Mamae v Insurance Australia Limited t/as NRMA Insurance

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Mamae v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 506
CLAIMANT:	Peggy-Lee Mamae
INSURER:	Insurance Australia Limited trading as NRMA
MEMBER:	Bridie Nolan
DATE OF DECISION:	25 September 2025
CATCHWORDS:	MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; miscellaneous claims assessment; delay in lodging statutory benefits claim; whether claimant provided a “full and satisfactory explanation” under section 6.13(3); claimant involved in a motor vehicle accident on 31 January 2024; claim received by insurer on 1 November 2024; explanation attributed delay to medical and psychological issues, difficulty obtaining a certificate of capacity, and lack of scheme awareness; prior CTP claim in 2009 not disclosed; absence of detail as to solicitor-led efforts between May and September 2024; medical evidence supported psychological sequelae but explanation found incomplete and insufficient; Held – claimant failed to provide a full and satisfactory explanation for the delay; insurer entitled to refuse payment of statutory benefits under Schedule 2, clause 3(h) and 3(k).
DETERMINATIONS MADE:	CERTIFICATE Pursuant to the Motor Accident Injuries Act 2017 (MAI Act) and Schedule 2 to the MAI Act, the Personal Injury Commission determines: 1. The claimant has not provided a full and satisfactory explanation within the meaning of s 6.13(3) of the MAI Act for the delay in making the claim for statutory benefits. 2. By operation of Schedule 2, cls 3(h) and 3(k), the insurer is entitled to refuse payment of statutory benefits by reason of that delay. 3. Effective Date: This determination takes effect on 31 January 2024. 4. Costs: The claimant’s legal costs are fixed at $4,382.40 inclusive of GST, in accordance with the Motor Accident Injuries Regulation 2017. 5. A brief statement of my reasons for this determination is attached to this certificate.

STATEMENT OF REASONS

INTRODUCTION

This is an application for assessment of a miscellaneous claims dispute under the Motor Accident Injuries Act 2017 (MAI Act). The dispute arises from the claimant’s failure to lodge a claim for statutory benefits within the three-month period prescribed by s 6.13(1). The issues for determination are:
(a) whether the claimant has provided a full and satisfactory explanation for the delay in lodging the claim within the meaning of s 6.13(3) and s 6.2 of the MAI Act, and
(b) if not, whether the insurer is entitled to refuse payment of statutory benefits, both retrospectively and prospectively, by operation of Schedule 2, cls 3(h) and 3(k) of the MAI Act.

