The following guideline is to be followed when further investigations, tests or imaging are requested by a Joint Medical Examiner.

Introduction

Joint Medical Examiners may recommend further investigations such as pathology and imaging services in order to provide a complete and accurate assessment relating to a client’s potential eligibility to treatment, services and entitlements.

Tests and imaging

As a general rule, additional investigations, tests or imaging may only be permitted where the findings of the Joint Medical Examiner would be otherwise incomplete or unreliable.

Medical examiners should not initiate any investigations, tests or imaging without consent from the client and prior consideration by their treating health practitioner.

If the Joint Medical Examiner requires further tests or imaging, this should be included as a recommendation in their report. This must include an explanation as to why they are unable to provide a complete assessment without the requested test, imaging or pathology.

Upon receiving the examiner’s report and any request for additional imaging, the initiating party will discuss the recommendations with the client and provide a copy to the client’s treating practitioner for their consideration.

If the client’s treating practitioner agrees that further imaging is required, and the TAC approves such imaging, the initiating party will then provide a copy of the investigation to the examiner for further comment.

Where a complete and reliable impairment assessment cannot be provided due to additional imaging being required, this explanation must also detail the table(s) and/or text from the AMA 4th Edition Guides relevant to the imaging requested.

It is acknowledged that special tests may be required and initiated by an examiner in the following circumstances: lung function testing, audiology or sleep studies, which form part of the assessment. An Addiction Medicine Specialist may conduct a breathalyser test, urine drug test and blood test(s) if considered necessary to provide an opinion. The client must provide their consent to such special tests.

Circumstances where the TAC must be asked for approval

If the client’s treating practitioner agrees that further imaging is required, the practitioner should provide a referral so that the client can go to an imaging centre.

In line with the TAC policy, pre-approval for this will be required when it has been more than 6 months since a client has had any treatment or service paid for by the TAC.

Please refer to X-rays and scans for more information on this process.

Where to send radiology approval requests

If pre-approval is required, the request can be sent to info@tac.vic.gov.au with the TAC claim number in the subject line.

Once the TAC receives a request

The TAC will assess the request and, where clinically justified, consider approval. The TAC will communicate its decision to the client, requesting treating practitioner and legal representative.

The TAC cannot pay for investigations or tests that are not:

• related to transport accident injuries
• reasonable, necessary or appropriate
• clinically justified.

How much we will pay

For detailed information about the TAC’s policy and the fees covered, please refer to X-rays and scans.

To request a reimbursement, a client may scan or take a photo of their receipt and submit it to the TAC using the ‘Claim reimbursement’ button on MyTAC, or alternatively, email it to info@tac.vic.gov.au.

Further imaging approved

Once the further imaging is completed, the initiating party should provide a copy of the imaging/scans/tests to the Joint Medical Examiner for further comment.

Please refer to the Joint Medical Examination Protocol and/or Impairment Assessment Protocol for guidance on supplementary report requests.

It is expected that the Joint Medical Examiner will provide their complete and reliable assessment as a supplementary report to both parties within 14 days of receiving the further information.

Escalation process for outstanding requests

Where a request for further imaging/scans/investigations has been received from the client’s treating practitioner and the request has not been approved by the TAC within 10 business days, an escalation may be sent to the TAC.

The relevant process is outlined in the Solicitors Contact Guide under the matter type 'Escalation/complaint,' then enquiry type 'Escalate a pending request (any type) to a Manager.' The process is to:

• Draft an email to tacclaims@tac.vic.gov.au
• Update the claim number and client surname in the subject line
• Provide sufficient information about the pending request to enable the manager to investigate and respond.