Thought it might be interesting read for all the Victorians on the site.
Victorians don't realise they are covered for income protection, ambulance, etc via the TAC.
1 What is a "transport accident"? A transport accident is defined to mean an “ incident directly caused by the driving of a motor car or motor vehicle, a railway train or a tram ”. 2 What is the Transport Accident Commission (TAC)? The TAC is the Government owned agency set up to administer the transport accident scheme. The Transport Accident Act 1986 governs the operation of the TAC. Under that Act, the TAC is required to pay no fault compensation to transport accident victims, to provide rehabilitation for victims and to try to reduce the road toll by promoting road safety. The TAC office is located at 222 Exhibition Street , Melbourne 3000. Its postal address is GPO Box 2751 , Melbourne 3001. The TAC runs an enquiry call centre – 1300 654 329 or STD toll free – 1800 332 556. The facsimile number is (03) 9664 6650. TAC is also the monopoly compulsory third party insurer of all Victorian registered motor vehicles. As such, TAC pays common law damages to seriously injured accident victims. 3 Who is covered by the Transport Accident Scheme? A person who is injured as a result of a transport accident is entitled to no fault benefits under the transport accident scheme if: • the accident occurred in Victoria ; or • the accident occurred outside Victoria (but in Australia ) and involved a Victorian registered motor vehicle and at the time of the accident the injured person was: • a Victorian resident; or • the driver of or a passenger in, the Victorian registered vehicle. A person who was dependant on another person who dies as the result of a transport accident is also eligible for benefits. 4 How do I lodge a claim for compensation? You can lodge a claim by ringing the TAC on 1300 654 329 or toll free on 1800 332 556. 5 Are medical and like expenses covered? All ambulance bills are covered. All public and private hospital bills are covered. All medical, radiological, pharmaceutical and like expenses are paid in full by TAC provided that you were treated as an overnight inpatient in a hospital on account of your injuries. If you were not a hospital inpatient, an excess of $564.00 applies before TAC is responsible to pay non-hospital medical and like expenses. 6 When do medical expense payments cease? TAC has a legal obligation to continue funding reasonable, accident related hospital, medical and like expenses indefinitely. The payment of an impairment lump sum benefit or common law damages does not bring this entitlement to an end. However, if TAC considers that medical treatment is unrelated to the accident injuries, it can refuse to fund it. Likewise, if TAC considers that a particular medical treatment is unreasonable, it can refuse to pay for it. 7 Is lost income covered? If you were an earner before the accident, and you are unable to work on account of your injuries, TAC has an obligation to pay you a loss of income benefit. The benefit is 80% of your pre-accident income less income tax, up to a maximum of $953.00 per week. This entitlement lasts for a period of 18 months from the date of the accident. TAC does not have to pay for the first 5 lost working days. If you are unable to return to full time employment but can work part time you may be entitled to receive a partial lost income payment during the 18 month period. At the 18 month anniversary of the accident, if you are still unable to work, TAC has a liability to pay loss of earning capacity benefits. The loss of earning capacity benefit is calculated in a different fashion to the lost income benefit. This benefit is paid for a further 18 months thereby providing a total period of 3 years income protection for most accident victims. Some accident victims, whose level of permanent impairment is determined by TAC at 50% or more, have an entitlement to receive lost earning capacity benefits until retirement age. 8 When do lost income benefits cease? Loss of earnings benefits cease 18 months after the accident. Loss of earning capacity benefits cease 3 years after the accident except in cases where the accident victim's level of permanent impairment is determined by TAC at 50% or more, in which case the entitlement ceases upon the accident victim reaching normal retirement age. In a practical sense, loss of income and lost earning capacity benefits also cease when you stop sending TAC medical certificates of incapacity. They can also be terminated by TAC in circumstances where TAC is of the view that your injuries no longer incapacitate you for work. 9 Does TAC pay lump sum compensation? Yes. TAC pays a no fault lump sum benefit called an “impairment benefit” to eligible accident victims. As the Compulsory Third Party Insurer of all Victorian registered motor vehicles, TAC also pays lump sum awards of common law damages to seriously injured transport accident victims. 