Background

The claimant, Ms Peggy-Lee Mamae, was involved in a motor vehicle accident on

31 January 2024 at the intersection of Erskine Park Road and Coonawarra Drive, Erskine Park. She was the driver of a sport utility vehicle with her four-year-old son and five-year-old daughter as passengers. The vehicle was struck on the driver’s side, forced onto two wheels, and rotated before coming to rest facing the opposite direction of traffic. The airbags deployed. The fire brigade, travelling behind, attended the scene. No police or ambulance were called at that time.
The claimant alleges that as a consequence she sustained physical injuries to the head (including a right parietal contusion), the right shoulder, the cervical, thoracic and lumbar spine, anterior chest, and bilateral hips, together with psychological sequelae. These included anxiety, post-traumatic stress disorder, sleep disturbance, and the development of uncontrollable motor and vocal tics described by practitioners as Tourette-like. Subsequent clinical records document ongoing incapacity and the need for psychiatric, psychological and occupational therapy interventions.
No Application for statutory benefits was lodged within the three-month period prescribed by s 6.13(1). The insurer, Insurance Australia Limited trading as NRMA, first received a Personal Injury Benefits Application Form dated 21 October 2024 on 1 November 2024, some nine months after the accident.
On 5 November 2024 the insurer requested an explanation for the delay. On 25 November 2024 it repeated that request. On 28 November 2024 the insurer issued a Liability Notice, declining payment of statutory benefits on the basis that the claim was out of time and no full and satisfactory explanation had been provided. The Notice expressly invited the claimant to provide a signed statement addressing her conduct, knowledge and belief over the period of delay.
On 6 February 2025, through her solicitors Shine Lawyers, the claimant served upon the insurer a signed statement dated 4 February 2025. In that statement, the claimant said that she had attended St Clair Medical Centre immediately after the accident but was informed that her usual practitioner, Dr Gupta, was on extended leave. She said she was advised by staff to seek an alternative general practitioner (GP). She then attended Dr Yang Wang at Rooty Hill Medical and Dental Centre on 3 February 2024, where she reported pain in her neck, back and shoulder, as well as the onset of stuttering and motor tics. She said Dr Wang indicated he would refer her for neurological review but did not provide medication or advise of any entitlement to lodge a CTP claim.
The claimant said that between February and April 2024 she attempted to manage her symptoms conservatively with over-the-counter analgesia such as Panadol and Nurofen. She said that in late April 2024 she consulted Dr Oo at Plumpton Medical Centre, who provided a neurological referral and for the first time raised the possibility of a claim under the CTP scheme. She said that Dr Oo informed her that he was unable to complete a Certificate of Capacity, not being her treating GP. She said she subsequently saw a neurologist at Blacktown in April 2024, who diagnosed Tourette’s syndrome.
She said she first contacted Shine Lawyers on 14 May 2024 for legal advice and formally retained them on 19 May 2024. She said that her solicitors advised her to complete an Application for benefits and to obtain a Certificate of Capacity. She said that she attempted to obtain this certificate from Dr Gupta (who remained away), from Dr Wang (who refused on the basis she was not his patient), and from Dr Oo (who declined on the basis he was not her usual GP). She said she was unable to locate any local practitioner willing to complete the certificate until she attended Dr Michael Malek at Covenant Medical Hub in September 2024, who on that day completed a Certificate of Capacity. She said the claim form and certificate were then served on the insurer, being received 1 November 2024.
On 28 March 2025, the insurer rejected the claimant’s explanation as not full or satisfactory, citing absence of detail for the period 31 January 2024 to 6 February 2025, lack of corroborating treatment evidence, absence of specification of periods of incapacity, and the claimant’s professed ignorance of CTP entitlements despite having previously lodged a CTP claim. The insurer affirmed that decision on 6 May 2025 following internal review, issuing a Certificate of Determination – Internal Review to that effect.
On 26 June 2025, the claimant lodged an Application for Miscellaneous Claims Assessment with the Commission. On 2 July 2025, the claimant sought leave to lodge additional documents, including a report of Dr Malek dated 27 June 2025. In that report Dr Malek diagnosed post-traumatic stress disorder, anxiety disorder, sleep disturbance, and Tourette-like tics, noted redundancy from employment, and documented functional incapacity in multiple domains. Leave to rely on that report and associated documents was granted at the preliminary conference.
The insurer filed a Reply on 17 July 2025 together with submissions dated 16 July 2025, reiterating its contentions that the explanation was neither full nor satisfactory. The submissions relied in particular on:
(a)     the Personal Injury Register search showing a prior CTP claim lodged by the claimant in 2009 and resolved in 2014;
(b)     discrepancies between the claimant’s statement and clinical records as to when Dr Oo advised of CTP entitlements, and
(c)     the absence of any account of solicitor-led efforts between May and September 2024.
At the preliminary conference on 25 July 2025, solicitor for the claimant reserved the right to put on further material by 18 August 2025. That reservation was noted on the record. No further material was filed by that date, or thereafter.
The matter has therefore proceeded to determination on the papers on the basis of the material as filed by 25 July 2025, including the claimant’s statement of 4 February 2025, the insurer’s submissions of 16 July 2025, and the additional documents lodged on 2 July 2025 with leave.

Submissions

Claimant’s submissions

The claimant’s case is that she provided a full and satisfactory explanation for the late lodgement of her claim within the meaning of s 6.13(3), read with s 6.2 of the MAI Act. The explanation is said to be both complete and objectively justified, when account is taken of the sequence of medical attendances, her lack of knowledge of scheme entitlements, and her personal circumstances.
The claimant relies on her statement dated 4 February 2025, which sets out the following matters:
(a)    after the accident on 31 January 2024, she attended St Clair Medical Centre but her usual GP, Dr Gupta, was away on leave. She was directed to Rooty Hill Medical Centre;
(b)    on 3 February 2024 she consulted Dr Wang, who noted her complaints of pain and onset of stuttering and tics. Dr Wang provided no medication, only indicating a possible neurological referral, and did not inform her of any CTP entitlements;
(c)    she managed her condition with Panadol and Nurofen until late April 2024, when she consulted Dr Oo at Plumpton Medical Centre. He first raised the possibility of a CTP claim but declined to complete a Certificate of Capacity as he was not her treating GP;
(d)    she saw a neurologist at Blacktown in April 2024, who diagnosed Tourette’s syndrome;
(e)
on 14 May 2024 she sought legal advice from Shine Lawyers and on

