Powell v Lifetime Care and Support Authority of New South Wales
[2025] NSWPIC 275
•12 June 2025
| CERTIFICATE OF DETERMINATION OF MEMBER | |
| CITATION: | Powell v Lifetime Care and Support Authority of New South Wales [2025] NSWPIC 275 |
| CLAIMANT: | Ashleigh Sue-Marie Powell |
| INSURER: | Lifetime Care and Support Authority (CTP Care) |
| MEMBER: | Susan McTegg |
| DATE OF DECISION: | 12 June 2025 |
CATCHWORDS: | MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; treatment and care; rehabilitation; liability for claim for statutory benefits; claimant sustained serious injury in a motor vehicle accident; transportation for social outings; referred as a miscellaneous claims dispute under Schedule 2 clause 3(n) to determine whether there is any liability for the services in dispute on the basis they meet the definition of “treatment and care”; Held – transportation for social outings constitutes rehabilitation within the meaning of treatment and care under section 1.4; whether transportation for social outings relates to the injury caused by the accident or are reasonable and necessary in the circumstances are medical assessment matters. |
| DETERMINATIONS MADE: | CERTIFICATE Issued under s 7.36 of the Motor Accident Injuries Act 2017 The findings of the assessment of this dispute are as follows: 1. The following constitutes rehabilitation within the meaning of the definition of treatment and care in s 1.4 of the Motor Accident Injuries Act 2017: · transportation for social outings. 2. I assess costs in favour of the claimant in the sum of $1,992.48 plus GST. |
STATEMENT OF REASONS
INTRODUCTION
Ashleigh Sue-Marie Powell (the claimant) sustained serious injury in a motor vehicle accident on 27 September 2019.
Lifetime Care and Support Authority (CTP Care) is the relevant insurer for the purposes of the Motor Accident Injuries Act 2017 (MAI Act).[1]
[1] Section 3.45 of the Motor Accident Injuries Act 2017.
The claimant seeks to recover travel costs to visit family and friends from the insurer as a "treatment and care" expense under Part 3.4 of the MAI Act.
On or about 21 October 2024 the claimant wrote to the insurer requesting that it approve treatment and care for the following:
· travel to and from approved medical appointments, and
· travel to and from for social outings.
On 21 October 2024 the insurer approved travel to and from approved medical appointments from 14 October 2024 to 14 April 2025. The insurer declined to approve the travel to and from social outings on the basis transportation for social outings is not considered treatment.
On 13 November 2024 Ms Powell requested an internal review of that decision.
On 26 November 2024 the insurer affirmed the decision to decline funding for travel unrelated to medical appointments, on the basis the travel expenses are not reasonable and necessary, were not incurred for the purposes of obtaining treatment and care, and do not constitute rehabilitation as per s 1.4 of the MAI Act.
The claimant filed an application in the Personal Injury Commission (Commission) on
10 March 2025 under schedule 2, cl 3(n) of the MAI Act.CTP Care denies liability for the cost of the claimant's travel on the grounds that the travel costs are not "rehabilitation" and are, therefore, not "treatment and care". Whether travel constitutes "treatment and care" is an issue relevant to CTP Care's liability to pay statutory benefits.
Pursuant to Schedule 2, cl 3 of the MAI Act, various matters are declared to be miscellaneous claims assessment matters including:
“(n) any issue of liability for a claim, or part of a claim, for statutory benefits not otherwise specified…”
The dispute has been referred to me as a miscellaneous claims dispute under Schedule 2, cl 3 (n) of the MAI Act where there is a preliminary dispute as to the liability for statutory benefits, that is, whether there is any liability for the services in dispute on the basis they meet the definition of “treatment and care”.
