You have rights if the Transport Accident Commission (TAC) rejects your claim for benefits after a transport accident. If the TAC has rejected your claim or issued an adverse decision, it is crucial to seek knowledgeable legal guidance as soon as possible.
Arnold Dallas McPherson Injury Lawyers (ADM) know how the TAC operates and the common reasons claims get rejected. Our transport accident lawyers can help you gather additional evidence and identify the options for lodging a dispute.
You have a limited time to dispute TAC claim rejections and adverse decisions. Call ADM at 1800 242 588 today to ensure you don’t lose the opportunity to recover compensation for your injuries.
Why Do TAC Claims Get Rejected?
The TAC may reject claims for a variety of reasons. Some of the most common have to do with eligibility, statutory time limits and insufficient information or evidence.
Eligibility Issues in TAC Claims
In Victoria, the transport accident compensation scheme applies to people injured in accidents caused by the driving of a motor vehicle, train or tram. This includes the occupants of cars, trucks, buses, trains and trams, as well as motorcyclists and pedestrians and cyclists injured by motor vehicles. If there is a question over whether the accident meets the definition of a transport accident, the TAC may reject the claim.
Time Limits in TAC Claims
TAC accident claims should be lodged within 12 months of the road accident or the date the injury first becomes apparent. The TAC may consider a claim lodged within three years if there are reasonable grounds for the delay. Claims for adults lodged after the 3rd anniversary of an accident will be rejected with no ability to dispute the decision.
Missing Information and Insufficient Evidence
ADM has written before about the large volume of information you need to make a TAC claim in Victoria. You will likely be asked to provide additional information rather than having your claim rejected outright, but you may run into problems if there isn’t enough information for the TAC to determine whether you are eligible for compensation.
If a TAC claim is rejected, you will receive a letter specifying the reasons why. An experienced lawyer can review the letter and identify your options for disputing the decision.
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How Long Does the TAC Have to Make a Decision?
The TAC generally has 21 days after receiving your claim to accept it, reject it or request additional information or a medical examination. If further information is required, the TAC must generally make a decision within 14 days after receiving the requested information or examination results.
If your claim is approved, the TAC can pay for medical and like services connected to your accident injuries. You may also be entitled to income support and return to work support.
What Happens If Your TAC Claim Is Rejected?
Rejection of a TAC claim may mean one of two different things. The first is the rejection of your initial claim for benefits after a transport accident. When this happens, you will not receive statutory benefits such as income support payments and the TAC will not cover medical and like services (unless the decision is reversed).
The second is rejection of specific entitlements or compensation claims after your initial TAC claim has been accepted. Potential consequences in this second scenario may include:
- Denial of medical treatments and services that require TAC approval (see examples).
- Termination of income support payments or denial of loss of earnings capacity benefits.
- Rejection of an impairment benefit, which provides a lump-sum payment for a permanent physical or psychological condition that meets certain criteria.
- Denial of common law damages; disputes often centre on whether you have a ‘serious injury’ as defined by Victoria’s transport accident legislation. Common law disputes follow a separate process, which we discuss below.
A TAC decision does not necessarily end your claim. An experienced road accident lawyer can discuss your options for lodging a dispute and represent you throughout the process.
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What Options Do I Have If the TAC Rejects My Claim?
You have several options for disputing decisions by the TAC. The appropriate pathway depends on the type of decision you are challenging.
Informal Review by the TAC
A TAC Review Officer can independently evaluate decisions made by the TAC. Informal review is free, and it is available whether or not you have legal representation. You or your lawyer may be asked to provide additional information to aid in the review process.
Informal review may result in a reversal of the original decision. Depending on the decision, this could lead to acceptance of your claim, reinstatement of previously terminated benefits, the TAC agreeing to pay for medical and like services and/or the right to additional compensation.
A review must be requested within 12 months of the date of the TAC’s decision.
TAC Dispute Resolution Protocols
If you have legal representation, your lawyer can lodge a dispute application through the TAC’s formal dispute resolution protocols. This step can be undertaken following an adverse TAC decision or if you disagree with the conclusion of an informal review.
Additional evidence may be needed to dispute TAC decisions. Your lawyer can advise you whether you need to undergo independent medical examinations and collect evidence to support your application.
