JME REQUEST FORM: JME PROTOCOLS

    Important notes:

    This form is to be used by lawyers requesting a Joint Medical Examination (JME) on behalf of a client and the TAC under Part 3 of the Transport Accident Act 1986 (TAA) and pursuant to the JME Protocols 2016.

    Please consider whether bypassing the impairment assessment process in accordance with the Supplementary Common Law Protocols would better serve the client's interests, particularly in fast-tracking their serious injury application or common law claim. For example, the client has a clear serious injury and you have information that indicates another party is at fault.

    Please complete this form identifying the JME(s) and provide any information and documents in support of your request.

    Client details

    ×

    Client's lawyer

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

    Request type

    Appointment details

    Exam 1

    Additional appointment needs

    Note: it is preferable for the client to find their own way to the examinations. However if your client is unable to use their pre-accident mode of transport because of their transport accident injuries, taxi travel may be reasonable
    ×
    ×

    Client's injuries

    Please list an injury and the TAC claim it relates to.

    One injury per line.

    ×

    Supporting documentation

    Where appropriate, please provide the following list of documents relied upon in the request and attach copies where not previously provided to the TAC.

    Check an option to upload your supporting documents.

    Other comments

    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