Section 1.4 of the MAI Act provides treatment and care means the following:
(a) medical treatment (including pharmaceuticals);
(b) dental treatment;
(c) rehabilitation;
(d) ambulance transportation;
(e) respite care;
(f) attendant care services;
(g) aids and appliances;
(h) prostheses;
(i) education and vocational training;
(j) home and transport modification;
(k) workplace and educational facility modifications, and
(l) such other kinds of treatment, care, support or services as may be prescribed by the regulations for the purposes of this definition, but does not include any treatment, care, support or services of a kind declared by the regulations to be excluded from this definition.
Section 1.4 of the MAI Act provides the following definition of rehabilitation:
“rehabilitation of an injured person, means the process of enabling or attempting to enable the person to attain and maintain—
(a) the maximum level of independent living, and
(b) full physical, mental, social and vocational ability, and
(c) full inclusion and participation in all aspects of life.”
Section 3.24 of the MAI Act provides:
“3.24 Entitlement to statutory benefits for treatment and care
(1) An injured person is entitled to statutory benefits for the following expenses (treatment and care expenses) incurred in connection with providing treatment and care for the injured person—
(a) the reasonable cost of treatment and care,
(b) reasonable and necessary travel and accommodation expenses incurred by the injured person in order to obtain treatment and care for which statutory benefits are payable,
(c) if the injured person is under the age of 18 years or otherwise requires assistance to travel for treatment and care, reasonable and necessary travel and accommodation expenses incurred by a parent or other carer of the injured person in order to accompany the injured person while treatment and care for which statutory benefits are payable is being provided.
(2) No statutory benefits are payable for the cost of treatment and care to the extent that the treatment and care concerned was not reasonable and necessary in the circumstances or did not relate to the injury resulting from the motor accident concerned.
(3) The Motor Accident Guidelines may provide for—
(a) circumstances in which the cost of treatment and care is taken to be reasonable for the purposes of this section, and
(b) circumstances in which treatment and care is taken to be reasonable and necessary for the purposes of subsection (2).
Note—
See Part 7 and Schedule 2 for provisions relating to disputes about whether treatment and care, or the cost or treatment and care, provided or to be provided to an injured person is reasonable and necessary.”
THE EVIDENCE
On 17 January 2025 the claimant uploaded a bundle of documents paginated from pages 1 to 176. On 11 February 2025 the insurer uploaded a bundle of documents paginated from pages 1 to 5 incorporating solely the insurer’s submissions.
The Westmead Hospital discharge summary notes the claimant was admitted on
27 September 2019 and discharged on 25 November 2019. She underwent six major operations and several other procedures. The following injuries are documented:(a) bladder rupture and vesico-cutaneous fistula;
(b) sepsis secondary to kocher-langenbeck infection from bladder leak;
(c) right kidney injury causing retroperitoneal bleed;
(d) comminuted pelvic fractures involving both acetabula and inferior pubic ramus with dislocation of the pubic symphysis and right hip;
(e) lacerations to both lower limbs;
(f) tears of the right medial cruciate ligament (MCL) (high grade) and posterior cruciate ligament (PCL) (complex);
(g) right foot drop, due to dysfunction of the right sciatic nerve or lumbosacral plexus;
(h) fracture of the shaft of the right ulna;
(i) right MF (mycosis fungoides) nailbed injury;
(j) right LP PIPJ (proximal interphalangeal joint) volar plate injury;
(k) fractured right 10th rib;
(l) pulmonary embolism in the context of immobilization;
(m) left chest pleural effusion, and
(n) left eye ptosis to be followed up with neurology clinic.
