POLICY

The TAC requires a certificate of capacity  to be completed and signed by an authorised provider to give information about a client's transport accident injuries and to assess and certify their capacity to work as a result of these injuries. The TAC will use the information to assess a client's eligibility for loss of earnings (LOE) and loss of earning capacity (LOEC) payments and to identify employment options which are suited to the client's work capacity.

Transport Accident Act 1986 reference: s.3 'medical service' (e)

GUIDELINES

Who can issue a certificate of capacity for a TAC client?

A certificate of capacity may be issued to the TAC by one of the following authorised providers, who must be registered and be the primary practitioner responsible for treating the client's injuries:

• medical practitioner
• dentist
• optometrist
• physiotherapist (including EIPF enrolled physiotherapists)
• chiropractor
• osteopath
• podiatrist
• occupational therapist.

Can the TAC consider a certificate of capacity issued by a member of a client's immediate family?

The TAC will not pay for services or pay benefits based upon a certificate of capacity issued by a member of a client's immediate family, unless exceptional circumstances exist, such as in an emergency situation or if a client resides in a remote area and the distance to access an alternative treater is excessive. Refer to the Funding Treatment by a Member of the Client's Immediate Family policy.

What information should be included in the certificate of capacity?

The TAC certificate of capacity is a key communication tool in the return to work process.  All relevant fields in the certificate of capacity should be completed and forwarded to the TAC. The Certificate of Capacity can be downloaded from our website tac.vic.gov.au/certificate. 

The TAC prefers providers to use the certificate of capacity form. Where this is not possible the TAC will accept a medical certificate which is not in the TAC format provided it contains the following information:

• the client's name, TAC claim number and other personal details
• the client's transport accident-related injuries
• a capacity assessment detailing the physical (e.g. sit, stand/walk, bend, squat)  and/or mental functions (e.g. attention/concentration, memory, judgement) that are affected by the client's transport accident injuries
• the client's capacity for employment as a result of their transport accident-related injuries, including the period of incapacity (if any)
• the client's treatment plan.

The TAC also requires the following information on every certificate of capacity or medical certificate:

• provider's name, practice address and telephone number
• provider's qualifications
• provider's signature
• date on which the certificate was written
• Medicare provider number.

When should a certificate of capacity be provided?

The TAC expects a client to provide their certificates of capacity to the TAC at least five working days prior to the expiration of the previous certificate to allow for the processing of any payments. This will ensure the continuous payment of LOE or LOEC benefits.

What certificates of capacity will not be accepted by the TAC?

The TAC will not accept:

• incomplete or illegible certificates of capacity
• backdated certificates of capacity (unless there is a reasonable explanation)
• a certificate of capacity from a provider who does not have the appropriate expertise to assess and comment on the injury or condition. For example, the TAC will not accept a certificate of capacity from a dentist that comments on a client's hip and arm fractures. However, in this case the TAC will accept a certificate from an orthopaedic surgeon.

Will the TAC accept a faxed or photocopied certificate of capacity?

The TAC can accept a faxed certificate of capacity.

The TAC will only accept a photocopied certificate of capacity where it is confirmed that the original certificate was referred elsewhere, such as a client's employer. The TAC will not accept photocopied certificates of capacity from a self-employed client.

Will the TAC pay LOE or LOEC for backdated periods?

The TAC will not pay LOE or LOEC benefits for backdated periods, i.e. periods of incapacity which are prior to the date of the consultation and completion of the certificate of capacity.

Are there any circumstances when the TAC will consider making ongoing income payments without a certificate of capacity?

The TAC will consider paying LOE or LOEC payments without a certificate of capacity in exceptional situations, or where there is:

• proof of in-patient treatment
• a recent medical report confirming ongoing incapacity for work
• verbal confirmation from a treating doctor, followed up with a certificate of capacity
• When a client loses his/her employment due to transport accident injuries but has been assessed as having sustained a loss of earnings. Refer to the Loss of Earnings policy.

Can the TAC pay LOE or LOEC benefits if a client is no longer claiming income benefits because they have returned to work but occasionally they will require time off work to attend transport-accident related treatment?

The TAC can pay LOE or LOEC benefits to a client who is required to attend for treatment for their transport accident injuries during their normal working hours, subject to the receipt of a certificate of capacity and the guidelines in the policies for LOE or LOEC benefits.

Refer to the following policies for more information:

• Loss of earnings policies
• Loss of earnings capacity policies
• Post hospital support payments policy.