Combination of compensable and non-compensable treatment

The TAC Medical Excess may apply to these services 

 

 

Policy

The TAC can only consider funding the reasonable cost of treatment of injuries which are the result of a transport accident.

Transport Accident Act 1986 reference: s.60

Background

This policy relates to situations where a person is treated by the same provider for a combination of injuries/conditions, some of which are transport accident related and some non accident related.

Guidelines

What will the TAC consider funding where a client has both accident related and non accident related injuries?

The TAC can only consider funding treatment for those injuries which are accident related.

What will the TAC consider funding where a pre-existing injury has been aggravated as a result of a transport accident?

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that injury. 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 injury.

How should a practitioner bill the TAC where the treatment has been for accident related and non accident related injuries?

Accounts for treatment of transport accident related injuries should be sent to the TAC.

Accounts for treatment of non transport accident related injuries should be sent to the patient (or patient's insurance provider).

Where a client requires surgery for both accident and non accident related injuries/conditions, what will the TAC consider funding?

Where the multiple operation rule applies, it is to be applied separately to the transport accident related and non transport accident related injuries being treated. For example:

Operation 1 Medicare claim (CMBS fee $600) payable by Medicare at 100%
Operation 2 TAC claim (TAC fee $900) payable by the TAC at 100%
Operation 3 TAC claim  (TAC fee $500) payable by the TAC at 50%