AAI Limited t/as GIO v Cim
[2025] NSWPIC 498
•12 August 2025
| CERTIFICATE OF DETERMINATION OF MEMBER | |
| CITATION: | AAI Limited t/as GIO v CIM [2025] NSWPIC 498 |
| CLAIMANT: | CIM |
| INSURER: | AAI Limited t/as GIO |
| MEMBER: | Elizabeth Medland |
| DATE OF DECISION: | 12 August 2025 |
CATCHWORDS: | MOTOR ACCIDENTS - Motor Accidents Compensation Act 1999; discretionary exemption pursuant to section 92 and rule 99 of the Personal Injury Commission Rules 2021 (PIC Rules); claimant is self-represented; claim involves a long history after the insurer lodging an application with the Commission; claimant makes varied and complex allegations in respect of her entitlements, validity of Commission medical assessments, and the conduct of the insurer; unusually large amount of material lodged by the claimant to date; difficulties directing the claimant to the various legislative provisions that govern her claim; Held – recommended that the claim is not suitable for assessment given the varied allegations made, the amount of material relied upon, difficulties in having the claimant directed to relevant legislation, and the anticipation that any hearing would be lengthy; court a more suitable forum, where proper examination and cross examination can take place, and with a power to compel witnesses; matter referred to Division Head; recommendation subsequently approved by the Division Head, as the President’s delegate. |
INTERIM DETERMINATION
INTRODUCTION
[CIM] (the claimant) was involved in a motor accident on 21 August 2015. The claimant was a pedestrian traversing a footpath and crossing over a footpath when she was struck by an exiting vehicle. The claimant alleges injury as a result and has lodged a claim for damages upon the compulsory third party (CTP) insurer of the relevant vehicle, AAI Limited t/as GIO (the insurer).
An application was lodged, on or about 18 January 2022, by the insurer with the Personal Injury Commission (Commission) seeking assessment of the claim for damages made by the claimant.
The claimant is self-represented.
Since the lodgement of the application a large number of preliminary conferences have been held with a view to the matter becoming ready for assessment. However, the path to assessment has, to date, been convoluted and lengthy.
An extraordinarily large number of documents have been lodged by the claimant, and various issues have been raised by the claimant that could be categorised as uncommon and complex. These are discussed further below.
There is an apparent significant disparity between what the insurer considers the assessment of damages should be and what the claimant considers reflects her entitlements. For instance, in the initial submissions of the insurer dated 18 January 2022 it is submitted that damages should be limited to a small amount for past and future out of pocket expenses totalling $3,963.30. By contrast, the claimant evidently suggests that her entitlement to damages totals several million dollars.
There is a significant dispute as to the extent of the claimant’s accident related injuries. After significant delays and complications, the claimant eventually came to assessment of her alleged injuries by the medical services division of the Commission.
The claimant was examined by three separate Medical Assessors. Medical Assessor Chan (15 May 2024) assessed the claimant’s alleged gynaecological injuries and assessed a 0% with the referred injuries of dysmenorrhoea, dyspareunia and painful orgasm not caused by the motor accident.
Medical Assessor Jones (6 June 2024) assessed the claimant’s alleged psychological injuries have resolved and give rise to no permanent impairment.
Medical Assessor Kenna (5 July 2024) assessed a 0% whole person impairment from soft tissue injuries to the cervical spine, lumbar spine and right shoulder caused by the accident.
[redacted]
The claimant has also expressed various allegations in respect of the handling of her case by the insurer, that includes allegations of unlawful conduct. I have indicated that the Commission for practical purposes, does not have jurisdiction to deal with any such allegations and the Claimant has insisted that it is relevant to the assessment of her claim and wishes for these issues to be ventilated before any final determination is made.
During discussions with the parties at the preliminary conferences, particularly on
19 March 2025, I raised my preliminary views that in light of the various allegations made by the claimant and the fact that she disputes the validity of the medical assessments that it may be that the matter is not suitable for assessment. I provided the parties with the opportunity to provide written submissions in this regard.
