At Ryan Carlisle Thomas Lawyers, our experienced and committed TAC claims lawyers approach each case with care and courage, recognising that every injury and recovery journey is unique. The legislation that applies to transport accident claims is complex, but our team is dedicated to helping you understand your entitlements and the options available to you.

One of the benefits a claimant is entitled to under their accepted TAC claim is the payment of “reasonable” medical and like expenses.

We have many clients that ask us for advice after the TAC has ceased funding for physiotherapy (and other physical therapies like osteopathy, acupuncture, etc.) after having received this benefit for an extended period of time.

We have seen in recent times more and more services like physiotherapy are being ceased by the TAC on the basis that the medical treatment is no longer “reasonable”.

The legislation that applies to transport accident claims (the Transport Accident Act 1986 (Vic)) says that the TAC must consider the “necessity” of the service when determining whether a cost, expense or fee is “reasonable”.

What does “necessity” mean?

The Courts and VCAT have made rulings regarding what the legislation means by “necessity”.

The Supreme Court of Victoria has said that what is “necessary” does not only include services that are “vital” to the existence of a claimant, but also includes treatment that is of a much lower urgency than that. However, the Supreme Court also said that what is necessary excludes treatment which is of a merely “temporary palliative effect”.

For treatment to be considered as having more than a “temporary palliative effect” there must be a “measurable benefit” from the service or treatment.

To consider whether a service or treatment is producing a “measurable benefit” to an injured claimant, the TAC ought to consider:

• Whether the continuation of the service is clinically justified – that is where there is a clear long-term objective improvement in an injured person’s condition based on the medical evidence.
• Whether the service or treatment allows the injured person to effectively participate in the community including the ability for a claimant to return to work.
• Whether there are any barriers to an injured person self-managing their condition.
• That the service or treatment is the most appropriate for the condition that is being treated.
• Whether the service or treatment prevents deterioration of the injured person’s condition but is more than a temporary holding pattern.

What does this mean for me?

If the TAC has ceased paying for a service or treatment you have been undertaking, we will evaluate whether your case fits the “reasonable” and “necessity” definitions and provide tailored advice to you as to your prospects in disputing the decision.

We will do so by obtaining medical material in support of the service or treatment providing a “long-term” and “measurable benefit”. We will also consider how the treatment allows you to participate in your community and the workforce.

Time Limitations

An injured claimant has 12 months from the date of any decision of the TAC to dispute the determination. This may be done so by:

• TAC Dispute Resolution Protocols; or
• Direct route to VCAT.

Should you wish to learn more about our TAC Claims services or to speak to one of our lawyers, please do not hesitate to contact our office on 03 9238 7878.