Latif v AAI Limited t/as GIO - [2021] NSWPIC 523

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Latif v AAI Limited t/as GIO [2021] NSWPIC 523
CLAIMANT:	Saiqa Latif
INSURER:	AAI Limited t/as GIO
MEMBER:	Brett Williams
DATE OF DECISION:	14 December 2021
CATCHWORDS:	MOTOR ACCIDENTS - Miscellaneous claims assessment matter; late claim for statutory benefits; accident 26 July 2018; claim made on 16 June 2021; sections 6.2 and 6.13 of the Motor Accident Injuries Act 2017; prior CTP claim; Held – claimant has provided neither full nor satisfactory explanation for the delay.
DETERMINATIONS MADE:	The findings of the assessment of this dispute are as follows: 1. For the purposes of section 6.13(3) of the Motor Accident Injuries Act 2017 the claimant has not provided a full and satisfactory explanation for the delay in making the claim. 2. For the purposes of section 6.13 of the Motor Accident Injuries Act 2017 the insurer is entitled to refuse payment of statutory benefits to the claimant. 3. Legal Costs: The claimant is entitled to recover from the insurer her reasonable and necessary costs in the amount of $1,710 plus GST. 4. A brief statement of my reasons for this determination are attached to this certificate.

Reasons for Decision

Issued under section 7.36(5) of the Motor Accident Injuries Act 2017

Background

This decision concerns whether Saiqa Latif (the claimant), who was injured in a motor vehicle accident on 26 July 2018, can make a late claim for statutory benefits. The claim was made on 16 April 2021, some two years and nine months after the accident. By letter dated 21 April 2021 the insurer sought a statement from the claimant that provided a full and satisfactory explanation for the delay in making the claim. Reasons for the delay in making the claim were provided by Ms Latif’s lawyers by letter dated 4 June 2021. On 16 June 2021 the insurer rejected the explanation for the delay on the basis that it was neither full nor satisfactory. An internal review of that decision was sought by Ms Latif. The internal reviewer issued a certificate on 23 July 2021 affirming the insurer’s decision to deny the claim on the basis that a full and satisfactory explanation for the delay in making the claim had not been provided. Ms Latif commenced these proceedings on 20 August 2021. The dispute is a miscellaneous claims assessment matter: Schedule 2 clause 3(k) of the Motor Accident Injuries Act 2017 (MAI Act).

On the papers

At the teleconference held on 11 October 2021 the parties agreed that the dispute could be determined on the papers. Having considered both s 52 of the Personal Injury Commission Act 2020 (PIC Act) and Procedural Direction PIC2 I have concluded that the proceedings can be determined on the papers. I am satisfied that sufficient information is available in connection with the proceedings to allow me to determine the dispute without holding a formal hearing.

Statutory provisions

The statutory provisions relevant to the dispute, s 6.13 and s 6.2, are in the following terms:
“6.13…

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

Case: [2021] NSWPIC 523
Decision Date: 14 December 2021

CaseChat Overview and Summary

In the case of Latif v AAI Limited t/as GIO, the plaintiff sought to recover statutory benefits under the Motor Accident Injuries Act 2017 for an accident that occurred on 26 July 2018. The defendant, AAI Limited trading as GIO, resisted the claim on the basis that it was lodged outside the statutory time limits. The plaintiff lodged the claim on 16 June 2021. The matter was before the court to determine whether the plaintiff's late claim could be accepted under the provisions of sections 6.2 and 6.13 of the Motor Accident Injuries Act 2017.

The court needed to decide if the plaintiff provided a full and satisfactory explanation for the delay in making the claim. The plaintiff had a prior CTP claim, which was a relevant factor in the court's consideration. The court examined the circumstances surrounding the delay, including any justification or mitigating factors that could be taken into account. The central issue was whether the delay was sufficiently explained and justified to warrant an extension of the statutory time limits.

The court found that the plaintiff had not provided a full and satisfactory explanation for the delay in lodging the claim. It was noted that the plaintiff had a prior claim, but this alone was not enough to constitute a satisfactory explanation. The court held that the plaintiff needed to demonstrate more substantial reasons for the delay. As the plaintiff had not done so, the court rejected the claim. Consequently, the plaintiff's application for statutory benefits was dismissed.

Orders