Transport Accident (Amendment) Regulations 2003 (Vic)
Transport Accident (Amendment) Regulations 2003
S.R. No. 31/2003
TABLE OF PROVISIONS
Regulation Page
1. Objective 1 2. Authorising provision 1 3. Commencement 1 4. Amendment to regulation 10 1 5. Forms for general compensation and emergency expenses 2 Form 5—General claim for Compensation under the
Transport Accident Act 1986 2
Form 5A—Emergency Expenses Claim for Compensation
under the Transport Accident Act 1986 12
6. Forms for funeral and dependency benefits claim 15 Form 6—Funeral and Dependency benefits claim for Compensation under the Transport Accident
Act 1986 15
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ENDNOTES 18
i
STATUTORY RULES 2003
S.R. No. 31/2003
Transport Accident Act 1986
Transport Accident (Amendment) Regulations 2003
The Governor in Council makes the following Regulations:
Dated: 23 April 2003Responsible Minister:
ROB HULLS
Minister for WorkCover
KATE HASTINGS
Acting Clerk of the Executive Council
1. Objective
The objective of these Regulations is to prescribe the claim for compensation forms to be used for the purposes of the Transport Accident Act 1986.
2. Authorising provision
These Regulations are made under section 132 of the Transport Accident Act 1986.
3. Commencement
These Regulations come into operation on
28 April 2003.
4. Amendment to regulation 10
After regulation 10(a) of the Transport Accident
Regulations 19961 insert—
"(aa) if the compensation claim is in relation to
ambulance or casualty expenses, the
prescribed form is Form 5A; or".
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5. Forms for general compensation and emergency expenses
For Form 5 in the Schedule to the Transport
Accident Regulations 1996 substitute—
'FORM 5
GENERAL CLAIM FOR COMPENSATION UNDER THE
TRANSPORT ACCIDENT ACT 1986
YOUR PERSONAL DETAILS TRANSPORT ACCIDENT DETAILS 1. Title
4.
Did police attend the scene of the accident?
• Surname No (go to 5)
• Given names Yes—Police Officer's name
• Male/Female Stationed at • Date of birth 5. The accident was reported to the police.
• Address Date reported
• Home telephone number Police Officer's name
• Work telephone number Stationed at • Mobile telephone number 6. Please provide the following details—
• Fax number
• Date of accident
• E-mail address
• Day of week
If you have been known by another name
or have changed your name in the past • Accident time am/pm 5 years, please provide details below— • Where did the accident happen?
• Previous surname • Please describe in your own words how the accident happened. • Previous given names • Please draw a diagram showing how 2. The TAC pays benefits by direct deposit
into your bank account. Please provide the accident happened.
details of the account into which you want 7. If travelling in a vehicle, what was your
your benefits paid. position in the vehicle immediately
before the accident?
• Account name
• BSB number (6 digits in total) 8. In this accident were you a— • Account number (up to 10 digits) • Driver (go to 9) • Bank name • Car or truck passenger (go to 10) • Branch • Motorcyclist (go to 9) • Address • Pillion passenger (go to 11) 3.
What is the main language you speak at • Tram Passenger (go to 14) home? • Train passenger (go to 14) English • Bus passenger (go to 14) Other (please specify) • Cyclist (go to 15)
• Pedestrian (go to 15) • Other (go to 15)
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• Name of company if a train, tram or 9. Please provide your licence details—
bus was involved (e.g. Connex
• Licence or permit number Trains)
• Expiry date of licence or permit • Was any other vehicle involved in • Length of time licence or permit has the accident? been held Yes (go to 15)
10. If travelling in a car or truck, were you No (go to 16) thrown out of the vehicle due to the 15. Please provide the following details of
accident?
any other vehicle involved in the
Yes accident. No
• Other driver's surname
11. Were you involved in a collision with a • Other driver's given names
fixed object? • Other driver's address Yes • Other driver's home phone No • Other driver's work phone
12. What was the speed limit at the accident • Other driver's mobile phone location?
• Other driver's vehicle registration
13. Were you the driver of the vehicle? Yes (go to 14)
number
• Was the vehicle registered in
If no, provide the following details— Victoria?
Yes• Driver's surname No
• Driver's given names
• If no, in what State was the vehicle
• Driver's address registered?
