Version No. 010
Transport Accident Regulations 1996
S.R. No. 164/1996
Version incorporating amendments as at 16 December 2003
table of provisions
RegulationPage
1
RegulationPage
Part 1—Preliminary
1.Objectives
2.Authorising provision
3.Revocation
4.Definition
Part 2—Prescribed Number of Hours
5.Prescribed number of hours
5A.Severe Injury
Part 3—Forms
6.Reference to forms by number
7.Statement of earnings form
8.Accident report forms
9.Notice of unreported accidents
10.Claim for compensation form
11.Application for review
12.Contract of insurance—trailers
13.Revoked
______
SCHEDULE
Form 1—Statement of Earnings
Form 2—Driver's Accident Report
Form 3—Transport Authority Accident Report
Form 4—Notice of a Transport Accident
Form 5—General claim for Compensation under the Transport Accident Act 1986
Form 5A—Emergency Expenses claim for Compensation under the Transport Accident Act 1986
Form 6—Funeral and Dependency Benefits claim for Compensation under the Transport Accident Act 1986
Form 7—Notice of Application for Review
Form 8—Contract of Insurance
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ENDNOTES
1. General Information
2. Table of Amendments
3. Explanatory Details
1
Version No. 010
Transport Accident Regulations 1996
S.R. No. 164/1996
Version incorporating amendments as at 16 December 2003
1
Transport Accident Regulations 1996
S.R. No. 164/1996
Part 1—Preliminary
1.Objectives
The objectives of these Regulations are—
(a)to prescribe forms to be used for the purposes of the Transport Accident Act 1986;
(b)to prescribe the number of hours a week for calculating an earner's average weekly earnings for the purposes of the Act;
(c)to provide for other matters authorised by the Act.
2.Authorising provision
These Regulations are made under section 132 of the Transport Accident Act 1986.
3.Revocation
(1)The Transport Accident Regulations 1986[1] are revoked.
(2)Part 4 of the Transport Accident (Miscellaneous) Regulations 1994[2] is revoked.
4.Definition
In these Regulations "the Act" means the Transport Accident Act 1986.
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Part 2—Prescribed Number of Hours
5.Prescribed number of hours
r. 5
The prescribed number of hours for the purpose of calculating an earner's average weekly earnings under section 4(4)(d) of the Act is 35 hours.
Reg.5A insertedby S.R. No. 156/2003 reg.3.
5A.Severe Injury
(1)For the purposes of section 60(2B) of the Act, the following injuries are a severe injury—
(a)permanent blindness;
(b)burns to not more than 50 percent of the body that cause severe disfigurement and comprise of full thickness burns—
(i)to the head, neck, arms or lower legs; or
(ii)that result in severe difficulties in performing mobility, communication and self care tasks;
(c)a brachial plexus injury that results in the loss of the use of a limb.
(2)In this regulation "permanent blindness" means—
(a)a field of vision that is constricted to 10degrees or less of arc from central fixation in the better eye irrespective of corrected visual acuity; or
(b)a corrected visual acuity of less than 6/60 of the Snellen Scale in both eyes; or
(c)a combination of visual defects resulting in the same degree of visual loss as referred to in paragraph (a) or(b).
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Part 3—Forms
6.Reference to forms by number
r. 6
In this Part a reference to a form by a particular number is a reference to the form of that number in the Schedule.
7.Statement of earnings form
The prescribed form of statement of earnings under sections 49(4), 50(4) and 51(5) of the Act is Form 1.
8.Accident report forms
(1)The prescribed form to be used for making a report under section 64(1) or (3) of the Act is Form 2.
(2)The prescribed form to be used for making a report under section 64(2) of the Act is Form 3.
9.Notice of unreported accidents
The prescribed form of notice which may be served on a person under section 65(1) or (2) of the Act is Form 4.
10.Claim for compensation form
For the purposes of section 67(1)(a) of the Act—
(a)the prescribed form of claim for compensation is Form 5; or
Reg. 10(aa) insertedby S.R.No. 31/2003 reg.4.
(aa)if the compensation claim is in relation to ambulance or casualty expenses, the prescribed form is Form 5A; or
(b)if the compensation involves the death of a person in a transport accident, the prescribed form is Form 6.
11.Application for review
r. 11
The prescribed form of application for review under section 77 of the Act is Form 7.
12.Contract of insurance—trailers
The prescribed form of a contract of insurance which may be entered into by the Commission with the owner of a trailer under section 86 of the Act is Form 8.