Following her discharge from Westmead Hospital the claimant was admitted to Westmead Rehabilitation Hospital until 23 January 2020. Ms Powell underwent the following further surgeries:
(a) ankle arthroscopy and Achilles lengthening on 28 February 2020;
(b) right knee arthroscopy and manipulation – 31 March 2020;
(c) right knee manipulation under anaesthetic and steroid injection – 21 July 2020;
(d) right hip heterotopic ossification (calcification in the soft tissues around the hip) ORIF and manipulation of the right knee – 28 October 2020;
(e) knee arthroscopy, excision of MCL osteoma and MCL attachment – 16 March 2021;
(f) scar revisionary surgery – 14 June 2022;
(g) emergency laparoscopy and appendectomy and adhesiolysis – 24 June 2022;
(h) Aspiration of Bakers cyst – 6 September 2022;
(i) scar revisionary surgery – 15 November 2022;
(j) left knee fluoroscopy and PCL reconstruction – 13 December 2022;
(k) scar revisionary surgery – 12 December 2023;
(l) rhino septoplasty surgery – 18 September 2024, and
(m) scar revisionary surgery – 12 November 2024.
In addition, Ms Powell also underwent PRP injections, ketamine infusions, steroid injections, and IVF harvest/egg/embryo freezing. She may require rotator cuff surgery to the right shoulder, redo of PCL reconstruction, and radio frequency denervation of the lumbar facet joints. Ms Powell had two further admissions to Westmead Rehabilitation Hospital, from
3 March 2020 to 10 March 2020 and from 1 April 2020 to 1 May 2020.
QBE Insurance (Australia) Limited (QBE) was the relevant insurer with liability to pay statutory benefits to the claimant under the MAI Act for the first five years post-accident. In an email to Mick Gilhooly at QBE dated 12 January 2021 the claimant states:
“… is that my mental health is really struggling as I am feeling isolated and have limited social interaction with friends or just getting outside in nature. I have always been a water baby and loved to hike or just go for a walk-through nature. As my current life involves constant physiotherapy and constant Dr appointments, scans, X-rays and surgeries I am struggling to feel normal and have that connection with friends or the outdoors .... As I can't drive I am literally stuck at home and getting more depressed as I can't enjoy the nice weather.
Therefore, I was hoping that I could get approval to be taken sometimes to places for outdoor exercise or just to a social event occasionally so I can reconnect socially.”
In an email to Mick Gilhooly at QBE dated 30 January 2021 the claimant states:
“I have been advised that I really need to reconnect socially and try to do things for myself that make me happy because my life is all about the accident. Therefore, I am hoping to get your approval for some driving time to help with my mental health and breath in the real world. For example, it would be to catch up and reconnect with friends for a coffee or for a swim, see my friend's baby or to just do personal self-care appointments. I've just missed so much, like friend’s birthdays and babies being born or being able to have a relationship with someone. It is really making me down and I feel so stuck at home. My sister takes me places when she can and is home, but she works full time and is limited.”
On 8 February 2021 Moore Rehab outcomes listed goals for rehabilitation. They included “for Ashley to have improved community access for purposes outside of her treatment and rehabilitation”. The action plan included liaising with the insurer regarding options for funded transport for community access considered reasonable and necessary.
In a report dated 9 February 2021 Dr Usman Malik, treating psychiatrist diagnosed post- traumatic stress disorder caused by the motor vehicle accident. His treatment plan included the following recommendation:
“I would advise that she start to see her friends again and be able to go out on her own. As she lives so far away from all her friends in Bondi, if the insurance company could support her transport cost to see people for mental and social well-being that would be very beneficial in her recovery.”
On 1 March 2021 QBE approved a budget of $500 per month for transportation costs, limited to three months and thereafter, it seems QBE was not prepared to approve transportation, even the cost of taxi fares (in the vicinity of $21) to the Nepean River to see two friends during COVID-19 in accordance with Government guidelines.
On 16 October 2023 Dr Jungfer, psychiatrist diagnosed a post-traumatic stress disorder, persistent depressive disorder and generalised anxiety disorder. She thought the claimant had no capacity for employment and expressed the view Ms Powell’s prognosis was poor.
