Dispute resolution application

No Fault Dispute Resolution Protocols

Important notes:

This form is to be used by lawyers lodging a Dispute Resolution Application (DR Application) pursuant to the No Fault Dispute Resolution Protocols 2016.

Please complete this form identifying the decision and the subject of the DR Application, and provide any information and documents in accordance with Chapters 5 and 10-15 of the No Fault Dispute Resolution Protocols which are already in the possession of the client and/or their lawyer and which are to be relied on in the DR.

Enquiries to: review@tac.vic.gov.au

Disputes Pathways Innovation Trial

We're requesting new information on this form to enable swift triage of matters and facilitate earlier outcomes for clients, where possible. This includes identifying the application type (Fast Track, Time Limit, Standard) and asking for an indication of what outcome the client is seeking. Please note that any outcome is provided on a without prejudice basis and does not affect your client’s right to explore other options or revise their position. It is intended to provide clarity on their goals and enable the TAC to proactively assess opportunities for resolution.

More information about the Dispute Pathways Innovation Trial is under the News tab on the TAC Protocols webpage.

Client details

Client first name *

Client last name *

Date of birth *

Date of accident *

Claim number *

Client's lawyer

Firm name *

Firm's address *

Street name and number *

City *

State *

Postcode *

Practitioner *

Reference number *

Phone number *

Fax number

Email address *We will email a copy of your application to this email address.

Decision(s) that the client is seeking to have reviewed

You can ask for a review of up to 6 TAC decisions using this form.

Date of decision *

Decision *

Reasons why the client does not agree with the decision *

Outcome client is seeking *

Application type *

Fast trackTime limitStandard

See Dispute pathways innovation trial definitions below

When do you anticipate the matter will be ready to proceed, or an update will be provided to TAC? (must be within 120 days) *

Number of days review date is from today

Please enter a review date that is within 120 days of today's date.

Number of days review date is from today

Fast track - TAC claim decision letter *

Browse

Please upload the TAC's decision letter that relates to this fast track application. Fast track will only be accepted if the request is made within 1 month of the date of the TAC's decision letter and meets the criteria below.

Add another decision? *

YesNo

Date of decision *

Decision *

Reasons why the client does not agree with the decision *

Outcome client is seeking *

Application type *

Fast trackTime limitStandard

See Dispute pathways innovation trial definitions below

When do you anticipate the matter will be ready to proceed, or an update will be provided to TAC? (must be within 120 days) *

Number of days review date is from today

Please enter a review date that is within 120 days of today's date.

Number of days review date is from today

Fast track - TAC claim decision letter *

Browse

Please upload the TAC's decision letter that relates to this fast track application. Fast track will only be accepted if the request is made within 1 month of the date of the TAC's decision letter and meets the criteria below.

Add another decision? *

YesNo

Date of decision *

Decision *

Reasons why the client does not agree with the decision *

Outcome client is seeking *

Application type *

Fast trackTime limitStandard

See Dispute pathways innovation trial definitions below

When do you anticipate the matter will be ready to proceed, or an update will be provided to TAC? (must be within 120 days) *

Number of days review date is from today

Please enter a review date that is within 120 days of today's date.

Number of days review date is from today

Fast track - TAC claim decision letter *

Browse

Please upload the TAC's decision letter that relates to this fast track application. Fast track will only be accepted if the request is made within 1 month of the date of the TAC's decision letter and meets the criteria below.

Add another decision? *

YesNo

Date of decision *

Decision *

Reasons why the client does not agree with the decision *

Outcome client is seeking *

Application type *

Fast trackTime limitStandard

See Dispute pathways innovation trial definitions below

When do you anticipate the matter will be ready to proceed, or an update will be provided to TAC? (must be within 120 days) *

Number of days review date is from today

Please enter a review date that is within 120 days of today's date.

Number of days review date is from today

Fast track - TAC claim decision letter *

Browse

Please upload the TAC's decision letter that relates to this fast track application. Fast track will only be accepted if the request is made within 1 month of the date of the TAC's decision letter and meets the criteria below.

Add another decision? *

YesNo

Date of decision *

Decision *

Reasons why the client does not agree with the decision *

Outcome client is seeking *

Application type *

Fast trackTime limitStandard

See Dispute pathways innovation trial definitions below

When do you anticipate the matter will be ready to proceed, or an update will be provided to TAC? (must be within 120 days) *

Number of days review date is from today

Please enter a review date that is within 120 days of today's date.

Number of days review date is from today

Fast track - TAC claim decision letter *

Browse

Please upload the TAC's decision letter that relates to this fast track application. Fast track will only be accepted if the request is made within 1 month of the date of the TAC's decision letter and meets the criteria below.

Add another decision? *

YesNo

Date of decision *

Decision *

Reasons why the client does not agree with the decision *

Outcome client is seeking *

Application type *

Fast trackTime limitStandard

See Dispute pathways innovation trial definitions below

When do you anticipate the matter will be ready to proceed, or an update will be provided to TAC? (must be within 120 days) *

Number of days review date is from today

Please enter a review date that is within 120 days of today's date.

Number of days review date is from today

Fast track - TAC claim decision letter *

Browse

Please upload the TAC's decision letter that relates to this fast track application. Fast track will only be accepted if the request is made within 1 month of the date of the TAC's decision letter and meets the criteria below.

Dispute pathways innovation trial

Fast track - Use when your Dispute application is lodged within 1 month of the TAC's decision and related to:

TAC claim eligibility,
income,
surgery (within 3 months of the appointment date), or
urgent hospital admission.

Fast Track applications will receive acknowledgment and direct communication via phone or email to agree upon the way forward. Please note that provision of 28-day documentation will be subject to this agreement.

Time limit – Use when your Dispute resolution application is lodged to preserve your client’s right to review while necessary lodgement information is collected or a concurrent matter is resolved.

Time Limit applications will receive an acknowledgment of receipt and confirmation of the review date provided by the lawyer. Please note that a pre-issue review will not commence, and 28-day documentation will not be automatically provided following lodgement.

Standard – Use when Fast track and Time limit do not apply. Clause 6.1 - 28 days documentation is applicable.

Supporting material

Do you have any supporting material to attach to this application? *

YesNo

This could include examiner or treater reports, client statements or any other documentation that supports your application. You can select multiple documents using the 'Browse' button below.

Please upload your supporting material *

Browse

A list of your supporting material

{{please upload your supporting material}}

Will you have any supporting material to send the TAC in the future? *

YesNo

Date 1

Date 2

Date 3

A timetable and proposed conference dates will be provided following receipt of TAC material in accordance with Chapter 6 of the No Fault Dispute Resolution Protocols.

Guardian / Administrator

Has the client had an administrator appointed? *

YesNo

Please upload supporting material *

Browse

Other comments

Additional comments

Internal TAC reference, please ignore

The form is completed on a without prejudice basis to promote the efficient administration of the Protocols and cannot be relied upon in any later Court or Tribunal proceedings (unless otherwise agreed).

The TAC’s privacy policy

The TAC respects the privacy of clients. The TAC will retain any information provided to the TAC as part of the JME process, and may use or disclose that information to make further inquiries or assist in the ongoing management of the client’s TAC claim. The TAC may also be required by law to disclose any information provided to the TAC.

If you require further information about the TAC’s Privacy Policy, please call the TAC on 1300 654 329 or visit our website at tac.vic.gov.au/yourprivacy

Information about using the 'Save and complete later' feature

You must not attach documents to this form until you are ready to submit.

Any attachments uploaded and saved without submitting are added at the user's risk, and the security of the information saved cannot be guaranteed by the TAC until the form is submitted.

Save and Complete Later