AAI Limited t/as AAMI v Simpraga - [2025] NSWPIC 186

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	AAI Limited t/as AAMI v Simpraga [2025] NSWPIC 186
CLAIMANT:	Stevo Simpraga
INSURER:	AAI Limited trading as AAMI
MEMBER:	Susan McTegg
DATE OF DECISION:	5 May 2025
CATCHWORDS:	MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; motor vehicle accident; claims assessment; damages for economic loss; damages for future economic loss; most likely future circumstances; pre-existing condition; 70-year-old claimant was injured in a motor vehicle on 2 January 2022; injuries to cervical, thoracic and lumbar spine, both shoulders, left knee; both hips, anxiety and depression; prior accidents; following 2016 accident compensated on basis no past or future work capacity until age 67 years; Held – no capacity to maintain longer term employment where not fully recovered and given age; buffer of $20,000 for impairment past earning capacity; no change in most likely future circumstances.
DETERMINATIONS MADE:	CERTIFICATE Issued under s 7.36(1) of the Motor Accident Injuries Act 2017 Assessment of Claim for Damages made in accordance with s 7.36 of the Act 1. On the issue of liability for the claim, the AAI’s insured owed a duty of care to the claimant, breached that duty of care and the claimant sustained injury loss and damage as a result of that breach of duty. 2. Under ss 7.36(3) and 7.36(4) of the Motor Accident Injuries Act2017 (the MAI Act), I specify the amount of damages for this claim as $20,000. 3. The amount of the claimant’s costs, taking into account the amount of damages assessed in respect of this claim, assessed in accordance with the MAI Act is $12,541.10 inclusive of GST. 4. Attached to this certificate are reasons for my assessment.

REASONS FOR DECISION

INTRODUCTION

On 3 January 2022 Mr Stevo Simpraga (the claimant) was a passenger in a motor vehicle stopped by the side of the road at Moss Vale in heavy rain when the insured vehicle collided at speed with rear of his vehicle (the accident).
The claimant alleges he sustained the following injuries:
(a)    injury to the neck;
(b)    injury to the thoracic spine;
(c)    injury to the lumbar spine;
(d)    injury to both shoulders;
(e)    injury to hips;
(f)    injury to the left knee, and
(g)    anxiety and depression, symptoms consistent with post-traumatic stress disorder.
I am asked to assess damages pursuant to the provisions of the Motor Accident Injuries Act 2017 (the MAI Act) in respect of the injury sustained by the claimant.
AAI Limited trading as GIO (the insurer) is the relevant insurer with liability to pay any damages to the claimant under the MAI Act.
In a liability notice issued under s 6.20(1) of the MAI Act dated 1 February 2024 the insurer has admitted liability for the claim.
The claim was listed for assessment conference on 28 March 2025.
At the outset of the assessment conference the claimant sought to amend the claim for future economic loss. The claimant sought to claim future economic loss to age 72 years. The insurer did not object to…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

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Details

Case: [2025] NSWPIC 186
Decision Date: 5 May 2025

CaseChat Overview and Summary

In the case of AAI Limited trading as AAMI v Simpraga, the claimant sought damages for injuries sustained in a motor vehicle accident on 2 January 2022. The claimant, a 70-year-old individual, had suffered injuries to their cervical, thoracic and lumbar spine, both shoulders, left knee, both hips, and was diagnosed with anxiety and depression. The dispute centred around the assessment of the damages for economic loss, both past and future, under the Motor Accident Injuries Act 2017, and whether there had been a change in the claimant's most likely future circumstances.

The court was required to decide whether the claimant had the capacity to maintain longer-term employment given their age and the extent of their injuries. The claimant had a history of prior accidents, with a previous accident in 2016 that had resulted in compensation on the basis that they had no past or future work capacity until age 67. The court had to consider the impact of the pre-existing condition and the extent to which it influenced the assessment of damages.

The court held that the claimant did not have the capacity to maintain longer-term employment due to the extent of their injuries and their age, which was a significant factor in the assessment of damages. Given that the claimant had not fully recovered, the court determined that it was appropriate to include a buffer of $20,000 for impairment of past earning capacity. The court concluded that there had been no change in the claimant's most likely future circumstances, and therefore, the damages were assessed accordingly.

The final orders included the determination of damages for economic loss, with a specific consideration of the claimant's age, the extent of their injuries, and the buffer for impairment of past earning capacity. The court's decision provided clarity on the assessment of damages for future economic loss in the context of a claimant's age and the impact of pre-existing conditions.

Orders