• Driver's home phone
• Make and model of vehicle
• Driver's work phone (e.g. Holden Commodore)
• Driver's mobile phone • Name of company if a train, tram or
14. Please provide details of the vehicle you were travelling in—
bus was involved (e.g. Connex
Trains)
• Vehicle registration number 16. Were you wearing a seatbelt or helmet? Yes
• Make and model of vehicle
(e.g. Holden Commodore) No •
Was the vehicle registered in 17. Is police action going to be taken in
Victoria? relation to the accident? Yes No (go to 18) No Don't know If no, in what State was the vehicle
registered? Yes
If yes, name of person charged• Are you the owner of the vehicle?
Yes 18. Had you consumed any alcohol in the 4 hours before the accident? No
No (to 20)
• If you were the driver at the time of
the accident, did you have permission Yes to drive the vehicle? If yes, type and amount consumed Yes
No
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19. Was a breath or blood test undertaken? No (go to 20)
FAMILY INVOLVEMENT
25. Were any members of your family
Yes injured in the transport accident? If yes, what was your reading? No Yes 20. Had you consumed any drugs (including
medication) on the day of the accident? If yes, please provide the following No (go to 21) details: Yes Family member 1 If yes, type and amount consumed Full name
Date of birth21. Did the accident happen on the way to or
from work? Address No Relationship (e.g. spouse) Yes Has the family member made a claim?
No22. Did the accident happen while you were
working? Yes No Family member 2 Yes Full name
23. Were you taking part in a motor vehicle race, speed trial, enduro or rally or a test
Date of birth
Address in preparation for one of these events?
Relationship (e.g. child)
No
Has the family member made a claim?
Yes
No
24. Were there any witnesses to the accident? No (go to 25)
Yes
Family member 3 If yes, please provide the following
details: Full name
Date of birth• Witness's surname Address
• Witness's given names Relationship (e.g. brother)
• Witness's address Has the family member made a claim?
• Witness's home phone No
• Witness's work phone Yes
• Witness's mobile phone Family member 4
Full name
Date of birth
Address
Relationship (e.g. parent)
Has the family member made a claim?
No
Yes
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YOUR INJURY DETAILS 32. Is this your usual doctor? 26. Please list all your injuries from the transport accident.
Yes
No 27. Were you transported by ambulance from the scene of the accident?
If no, please provide your usual doctor's
details—
• Doctor's name No
• Doctor's address
Yes
• Doctor's telephone number
28. Were you taken to hospital?
No (go to 29) PREVIOUS INJURIES OR CONDITIONS Yes
33. Before the accident, have you ever If yes, provide the following details— required treatment—
• by a chiropractor or physiotherapist? • Hospital name
• by a psychologist or psychiatrist?
• Was it a visit to the casualty department only? • involving hospitalisation in the last Yes (go to 29) 5 years? No • causing more than 4 weeks off work If no, date admitted for a medical condition?
• Have you been discharged from 34. Before the accident, have you ever
hospital? suffered from any of the following No conditions or problems?
• Lower back condition or pain Yes
• Neck condition or pain If yes, date discharged
• Head injury or neurological
29. Did you sustain an injury to the head? condition
No • Hip, knee or shoulder condition or Yes pain
30. Did you lose consciousness? • A drug or substance dependency
No (please specify)
• Learning difficulties or ADHD
Don't know
• Arthritis
Yes
• Orthopaedic or spinal injury
If yes, for how long? (hours/minutes)
• Work related injury
31. Are you still receiving treatment or expecting to receive treatment for your
•
Epilepsy
transport accident injuries? • Migraine or similar episodic No (go to 33) headache Yes • Asthma If yes, please provide details of the doctor • Respiratory condition who is treating your injuries • Heart condition
• Doctor's name • High blood pressure • Doctor's address • Diabetes • Doctor's telephone number
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35. Did you answer "yes" to any part of question 33 or 34?
39. Have you ever made a personal injury
claim?
No (go to 36) No (go to 40) Yes If yes, please provide the following If yes, please provide details of the injury details: or condition and the treatment you were
• Number of previous claims receiving before the accident. In relation to the most recent claim, Injury or Treatment received please provide the following details— Condition (e.g. Physiotherapy
• Claim number (e.g. bad back) once a week)
• Date of injury or incident Please list all medication you were taking in relation to the condition or treatment.
• Injuries sustained • Insurance company or employer 36. Before the accident, did you have home
services, gardening, childcare, or personal • Settlement date care assistance? OCCUPATION DETAILS
No (go to 37)
Yes 40. What was your occupation at the time of the accident?