Reg.13 revoked by S.R. No. 156/2003 reg.4.
*****
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SCHEDULE
Sch.
Regulation 7
Form 1
Statement of Earnings
BY A LOSS OF EARNING CAPACITY BENEFICIARY
Name of claimant
Address
Claim No
Statement period
Earnings received as an employee
Start dateFinish dateName and addressWeekly hours Gross pay
of employer
Other earnings
Start dateFinish dateNature of activityGross earnings
DECLARATION
I declare that the information on this form is true and correct to the best of my knowledge and belief.
Signed Date of signing
______
Form 2
Sch.
Regulation 8(1)
Driver's Accident Report
FORM 2—continued
Sch.
______
Form 3
Sch.
Regulation 8(2)
Transport Authority Accident Report
FORM 3—continued
Sch.
______
Form 4
Sch.
Regulation 9
Notice of a Transport Accident
The Transport Accident Commission has been advised of the following details relating to a transport accident:
Driver's Name:
Address:
Registered No.:
Date of Accident:
The Transport Accident Act 1986requires drivers of motor vehicles involved in transport accidents to report the details on the enclosed Driver's Accident Report form when, as a result of the accident—
- a person is or may have been injured or dies; and
- a person may be entitled to claim for compensation.
The form must be completed by the driver of the vehicle involved in the accident and must be lodged with the Transport Accident Commission within 28 days of the date of accident or within 14 days of service of this notice, whichever is the later.
In the case of a recreation vehicle, if the driver is under 15 years of age, the form is to be completed by the owner, or, if the owner is also under 15 years of age, by the parent or guardian of the owner.
A person who does not submit a Driver's Accident Report within the required time is liable to pay a penalty of $50.
______
Sch. Form 5 substituted by S.R. Nos 64/1999 reg.4, 106/2000 reg.4, 31/2003 reg.5.
Form 5
Sch.
General claim for Compensation under the Transport Accident Act 1986
YOUR PERSONAL DETAILS1.Title
- Surname
- Given names
- Male/Female
- Date of birth
- Address
- Home telephone number
- Work telephone number
- Mobile telephone number
- Fax number
- E-mail address
- Previous surname
- Previous given names
- Account name
- BSB number (6 digits in total)
- Account number (up to 10 digits)
- Bank name
- Branch
- Address
English
Other (please specify) / TRANSPORT ACCIDENT DETAILS
4.Did police attend the scene of the accident?
No (go to 5)
Yes—Police Officer's name
Stationed at
5.The accident was reported to the police.
Date reported
Police Officer's name
Stationed at
6.Please provide the following details—
- Date of accident
- Day of week
- Accident time am/pm
- Where did the accident happen?
- Please describe in your own words how the accident happened.
- Please draw a diagram showing how the accident happened.
8.In this accident were you a—
- Driver (go to 9)
- Car or truck passenger (go to 10)
- Motorcyclist (go to 9)
- Pillion passenger (go to 11)
- Tram Passenger (go to 14)
- Train passenger (go to 14)
- Bus passenger (go to 14)
- Cyclist (go to 15)
- Pedestrian (go to 15)
- Other (go to 15)
9.Please provide your licence details—
- Licence or permit number
- Expiry date of licence or permit
- Length of time licence or permit has been held
Yes
No
11.Were you involved in a collision with a fixed object?
Yes
No
12.What was the speed limit at the accident location?
13.Were you the driver of the vehicle?
Yes (go to 14)
If no, provide the following details—
- Driver's surname
- Driver's given names
- Driver's address
- Driver's home phone
- Driver's work phone
- Driver's mobile phone
- Vehicle registration number
- Make and model of vehicle (e.g.Holden Commodore)
- Was the vehicle registered in Victoria?
No
If no, in what State was the vehicle registered?
- Are you the owner of the vehicle?
No
- If you were the driver at the time of the accident, did you have permission to drive the vehicle?
No /
- Name of company if a train, tram or bus was involved (e.g.Connex Trains)
- Was any other vehicle involved in the accident?
No (go to 16)
15.Please provide the following details of any other vehicle involved in the accident.
- Other driver's surname
- Other driver's given names
- Other driver's address
- Other driver's home phone
- Other driver's work phone
- Other driver's mobile phone
- Other driver's vehicle registration number
- Was the vehicle registered in Victoria?
No
- If no, in what State was the vehicle registered?