LEGISLATIVE FRAMEWORK
Section 92 of the Motor Accidents Compensation Act1999 (the MAC Act) provides:
“(1) A claim is exempt from assessment under this Part if –
a.the claim is of a kind that is exempt under the regulations, or
b.the Commission has made a preliminary assessment of the claim and has determined (with the approval of the President) that the claim is not suitable for assessment under this Part.
(2) If a claim is exempt from assessment under this Part, the President must, as soon as practicable, issue to the insurer and the claimant of a certificate to that effect (enabling court proceedings to be commenced in respect of the claim concerned).”
Rule 99 of the Personal Injury Commission Rules 2021 (the PIC Rules) sets out the requirements for the President’s delegate to grant an application for discretionary exemption. It provides:
“(1) A claimant or insurer may apply for an exemption from assessment under section 92(1)(b) of the MAC Act or section 7.34(1)(b) of the MAI Act by lodging an application.
(2) In determining whether a claim is not suitable for assessment for the purposes of section 92(1)(b) of the MAC Act or section 7.34(1)(b) of the MAI Act, the Commission must consider the objects of the PIC Act and the circumstances of the claim.
(3) Without limiting the matters that may be considered, the Commission may consider the following –
(a) whether the claim involves complex legal or factual issues, or complex issues in the assessment of the amount of the claim,
(b) whether the claim involves issues of liability, including contributory negligence, fault or causation,
….”
SUBMISSIONS
The claimant has not provided written submissions. The insurer provided written submissions dated 16 May 2025. The insurer submits that the claim is capable of assessment in the Commission and noted that the claimant has been assessed by the Commission clarifying that there is no entitlement to damages for non-economic loss.
The insurer submits that the legislation defines what damages are available, the claim is capable of quantification consistent with the legislation and adjudication with the Commission.
The insurer further submits that an exemption is not desirable as it would add more delay to the resolution of a claim which relates to an accident that occurred 10 years ago.
At a subsequent preliminary conference occurring on 23 May 2025, the claimant expressed her view that the matter is not suitable for assessment by the Commission as there was a fundamental disconnect between her claims and what can be achieved at the Commission.
She was very clear in her view that the matter should not be determined by the Commission.
REASONS
I agree with the insurer’s submissions that the claimant’s entitlements to damages is defined by the provisions of the MAC Act.
However, the question is whether the claim is suitable for assessment by the Commission. Whilst the calculation of damages may well be a simple process on the material currently before the Commission, I have concerns that the process of providing the claimant with procedural fairness in presenting her case renders the matter not suitable for assessment.
The claimant’s various allegations and claims render it especially difficult to have the matter dealt with in an efficient manner given that the claimant has proven to make extensive and lengthy arguments. There is also a copious amount of material that has been lodged to date, with apparently more material to follow. The amount of material is well beyond what the Commission routinely deals with.
In addition, in more recent times the insurer has instructed lawyers to act on their behalf. At the preliminary conference when the insurer’s representative attended, the claimant indicated that she objected to the appearance of the legal representative. It was alleged that the insurer required her consent to be represented. As I understand it the argument is that the insurer is there to provide benefit to the claimant and as such any third party engaged required her approval. I attempted to explain that the insurer was entirely within its right to be legally represented but this explanation was rejected forcefully.
I have formed the view from my various interactions with the unrepresented claimant that it is not likely that any assessment hearing would be concluded within the normal timeframes that claims are set for assessment hearing. It has also proven difficult to have the claimant directed to the relevant legislative provisions that govern her claim, and the claimant has raised serious allegations in respect of the validity of the medical assessments issued by the Commission. I have formed the view that the claimant has exhibited a hostile approach to the claims process and in particular, to the insurer, such that the forum of the Commission is not suitable.
CONCLUSION
Having made a preliminary assessment of the claim, I determine for the reasons set out above that this claim is not suitable for assessment under s 99 of the MAC Act and I recommend to the President that it be exempt from assessment.
In accordance with 92(1)(b) of the Motor Accidents Compensation Act 1999, the Division Head (Motor Accident Division) as Delegate of the President, on 23 September 2025, approved Member Elizabeth Medland‘s recommendation that the claim is not suitable for assessment.
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