If yes, please provide details of the type of
service, number of hours of service 41. Have you received or applied for received per week and who provided the Centrelink payments because of this service. transport accident?
PREVIOUS CLAIMS
No Yes
37. Have you ever made a Workers
• If yes, what type of Centrelink Compensation Claim?
benefit?
No
• Centrelink reference number
Yes
If yes, please provide the following 42. Are you liable for a HECS debt as a details— result of tertiary studies?
• Number of previous claims 43. What was your employment status at the
In relation to your most recent claim, time of this accident? please provide the following—
• Employed (go to 44)
• Claim number • Self employed (go to 44) • Name of the Insurance • Unemployed (go to 68) company/employer • Not gainfully employed (go to 72) • Date of injury or incident • Injuries sustained • Settlement date 38. Are you currently receiving WorkCover or other workers compensation benefits? No
Yes
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44. Have you had time off work because of your transport accident injuries?
48. Is the nature of your work physical or non-physical?
No (go to 72) Physical Yes Non-physical
• If yes, have you been absent or do • Please provide details of your daily you expect to be absent from work work duties for more than 5 working days? 49. Are alternative duties available to you
No (go to 72) (e.g. light or modified duties) Yes 50. Please provide details of your working
• If yes, please provide the days and week— dates of the first 5 days absence or
• Which days do you work? expected absence
• Average hours per day
Day 1 date Day 2
date
51.
Has your employer paid any amounts to you in respect of your absence from
Day 3 date work?
Day 4 date No
Day 5 date Yes
• Have you returned to work? If yes, please provide the following
No Expected date of return details— Yes Date on which you returned
• Nature of payment (e.g. sick leave, If self-employed (go to 62) annual leave)
• Date paid from
EMPLOYMENT DETAILS
• Date paid to
If you are an employee
• Gross amount paid
45. Please provide the following details regarding your employment—
52. Is your employer continuing to pay your
wage?
• Employee number No
• Date employment commenced Yes
• Basis of employment (permanent,
temporary, casual or seasonal) If yes, when will payments cease?
46. Are you employed on a contractual basis for a fixed period?
53. Would you prefer to receive any TAC
payments to which you are entitled via
your employer?No
No
Yes
Yes
If yes, please provide the following
details—
54.
On the day of the accident, were you on any type of leave from work or were you
• Date contract commenced due to commence leave within 4 weeks
• Date contract expires after the date of your accident?
47. Are you an apprentice or trainee? No No Yes Yes If yes, please specify the type of leave If yes, provide the following details— (e.g. sick leave, annual leave, maternity
leave or unpaid leave)
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55. Is regular overtime a condition of your employment?
57. To assist in processing your claim more quickly, please indicate those documents
No you can provide to confirm your wage.
• Pay slips (for a minimum of six pay Yes periods before the accident)
If yes, how much overtime do you work
• Most recent tax return
on average each week? hours minutes
•
Printout of payments from your
56. Have you had a permanent change to your wages (e.g. a pay rise) in the 12 months
employer
• Group certificate
before the accident? • Other No • None of the above (go to 58) Yes
If yes, date changed58. Please provide details of your wages over the 6 pay periods immediately before the accident
Pay period Gross Overtime Shift Other Allowance ending normal allowance allowance amount wage
59. Please provide the following details regarding your employer—
OPTIONAL EMPLOYER'S
ENDORSEMENT
• Business name To assist in processing your claim more quickly, you may ask your employer or • Address employer's representative to endorse your • Phone number answers to questions 45–61. • Nature of business The claimant has answered questions 45 to 61
and I certify that the answers to those• Payroll officer's name questions are true and correct. • Payroll officer's contact number Employer's signature or stamp— • Is the number of employees on the payroll more than 5? Name and signature of employer's
representative
60. Are you related to your employer? (go to 72) No
If you are self employed
Yes
If yes, how (e.g. employer is aunt)? 62. Please provide the following details—
• Type of business
61. Does your employer have a person to assist you to return to work?
•
Business name and address
• Australian Business Number (ABN)
If yes, please provide the following details—
•
What is the status of the business (e.g. sole trader, partnership, trust,
• Contact name company)?
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63. Estimate the loss suffered by your 69. Did you work during the 2 years before
business as a result of the accident. the accident? Has the business ceased completely since No the accident? Yes No If yes, provide the following details— Yes
• Employer's name
64. Have you lodged any taxation returns for the last 3 financial years?
•
Date employed from
• Date employed to No
70. At the time of the accident had you
Yes received an offer of employment?
