Bro v CRG - [2024] NSWPICMR 18

CERTIFICATE OF DETERMINATION OF MERIT REVIEWER
CITATION:	BRO v CRG [2024] NSWPICMR 18
CLAIMANT:	BRO
INSURER:	CRG
MERIT REVIEWER:	Katherine Ruschen
DATE OF DECISION:	19 July 2024
CATCHWORDS:	MOTOR ACCIDENTS - Motor Accident Injuries Act 2017 (MAI Act); Civil Liability Act 2002 (CLA); merit review; dispute about payment of weekly benefits under Division 3.3 of the MAI Act; whether the insurer is entitled to refuse payment of statutory benefits in accordance with Part 3 of the CLA (as applied by section 3.39 of the MAI Act); limitation on statutory benefits in relation to certain mental harm; section 30 of the CLA; meaning of close member of the family of the victim; meaning of being put in peril; Held – the reviewable decision is affirmed.
DETERMINATIONS MADE:	CERTIFICATE Issued under s 7.13(4) of the Motor Accident Injuries Act2017 The reviewable decision is about whether the insurer is entitled to refuse payment of statutory benefits in accordance with Part 3 of the Civil Liability Act 2002 (as applied by s 3.39 of the Motor Accident Injuries Act 2017 (the MAI Act) (Limitation on statutory benefits in relation to certain mental harm) and is therefore a merit review matter under Schedule 2(1)(t) of the MAI Act. 1. The reviewable decision is affirmed.

STATEMENT OF REASONS

INTRODUCTION

A dispute has arisen between BRO (the claimant) and the insurer about the claimant’s entitlement to payment of weekly benefits under Division 3.3 of the Motor Accidents Injuries Act 2017 (MAI Act).
The claimant’s niece, BQG, (the victim), was injured in a motor accident on 1 September 2023.
The claimant made a claim for statutory benefits under the MAI Act arising from pure mental harm suffered by the claimant in connection with the victim’s motor accident.
On 30 November 2023 the insurer determined the claimant was not entitled to statutory benefits as she was not a person who is eligible to bring a claim for pure mental harm under s 30 of the Civil Liability Act2002 (the CLA).
On 13 December 2023 the claimant requested an internal review of the insurer’s decision dated 30 November 2023.
On 22 December 2023 the insurer issued their internal review decision, which affirmed the insurer’s original decision that the claimant is not entitled to statutory benefits pursuant to s 30 of the CLA.
The claimant has requested a merit review of the insurer’s internal review decision dated 22 December 2023 (the Application).

SUBMISSIONS

The claimant submits she is an eligible person under s 30 of the CLA on the basis she:
(a) is a close member of the family of the victim, and/or
(b) she witnessed, at the scene, the victim being put in peril.
The claimant submits she meets the definition of “close member of the family” of the victim under s 30 on the basis she and the victim “were in a close family relationship in that they considered one another sisters”.
In the alternative, the claimant submits she attended the scene after the accident and “witnessed…

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.

Continue reading Bro v CRG

Details

AGLC: Bro v CRG [2024] NSWPICMR 18
Case: [2024] NSWPICMR 18
Decision Date: 19 July 2024

CaseChat Overview and Summary

In the matter of Bro v CRG, the parties were involved in a dispute concerning the payment of weekly benefits under Division 3.3 of the Motor Accident Injuries Act 2017. The case was heard and determined in the relevant Australian court. The central issue was whether the insurer could refuse to pay statutory benefits in accordance with Part 3 of the Civil Liability Act 2002, as applied by section 3.39 of the Motor Accident Injuries Act, in light of a limitation on statutory benefits in relation to certain mental harm under section 30 of the Civil Liability Act. Furthermore, the court had to determine the meaning of a "close member of the family of the victim" and whether such a member was "put in peril" in the context of the case.

The court examined the relevant statutes and the precedents set by previous cases. It considered the arguments presented by both parties and their interpretations of the statutory provisions. The court ultimately held that the reviewable decision was affirmed, upholding the insurer's right to refuse payment of statutory benefits under the given circumstances. The court's interpretation of the meaning of "close member of the family of the victim" and "being put in peril" were also central to its decision.

The court's reasoning and outcome were based on the application of statutory provisions and the interpretation of relevant terms within the context of the case. The court found that the statutory limitation on benefits for mental harm applied in this situation, and the insurer's decision to refuse payment was justified. The court's decision was in line with the applicable law and the facts presented in the case.

The final orders of the court affirmed the reviewable decision, upholding the insurer's right to refuse payment of statutory benefits under the given circumstances, and the interpretation of the terms "close member of the family of the victim" and "being put in peril" as applied to the case.

Orders