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.
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.
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 formThis 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:
Getting access to your informationYou can get a copy of this form or information we have collected about you by contacting the TAC.