19 May 2024 formally retained them. She was advised to obtain a Certificate of Capacity;
(f)    she attempted to obtain that certificate from Dr Gupta (who remained on leave), Dr Wang (who declined on the basis she was not his patient), and Dr Oo (who also declined), and
(g)    in September 2024 she consulted Dr Malek at Covenant Medical Hub, who completed a Certificate of Capacity. That enabled her to lodge her claim, which was received by NRMA on 1 November 2024.
The claimant submits that she had never previously lodged a CTP claim, was unaware of statutory entitlements until April–May 2024, and took reasonable steps thereafter to pursue her claim. She submits that the gaps in time are explained by her inability to locate a treating GP willing to complete the necessary certification, compounded by her deteriorating psychological condition, redundancy from employment, and stress associated with family illness.
Reliance is placed on the report of Dr Malek dated 27 June 2025, admitted with leave, which documents post-traumatic stress disorder, anxiety disorder, sleep disturbance and Tourette-like tics. It is said this evidence supports that her functional and cognitive difficulties contributed to the delay, and that a reasonable person in her position could not have achieved earlier lodgement.
The claimant submits that, when judged against the statutory purposes in s 1.3 of the MAI Act to provide support and treatment to injured road users, her explanation is both full and satisfactory.

Insurer’s submissions

The insurer contends that the claimant has not provided a full and satisfactory explanation within the meaning of ss 6.13(3) and 6.2 of the MAI Act. Its submissions are dated

16 July 2025 and are supported by a Personal Injury Register search and earlier correspondence of 5 and 25 November 2024.
The insurer accepts that the claim was lodged on 1 November 2024, some nine months after the accident, and that it was required to consider whether s 6.13(3) of the MAI Act could be engaged. It contends that the claimant’s explanation fails at both limbs.
On the “full” limb, the insurer submits:
(a)    the claimant failed to disclose her prior CTP claim lodged with Allianz in 2009 and resolved in 2014. That omission, uncovered by the Personal Injury Register, is directly relevant to her state of knowledge and belief;
(b)    the claimant’s account contains inaccuracies. Her statement places Dr Oo’s advice about CTP entitlements in “late April 2024”, but the Plumpton clinical records show an attendance on 22 March 2024, and
(c)    the claimant has not explained the role of her solicitors after being retained in May 2024. No account is given of steps taken by them to secure certification between May and September 2024.
The claimant has not explained her attendances with Dr Su Hianing Win at Plumpton Medical Centre in early 2024, though those consultations are recorded in the clinical material.
On the “satisfactory” limb, the insurer submits:
(a)    even accepting the claimant experienced some difficulty obtaining a certificate, the delay of six months from May to November 2024 is not objectively justified. A reasonable person, having retained solicitors and being aware of statutory time limits, would not have allowed such a delay to persist;
(b)    the claimant’s assertion that she was unaware of entitlements is undermined by her prior CTP claim. The insurer submits that the ignorance she asserts is not credible, and
(c)    the medical evidence does not establish incapacity of a kind that would justify such prolonged delay.
The insurer relies on the authorities of Mancini v Thompson [2002] NSWCA 38 (Mancini), Walker v Howard [2009] NSWCA 408; 78 NSWLR 161 (Walker), and Rahman v Al-Maharmeh [2021] NSWCA 31; 95 MVR 394 (Rahman) to emphasise that the explanation must be complete, and that solicitor conduct forms part of the narrative. It also invokes Karambelas v Zaknic (No 2) [2014] NSWCA 433 (Karambelas) to stress that the period of lateness to be explained is 1 May 2024 to 1 November 2024.
Accordingly, the insurer contends that the Commission must find the claimant has not provided a full and satisfactory explanation, and that the insurer was entitled under Schedule 2, cl 3(k) to refuse payment of statutory benefits.