- Make and model of vehicle(e.g.Holden Commodore)
- Name of company if a train, tram or bus was involved (e.g.Connex Trains)
Yes
No
17.Is police action going to be taken in relation to the accident?
No (go to 18)
Don't know
Yes
If yes, name of person charged
18.Had you consumed any alcohol in the 4hours before the accident?
No (to 20)
Yes
If yes, type and amount consumed
Sch.
19.Was a breath or blood test undertaken?No (go to 20)
Yes
If yes, what was your reading?
20.Had you consumed any drugs (including medication) on the day of the accident?
No (go to 21)
Yes
If yes, type and amount consumed
21.Did the accident happen on the way to or from work?
No
Yes
22.Did the accident happen while you were working?
No
Yes
23.Were you taking part in a motor vehicle race, speed trial, enduro or rally or a test in preparation for one of these events?
No
Yes
24.Were there any witnesses to the accident?
No (go to 25)
If yes, please provide the following details:
- Witness's surname
- Witness's given names
- Witness's address
- Witness's home phone
- Witness's work phone
- Witness's mobile phone
25.Were any members of your family injured in the transport accident?
No
Yes
If yes, please provide the following details:
Family member 1
Full name
Date of birth
Address
Relationship (e.g. spouse)
Has the family member made a claim?
No
Yes
Family member 2
Full name
Date of birth
Address
Relationship (e.g. child)
Has the family member made a claim?
No
Yes
Family member 3
Full name
Date of birth
Address
Relationship (e.g. brother)
Has the family member made a claim?
No
Yes
Family member 4
Full name
Date of birth
Address
Relationship (e.g. parent)
Has the family member made a claim?
No
Yes
Sch.
YOUR INJURY DETAILS26.Please list all your injuries from the transport accident.
27.Were you transported by ambulance from the scene of the accident?
No
Yes
28.Were you taken to hospital?
No (go to 29)
Yes
If yes, provide the following details—
- Hospital name
- Was it a visit to the casualty department only?
No
If no, date admitted
- Have you been discharged from hospital?
Yes
If yes, date discharged
29.Did you sustain an injury to the head?
No
Yes
30.Did you lose consciousness?
No
Don't know
Yes
If yes, for how long? (hours/minutes)
31.Are you still receiving treatment or expecting to receive treatment for your transport accident injuries?
No (go to 33)
Yes
If yes, please provide details of the doctor who is treating your injuries
- Doctor's name
- Doctor's address
- Doctor's telephone number
Yes
No
If no, please provide your usual doctor's details—
- Doctor's name
- Doctor's address
- Doctor's telephone number
33.Before the accident, have you ever required treatment—
- by a chiropractor or physiotherapist?
- by a psychologist or psychiatrist?
- involving hospitalisation in the last 5years?
- causing more than 4 weeks off work for a medical condition?
- Lower back condition or pain
- Neck condition or pain
- Head injury or neurological condition
- Hip, knee or shoulder condition or pain
- A drug or substance dependency (please specify)
- Learning difficulties or ADHD
- Arthritis
- Orthopaedic or spinal injury
- Work related injury
- Epilepsy
- Migraine or similar episodic headache
- Asthma
- Respiratory condition
- Heart condition
- High blood pressure
- Diabetes
Sch.
35.Did you answer "yes" to any part of question 33 or 34?No (go to 36)
Yes
If yes, please provide details of the injury or condition and the treatment you were receiving before the accident.
Injury or Treatment received
Condition (e.g. Physiotherapy
(e.g. bad back) once a week)
Please list all medication you were taking in relation to the condition or treatment.
36.Before the accident, did you have home services, gardening, childcare, or personal care assistance?
No (go to 37)
Yes
If yes, please provide details of the type of service, number of hours of service received per week and who provided the service.
PREVIOUS CLAIMS
37.Have you ever made a Workers Compensation Claim?
No
Yes
If yes, please provide the following details—
- Number of previous claims
- Claim number
- Name of the Insurance company/employer
- Date of injury or incident
- Injuries sustained
- Settlement date
No
Yes / 39.Have you ever made a personal injury claim?
No (go to 40)
If yes, please provide the following details:
- Number of previous claims
- Claim number
- Date of injury or incident
- Injuries sustained
- Insurance company or employer
- Settlement date
40.What was your occupation at the time of the accident?
41.Have you received or applied for Centrelink payments because of this transport accident?
No
Yes
- If yes, what type of Centrelink benefit?
- Centrelink reference number
43.What was your employment status at the time of this accident?
