Please complete and submit the form below.
This form gives your consent for the TAC to access information about you from other parties related to your transport accident claim. It also allows us to share your information with these parties when necessary. (A list of these parties is on the form below).
If we don't have your consent we may be unable to manage your TAC claim and make decisions about the treatment and benefits we will pay for.
Please note: We will never ask you to disclose passwords or transfer funds into an unknown bank account. Please contact us if you have any concerns.
I consent to the persons and bodies listed below to give relevant information about me to the TAC to help manage my TAC claim:
The TAC may ask the above for information and documents about:
The TAC may also ask about any financial loss suffered as a result of the accident from:
* As defined by the Health Records Act 2001.
The TAC will only collect information relating to the injuries and time periods relevant to the administration of my TAC claim.
If you are not a parent/guardian of an under 18 year old, administrator or power of attorney please ensure the client has completed a client representative form to allow you to sign this form on their behalf
The Transport Accident Act 1986 (the Act), states that when requested to by the TAC, a person must sign this ‘Authority to Release Information Form’. Section 67 of the Act also says that this form cannot be revoked until a claim is finally determined.
Why does the TAC need this information?
The TAC may need to share or collect your information from other parties to carry out its functions under section 12 of the Transport Accident Act 1986. These functions include assessing claims for compensation, defending proceedings, paying compensation, etc.
The TAC will only use this form to collect or share relevant information for processing, assessing or managing your TAC claim.
Who may the TAC share your information with?
The TAC may disclose the personal and health information it has obtained about you where it is required by law to do so, or where it is necessary to manage your claim for compensation.
It may be necessary to disclose your information to:
Other ways the TAC may use and disclose your information
The TAC may use or disclose personal and/or health information for the purposes of research to its research service providers, road safety partners and other government agencies to facilitate research into treatment for, or the prevention of, transport accident injuries.
The TAC removes your identifying information before disclosure so that research can be conducted in either an anonymised form (where your name or identity is not apparent from the data set) or a de-identified form (where your name or identity is not apparent from the data set, and you are not capable of being re-identified).
If you wish to opt out of having your de-identified/anonymised information being used or disclosed by TAC for any of its listed research projects, please contact firstname.lastname@example.org
Health Safety and Wellbeing
The TAC is required under the Occupational Health and Safety Act 2004 to provide and maintain a working environment that is safe and without risks to health. Where a client exhibits behaviours of concern (BOC), contracted/ registered service providers to the TAC may be notified for safety purposes. A BOC includes, but is not limited to, where:
Getting access to your information
You can get a copy of this form or information we have collected about you by contacting the TAC.