Relevant Legal Principles

Section 6.13 of the MAI Act provides a statutory scheme for the timely lodgement of claims for statutory benefits. Subsection (1) requires that such a claim be made within three months of the motor accident. Subsection (2) imposes a consequence for claims lodged after 28 days: weekly payments are not payable for any period before the claim is made. Subsection (3) provides a saving mechanism, permitting claims outside the three-month period where two conditions are satisfied: first, that the claim is made within three years; and second, that the claimant provides a “full and satisfactory explanation” for the delay.
The composite requirement of a “full and satisfactory explanation” has been judicially considered in a line of decisions commencing under earlier motor accident legislation.
In Russo v Aiello (2003) 215 CLR 643 (Russo), Gleeson CJ explained (at [4], and [11]–[13]) that the phrase directs attention to two related but distinct questions. “Full” requires a complete account of the claimant’s conduct, including actions, knowledge and belief, from the date of the accident until the explanation is given. “Satisfactory” requires an evaluative judgment that a reasonable person in the claimant’s position would have been justified in experiencing the delay. At [25] McHugh J emphasised that the inquiry does not extend to prejudice to the insurer.
That “full” means complete was made plain in Mancini, where Rolfe AJA (with whom Beazley and Stein JJA agreed) said at [46]–[47] that a claimant cannot “pick and choose” convenient facts but must disclose the whole of the conduct relevant to delay. Stein JA (with whom Handley and Davies AJA agreed) in Laidlaw v Touma [2002] NSWCA 190 at [19] expressed the same: “full must be given some meaning … it means complete — that is, that a complete explanation is required.”
Allsop P, (with Spigelman CJ, Campbell, Macfarlan and Young JJA agreeing) in Walker, said at [104] that perfection is not demanded, nor a prolix recounting of every moment, but completeness is required in the sense of an account sufficient to permit evaluation. At [110] the President explained that the conduct of those acting or purporting to act for the claimant is part of the narrative that must be set out.
The Court of Appeal in Rahman held that a claimant’s explanation is not deficient merely because it lacks evidence from the solicitors as to why they failed to act. Brereton JA at [39] – [44] (Meagher and Leeming JJA agreeing) said that it is sufficient if the claimant’s account narrates the solicitors’ conduct insofar as it bears on delay; the claimant is not required to include the solicitors’ “actions, knowledge and belief.”
As to “satisfactory,” the test is objective. In Russo at [4] – [5], Gleeson CJ held that the question is whether a reasonable person in the claimant’s position would have been justified in experiencing the same delay. In Walker at [97]–[101], Allsop P emphasised that the “position of the claimant” includes the claimant’s incapacities, such as mental illness or cognitive impairment; the assessment must take such limitations into account.
In Rahman, Brereton JA added (at [43]) that it suffices if some reasonable persons in the claimant’s position would have experienced the delay. Unanimity of all reasonable persons is not required.
The period of delay to which the “satisfactory” inquiry is directed is confined. In Karambelas v Zaknic (No 2) [2014] NSWCA 433; 69 MVR 127, Meagher JA (Basten and Simpson JJA agreeing) at [15]–[17] held that the evaluative judgment is concerned with the period between the expiry of the statutory three-month limit and the lodgement of the claim. The requirement of a “full” explanation obliges a narrative from the accident forward, but the focus of the “satisfactory” enquiry is the lateness period.

Consideration

The accident occurred on 31 January 2024; the claimant’s Application for personal injury benefits was received on 1 November 2024; the insurer sought an explanation on

5 November and 25 November 2024, then issued a liability notice declining benefits on

28 November 2024; a signed statement dated 4 February 2025 was later provided and an internal review on 6 May 2025 affirmed the original decision; the Miscellaneous Claims Application was filed on 26 June 2025; leave was granted to rely on additional documents lodged 2 July 2025; the matter then proceeded to determination on the papers after the preliminary conference on 25 July 2025. Those dates and steps are not in controversy on the material before the Commission.

Period of lateness and factual chronology

Under s 6.13(1), the three-month period expired on 30 April 2024. The period of lateness for the s 6.13(3) inquiry is therefore 1 May 2024 to 1 November 2024, when the insurer received the claim. The claimant’s account is that:
(a)    early medical attendances occurred in February 2024 at Rooty Hill Medical and Dental Centre (Dr Wang); further attendance at Plumpton Medical Centre occurred in March/April 2024 (Dr Oo), when the possibility of a CTP claim was first raised;
(b)    the claimant retained Shine Lawyers on 14–19 May 2024;
(c)    she experienced difficulty obtaining a Certificate of Capacity before October 2024, when Dr Malek (Covenant Medical Hub) completed one, and
(d)    the Application for benefits then followed and was received 1 November 2024.
The insurer’s internal review records that the claimant’s explanation as to doctor access was that Dr Gupta (St Clair Medical Centre) was on leave and that Dr Wang would not certify because the claimant was not his patient; that Dr Oo raised the CTP possibility but indicated he could not certify; and that the claimant was not familiar with scheme entitlements until legal advice was obtained. Those assertions are recorded and were considered by the internal reviewer.