65. Have you employed substitute labour as a result of the transport accident?
No
Yes
No If yes, provide the following details— Yes
• Employer's name If yes, please provide a separate statement
• Employer's address detailing—
• Employer's phone • Name and address of person
employed • Scheduled employment start date •
Nature of duties performed Have you started this employment? •
Period of each employment No Yes • Gross and net wages paid each week If no, reason for not starting
• Method of taxation deductions made
(i.e. group tax, withholding tax) If yes, date started •
Documentary evidence of payment Dependant's details such as cheque butts, bank statements
etc.
71.
Please provide details of all persons who are wholly or partly dependent on you.
66. Please provide details of any other income you earned from personal exertion.
A dependant is a person who relies on
your income in any way. 67. Please provide details of your accountant or the person to contact regarding your
• Full name • Date of birth financial records—
• Relationship to you (e.g. son or
• Name daughter) • Address Is the dependant person a full time • Phone number student? (go to 72)
If you are unemployed
68. Did your injuries prevent you from
No
Yes
If yes, how long? (weeks).looking for work? from looking for work?
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72. DECLARATION AND AUTHORITY TO RELEASE INFORMATION
This declaration and authority allows the Transport Accident Commission to obtain records or information, which may affect your claim.I (insert name) declare that the information provided in this claim for relevant to my transport accident injuries and relevant to any injury or condition that existed before the transport accident and has been affected by the accident from—
compensation is true and correct.
• a doctor, ambulance service, hospital or other health service provider; and • an insurer carrying on the business of providing Worker's Compensation insurance or motor vehicle insurance; and • the Trustee or Trustees of any superannuation fund; and • a department, agency or instrumentality of the Commonwealth or the State of Victoria or another State that administers police, Health Insurance Commission payments or social welfare laws.
I further authorise the Transport Accident Commission to contact and obtain information and documents relevant to any financial loss suffered by me as a result of the accident from—
• my employer (or previous employer); and • my accountant.
I consent to each of the persons and bodies mentioned in this authority providing the relevant information and documents to the Transport Accident Commission to assist in the management of my claim for compensation.
This information may be provided to the Transport Accident Commission upon being provided with a clear photocopy or imagery reproduction of this declaration and authority.
Important notes accompanying the declaration and authority
1. Section 67(1A) of the Transport Accident Act 1986 provides that an authority to release information in a claim for compensation has effect and cannot be revoked until a claim is finally determined.
2. It is an offence under Part 8 of the Transport Accident Act 1986 to provide the Transport Accident Commission (TAC) with false or misleading information in an application or to attempt to obtain benefits fraudulently.
3. The TAC respects your privacy and is obliged to manage your personal information and health information in accordance with relevant privacy law and the TAC's privacy policy. The TAC is prevented from divulging information about you unless this is required by law or is required to carry out a function or exercise a power under the Transport Accident Act 1986.
4. The TAC will retain the information provided in this claim for compensation and any information obtained using this authority on your claim file. The TAC will use this information to process, assess and manage your claim. The TAC will also use this information to verify your entitlement to benefits under the Transport Accident Act 1986, or to common law damages. If the TAC is unable to collect relevant personal and health information, this may affect the TAC's ability to assess entitlements to benefits.
5. about you where this is required by law or where this is necessary to manage your claim
The TAC may disclose the personal and health information that the TAC has obtained medical and health service providers; your employer; a solicitor acting in relation to your claim; other government agencies, such as the Victorian WorkCover Authority; a Court or Tribunal; and a person you authorise to obtain the information.
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Signature of claimant
I declare that the claimant appeared to understand the contents of this declaration and authority.
Name of witness
Signature of witness
Dated
If the Claimant is unable to sign this form because of a medical condition
Name of person representing the claimant
Signature
Relationship to claimantDated
__________________
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FORM 5A
EMERGENCY EXPENSES CLAIM FOR COMPENSATION UNDER
THE TRANSPORT ACCIDENT ACT 1986
YOUR PERSONAL DETAILS
5.