- Employed (go to 44)
- Self employed (go to 44)
- Unemployed (go to 68)
- Not gainfully employed (go to 72)
Sch.
44.Have you had time off work because of your transport accident injuries?No (go to 72)
Yes
- If yes, have you been absent or do you expect to be absent from work for more than 5 working days?
Yes
- If yes, please provide the days and dates of the first 5 days absence or expected absence
Day 2date
Day 3date
Day 4date
Day 5date
- Have you returned to work?
Yes Date on which you returned
If self-employed (go to 62)
EMPLOYMENT DETAILS
If you are an employee
45.Please provide the following details regarding your employment—
- Employee number
- Date employment commenced
- Basis of employment (permanent, temporary, casual or seasonal)
No
Yes
If yes, please provide the following details—
- Date contract commenced
- Date contract expires
No
Yes
If yes, provide the following details—
- Type of apprenticeship or traineeship
- Date commenced
- Expected completion date
Physical
Non-physical
- Please provide details of your daily work duties
50.Please provide details of your working week—
- Which days do you work?
- Average hours per day
No
Yes
If yes, please provide the following details—
- Nature of payment (e.g. sick leave, annual leave)
- Date paid from
- Date paid to
- Gross amount paid
No
Yes
If yes, when will payments cease?
53.Would you prefer to receive any TAC payments to which you are entitled via your employer?
No
Yes
54.On the day of the accident, were you on any type of leave from work or were you due to commence leave within 4 weeks after the date of your accident?
No
Yes
If yes, please specify the type of leave (e.g. sick leave, annual leave, maternity leave or unpaid leave)
Sch.
55.Is regular overtime a condition of your employment?No
Yes
If yes, how much overtime do you work on average each week?
hours minutes
56.Have you had a permanent change to your wages (e.g. a pay rise) in the 12 months before the accident?
No
Yes
If yes, date changed / 57.To assist in processing your claim more quickly, please indicate those documents you can provide to confirm your wage.
- Pay slips (for a minimum of six pay periods before the accident)
- Most recent tax return
- Printout of payments from your employer
- Group certificate
- Other
- None of the above (go to 58)
58.Please provide details of your wages over the 6 pay periods immediately before the accident
Sch.
Pay period ending / Gross normal wage / Overtime / Shift allowance / Other allowance / Allowance amount59.Please provide the following details regarding your employer—
- Business name
- Address
- Phone number
- Nature of business
- Payroll officer's name
- Payroll officer's contact number
- Is the number of employees on the payroll more than 5?
No
Yes
If yes, how (e.g. employer is aunt)?
61.Does your employer have a person to assist you to return to work?
If yes, please provide the following details—
- Contact name
- Phone number
To assist in processing your claim more quickly, you may ask your employer or employer's representative to endorse your answers to questions 45–61.
The claimant has answered questions 45 to 61 and I certify that the answers to those questions are true and correct.
Employer's signature or stamp—
Name and signature of employer's representative
(go to 72)
If you are self employed
62.Please provide the following details—
- Type of business
- Business name and address
- Australian Business Number (ABN)
- What is the status of the business (e.g. sole trader, partnership, trust, company)?
63.Estimate the loss suffered by your business as a result of the accident.
Has the business ceased completely since the accident?
No
Yes
64.Have you lodged any taxation returns for the last 3 financial years?
No
Yes
65.Have you employed substitute labour as a result of the transport accident?
No
Yes
If yes, please provide a separate statement detailing—
- Name and address of person employed
- Nature of duties performed
- Period of each employment
- Gross and net wages paid each week
- Method of taxation deductions made (i.e. group tax, withholding tax)
- Documentary evidence of payment such as cheque butts, bank statements etc.
67.Please provide details of your accountant or the person to contact regarding your financial records—
- Name
- Address
- Phone number
If you are unemployed
68.Did your injuries prevent you from looking for work?
No
Yes
If yes, how long? (weeks).
Are your injuries still preventing you from looking for work? / 69.Did you work during the 2 years before the accident?
No
Yes
If yes, provide the following details—
- Employer's name
- Date employed from
- Date employed to
No
Yes
If yes, provide the following details—
- Employer's name
- Employer's address
- Employer's phone
- Scheduled employment start date
No
Yes
If no, reason for not starting
If yes, date started
Dependant's details
71.Please provide details of all persons who are wholly or partly dependent on you. Adependant is a person who relies on your income in any way.
- Full name
- Date of birth
- Relationship to you (e.g. son or daughter)
Sch.