Dr Jungfer reported the claimant’s friendship networks had restricted noting she cannot get to her friends’ places which affects her contact. She reported Ms Powell feels anxious as she feels trapped and isolated at home. She stated:
“She rarely goes out and socialises and this relates to problems with her mobility, her inability to drive a vehicle. She perceives herself as not being capable of driving due to the medication, her physical injuries as well as a sense of anxiety regarding her welfare and safety. She relies on transport of others, such as taxis, and spent substantive periods of time in the appointment focussing on the lack of appropriate funding from the insurer that allows her to be mobile within the community.”
On 29 September 2023 Dr Alan Hopcroft reported Ms Powell did not drive and relied on taxis/Uber for everyday life to get to and from appointments. He noted she had a support network consisting of her parents, family and friends who help with many tasks including attending appointments with her and collecting her and taking her shopping.
On 8 March 2024, Associate Professor Boesel, pain physician concluded:
“I am of the opinion that Ashleigh is currently not fit for any suitable duties. I note that previously she had been a financial advisor and subsequently opened a publishing house. Both these jobs require high levels of concentration and high levels of executive functioning. She is currently not able to function at this level due to pain-related interference in concentration and thinking, low energy levels and intrusive PTSD symptoms. The capacity to do physical work is zero based on the extensive nature of her musculoskeletal injuries. Other sedentary work will be interfered with due to the effects of pain and PTSD. She is currently unable to sit and work in a sedentary capacity.”
In “The Key to Mental Wellbeing”, Beyond Blue reports:
“Connections to other people and relationships give us support, meaning and purpose in life. Positive relationships have been found to have enormous influence on our well-being.”
In summary The Wellbeing Webpage from the Black Dog Institute Website provides:
(a) having a sense of connection that can help a person feel safe, grounded and valued, for example, connecting with a family member or friend or spending time somewhere a person loves is important to a person’s wellbeing;
(b) taking action about doing the things that help a person feel good and thrive which may involve getting out is important to a person’s wellbeing, and
(c) connecting with other people and relationships provide support, meaning and purpose in life.
In her report dated 10 September 2024 Ms Natalia James, the claimant’s treating psychologist states:
“Ashleigh has engaged in continued therapy with notable changes, during difficult situations. She has gained thorough insight and is able to self-manage her emotions promptly in an appropriate manner. Ashleigh has also experienced many emotional relapses when faced with a lack of coherent correspondence, care and support by QBE.
An important premise of treatment and recovery is to restore quality of life and resume normal social routines with friends and family. Ashleigh disclosed that she feels self-limited by her current capacity to exercise the freedom to enjoy the pleasure of independently travelling via driving. Ashleigh disclosed that she feels distressed when she needs to seek support from a person and is unable to drive to visit her support person.
I believe that Ashleigh needs to engage and prioritise social gatherings and or events that would ultimately increase her quality of life. It is important for Ashleigh to be supported to facilitate these opportunities by your approval of ‘driver pick and drop off’ services, as needed.”
In his report dated 11 September 2024 Dr Malik, reported the claimant needed help with transport costs as her injuries prevent her from driving. He supported her claim to have transport costs covered where seeing friends and family is beneficial to her physical and mental health noting it makes her feel better and is an important component to her recovery and therapy overall.
SUBMISSIONS
Claimant’s submissions
The claimant provided submissions dated 6 January 2025.
As a result of the injury sustained in the accident the claimant does not drive. The claimant’s psychiatrist and psychologist recommend assistance with transportation to assist with the claimant’s rehabilitation for her post-traumatic stress disorder, anxiety and depression.
The claimant submits that travel to facilitate community participation and to see family and friends is important to the rehabilitation of the claimant for the following reasons:
(a) Connection with community and establishing independence in the community will boost confidence, enabling the claimant to act independently and build autonomy, reduce isolation, create routine and a sense of normalcy and self-reliance thereby providing structure and purpose which are key to maintaining mental health.
(b) Exposure therapy for those with post-traumatic stress disorder or anxiety encourages the gradual re-engaging in everyday tasks, helping to reduce fear and avoidance over time.
