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.
We will also never ask you to disclose passwords or transfers fund 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.
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:
Getting access to your information
You can get a copy of this form or information we have collected about you by contacting the TAC.