General Claims Management Policies
Correspondence Sent to Us
To ensure that we are able to deal with any requests or reimbursements in a timely manner, please ensure that all correspondence sent to us quotes your claim number and full name.
Contact Address and Telephone Details
It is important that we have correct contact details at all times. This is to ensure that payments on your claim are not delayed. You should contact us immediately if you change address or telephone number.
Reimbursement of Medical & Rehabilitation Costs
You have a choice either to:
(1) pay for the medical and rehabilitation costs and forward the receipts to us for reimbursement ; or
(2) you can arrange for the provider to send their bill to us.
All receipts or accounts that relate to your claim must be sent to us for payment. You are not entitled to claim these expenses from Medicare. We are only required to reimburse reasonable expenses.
General Consultation Reimbursements
General consultations with your doctor are paid at the Australian Medical Association scheduled rates (indexed annually on 1 November). If your doctor charges in excess of the AMA prescribed fee, you will be responsible for the difference.
Updated Referrals
A doctor's referral for physiotherapy, chiropractic, massage or other hands-on treatment is only valid for six weeks. If you require ongoing treatment you must supply a current medical referral to ensure that the costs of the treatment will be reimbursed. Such treatments should be approved by us prior to commencement.
Payments of Benefits by Electronic Funds Transfer (EFT)
When we pay money to you we prefer to make the payment by EFT to your nominated account. Payments are deposited into your account as cleared funds. If you have not already provided us with your bank details, please provide them to us.
Requirement to Attend Medical Appointments
From time-to-time we may require you to attend a medical appointment by a specialist. These appointments can be conducted for a number of reasons, including a general review of your injuries, advice on future treatment requirements, and assessment of continuing entitlements to benefits. We will endeavour to arrange these appointments at a time and location that is convenient for you, when possible.
Requirement to Undertake Rehabilitation
Various medical and rehabilitation service providers may be involved in the management of your recovery. Once treatment or rehabilitation has been agreed, you are obligated to complete the program. If you do not comply without a reasonable explanation it is possible that your benefits may be suspended with no back-payment of those benefits.
Changes to Benefit Entitlements
When we make a decision on your claim regarding your entitlement to benefits we will advise you of the outcome as soon as practicable. Where a decision has been made to reduce or cease a benefit, you will be notified in writing. If you do not agree with a decision we have made, you are entitled to request a formal decision. Your request must be in writing and addressed to the Designated Person, TIO MAC. This must be done as soon as practicable after receiving written advice from us regarding the initial decision. You must seek a review within 28 days of receiving our decision.
Time frames are in place to ensure that our review is conducted as quickly as possible. You will be informed of the Designated Person's decision, in writing, and further options for appeal. For further information refer to the Appeal Process under "Additional Information".