funded treatment.

Physiotherapists must complete an Allied Health Treatment and Recovery Plan to request further treatment. The TAC will use this information to consider if the client is receiving treatment that aligns with the Clinical Framework and continues to be reasonable, clinically justified and outcome focused. Based on this assessment, the TAC will inform the provider and client about what the TAC will help pay for and for how long.

To provide TAC funded physiotherapy, a physiotherapist must:

• be registered under the Health Practitioner Regulation National Law (AHPRA) to practice in the physiotherapy profession (other than as a student)
• comply with the TAC Allied Health Policy
• adhere to the principles of the Clinical Framework for the Delivery of Health Services.

Promoting independence and avoiding treatment dependence

In line with Principle 3 of the Clinical Framework, the TAC expects that physiotherapists promote independence from treatment through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies to empower the injured person to manage their injury and discourage overreliance on treatment should be incorporated in all phases of recovery. Further guidance on promoting injury self-management is available in the Clinical Framework.

The treating physiotherapist may recommend Allied Health Assistants at the rates approved by the TAC. Allied Health Assistance cannot be charged at the same rate as a physiotherapist.

Physiotherapists must ensure their insurance policy covers employing an Allied Health Assistant. When engaging an independent Allied Health Assistant, the physiotherapist must ensure the Allied Health Assistant holds the appropriate qualifications, experience, relevant liability and/or personal indemnity insurances and, where relevant, a current police check, working with children check and/or working with vulnerable people check.

Physiotherapists are expected to:

1. provide the TAC with a program of activity when delegating to a Grade 2 or 3 Allied Health Assistant
2. refer and delegate to appropriately experienced and qualified Allied Health Assistants
3. ensure Allied Health Assistants are following the prescribed delegated program of activity while supporting the client to achieve their TAC approved goal
4. identify when a TAC client requires clinical support from an Allied Health Assistant delivering rehabilitation services or when the support is more appropriately delivered by

Attendant Care disability services such as disability maintenance and non-clinical support e.g. daily living.

Allied health assistance

The treating physiotherapist may recommend allied health assistance to help a client with achieving rehabilitation or recovery goals. This is to be charged as per the allied health assistant fee schedule and cannot be charged at the same rate as a physiotherapist.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

Podiatrists assess, diagnose, treat and manage conditions of the lower limbs including feet and ankles. Clients can find a podiatrist on the Australian Podiatry Association website.

The TAC can pay the reasonable cost of podiatry treatment provided to TAC clients, required as a result of transport accident injuries.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC will pay the reasonable cost of podiatry treatment. This includes:

• Podiatry consultations, which may involve:
  • assessing and diagnosing injuries
  • developing treatment plans and reviewing progress using outcome measures
  • conducting psychosocial screening
  • providing education, manual therapy and exercise-based treatment
  • preparing Certificates of Capacity
  • advising on footwear and prescribing orthoses or partial prostheses.
• Provider travel when the client is medically unfit to travel or where treatment in the client’s functional environment is clinically justified (included as part of the out of rooms consultation fee).
• Podiatry services provided in hospital where the cost of podiatry is not included in the hospital bed fee.
• Biomechanical examinations where there is clinical justification to conduct examinations outside of the scope of a podiatry consultation.
• Orthomechanical services and procedures, such as impressions and models, prescription orthoses and simple digital or partial prosthesis.
• In-rooms podiatric surgery. For podiatric surgery occurring in hospital, see our Medical practitioner guidelines and Private hospital guidelines.
• Equipment in accordance with the Medical and rehabilitation equipment policy.

The TAC will pay for treatment and services according to the Podiatry fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

The TAC won't pay for:

• services that are not required for the treatment of transport accident-related injuries.
• services provided by individuals who do not meet the provider guideline requirements or comply with the Allied Health Policy
• services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• Podiatry provided by students or by practitioners who are not registered with AHPRA.
• Diagnostic services billed in conjunction with a consultation fee unless the diagnostic service was beyond the scope of consultation conducted.
• Repair or replacement of an orthoses that was not damaged as a result of the transport accident injury.
• Maintenance, repair, modification or replacement of an orthoses under warranty.
• Footwear normally issued by an employer.
• Standard off the shelf footwear unless required to fit custom modifications or orthotics required as a result of transport accident injuries.
• Concurrent treatment where a client is receiving podiatry at the same time as physiotherapy for the same lower limb injury, except in exceptional circumstances. See the Allied Health Policy for further information.

Further information can be found at What we cannot pay for.

Within the first 90 days of a client’s accident, the TAC can help pay for podiatry without the need for prior TAC approval. The TAC may contact clients or their service providers to discuss client progress and ensure that treatment is clinically justified, and outcome focused.

If a client needs podiatry beyond 90 days after their transport accident, the provider must seek TAC approval before funded treatment can be delivered. Prior approval is also needed if it has been more than 6 months since the client last received TAC-funded treatment.

Podiatrists must complete an Allied Health Treatment and Recovery Plan to request further treatment. The TAC will use this information to consider if the client is receiving treatment that aligns with the Clinical Framework and continues to be reasonable, clinically justified and outcome focused. Based on this assessment, the TAC will inform the provider and client about what the TAC will help pay for and for how long.

To provide TAC-funded podiatry, a podiatrist must:

• be registered under the Health Practitioner Regulation National Law (AHPRA) to practice in the podiatry profession (other than as a student)
• comply with the TAC Allied Health policy
• adhere to the principles of the Clinical Framework for the Delivery of Health Services.

Promoting independence and avoiding treatment dependence

In line with Principle 3 of the Clinical Framework, the TAC expects that podiatrists promote independence from treatment through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies to empower the injured person to manage their injury and discourage overreliance on treatment should be incorporated in all phases of recovery. Further guidance on promoting injury self-management is available in the Clinical Framework.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.