AAS v NRMA Ltd
[2021] NSWPICMR 11
•19 May 2021
| CERTIFICATE OF DETERMINATION OF MERIT REVIEWER | |
| CITATION: | AAS v NRMA Ltd [2021] NSWPICMR 11 |
| APPLICANT: | AAS |
| RESPONDENT: | NRMA Ltd |
| MERIT REVIEWER: | Roohi Koya |
| DATE OF DECISION: | 19 May 2021 |
| CATCHWORDS: | MOTOR ACCIDENTS- Merit review; amount of weekly payments of statutory benefits under Division 3.3 of the Motor Accident Injuries Act 2017; date of accident 27 September 2020; decision not to pay statutory benefits from 28 September 2020 to 31 December 2020; late claim; not made within 28 days after the date of the motor accident; the Act and the Guidelines do not provide exceptions to the 28 day time frame; no discretion; Held- affirm the insurer’s decision. |
| DETERMINATIONS MADE: | 1. The reviewable decision is: (a) affirmed 2. This decision takes effect from 14 May 2021. |
Background
There is a dispute between AAS (the claimant) and the insurer about payments made under sections 3.6 and 3.7 of the Motor Accidents Injuries Act 2017 (the Act).
AAS was involved in a motor vehicle accident on 27 September 2020 and sustained injuries.
On 1 January 2021 the insurer received a claim from AAS for payment of Statutory Benefits under the Act.
The insurer accepted liability and agreed to pay AAS Statutory Benefits under the Act from 1 January 2021 instead of the date of the accident.
On 15 January 2021 the claimant requested an Internal Review of the NRMA Claims Teams decision not to pay statutory benefits for 28 September 2020 - 31 December 2020.
An internal review was completed by the insurer on 19 January 2021 affirming the NRMA claims teams’ decisions.
On 19 February 2021 AAS made an application to the Dispute Resolution Services which is now in front of me to consider.
Submissions
The claimant submits as follows:
(a) That he was badly injured and for 3 months he did not have the energy in his body to enable him to complete a claim for payment of Statutory Benefits.
(b) That he is therefore entitled to payments of statutory benefits for the period 28 September 2020 to 31 December 2020 which has been denied by the insurer.
The insurer submits as follows:
(a) The insurer notes that whilst there may be discretion with respect to accepting a late claim with reference to section 6.13(1) of the Act, however, there is no discretion provide with respect to section 6.13(2).
(b) In order for the income loss payments to be received from the date of accident, the application for person injury benefits needed to have been lodged within 28 days of the date of accident.
(c) As the application was lodged on 1 January 2021, AAS was not entitled to weekly payments of statutory benefit in respect of any period before the claim was made.
Reasons
The following matters arise for my determination:
(a) Was the claim for payment of statutory benefits made as per the time frame set by the Act?
(b) Is AAS entitled to receive Statutory Benefits for any period before 1 January 2021?
Sub-section 6.13(2) of the Act states “(2) If a claim for statutory benefits is not made within 28 days after the date of the motor accident, weekly payments of statutory benefits are not payable in respect of any period before the claim is made.”
The Motor Accident Guidelines further clarifies at clause 4.15 “as per Division 6.3, section 6.12 and section 6.13 of the Act, to make a claim for statutory benefits, a claimant must give notice of the claim to the relevant insurer within the following timeframes:
(a) three months after the date of the motor accident to which the claim relates, or
(b) to be entitled to receive weekly payments of statutory benefits from the day after the date of the motor accident, within 28 days after the date of the accident.”
Both the Act and the Guidelines do not provide exceptions to the 28 day time frame noted in the respective provisions quoted above.
In his submission AAS has noted that he “… was badly hurt and for 3 months and … didn’t had energy in my body to file up claim” thereby indicating that his injury and medical condition was the cause for the delay in lodging a claim for Statutory Benefits with the insurer.
The Guidelines further note at clause 4.9 that the insurer must communicate with a friend of the claimant, “where a friend assists the claimant with the claim”. This clarifies therefore that AAS could have lodged the claim with the assistance of a friend if he was not able to do so himself. There is no evidence in front of me to say that AAS sought the assistance of a friend in making the claim.
Based on the facts and evidences in front of me therefore, I agree with the insurer’s assertion that there is no discretion to permit commencement of statutory benefits from the date of the accident in circumstances where the claim is lodged outside the 28 day period. I find therefore that AAS did not satisfy the requirements of section 6.13(2) of the Act and the decision of the insurer to deny payments for the period 28 September 2020 to 31 December 2020 is within the provisions of section 6.13 of the Act and I accordingly affirm the insurer’s decision.
Conclusion
The reviewable decision is:
(a) affirmed.
This decision is to take effect on 14 May 2021.
Legal costs - not applicable.
Legislation and Guidelines
In making this decision, I have considered the following:
· The Application, Reply and supporting documentation;
· Motor Accident Injuries Act2017 (NSW);
· Motor Accident Guidelines, and Motor Accident Injuries Regulation 2017, Personal Injury Commission Regulation 2020.
Roohi Koya
Merit Reviewer
Personal Injury Commission
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