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Dispute Resolution Application
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Getting Started

Dispute Resolution Application
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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 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 claimant and/or their lawyer and which are to be relied on in the DR.

Enquiries to: iew@tac.vic.gov.au
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 claimant and/or their lawyer and which are to be relied on in the DR.

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

Claimant Details

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Claim Number validated

Claimant’s Lawyer

Firm Address *

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

Supporting material provided by the claimant with this DR Application

Source
Type of information
Supporting Material
TAC
File:

Request for Joint Medical Examination(s)

Please note this form constitutes a formal request for a JME relating to the decision(s) the subject of this dispute – a separate JME request form is not required.

Timetable for claimant statement/supporting material to be provided in support of this DR application

Source
Type of information

Denial of claim (Chapter 10) – request for TAC to pay for material

Source
Type of information

Proposed DR conference dates when the claimant will be able to participate in a DR conference

Guardian / Administrator

Has the claimant had an administrator appointed? *
Please provide supporting documentation.
TAC
File:

Claimant Statement / Additional Attachments

Please provide any supporting material not already attached to this application.
TAC
File:

Information for Solicitors

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 claimants. The TAC will retain any information provided to the TAC as part of the dispute resolution process, and may use or disclose that information to make further inquiries or assist in the ongoing management of the claimant’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 www.tac.vic.gov.au.