(c) Restoring the claimant's quality of life, mental health and social well-being by resuming activities and social routines with family and friends, encouraging social interaction, participation in daily activities and emotional support, are beneficial strategies for managing post-traumatic stress disorder, anxiety and depression.
(d) Not feeling limited by her current capacity to exercise freedom and to enjoy the pleasure of independent travel.
(e) Avoiding relapses in her condition.
(f) Avoiding distress when unable to access the assistance of a support person.
The claimant submits travel to see family and friends and to facilitate community participation falls within the definition of rehabilitation in s 1.4 of the MAI Act. The claimant relies upon the opinion of Ms James who recommends Ms Powell be able to engage in social gatherings and events thereby increasing her quality of life noting, “An important premise of treatment and recovery is to restore quality of life and resume normal social routines with friends and family”.
The claimant’s treating psychiatrist Dr Malik also reported transport to see friends, family, and health professionals was beneficial for the claimant’s physical and mental health and an important component to her recovery and therapy overall.
Whilst not decisive the claimant notes having transitioned to CTP Care she is now in receipt of a Centrelink disability pension and would face financial pressure if she was compelled to pay for travel for the purpose of rehabilitating her mental health conditions.
The claimant relies on the decision of Member Cassidy in Irani v Insurance Australia Limited t/as NRMA Insurance[2] where she determined that a therapy dog fell within the definition of rehabilitation within the meaning of the MAI Act because it would help Mr Irani manage his psychological symptoms and prevent a deterioration.
Insurer’s submissions
oukld[2] Irani v Insurance Australia Limited t/as NRMA Insurance [2024] NSWPIC 455 (Irani).
The insurer provided submissions dated 11 February 2025. The insurer submits the claim for travel costs should be denied.
The insurer submits the claimant is essentially arguing:
(a) visiting friends and family constitutes "rehabilitation", and
(b) that rehabilitation can only occur if her travel costs to see friends and family are covered.
Therefore, the insurer submits the central question is whether socialising falls within the definition of "rehabilitation" in s 1.4 of the MAI Act. The insurer submits it does not.
The insurer submits that traditionally, rehabilitation services aimed at "enabling or attempting to enable the [injured] person to attain and maintain" maximised levels of independent living and vocational ability are provided by recognised rehabilitation providers. The insurer argues the concept that rehabilitation should be left to the professionals is recognised by FAQ’s issued by SIRA, "Providing rehabilitation services in the NSW CTP schemes – FAQs" which provide:
"Rehabilitation services should not be provided by an employee of the CTP insurer, solicitor, attendant care providers, family member or guardian."
Further, the insurer submits that each of the examples of treatment and care listed in s 1.4 of the MAI Act are provided by professionals and given the MAI Act only allows for the recovery of paid services, even attendant care services are provided by professionals, not friends and family. In other words, all forms of treatment are provided by professionals “who know what they are doing”. The insurer submits that "rehabilitation", just like any other kind of treatment must be provided by a specialist rehabilitation provider.
The insurer submits whilst Member Cassidy in Irani found that the provision of a therapy dog fell within the concept of “rehabilitation” that decision is not binding in this dispute.
In any event the insurer submits the reasoning of Member Cassidy in Irani supports its position in this dispute. Member Cassidy cited the health benefits of dogs which had been trained to provide specific assistance and to seeing eye dogs which are trained to assist people with impaired vision. She also referred to dogs trained in the mindDog program to assist people with emotional difficulties. It is submitted the reasoning of Member Cassidy in Irani supports the insurer’s argument that rehabilitation is provided by professionals, albeit professional canines in those instances.
The insurer highlights that even if the claimant cannot claim the cost of travelling to visit friends and family as a statutory benefit, she may be able to claim that cost in her claim for damages under common law pursuant to s 4.5(1)(b) of the MAI Act and cl 9 of the Motor Accident Injuries Regulation 2017. The insurer submits that the damages claim is better equipped to compensate the claimant for any need she has for travel costs where at present the claim for travel is open ended and no information is available regarding the cost, frequency or duration of the travel.