The medical material includes a suite of Certificates of Capacity and a mental health assessment by Dr Malek from October 2024 recording Tourette-like tics, post-traumatic stress disorder, anxiety and sleep disturbance, with a K10 of 27, and documenting functional limitations and later changes in capacity status. That material sits within the relevant period and is not contested as having been created.
The insurer’s reply submissions, together with the emails of 5 and 25 November 2024, and the decline/internal review letters, raise the following points of scrutiny:
(a)    the claimant did not disclose a prior CTP claim lodged in 2009 (revealed on a Personal Injury Register search) and therefore her asserted ignorance of the scheme should be treated with caution;
(b)    there is an inconsistency in the claimant’s timing of when Dr Oo raised the CTP possibility (the clinical notes show 22 March 2024, not “late April”);
(c)    there are gaps in the account, especially May to September 2024, after solicitors were retained and before Dr Malek certified, and
(d)    clinical attendances with Dr Su Hianing Win are not addressed in the explanation though they appear in the record.

“Full” explanation

Applying the authorities, “full” requires a complete account sufficient to enable an evaluative judgment. I am satisfied that the claimant has identified the key inflexion points: early GP attendances; advice from Dr Oo; retention and advice from her solicitors in May 2024; difficulty obtaining a doctor to certify; Dr Malek’s October certification; and subsequent lodgement. Those elements are set out with reasonable particularity in the claimant’s material as recorded in the internal review and supplemented by the additional documents admitted by leave.
However, two matters materially undermine completeness.
First, the prior CTP claim. The insurer’s Personal Injury Register search shows that the claimant lodged a CTP claim in 2009 for “nervous shock” following the death of her brother in a motor vehicle accident. This claim which was resolved in 2014. That history was not disclosed in her statement of 4 February 2025, nor was any explanation subsequently provided, despite the issue having been squarely raised in the insurer’s decision and submissions and the claimant reserving the right to put on further material by 18 August 2025. The omission is material because the claimant’s account rests heavily on her asserted unfamiliarity with the statutory requirements of the CTP scheme.
I accept that there are differences between the statutory scheme in force at the time of the 2009 accident involving her brother, in which she pursued a nervous shock claim, and the scheme presently governing statutory benefits. However, it is not open to me to speculate that the claimant did not understand the need for expedition. On the contrary, I would infer that she was aware the CTP scheme imposed statutory requirements which, in practice, necessitate the assistance of a legal practitioner. Her earlier 2009 claim arose from the psychological consequences of her brother’s death in a motor vehicle accident, which makes it more difficult to accept that her psychological sequelae now sufficiently explain the present delay. It would have been a simple matter to reconcile these issues in a short statement given the grant of leave to put on further material by 18 August 2025, but such evidence was not provided.
Absent any attempt to reconcile that assertion with the features of her previous claim, which could have been simply explained, I am not satisfied that a full account has been given of her knowledge and belief over the relevant period. The gap impedes proper evaluation of her explanation and weighs against a finding that it is “full” within the meaning of s 6.13(3).
Second, the interval May–September 2024. The claimant’s explanation attributes delay to inability to obtain certification (Dr Gupta away; Dr Wang unwilling; Dr Oo unable). Those are potentially cogent reasons. But after 14–19 May 2024, the claimant had legal representation. The explanation is silent as to what steps (if any) her solicitors took (or were instructed to take) to locate an alternative GP, to escalate, or to utilise other available pathways (for example, different medical practices). While a claimant need not produce the solicitors’ own affidavit, the claimant’s narrative should still state, in substance, what the solicitors did or attempted, insofar as that bears on delay. That detail is missing. The absence operates against a finding that the account is complete in the relevant period.
In combination, those deficiencies mean the explanation does not meet the “full” limb. Even allowing that s 6.13(3) of the MAI Act does not require prolix recitation, the account must be “warts-and-all” complete on matters central to delay. The omission of the prior CTP history and the lack of any narrative of solicitor-driven steps during May–September 2024 leave material gaps.