10 What is an impairment benefit? An impairment benefit is a no fault lump sum payment designed to compensate for pain and suffering. To be eligible to receive an impairment lump sum payment, your level of impairment, expressed as a percentage of the whole body, must exceed 10%. The impairment percentage is calculated by TAC after having you examined by medical specialists who have successfully completed an Accreditation course in the use of the impairment guides. Impairment percentages are calculated using the methods contained in the Guides to the Evaluation of Permanent Impairment – 4 th Edition published by the American Medical Association. It is important to note that impairment is different from disability . The impairment guides do not assess disability. They only assess impairment. Whilst the impairment guides are said to be scientific, experience shows that the application of the guides by similarly qualified medical specialists often produces significantly different impairment outcomes. Expert legal advice concerning the impairment issue is strongly recommended. 11 What is the impairment benefit worth? In the case of accident victims injured in transport accidents occurring before 16 December 2004, the impairment benefit is worth approximately $920.00 for each point over 10. No impairment benefit is payable for the first 10 impairment points. Accordingly, an impairment score of 20% would produce an impairment benefit of approximately $9,200.00. Accident victims injured in transport accidents occurring after 15 December 2004 are entitled to a considerably higher level of benefits. The benefit payable for an 11% impairment is $5,770.00 and it increases by $1,050.00 for each impairment point up to 19%. A 20% impairment produces a lump sum of $15,750.00 and each additional point up to 49% is worth $1,570.00. The maximum that can be paid for accidents occurring after 15 December 2004 is currently $264,590.00. The maximum that can be paid for accidents occurring before 16 December 2004 is currently $83,410.00. 12 When is an impairment benefit paid? It used to be paid at the 18 month anniversary of the accident. However, due to a recent amendment to the Transport Accident Act , interim impairment benefits can now be paid to accident victims at any time after the accident. Provided an injury is stable, TAC can assess and determine the impairment applicable to that injury and pay a benefit. In the case of children, (i.e. victims under the age of 18 years), the final impairment determination is made at 18 years of age. 13 What happens if TAC makes a decision you don't agree with? When TAC makes a decision concerning no fault benefits, you have a period of 12 months within which to challenge that decision by means of an appeal to the Victorian Civil and Administrative Tribunal (VCAT). The 12 month period commences on the day that you become aware of the decision. Accident victims who are represented by a lawyer must submit to a no fault dispute resolution protocol which requires a comprehensive exchange of information concerning the disputed decision, leading up to a dispute resolution conference, before you can avail yourself of the formal VCAT appeal process. 14 What if I am injured in a transport accident that occurs in the course of my employment? If you are injured in an accident that occurs in the course of your employment, other than when you are travelling to or from work, you are not entitled to receive TAC benefits. In this type of case, you are entitled to receive benefits under the WorkCover Scheme. For further information regarding WorkCover claims we recommend Workforce Legal, expert WorkCover Lawyers: www.workforcelegal.com.au . 15 What if I was driving an unregistered vehicle? If you were the driver of a vehicle owned by you which is unregistered and you are injured in a transport accident, you would be ineligible to receive loss of income benefits for the first 18 months after the accident. You would otherwise be entitled to receive all other no fault benefits. 16 What if I was driving and had been drinking? If you were the driver and suffered injuries in the accident your entitlement to receive loss of income benefits in the first 18 months will be reduced by 1/3 if your blood alcohol level was more than .05% but less that .12%. There will be a 2/3 reduction if the reading was .12% or more but less than .24%. No benefit is payable if the blood alcohol reading was .24% or more. If the alcohol played no role in causing the accident, then these reductions do not apply. The reductions only apply to drinking drivers. They do not apply to passengers or pedestrians. 17 What if I was driving whilst unlicensed? The driver of a vehicle involved in a transport accident who at the time of the accident was unlicensed or their licence was suspended, is not entitled to loss of income benefits in the first 18 months after the accident. Otherwise, the person is entitled to all of the other no fault benefits. 18 What if I were injured on my way to or home from work? If you were injured on a journey from your home to your workplace or from your workplace to home, your entitlements to compensation fall within the Transport Accident Scheme. 