Treating Health Practitioner (Medical) Reports requested by the TAC

POLICY

The TAC can pay the reasonable costs of Treating Health Practitioner (THP) (medical) reports when requested by the TAC in order to determine a client's initial or ongoing entitlement under the Transport Accident Act 1986.

For information about independent medical examination and impairment assessment medico-legal reports, refer to the Joint Medical Examination policy or the Independent Medical Examination requested by the TAC only (non joint) policy.

DEFINITIONS

In this policy:

• a treating health practitioner (THP) is a medical practitioner or an allied health service provider who has provided treatment to the client 
• a THP report is a report requested by the TAC for completion by a THP authorised to report on services and clinical information relating to a client's transport accident injury. A THP report will provide information to assist in:
  • determining a client's initial entitlements under the Transport Accident Act 1986
  • determining a client's entitlement to weekly benefits, and medical and health services
  • reviewing a client's entitlement to weekly benefits, and medical and health services
  • the management of a client's rehabilitation and return to work.

GUIDELINES

What can the TAC pay for in relation to a THP (medical) report?

The TAC can pay for a THP (medical) report when the:

• TAC has requested the report from the THP
• TAC is satisfied that the report provided addresses the information requested
• THP (medical) report invoice meets the TAC minimum invoicing guidelines.

The TAC can also pay for copies of clinical notes from THPs when specifically requested by the TAC. The TAC will only request clinical notes when necessary to determine liability for a pre-existing injury/condition, or to establish liability for the claim.

Treating health practitioner (medical) reports that are obtained at the request of the TAC for the purpose of determining a client's entitlement to benefits are not subject to the medical excess. The TAC will pay for a report in these instances whether the medical excess has been reached or not.

Who may the TAC request to complete a THP (medical) report?

The TAC may request a THP (medical) report from the following providers who must be registered to provide services to clients, and who has provided treatment to the client:

• Medical Practitioners (e.g. general practitioners, psychiatrists, specialist physicians)
• Dentists
• Optometrists
• Physiotherapists
• Chiropractors
• Osteopaths
• Podiatrists
• Psychologists
• Neuropsychologists
• Occupational therapists.

What information does the TAC require in a THP (medical) report?

A request for a THP (medical) report will list 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, this should be documented by the THP in the report.

A General Practitioner (GP) will receive a customised request for a report. They are requested to answer each specific question relevant to the client's claim. If a GP report includes questions that are not applicable or are unable to be answered, this should be documented by the GP in the report.

Depending on the purpose of the requested report, the GP may be asked to include information regarding the client's history, diagnosis, prognosis, progress, outcomes, capacity for work and medical management.

GPs will be requested to complete one of several different types of reports:

1. Short Report - contains up to 3 questions
2. Standard Report - contains 4 to 6 questions
3. Comprehensive Report - contains 7 to 10 questions
4. Other specific reports.

A Standard or Comprehensive Report will be requested no more than once per year, except in exceptional circumstances.

How long does a THP have to return a THP (medical) report?

A THP (medical) report should be returned to the TAC within 10 working days of receiving the request. If a THP is unable to complete the report within this time, they should contact the TAC.

Can the TAC release a THP (medical) report?

The TAC can release a THP (medical) report to the client, another THP or client's legal representative upon receipt of a verbal or written request from a client or their legal representative.

What are the TAC's invoicing requirements when a THP (medical) report is submitted?

The TAC will pay the provider of a THP (medical) report only after the report has been completed and a compliant invoice has been submitted to the TAC.

For details on the information required when submitting invoices for medical services, refer to the TAC's Invoicing Guidelines for medical practitioners.

What fees are payable for THP (medical) reports?

The TAC can pay the invoiced amount where the THP (medical) report invoice is in accordance with the relevant TAC fee schedule for GP reports. For all other medical reports, the TAC can pay the reasonable cost of the medical report in accordance with the following fee schedules:

Medical Services

• Scheduled fee as listed by the Department of Health (Vic)
• Reimbursement Rates for Medical Services

Other Services

Schedule of fees for the following services, Physiotherapy, Chiropractic, Osteopath, Dietitian, Social Work, Speech Pathology, Occupational Therapy, Psychology and Private Hospital services (Non Arrangement).

Clinical notes from a THP will be paid in accordance with the Health Records Regulations 2002 and under the guidelines set out in the Health Records Act 2001.

In relation to THP (medical) reports, what will the TAC not pay for?

The TAC will not pay for:

• treatment or services for a person other than the client/worker
• treatment or services not authorised by the TAC under the Transport Accident Act 1986
• treatment or services subcontracted to, or provided by a non-registered provider
• the same THP (medical) report provided more than once, for example a reissue of a previous report or multiple copies
• THP (medical) reports not requested by the TAC
• the invoiced amount where the THP (medical) report has not been invoiced in accordance with the relevant TAC fee schedule. Where a fee schedule does not exist, payment will not be made if the fee is not considered reasonable for that report
• a consultation used for the purposes of preparing a THP (medical) report. When a report is requested it is expected that it is completed on the basis of clinical notes. A consultation is not generally expected to be required for the preparation of the report. If, in exceptional circumstances, an examination is required, the TAC will pay for the consultation in accordance with its schedule of fees for the relevant discipline
• a THP (medical) report prior to the provision of the report (unless by agreement with the TAC)
• a copy of the clinical notes only without the provision of a report
• treatment or services provided by telephone or other non face to face mediums
• telephone calls and telephone consultations between providers and clients/workers, and between other providers, including hospitals 
• treatment or 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.