“Satisfactory” explanation

Were it necessary to proceed to the second limb, the inquiry is whether a reasonable person in the claimant’s position would have been justified in the delay over 1 May–1 November 2024.
The claimant’s position included persisting psychological sequelae (tics, anxiety, post-traumatic stress disorder features, sleep disturbance), functional cognitive complaints (short-term memory issues), and employment disruption. These matters are documented contemporaneously by Dr Malek and are not to be discounted at this interlocutory stage. A reasonable person burdened with those conditions, and who genuinely encountered practical difficulty securing a GP willing to certify, might well experience substantial delay. That consideration supports a conclusion of objective justification for at least part of the lateness period.
There are, however, countervailing considerations. The claimant had solicitors from mid-May 2024. Although incapacity and symptoms can slow progress, representation would reasonably be expected to reduce the time needed to identify an alternative doctor for certification. The passage of four to five months to achieve certification (May to October) is not itself determinative, but in the absence of any articulated steps taken by the solicitors, it is difficult to conclude that a reasonable person in the claimant’s position would have encountered a delay of this duration. The prior CTP experience, while not conclusive of present knowledge, further reduces the weight to be given to asserted unfamiliarity as an ongoing cause of delay through the lateness period.
Balancing those factors, and confining attention to 1 May –1 November 2024, I am not satisfied the explanation is objectively justified across the period as a whole. On the present record, some delay is explicable (particularly May–June while a new treating GP was being located against a background of genuine psychological morbidity). But the continued delay into September–October, without any detail of solicitor-led steps, and with the prior-claim omission, leads me to the view that the explanation is not “satisfactory” for the full period of lateness.

Conclusion under s 6.13(3) of the MAI Act

While I am conscious that the MAI Act is remedial legislation designed to provide timely support to injured road users, the statutory requirement in ss 6.13(3) that a claimant provide a “full and satisfactory explanation” is a jurisdictional condition which must be strictly met.
The claimant’s psychological comorbidities are well-documented. Dr Malek records persisting post-traumatic stress disorder , anxiety, sleep disturbance and Tourette-like tics, together with cognitive symptoms of poor concentration and memory loss. Those impairments, taken with her employment disruption and family stressors, are matters that a reasonable person in her position might well find disabling, and, as I have stated, I accept they are capable of contributing to delay. The authorities require that such incapacity be factored into the objective inquiry. However, the unexplained omission of the prior CTP claim, coupled with the absence of any narrative as to what steps her solicitors took after May 2024, means that the Commission does not have a complete platform upon which to assess whether the delay was objectively justified. In that circumstance, although the claimant’s comorbidities attract real sympathy and could otherwise support a finding of “satisfactory” delay, the explanation as advanced remains inadequate under s 6.13(3).
The omission of any reference to the claimant’s prior CTP claim, in circumstances where her present explanation rests upon asserted ignorance of the scheme until consulting Dr Oo, is a matter of direct relevance to her knowledge and belief. That omission, compounded by the absence of any attempt to address it notwithstanding the reservation to file further material by 18 August 2025, leaves me unable to undertake the evaluative task mandated by the section. However sympathetic one might be to the claimant’s difficulties, the explanation as advanced is not “full” within the meaning of the MAI Act, and consequently cannot be found to be “satisfactory”.
Because the claimant has not provided a “full and satisfactory explanation” within s 6.13(3), the statutory saving does not apply. The insurer was accordingly entitled to refuse payment of statutory benefits (Schedule 2, cl 3(k)) and, by force of s 6.13(2) – (3), weekly payments are not payable for any period.

Disposition

For these reasons, the Commission determines:
(a) the claimant has not provided a full and satisfactory explanation within ss 6.2 and 6.13(3) of the MAI Act for the delay in making the claim for statutory benefits, and
(b) By operation of Schedule 2, cls 3(h) and 3(k), the insurer is entitled to refuse payment of statutory benefits by reason of that delay.

Costs

Pursuant to s 8.10(1) of the MAI Act, the claimant is entitled to regulated costs for the two miscellaneous claims disputes determined by this application. At the current unit value of $124.53, the claimant is entitled to 32 units in total, amounting to $3,984.96 exclusive of GST, in legal costs. I consider that that is a fair and reasonable sum to award in this case.

[2025] NSWPIC 506

25 September 2025