ACH v Allianz Australia Insurance Limited

The dispute between ACH and Allianz Australia Insurance Limited was heard in the Motor Accident Authority of New South Wales. The Claimant sought a review of a decision made by the Insurer, which denied the Claimant's claim for weekly payments in accordance with section 3.8 of the Motor Accident Injuries Act 2017 (MAI Act). The Claimant alleged a partial loss of earning capacity following a motor accident, while the Insurer disputed that the Claimant suffered such a loss and argued that the dispute about earning capacity constituted a medical assessment matter, thereby removing it from the Commission's jurisdiction.

The court was required to determine whether the dispute about the Claimant's earning capacity was a merit review matter, which would allow the Commission to review it, or a medical assessment matter, which would fall outside the Commission's jurisdiction. The court considered the definitions of "loss of earning capacity" and "impairment of earning capacity" as used in the MAI Act, and whether the dispute related to statutory benefits or damages. The court also assessed whether the Insurer had adequately considered all relevant evidence when determining the Claimant's post-accident earning capacity.

The court held that the dispute was a merit review matter because it related to the amount of statutory benefits payable under Division 3.3, rather than "impairment of the earning capacity." The court found that the Insurer had placed too much weight on the Claimant's ability to perform some overtime after returning to work, and had failed to adequately address the balance of relevant matters. Consequently, the court set aside the Insurer's decision and remitted it for reconsideration, directing the Insurer to determine the Claimant's post-accident earning capacity in accordance with Schedule 1 clause 8 and by reference to the totality of the relevant evidence.

In light of the court's decision, the Insurer was directed to reconsider the Claimant's claim for weekly payments under section 3.8, taking into account the totality of the relevant evidence and determining the Claimant's post-accident earning capacity in accordance with Schedule 1 clause 8. The court's decision provided clarity on the jurisdictional scope of the Commission in relation to disputes about earning capacity and emphasised the importance of adequately considering all relevant evidence in such determinations.