Gym and Swimming Membership

Policy

The TAC can pay the reasonable costs of gym and/or swimming programs required as a result of a transport accident injury following written approval under sections 23 and 60 of the Transport Accident Act 1986 .

Definitions

In this policy:

  • A health professional is a registered medical practitioner, physiotherapist, chiropractor, osteopath or an accredited exercise physiologist
  • A gym program is an exercise program that is developed and monitored by a health professional for a client to perform independently in a gym for the purpose of rehabilitation. Programs are for a fixed duration, generally three months
  • A swimming program is an exercise program that is developed and monitored by a health professional for a client to perform independently in a pool for the purpose of rehabilitation. Programs are for a fixed duration, generally three months
  • An appropriate gym and/or pool facility:
    • is a commercial gym and/or pool facility designed for public use or a gym and/or pool within the premises of a health professional
    • is located in a practical location, within a reasonable distance of the client's home or work
    • is designed and equipped for various modalities of exercise, sports and physical training
    • has suitable equipment to meet the needs of the client as recommended by the health professional
    • has suitably qualified staff to ensure client safety.

Guidelines

What can the TAC pay for in relation to gym and/or swimming programs?

The TAC can pay the reasonable costs of a gym and/or swimming program when:

  • required as a result of the transport accident injury
  • reasonable, necessary or appropriate in the circumstances
  • requested in writing by a health professional
  • monitored by a health professional who will evaluate the outcomes expected from the program
  • clinically justified and the program will assist the client to achieve their specified physical rehabilitation goals
  • it will assist a client in the transition from health professional based treatment to a self managed program
  • the program is provided in accordance with the TAC's policies.

The TAC can pay for an initial three month gym and/or swimming program. In exceptional circumstances only, the TAC may consider paying for a subsequent program or an extended program (longer than three months). For example, an extended program may be considered when a client has a complex injury and requires more than three months to achieve their specific functional goals. Complex injuries may include spinal cord injuries, moderate to severe acquired brain injuries, crush injuries, extensive burns, multiple orthopaedic injuries and/or limb amputations.

The TAC will not fund any further gym and/or swim programs after a client's functional condition has stabilised because the client has entered the maintenance phase of treatment and should be capable of self-managing his/her condition at this point.

The TAC will consider paying for assistance for a client to attend a gym and/or swimming program when required due to their transport accident injury in accordance with the following:

Where can gym and/or swimming programs be provided?

Gym and/or swimming programs can be provided at a commercial gym and/or pool facility or gym/pool within the premises of an allied health care provider.

What information does the TAC require to consider paying for gym and/or swimming programs?

Initial gym and/or swimming program

For clients who do not have a 'severe injury' the TAC requires a recommendation from a health professional containing the following information to consider paying the reasonable costs of an initial three month gym and/or swimming program. This is information is required before commencement of the program:

  • the functional goals of the program
  • the current clinical status of the client (including standardised outcome measure scores)
  • the method and frequency in which the health professional will monitor and evaluate the effectiveness of the program (including standardised outcome measures to be used)
  • the frequency of attendance required at the facility
  • the requested duration of the program
  • the recommended gym and/or swimming facility
  • the costs of the program
  • confirmation that the client is willing to actively participate in the program
  • confirmation that the client understands how to safely perform the exercises recommended by the requesting health professional
  • confirmation that qualified gym and/or swimming staff will be in attendance to ensure the client's safety.
Extended gym and/or swimming programs

A health professional recommending an extended program (longer than three months) must provide:

  • the information required in a request for an initial program
  • the reasons why the extended program is required.

Subsequent gym and/or swimming programs

The TAC must be provided with the following information in writing prior to the start of an approved subsequent program:

  • a completed TAC Gym/Swim Evaluation form
  • confirmation of regular client attendance throughout the initial program 
  • plans for the subsequent program as per the list of information required from a health professional in the written request for the initial program.

For clients with a 'severe injury' a request for an initial, extended or subsequent gym and/or swimming program will be approved as part of the independence planning process.  Outcome measures are to be recorded throughout the treatment and provided to the TAC upon request 

When will the TAC respond to a request?

The TAC will respond to written treatment and service requests as set out in the TAC Service Charter.

What fees are payable for gym and/or swimming programs?

The TAC can pay the reasonable fees for a gym and/or swimming program.

What won't the TAC pay for in relation to gym and/or swimming programs?

The TAC will not pay for:

  • programs or services for a person other than the client
  • services for injuries or a condition that existed before a transport accident or that is not a result of a transport accident
  • extra services offered by the facility, such as spa or sauna or yoga classes
  • casual pilates/gym and swim sessions concurrently or in isolation
  • personal trainers
  • a gym and/or pool membership chosen by a client because it offers extra services when there is a standard gym available - the client is responsible for funding the difference in cost in such a case
  • services where the costs are not considered reasonable
  • a gym and/or swimming membership for the purposes of maintaining physical fitness once rehabilitation goals have been achieved
  • gym attire, swimming costumes or additional equipment
  • more than one gym and/or or swimming program at the same time
  • gym or swimming programs conducted by a member of the client's immediate family
  • concurrent gym and pilates memberships for clients, other than in exceptional circumstances such as where there is clinical justification and the memberships are part of an overall coordinated rehabilitation plan which has been approved by the TAC
  • treatment or services subcontracted to or provided by a non-registered provider
  • fees associated with cancellation or non-attendance
  • treatment or services provided outside the Commonwealth of Australia
  • the cost of telephone calls and telephone consultations between health professionals and clients, and between other providers, including hospitals
  • treatment, services or equipment where there is no published evidence in a recent peer-reviewed journal article that the treatment, service or equipment is safe and effective. Refer to the Non-Established, New or Emerging Treatments and Services policy
  • treatment or services provided more than once on the same day to the same client 
  • treatment or services provided more than two years prior to the request for funding except where the request for payment is made within three years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy

View Information for people with soft tissue injuries

Information for people with soft tissue injuries

Summary:

This booklet provides information about soft tissue injuries (e.g. painful strains, sprains and bruises) and how health care professionals can help you recover faster by getting moving. As well as explaining the types of treatment and services the TAC can fund, there are handy tips about working with your therapy providers, staying motivated and measuring progress.

View Gym/Swim program: evaluation form (for Provider use only)

Gym/Swim program: evaluation form (for Provider use only)

Summary:

This form is for reporting the progress of clients participating in TAC-funded gym, swimming and pilates programs as part of their rehabilitation.