PRELIMINARY CONFERENCE ON 16 MAY 2025
The matter was listed for preliminary conference before me on 16 May 2025.
Mr Elhage of Penrose Lawyers appeared for the claimant and Ms Hunt of Curwood Lawyers appeared for the insurer.
The parties agreed the dispute as to whether the travel claimed constitutes "treatment and care" under the MAI Act is an issue of liability for a claim, or part of a claim, for statutory benefits not otherwise specified in Schedule 2.
During the preliminary conference Mr Elhage made the point, in response to the insurer’s submissions, that not all rehabilitation is provider by a professional rehabilitation provider. By way of example Mr Elhage noted that insurers commonly fund a gym pass and travel costs where an injured claimant undertakes exercise which is not facilitated by a physiotherapist or exercise physiologist.
Both parties sought to rely on the evidence and submissions before me and agreed it was appropriate for the matter to be dealt with on the papers.
CONSIDERATION
In accordance with s 52(3) of the Personal Injury Commission Act 2020 (PIC Act) and Procedural Direction PIC2 I am satisfied that sufficient information has been supplied to the Commission and I consider it appropriate to determine the matter on the papers.
Schedule 2(3)(n) of the MAI Act provides me with the power to determine “any issue of liability for a claim, or part of a claim, for statutory benefits now otherwise specified in this schedule”.
The dispute to be determined by me will be whether transportation for social outings meets the definition of treatment and care under s 1.4 of the MAI Act.
However, if I determine the travel to and from social outings constitutes treatment and care under s 1.4 there will still be a dispute as to whether the treatment and care claimed, “is reasonable and necessary in the circumstances or relates to the injury caused by the motor accident”. This is a medical assessment matter for determination by one or more Medical Assessors under schedule 2(1)(i) of the MAI Act. This is not the dispute currently before me and if Ms Powell wishes to pursue that dispute, in the absence of any agreement with the insurer, she will have to file an application for assessment of a treatment dispute with the Commission.
Rehabilitation as defined in s 1.4 of the MAI Act
The definition of treatment and care in s 1.4 of the MAI Act includes rehabilitation.
Ms Powell is a single woman now aged 38 years. She was 33 years of age at the time of the motor vehicle accident on 27 September 2019.
There is no dispute that Ms Powell sustained serious injury in the motor vehicle accident and that because of those injuries she cannot drive.
The insurer has not provided any evidence to counter the evidence of Ms James, treating psychologist, Dr Malik, treating psychiatrist and Dr Jungfer, psychiatrist qualified on behalf of the claimant. Accordingly, I accept the opinion of Dr Jungfer that the claimant has post-traumatic stress disorder, persistent depressive disorder and generalised anxiety disorder.
I propose to address the definition of rehabilitation as it appears in s 1.4 of the MAI Act.
Maximum level of independent living
Where the definition of rehabilitation under s 1.4 of the MAI Act means the process of enabling or attempting to attain and maintain the maximum independent living arguably it includes facilitating transport which would enable the claimant to participate in community activities and to engage in social routines involving family members and friends without being dependent on those family members and friends to provide transportation.
Dr Jungfer commented the claimant rarely goes out and socialises due to her problems with mobility, noting Ms Powell focussed on the lack of funding from the insurer which allows her to be mobile within the community. Ms James also reported the claimant felt limited by her lack of independent travel and feels distressed when she requires support but is unable to visit her support person.
The provision of funding for transportation for social outings would facilitate the claimant in her attempt to maintain a maximum level of independent living where she would not be dependent upon family members or friends for transport.
Whilst I do not accept the insurer’s argument that rehabilitation is limited to services provided by professionals, arguably the provision of transportation services would be provided by professional drivers, not unlike the professional canines referred to by the insurer in the matter of Irani.