19 What if the accident was my own fault? The TAC Scheme is essentially a “no fault” scheme. Accordingly, even if the accident was your own fault you may still be entitled to no fault benefits. You would not be entitled to recover common law damages unless you could prove that someone else was at fault. 20 Do I have to live in Australia to be covered by TAC? No. However, TAC is not liable to pay any hospital, medical or like expenses incurred outside Australia . TAC does have a liability to pay loss of income benefits and loss of earning capacity benefits to an accident victim who resides outside Australia . Similarly, TAC has an obligation to pay the impairment lump sum benefit to a person who resides outside Australia . Accident victims who reside overseas can still bring a common law damages claim if they suffer a serious injury and can prove that the injuries resulted from the negligence or carelessness of another person. In such a common law claim, the accident victim can recover damages for medical costs incurred outside Australia and also an allowance for future medical costs that will be incurred outside Australia . It is very important for non-Australian residents, injured in transport accidents in Australia to seek expert legal advice concerning their rights. It is possible for such accident victims to inadvertently lose their rights under the Transport Accident Scheme. Expert legal advice must be obtained. 21 Is compensation payable for death? Yes – a dependant of a person who dies as a result of a transport accident is entitled to receive a lump sum payment and a weekly loss of dependency benefit. The weekly benefit is payable for a period of 5 years or until the youngest dependant child completes full time education, which ever last occurs The maximum weekly benefit payable is currently $953.00. The maximum lump sum death benefit is currently $138,970.00. Dependant children also have an entitlement to an education allowance. Family members are entitled to counselling paid by the TAC to enable them to cope with the death of their loved one. Expert legal advice should be obtained concerning the entitlement to and quantum of the death benefits. 22 Who can receive death benefits from TAC? Any dependant children of the deceased and the dependant spouse of the deceased. The surviving spouse of the deceased is also eligible in circumstances where the deceased wasn't working but was engaged in the full time care of children of the deceased. Again, expert legal advice needs to be obtain about theses matters. 23 Who can sue for common law damages? Anyone who suffers a “serious injury” in a transport accident can sue the person whose negligence caused the accident in order to recover common law damages. 24 What is a “serious injury”? A “serious injury” is a formal, legal classification. It is defined as follows: (a) serious long term impairment or loss of a body function; or (b) permanent serious disfigurement; or (c) severe long term mental or severe long term behavioural disturbance or disorder; or (d) loss of a foetus The definition of serious injury has been interpreted by the Victorian Court of Appeal. The question of serious injury is one that is technical and complex. However, in simple terms, it is not the injury as such that must be “serious”, but the consequences of the injury. If you believe that you might have sustained a serious injury as a result of the negligence of some other person, you should obtain expert legal advice. 25 What type of damages can be recovered? There are 2 types of damage that can be recovered. You can obtain an award for pain and suffering . You can also obtain an award for pecuniary loss . In rare cases, it is possible to obtain an award of damages for future medical costs. However, in the vast majority of cases damages for future hospital, medical and like expenses are not recovered because the Scheme provides for an ongoing entitlement to have TAC pay hospital, medical and like expenses indefinitely, even after resolution of the common law claim. The maximum amount that can be awarded in a common law damages claim for pain and suffering is currently $411,050.00. The maximum amount that can be awarded for pecuniary loss damages is currently $924,900.00. You should obtain expert legal advice in relation to the question of common law damages. 