This form gives us permission to collect information about you from a medical practitioner to help us make the payments for the treatment and services you need. It also enables us to disclose information to other parties so we can manage your claim.
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.
authorise you to provide the TAC with information and documents relevant to:
The TAC will only collect information pertaining to the injuries and time periods relevant to the administration of my TAC claim.
Information about this consent form
This is an ‘Authority to Release Information: Medical Practitioner’ form. The Transport Accident Act 1986 (the Act), states that when requested to by the TAC, a person must sign this 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 needs your information in order 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 relevant information for processing, assessing or managing your TAC claim.
What happens if you don’t sign this consent form?
If you do not sign this consent form, the TAC may not be able to make decisions about your entitlement to TAC benefits.
Who will the TAC disclose your information to?
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
Research 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.
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 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.