Independent Medical Examination requested by the TAC only (non joint)
The TAC can pay the reasonable costs of examinations requested by them to determine a client's initial or ongoing entitlement under the Transport Accident Act 1986 (the Act).
This policy is only about medico-legal reports arising from an independent medical examination or an impairment assessment that is requested by the TAC only. For information about medico-legal reports that are requested jointly by the TAC and the client or their legal representative, refer to the Joint Medical Examination policy.
For information about medical reports from a client's treating health practitioner, refer to the Treating Health Practitioner (Medical) Reports requested by the TAC policy.
This policy must be read in conjunction with the following:
- Medical reports fee schedules
- Time Limit to Apply for the Payment of Medical and Like Expenses policy
- The TAC Protocols.
In this policy:
- Independent Medical Examination is an examination and report completed by a non-aligned medical practitioner to assist in determining a client's entitlements under the Act. This includes medico-legal reports.
- Impairment Assessment is an examination and report completed by an accredited Impairment Assessor to assist in determining a client's level of impairment under the Act.
What can the TAC pay for in relation to medico-legal reports?
The TAC can pay the reasonable costs of medico-legal reports where the report is:
- requested by the TAC
- required as a result of the transport accident injury
- reasonable, necessary or appropriate in the circumstances
- prepared by an independent medical examiner nominated by the TAC or an impairment assessor.
Who can provide TAC requested medico-legal reports?
TAC requested medico-legal reports can be only be provided by:
- an independent medical examiner nominated by the TAC from one of the following professions:
- Medical practitioners (e.g. general practitioners, psychiatrists, specialist physicians)
- Occupational therapists
- impairment assessors who have relevant impairment assessment training as prescribed by the Act.
What information does the TAC require to consider paying for a medico-legal report(s)?
The independent medical examiner should always submit a copy of their report and invoice with the relevant TAC item number to the TAC for payment. They should also include copies of any other documents used in the preparation of the original report, for example a copy of the radiologist's reports or photographs, etc.
What information does the TAC require in the report(s)?
A request for a medico-legal report will include specific questions relevant to the management of a client's claim. If a request for a report includes questions that are not applicable or are unable to be answered, the examiner should document this in the report.
The report should be submitted to the TAC within 10 working days of the examination occurring. If this time frame is unable to be met, the medical examiner should contact the TAC.
What are the TAC's invoice requirements?
Refer to the:
What fees are payable for TAC requested medico-legal reports?
Refer to the relevant Medical Reports Fee Schedule.
In relation to TAC requested medico-legal reports, what won't the TAC pay for?
The TAC will not pay for:
- services for a person other than the client
- services not authorised by the TAC under the Act
- services subcontracted to, or provided by a non-registered provider
- the same medico-legal report provided more than once, for example a reissue of a previous report or multiple copies
- medico-legal reports not requested by the TAC
- medico-legal reports where the invoice is not in accordance with the relevant TAC fee schedule. Where a fee schedule does not exist, payment will not be made if the fee is considered unreasonable for the report
- services provided by telephone or other non face to face mediums
- telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
- 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.