If a dispute conference is required, you and your lawyer will meet with a TAC representative to discuss the matter and try to reach a resolution. The TAC will advise you and your lawyer in writing if they have changed or varied the decision, which may result in a favourable outcome for you.
A dispute resolution application must be lodged within 12 months of the date of the TAC’s decision.
Victorian Civil and Administration Tribunal (VCAT) Review
You can also apply for a VCAT merit review of a TAC decision. This may be an option instead of informal review, or after other review processes have failed to resolve the dispute.
The VCAT review process may involve one or more conferences or hearings. A member of the Victorian Civil and Administration Tribunal will adjudicate the proceedings, reviewing the TAC’s original decision and considering the evidence and other information before the Tribunal.
Ultimately, a VCAT review may result in an agreement between you and the TAC, potentially leading to acceptance of your claim and payment of benefits and entitlements. Alternatively, the VCAT member may issue a binding decision that resolves the matter.
An Application to VCAT must be lodged within 12 months of the date of the TAC’s decisions or within 3 months from the conclusion of the Dispute Resolution Protocols.
What If the TAC Rejects a Common Law Claim?
Disputes concerning serious injury applications and common law damages may be resolved through one or more conferences under the TAC Common Law Protocol. If the relevant protocol process does not resolve the matter, Court proceedings may be necessary.
The options available to you depend on the nature of the dispute:
- Originating motion: If the TAC refuses to recognise that you have a ‘serious injury’ under the terms of the scheme, your lawyer can file an originating motion with the Court. A judge will review the evidence and rule whether your injury meets the serious injury threshold.
- Writ: If a common law damages claim cannot be resolved through the TAC protocols, your lawyer can file a writ with the appropriate Court. This marks the beginning of the litigation process.
Common law damages disputes and Court proceedings are complex. It is in your best interests to entrust the matter to an experienced lawyer.
How Long Do I Have to Dispute TAC Decisions?
Strict time limits apply to TAC disputes and common law claims. These include:
- 12 months from the date you become aware of a TAC decision to request an informal review.
- 12 months from the date you become aware of a TAC decision to lodge a dispute application.
- Generally, 12 months from the date you become aware of a TAC decision to commence VCAT proceedings. If you have completed the TAC dispute resolution process, a different deadline may apply.
- Generally, 6 years from the date of the transport accident to commence Court proceedings for common law damages.
It is important to note that requesting an informal review does NOT extend the 12-month time limit for applying to VCAT.
You do not want to lose the opportunity to challenge decisions about statutory benefits, impairment benefits or common law damages. It is in your best interest to seek legal guidance as soon as you are notified of a TAC claim rejection so you can mount an effective dispute.
How Do I Challenge a Rejected TAC Claim?
Many TAC disputes can be resolved by providing additional information or evidence. Depending on the circumstances, this may include:
- Medical records and reports
- Photographs and video
- Traffic accident reports
- Witness statements
- Testimony from treating doctors and other experts
Simply providing more evidence may not be enough. The evidence should directly address the reasons given by the TAC for rejecting your claim or entitlement. This may involve establishing how the transport accident caused your injuries, the treatment or support you need, your loss of earnings or the extent of any permanent impairment.
Why You Should Contact a TAC Claim Lawyer
Having your TAC claim rejected can be very stressful. It can leave you without benefits to pay for medical care or your monthly bills. Denial of claims for lump-sum compensation can prevent you from getting the financial resources you need to deal with the long-term effects of serious injuries.
An experienced TAC lawyer can review the reasons for the adverse decision, determine which dispute pathway applies, gather evidence to address the issues raised by the TAC and represent you through dispute resolution or Court proceedings where necessary.
Learn How ADM Can Help
TAC claim lawyers at ADM provide steady guidance when you are worried and overwhelmed by the aftermath of a transport accident. We treat every client like an individual, enabling us to represent you effectively following a claim rejection, denial of medical and like services or termination of benefits.
It costs nothing to speak with us about your claim. Call ADM at 1800 242 588 today for a FREE consultation. We serve clients from offices in Melbourne, Bendigo and more than a dozen locations across Victoria.
