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JME Request Form
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Getting Started

JME Request Form
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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 claimant and the TAC under Part 3 of the Transport Accident Act 1986 (TAA) and pursuant to the JME Protocols 2016. Please complete this form identifying the JME(s) and provide any information and documents in support of your request.

Where do I send the JME request?
Correspondence to: protocols@tac.vic.gov.au

Claimant Details

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Claim Number validated
Is the claimant under 18 years of age? *
Does the claimant have any other claims? *
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Claim Number validated
Is this claim relevant to this examination?

Claimant’s Lawyer

Firm Address *

Request type

Part A: Request for JME
Require:
Appointment details
Please note, the date selected is within 28 days, please ensure you have discussed this with the relevant TAC case owner before submitting request.
Additional needs
Travel and Accommodation needs
Does your client require assistance to travel? *
If yes, provide medical documentation specifically confirming the need. Please also provide full name and DOB of additional carer. Please note these details are compulsory for the TAC to secure tickets with external providers (booking flights etc.).
What airport is most convenient for your client to travel in and out of?
What are the approximate departure and arrival dates/times required?
Is your client travelling with a carer? *
If yes, provide full name of carer and whether separate beds or bedrooms are required.
Are separate bedrooms required? *
Are separate beds required? *
What are the preferred dates of check in and check out?
Part B: Primary reason for examination *
Part B: Primary reason for examination *

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 JME 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..