Unless you were a cyclist or pedestrian, please provide details of the vehicle you
1. Title were traveling in—
• Surname • Vehicle registration number • Given names • Make and model of vehicle • Male/Female (e.g. Holden Commodore) • Date of birth • Was the vehicle registered in Victoria? • Address Yes • Home telephone number No • Work telephone number If no, in what State was the vehicle • Mobile telephone number registered? • Fax number • Are you the owner of the vehicle? • E-mail address Yes
If you have been known by another name No or have changed your name in the past
• Name of company if a train, tram or
5 years, please provide details below—
bus was involved (e.g. Connex
• Previous surname Trains)
• Previous given names • Was any other vehicle involved in
POLICE INVOLVEMENT this accident? Yes (go to 6) 2. Did police attend the scene of the
accident? No (go to 7)
No (go to 3) 6. Please provide the following details of
Yes—Police Officer's name any other vehicle involved in this
accident.Stationed at
• Other driver's surname
3. The accident was reported to the police. • Other driver's given names Date reported • Other driver's address Police Officer's name • Other driver's home phone Stationed at • Other driver's work phone
TRANSPORT ACCIDENT DETAILS • Other driver's mobile phone
4. Please provide the following details— • Other driver's vehicle registration
number
• Date of accident
• Was the vehicle registered in
• Day of week Victoria?
• Accident time am/pm Yes
• Where did the accident happen? No
• Please describe in your own words
how the accident happened. If no, in what State was the vehicle registered?
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7. Were you the driver of the vehicle? FAMILY INVOLVEMENT Yes (go to 8) 10. Were any members of your family
If no, provide the following details— injured in the transport accident?
• Driver's surname No
Yes, please provide details below—• Driver's given name • Driver's address Family member 1 • Driver's home phone number Full name • Driver's work phone number Address • Driver's mobile phone number Date of birth
Relationship (e.g. spouse)8. Did the accident occur while you were
working? Has the family member made a claim? Yes No No Yes Please note, "while you were working" Family member 2 refers to anytime you were— Full name
• On duty; or Address • On an authorised break, e.g. lunchtime; or Date of birth
Relationship (e.g. parent, brother, child)• Performing activities for your employer Has the family member made a claim?
No9. Were you taking part in a motor vehicle
race, speed trial, enduro or rally or a test Yes
in preparation for one of these events? YOUR INJURY DETAILS Yes 11. Please list all your injuries from the
No transport accident. 12. Were you transported by ambulance from
the scene of the accident?
No
Yes13. No
Yes (hospital name)
Was it a visit to the casualty department
only?Were you taken to hospital? No (Date admitted)
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14. DECLARATION AND AUTHORITY TO RELEASE INFORMATION
This declaration and authority allows the Transport Accident Commission to obtain information and documents relevant to your claim for compensation if you later decide to claim benefits in addition to ambulance and casualty expenses.I (insert name) declare that the information provided in this claim for relevant to my transport accident injuries and relevant to any injury or condition that existed before the transport accident and has been affected by the accident from—
compensation is true and correct.
• a doctor, ambulance service, hospital or other health service provider; and • an insurer carrying on the business of providing Worker's Compensation insurance or motor vehicle insurance; and • the Trustee or Trustees of any superannuation fund; and • a department, agency or instrumentality of the Commonwealth or the State of Victoria or another State that administers police, Health Insurance Commission payments or social welfare laws.
I further authorise the Transport Accident Commission to contact and obtain information and documents relevant to any financial loss suffered by me as a result of the accident from—
• my employer (or previous employer); and • my accountant.
I consent to each of the persons and bodies mentioned in this authority providing the relevant information and documents to the Transport Accident Commission to assist in the management of my claim for compensation.
This information may be provided to the Transport Accident Commission upon being provided with a clear photocopy or imagery reproduction of this declaration and authority.
Important notes accompanying the declaration and authority
1. Section 67(1A) of the Transport Accident Act 1986 provides that an authority to release information in a claim for compensation has effect and cannot be revoked until a claim is finally determined.
2. It is an offence under Part 8 of the Transport Accident Act 1986 to provide the Transport Accident Commission (TAC) with false or misleading information in an application or to attempt to obtain benefits fraudulently.
3. The TAC respects your privacy and is obliged to manage your personal information and health information in accordance with relevant privacy law and the TAC's privacy policy. The TAC is prevented from divulging information about you unless this is required by law or is required to carry out a function or exercise a power under the Transport Accident Act 1986.
4. The TAC will retain the information provided in this claim for compensation and any information obtained using this authority on your claim file. The TAC will use this information to process, assess and manage your claim. The TAC will also use this information to verify your entitlement to benefits under the Transport Accident Act 1986, or to common law damages. If the TAC is unable to collect relevant personal and health information, this may affect the TAC's ability to assess entitlements to benefits.
