Carney v Insurance Australia Limited ACN 000 016 722 T/As NRMA (Motor Accident Injuries)

In the matter of Carney v Insurance Australia Limited ACN 000 016 722 T/As NRMA (Motor Accident Injuries), the applicant, Ms Carney, sought external review of a decision by Insurance Australia Limited (the respondent) to deny payment for her right total hip replacement surgery, which she argued was a result of injuries sustained in a motor accident on 2 February 2024. The dispute centred on the causation of her hip condition and the appropriateness of the requested surgery as a treatment and care expense directly related to the accident. The Motor Accident Injuries Tribunal (the Tribunal) was tasked with determining whether the respondent's decision was legally sound and procedurally fair.

The primary legal issues before the Tribunal were whether the respondent's decision was affected by errors of law or fact and whether the respondent provided procedural fairness to the applicant. Specifically, the Tribunal had to consider whether the respondent correctly applied sections 120 and 126 of the Motor Accident Injuries Act 2019 and whether the respondent afforded the applicant an opportunity to comment on Dr Powell’s supplementary report before the internal review decision was made. Additionally, the Tribunal examined the evidence provided by the applicant’s treating medical practitioners and the respondent’s reliance on Dr Powell’s report.

The Tribunal found that the respondent's decision was indeed affected by errors of law. It held that the respondent erroneously relied on Dr Powell’s report, misidentified the date that treatment had first been sought for hip symptoms, and failed to properly consider the medical opinions of the applicant’s treating medical practitioners. These factual errors led to a legal error through the misapplication of sections 120 and 126 of the MAI Act. Furthermore, the Tribunal concluded that the respondent failed to provide procedural fairness by not allowing the applicant to comment on Dr Powell’s supplementary report before the internal review decision was made. Consequently, the Tribunal set aside the internal review decision of 3 October 2024 and remitted the matter to the respondent for reconsideration in accordance with the Motor Accident Injuries Act 2019 and the relevant Motor Accident Injuries Guidelines.

In light of its findings, the Tribunal ordered that the respondent pay the applicant’s costs, as agreed or assessed, in accordance with section 198 of the MAI Act and the Motor Accident Injuries (ACAT Costs Orders) Regulation 2020. The Tribunal also outlined the procedures for the parties to follow if they wished to provide proposed consent orders or if they did not reach an agreed position on costs, including timelines and the potential for a costs application to be decided on the basis of documents.