26 How are damages calculated? Pain and suffering damages, as the name suggests, are awarded for the pain, suffering and loss of enjoyment of life experienced as a result of the injuries. There is no yard stick or scale that applies to the assessment of pain and suffering damages. The personal circumstances of the accident victim are considered in detail in assessing these damages. Every case is different. Expert legal advice is required in order to determine the likely award of pain and suffering damages. Pecuniary loss or loss of income damages can only be awarded for income lost from the 18 month anniversary of the accident up until the time the claim is resolved. You are entitled to recover the after tax income that you would have earned during the subject period had the accident not occurred. You are also entitled to recover damages for lost earning capacity. Again, the assessment of lost earning capacity damages is based upon the personal circumstances of the accident victim. The assessment takes into account pre-accident earning capacity and any earning capacity retained by the accident victim despite the injuries. The calculation of the damages involves the application of an actuarial formula in order to work out the size of the lump sum that should be paid to compensate for this particular loss. The lump sum must also take into account the normal risks of life. Generally, a lump sum for lost earning capacity will be reduced by about 15% to cover the risks of living. Again, you should obtain expert legal advice in relation to the question of pecuniary loss damages. 27 Who pays the damages? The damages are ordered to be paid by the defendant – i.e. the person you sue. However, in the vast majority of cases the person you sue is the driver or owner of a motor vehicle. In such cases the Compulsory Third Party Insurer is the body that pays the damages on behalf of the named defendant. In most TAC common law claims, the TAC itself is the organisation that pays the common law damages. 28 How soon after the accident can I sue for damages? Before being able to sue for damages you must be classified as having suffered a serious injury . Before you can be classified as having suffered a serious injury , you must have undergone an impairment assessment . An impairment determination will not be made until your injuries are stable or at least substantially stable. Hence, you cannot commence a common law damages claim until your injuries are stable and you have undergone an impairment assessment and have been classified as having suffered a serious injury . In some cases, such as in cases involving catastrophic spinal cord injuries or amputations, it is possible to have the impairment determined and the serious injury classification made within a few months of the accident. In other cases, where the injuries require a lot of ongoing treatment, it might take a year or more for the injuries to become stable. 29 Does TAC still have to pay any benefits after a common law claim is resolved? Yes. The TAC is obliged to continue paying for your reasonable, accident related hospital, medical and like expenses. The resolution of a common law damages claim brings to an end the entitlement to receive loss of earning capacity weekly benefits. It also brings to an end any entitlement to receive an impairment lump sum payment. Expert legal advice should be obtained concerning these matters. 30 Will I have to repay Centrelink benefits from my damages? If you have received Centrelink benefits between the date of the accident and the resolution of your common law claim, and you recover pecuniary loss damages, (i.e. damages for lost income and impaired earning capacity) you will have to repay the amounts you have received from Centrelink. Further, depending upon the size of your damages award, you may also be ineligible to receive Centrelink benefits for a period of time in the future. Because of this, it is vitally important that recipients of common law damages obtain independent, expert investment advice after resolution of the damages claim. 31 Are there time limits that apply to TAC claims? Yes. The time limits are: • to lodge a TAC claim for compensation – 1 year from the date of the accident or from the date the injury first manifested itself. TAC does have a discretion to accept a claim lodged after 12 months, but within 3 years of the accident, provided the accident victim can provide reasonable grounds for late lodgement. • no fault benefit decisions made by TAC – there is a 12 month period within which the accident victim can challenge the decision by means of lodgement of an appeal with the VCAT. The 12 month period runs from the date the accident victim first became aware of the decision. It is important to note that TAC also has an “internal review” process. Applying for an internal review by TAC does not stop the clock in relation to the 12 month limitation period. Time still runs even if an internal review is being undertaken. • common law damage claims – such claims must be brought within 6 years of the accident. It is possible, however, for claims to be brought after the 6 year period has expired but only in limited circumstances. It is imperative that exert legal advice be obtained in relation to the common law damages time limit.
Hey guys this is very true but I work as a financial advisor and there are several loop holes that TAC have in order to remove payments and even the way they calculate payments for individuals is pretty rubbish the policy does not cover you long term it is perfect for hospital costs and ambulance but not long term financial stability
