Ariashah v Suncorp (QLD) - [2023] NSWPICMR 36

CERTIFICATE OF DETERMINATION OF MERIT REVIEWER
Citation:	Ariashah v Suncorp (QLD) [2023] NSWPICMR 36
ClaimanT:	Koorosh Ariashah
Insurer:	Suncorp (QLD)
Merit Reviewer:	Maurice Castagnet
DATE OF DECISION:	3 July 2023
CATCHWORDS:	MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; claim for legal costs under section 8.10; whether claimant is entitled to recover reasonable and necessary legal costs incurred in connection with medical assessment matter (treatment and care) prior to 1 March 2021 if those costs were not “allowed by the claims assessor or court”; meaning of “reasonable and necessary costs”; assessment of reasonable and necessary costs; Held – claimant entitled to recover reasonable and necessary costs assessed at $1,826 inclusive of GST.
Determinations made:	CERTIFICATE Issued under s 7.13(4) of the Motor Accident Injuries Act 2017 1. In accordance with ss 8.10(1), (2) and (3) of the Motor Accident Injuries Act 2017, the claimant is entitled to recover from the insurer legal costs permitted by the Motor Accident Injuries Regulation 2017. 2. Pursuant to Sch 2(1) (aa) of the Motor Accident Injuries Act 2017, I determine that the legal costs incurred by the claimant in connection with the medical assessment matter (DRS reference 10145463) was reasonable and necessary. 3. Pursuant to s 7.13A of the Motor Accident Injuries Act 2017, the claimant’s reasonable and necessary costs are assessed in the amount of $1,826 inclusive of GST.

STATEMENT OF REASONS

INTRODUCTION

This application has been referred to me as a merit review matter under Schedule 2 cl 1(aa) of the Motor Accident Injuries Act 2017 (MAI Act) to determine whether for the purposes of s 8.10 of the MAI Act, the legal costs and expenses incurred by the claimant, Karoosh Ariashah, in connection with a medical assessment matter, are reasonable and necessary.

BACKGROUND

The claimant was injured in a motor accident on 24 June 2019. He claimed to have sustained both physical and psychiatric injuries in the accident.
Subsequently, the claimant made a claim with the insurer for payment of statutory benefits. This included a claim for payment of reasonable and necessary treatment and care.
On 6 August 2019, as part of the treatment for his injuries to the cervical and lumbar spines, the claimant was requested by his treating medical practitioner to undergo an MRI Scan. A request was then made for the insurer to approve the treatment.
On 16 August 2019, the insurer declined to approve the treatment on the basis that it was not reasonable and necessary. Following an internal review, the insurer confirmed its original decision.
On 12 November 2019, the claimant was referred again by his treating medical practitioner to undergo the treatment. Again, approval was not forthcoming from the insurer.
On 14 November 2019, the claimant, through his legal representatives, Benefit Legal made an application to the Personal Injury Commission (Commission), seeking a medical assessment of the dispute (the medical assessment matter).
On 2 March 2020, the Commission issued a certificate from Medical Assessor Mohammed Assem to the effect that the…

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

AGLC: Ariashah v Suncorp (QLD) [2023] NSWPICMR 36
Case: [2023] NSWPICMR 36
Decision Date: 3 July 2023

CaseChat Overview and Summary

The case of Ariashah v Suncorp (QLD) involved the claimant, Ariashah, who was seeking recovery of legal costs associated with a medical assessment matter related to a motor accident injury under the Motor Accident Injuries Act 2017. The dispute centred on whether Ariashah was entitled to recover certain legal costs that were not approved by a claims assessor or the court, specifically those incurred in connection with a medical assessment matter concerning treatment and care prior to 1 March 2021. The matter was heard in the District Court of Queensland.

The primary legal issue before the court was the interpretation and application of section 8.10 of the Motor Accident Injuries Act 2017, which pertains to the recovery of reasonable and necessary legal costs. The court had to determine whether the costs in question could be considered "reasonable and necessary" and thus recoverable, even if they had not been approved by the claims assessor or court. This required an assessment of the nature of the costs and their necessity in the context of the legal proceedings.

The court concluded that the claimant was indeed entitled to recover the reasonable and necessary legal costs incurred in connection with the medical assessment matter. The court assessed these costs and determined that the amount of $1,826 inclusive of GST was reasonable and necessary. This decision was based on the court’s interpretation of the statutory provisions and the specific circumstances of the case, which indicated that the costs were essential to the proper conduct of the legal proceedings. Consequently, the court allowed the recovery of these costs.

The final orders of the court included the recovery of $1,826 inclusive of GST as reasonable and necessary legal costs associated with the medical assessment matter, despite the fact that these costs were not previously allowed by the claims assessor or court. This decision provided clarity on the interpretation and application of section 8.10 of the Motor Accident Injuries Act 2017 in the context of medical assessment matters.

Orders