5. about you where this is required by law or where this is necessary to manage your claim
The TAC may disclose the personal and health information that the TAC has obtained medical and health service providers; your employer; a solicitor acting in relation to your claim; other government agencies, such as the Victorian WorkCover Authority; a Court or Tribunal; and a person you authorise to obtain the information.
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Signature of claimant
I declare that the claimant appeared to understand the contents of this declaration and authority.
Name of witness
Signature of witness
Dated
If the Claimant is unable to sign this form because of a medical condition
Name of person representing the claimant
Signature
Relationship to claimantDated
__________________'.
6. Forms for funeral and dependency benefits claim
For Form 6 in the Schedule to the Transport
Accident Regulations 1996 substitute—
"FORM 6
FUNERAL AND DEPENDENCY BENEFITS CLAIM FOR
COMPENSATION UNDER THE TRANSPORT ACCIDENT ACT 1986
1. PERSONAL DETAILS OF THE 2. OCCUPATION DETAILS DECEASED What was the deceased's occupation at the
• Title time of the accident (including student,
pension type, home duties, unemployed)?• Surname Employed • Given names Self employed • Address
• Name of employer/own business • Date of birth
• Address of employer/own business • Male/Female
• Work telephone number • Marital status • Home telephone number • Language spoken in the family home
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3. SPOUSE, PARTNER AND 4. TRANSPORT ACCIDENT DETAILS DEPENDANT CHILDREN DETAILS Accident date Day of the week Please provide details of the spouse or Accident time partner and the children of the deceased. Where did the transport accident happen? Family member 1 At the time of the accident, what type of
• Full name transport user was the deceased? • Address
• Driver • Date of Birth
• Car or truck passenger • Relationship to the deceased
• Motorcyclist • Is the person a full time student
• Pillion passenger Yes
• Tram Passenger No
• Train passenger • Bus passenger Family member 2
• Cyclist
• Full name
• Pedestrian
• Address • Other
• Date of Birth Please provide details of all vehicles • Relationship to the deceased involved in the accident
Deceased's vehicle (if relevant)• Is the person a full time student
• Name of driver Yes
• Registration number of the vehicle No
• State of Registration (e.g. Vic) Family member 3
• Make and model of vehicle
• Full name Other vehicle • Address
• Name of driver • Date of Birth
• Registration number of the vehicle • Relationship to the deceased
• State of Registration (e.g. Vic) • Is the person a full time student
• Make and model of vehicle Yes Did the accident happen while the No deceased was on the way to or from
work?Did the accident happen while the deceased was performing his or her daily work duties?
Was the deceased taking part in a motorvehicle race, speed trial, enduro or rally or a test in preparation for one of these events?
5. Date of death
Please describe the deceased's transport
accident injuries
Name of hospital to which the deceased
admittedINJURY DETAILS health conditions the deceased may have had before the transport accident.
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Important notes accompanying the declaration
1. It is an offence under Part 8 of the Transport Accident Act 1986 to provide the Transport Accident Commission (TAC) with false or misleading information in an application or to attempt to obtain benefits fraudulently.
2. The TAC respects privacy and is obliged to manage personal information and health information in accordance with relevant privacy law and the TAC's privacy policy. The TAC is prevented from divulging information about you unless this is required by
law or is required to carry out a function or exercise a power under the Transport
Accident Act 1986.3. The TAC will retain the information provided in this claim for compensation and any other information obtained on your claim file. The TAC will use this information to process, assess and manage your claim. The TAC will also use this information to
verify your entitlement to benefits under the Transport Accident Act 1986, or to
common law damages. If the TAC is unable to collect relevant personal and health
information, this may affect the TAC's ability to assess entitlements to benefits.4. The TAC may disclose the personal and health information that the TAC has obtained from you where this is required by law or where this is necessary to manage your claim for compensation. Relevant information may be disclosed when this is necessary to:
medical and health service providers; a solicitor acting in relation to your claim; other
government agencies; or a Court or Tribunal.
DECLARATION
I (insert name) declare that the information provided in this claim for compensation is true and correct.
Name of person completing the claim
Relationship to the deceased
Signature
I declare that the person completing the claim appeared to understand the contents of this declaration.
Name of witness
Signature of witness
Dated__________________". ═══════════════
Transport Accident (Amendment) Regulations 2003
Endnotes
S.R. No. 31/2003
ENDNOTES
1 Reg. 4: S.R. No. 164/1996 as amended by S.R. Nos 64/1999 and 106/2000.
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