Legal Research
Cases
Obeid v AAI Ltd

Obeid v AAI Ltd

Link copied

Case Copied 5 April 2022 26 min read

Contents

On this page

DETERMINATION OF REVIEW PANEL
CITATION:	Obeid v AAI Ltd t/as AAMI [2022] NSWPICMP 76
CLAIMANT:	Mohamed Obeid
INSURER:	AAI Ltd t/as AAMI
REVIEW PANEL:	Principal Member John Harris Dr Drew Dixon Dr Geoffrey Stubbs
DATE OF DECISION:	5 April 2022
CATCHWORDS:	MOTOR ACCIDENTS- The claimant was involved in a motor accident on 20 March 2020 and requested the insurer to pay for various treatment including right shoulder surgery and diagnostic blocks; an issue arose whether the Panel had power to determine a claim for medical expenses not incurred and not provided; discussion of various provisions of the Motor Accidents Injuries Act 2017 (MAI Act) including section 3.24 and Schedule 2 clause 2(b) of the MAI Act, which referred to the expenses “incurred” or provided”; observations that clause 2(b) of the MAI Act must be read in context with section 3.24 of the MAI Act; neither provision referred to expenses not incurred or to be provided; comparisons made with the Motor Accidents Compensation Act 1999 which referred to expenses “to be provided”; plain meaning consistent with other parts of the MAI Act such as section 3.27 of the MAI Act which required expenses to be verified before they could be paid; submission that MAI Act be read beneficially rejected as no purpose identified when there were contrasting objects; All Seasons Air Pty Ltd v Regal Consulting Services Pty Ltd applied; Panel determined that there was no power with the Medical Assessor and it to determine the claim; assessment revoked.
DETERMINATIONS MADE:	The Review Panel revokes the certificate dated 7 July 2021 and issues a new certificate determining that it does not have power in this matter.

Replacement Certificate issued under section 7.23(1) of the Motor Accident Injuries Act 2017

REASONS

Background

Mr Mohamed Obeid suffered injury in a motor accident on 20 March 2020 when the insured vehicle failed to give way and struck the back-passenger side of his vehicle.[1]
[1] Claimant’s bundle, page 45.
The insurer insured the owner and driver of the other motor vehicle for liability to pay Mr Obeid any damages and/or statutory compensation entitlements under the Motor Accident Injuries Act 2017 (the MAI Act).
This decision concerns whether a Medical Assessor, and on review, a Review Panel can determine whether treatment not yet provided or incurred is “reasonable or necessary in the circumstances” and/or “relates to the injury caused by the motor accident”. The issue arises from that part of the definition of “medical assessment matters” in Schedule 2 clause 2(b) of the MAI Act which provides:
“whether any treatment and care provided to the injured person is reasonable and necessary in the circumstances or relates to the injury caused by the motor accident for the purposes of section 3.24 (Entitlement to statutory benefits for treatment and care.”
By letter dated 30 September 2020 the insurer accepted that Mr Obeid had suffered a non-minor injury and that the liability to make statutory payments for the claim extended beyond the 26-week period.[2]
[2] Insurer’s bundle, page 178.

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.

Keep reading for free

Create a free CaseChat account to read Obeid v AAI Ltd and more:

Read every judgment in full
Ask AI and get answers linked to paragraphs
See how each paragraph was cited in later cases
Download judgments as PDF or Word

Continue with Google

One click creates your free account or signs you in.

By continuing you agree to the Terms and Privacy Policy.

Details

Case: [2022] NSWPICMP 76
Decision Date: 5 April 2022

CaseChat Overview and Summary

The case of Obeid v AAI Ltd was heard by a Panel, focusing on a dispute concerning the insurer's refusal to pay for certain medical treatments following a motor accident. The claimant, Obeid, sought compensation for medical expenses that were not yet incurred or provided, including right shoulder surgery and diagnostic blocks. The crux of the dispute was whether the Panel had the authority to decide on claims for expenses that were neither incurred nor provided, as stipulated by the Motor Accidents Injuries Act 2017 (MAI Act).

The court examined various provisions of the MAI Act, particularly section 3.24 and Schedule 2 clause 2(b), which both reference expenses that were "incurred" or "provided". The court held that clause 2(b) must be interpreted in the context of section 3.24 and noted that neither provision explicitly addressed expenses that were not incurred or to be provided. The court also compared these provisions with those of the Motor Accidents Compensation Act 1999, which referred to expenses "to be provided", and concluded that the plain meaning of the MAI Act provisions aligned with other sections, such as section 3.27, which required expenses to be verified before payment. The Panel rejected the submission that the MAI Act should be interpreted benevolently, as there were contrasting objects and purposes that did not support such an interpretation. The decision in All Seasons Air Pty Ltd v Regal Consulting Services Pty Ltd was applied, reinforcing the Panel's conclusion that it lacked the power to determine the claim.

The Panel found that, given the statutory framework, it did not have the authority to assess the claim for medical expenses that were not incurred or provided. Consequently, the assessment was revoked. The court’s decision underscored the importance of interpreting statutory provisions in their specific context and rejected a broad, benevolent interpretation of the MAI Act. The final orders reflected the Panel's determination, affirming that the insurer was not obligated to pay for the medical treatments in question.

Orders