The TAC can pay the reasonable costs of dental services, provided in Australia, when required for the treatment of transport accident-related injuries.

Clients do not need to contact the TAC for approval first if:

• it is within the first 90 days after an accident, and
• they have a TAC claim number, and
• their doctor or health professional recommends it.

Dentist – a medical professional trained to treat injuries, diseases and conditions that affect the teeth, gums, jaw and mouth

Dental prosthetist – a health professional who assesses, designs, constructs, fits, and repairs removable dentures (full, partial, implant-supported)

Oral and maxillofacial surgeon – a dental specialist trained to diagnose and surgically treat diseases, injuries, and defects of the mouth, jaws, face, and neck, requiring dual qualifications in Medicine and Dentistry.

The TAC pays the reasonable cost of dental treatment and services required as a result of transport accident injuries.

Under the Transport Accident Act 1986 (the Act) the TAC can pay for the reasonable cost of a range of specified types of services. This includes dental services that enable the client to participate in their rehabilitation and recovery (including disputes, common law claims and impairment). These services must be performed and received in Australia, meaning the client and the provider must be in Australia to be eligible.

Dental services are considered by the TAC as a medical expense to facilitate rehabilitation and recovery in circumstances where needed.

Sections 3 and 60 of the Act allow the TAC to pay for these dental services to enable rehabilitation and recovery.

Dental services may include visiting a dentist, dental prosthetist, or an oral and maxillofacial surgeon for assessment, care planning and treatment. The client’s dental service provider may also recommend treatments such as:

• partial or full dentures
• dental implants and associated procedures, such as bone and soft tissue grafts
• prosthodontics including the construction and insertion of an implant-supported prosthesis.

The TAC can pay the reasonable cost of dental services provided to a TAC client that are:

• required as a result of the transport accident injury
• reasonable, necessary, or appropriate in the circumstances
• clinically justified, safe and effective
• in accordance with the TAC’s policies.

The TAC can pay the reasonable cost of dental services provided by a dentist, dental prosthetist, or an oral and maxillofacial surgeon for assessment, care planning and treatment required due to a transport accident.

A dental report including client’s dental history is to be provided to the TAC when invoicing or seeking reimbursement for any dental services within the first 90 days.

Examples of dental services that may be required include:

• general dental services
• specialist dental services
• bridges, crowns and restorative services
• surgical procedures
• dental prosthetist services.

The TAC will pay for treatment and services according to the fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference.

Information about how the TAC pays for services can be found on the Paying for treatment and services page.

• directly to the service provider, when the client has given the service their TAC claim number
• the client can pay for the service and then using myTAC, send a copy of their receipt to TAC for reimbursement.

The TAC can’t pay for services that:

• are for a person other than the client
• do not treat a client’s transport accident injuries
• are not reasonable, necessary or appropriate
• are not clinically justified, safe and effective
• are provided by individuals who do not meet the Provider Guidelines requirements
• treatment or services outside of the Commonwealth of Australia
• treatment or services inconsistent with pre-accident standard of dental care
• treatment or services that a client would have required regardless of their transport accident.

Refer to further information on what the TAC cannot pay for.

The TAC may contact a client’s dental service provider to discuss client progress or request an assessment to make sure the client:

• has access to the most appropriate treatment and support
• is getting proven, evidence-based treatment and not receiving treatment that isn’t helping recovery.

This will help the TAC make sure the treatment is helping client recovery. It will allow the TAC to make decisions about what treatment can be paid for and how long the TAC can pay for it.

Dental service providers can support TAC clients with services that fulfil the following conditions:

• are required as a direct result of a transport accident injury (not for a pre-existing condition)
• are safe and effective
• promote recovery, functional independence, or self-management
• are reasonable
• comply with all responsibilities relating to the dental profession or service
• comply with all relevant legislative requirements, including the Transport Accident Act 1986, the Health Records Act 2001, the Disability Act 2006, the Income Tax Assessment Act 1997 and the Charter of Human Rights and Responsibilities 2006.

Before providing service, a provider can confirm that the client has an accepted TAC claim by either:

• asking them to share their TAC claim number (found on their claim acceptance letter or the myTAC app)
• calling the TAC so the claim can be confirmed.

The TAC can pay for services in line with the published fees schedule. If an item is not in the fee schedule, it cannot be paid for.

For more information, refer to Working with the TAC.

A dental service provider can deliver dental services to a TAC client if they are registered under the Health Practitioner Regulation National Law with the Dental Board of Australia to practice in the dental profession (other than as a student).

A provider should contact the TAC for approval if it is:

• close to or more than 90 days since the client’s transport accident and the TAC has not already approved more treatment
• more than 6 months since the client has had any treatment or service paid for by the TAC.

Dental service providers can use these reports to provide information to the TAC about a client’s injury and required treatment.

• Dental Report Form
• Maxillo-facial Report Form

Safeguarding support - concerns and complaints provides TAC clients and the community with a pathway to raise concerns or complaints about the quality and safety of TAC funded services.

The TAC expects dental service providers to integrate the principles of the Clinical Framework for the Delivery of Health Services in their daily practice.

Professional standards should be followed according to Australian Health Practitioner Regulation Agency (AHPRA) requirements.

Providers are expected to deliver services in line with the TAC’s policy on Funding Treatment by a Member of the Client's Immediate Family.

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
• results in a measurable benefit to the injured person
• reflects the adoption of a biopsychosocial approach
• empowers the client to self-manage their injury
• has goals focused on optimising function, participation and return to work and health
• is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan.
• The treatment or service should be discontinued and the client discharged when either:
• the client can independently manage their recovery,
• the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
• there is no measurable benefit on outcome measure scores from continued treatments or services.

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.

For more information on TAC decision making, see the ‘How we make decisions’ page.