In any event it is apparent from the report of Moore Rehab dated 8 February 2021 that transportation for community access was a listed goal for the claimant’s rehabilitation, and it has been supported by Ms James, treating psychologist and Dr Malik, treating psychiatrist.
Full physical, mental, social and vocational ability
The medical evidence suggests the claimant’s vocational ability is limited due to the serious injury sustained in the accident.
However, it is difficult to see how the claimant can attempt to attain and maintain her full physical, mental and social ability where her independence is limited by her lack of mobility. The Well Being page from the Black Dog Institute website describes how a sense of connection can help a person feel safe, grounded and valued noting getting out may be necessary to enable a person to do the things which help that person to thrive. Without the provision of transportation services, the claimant is limited in her ability to get out and to do the things which may help her thrive.
In her communication with Mr Gilhooly in 2021 Ms Powell emphasized without access to transportation she was stuck at home unable to connect socially or to access nature for the purposes of outdoor exercise. The benefit of connections with other people and being able to do things which help a person feel good are emphasized in the material provided by both Beyond Blue and the Black Dog Institute.
Ms James states the claimant needs to engage and prioritise social gatherings and or events that may ultimately increase her quality of life and these opportunities need to be facilitated by the provision of transport.
Dr Malik also notes seeing friends and family is beneficial to the claimant’s physical and mental health and an important component to her recovery and therapy.
The provision of funding for transportation for social outings would facilitate the claimant in her attempt to attain and maintain her full physical, mental and social ability where she would be able to attend gatherings of family and friends or engage in other community events or outdoor exercise which would be beneficial to her physical, mental and social well-being.
The inclusion and participation in all aspects of life
The claimant cannot participate in all aspects of life if she cannot readily leave her home. The claimant is a relatively young woman of 38 years of life with a life expectancy of 44 years who suffers not only from significant physical disabilities but also a significant psychological illness. She is incapable of inclusion and participation in all aspects of life where she is dependent on the goodwill of family members or friends for transportation. Dr Jungfer reported the claimant felt trapped and isolated at home and in her communication with
Ms Gilhooly on 12 January 2021 the claimant described becoming more depressed where she was “literally stuck at home”.
Transportation is essential to provide the claimant with an opportunity to participate in all aspects of life by engagement in community events and by facilitating connection with family members and friends. Transportation for social events would facilitate the claimant’s ability to maintain connections and build relationships with family members and friends.
I find transportation for social events does meet the definition of rehabilitation as it appears in s 1.4 of the MAI Act. Accordingly, I find there is a liability for transportation for social outings on the basis it is rehabilitation under the definition of “treatment and care” as it appears in s 1.4 of the MAI Act.
Common law claim
The claimant’s common law claim is not before me. Whether the claimant is likely to be compensated for transportation for social outings is not something I can consider where I am only required to determine whether transportation for social outings meets the definition of treatment and care under s 1.4 of the MAI Act.
COSTS
On 5 June 2025 I caused the following message to be sent to the parties:
“I note no application has been made for costs. The proceedings were referred to me as a miscellaneous claims assessment matter under Schedule 2(3)(n) and in accordance with Schedule 1 (3)(2)(g1) of the Motor Accident Injuries Regulation 2017 a claimant is entitled to recover costs.
Unless I receive submissions to the contrary by close of business 11 June 2025, I propose to assess the maximum costs in favour of the claimant of up to 16 monetary units or the sum of $1,992.48.”
On 12 June 2025 the claimant advised there were no objections. No further submissions were received from the insurer.
CONCLUSION
I find the following constitutes “rehabilitation” and comes within the definition of treatment and care as defined by s 1.4 of the MAI Act:
· transportation for social outings.
I assess costs in favour of the claimant of up to 16 monetary units or the sum of $1,992.48 plus GST.
Any further dispute relating to the claimant’s entitlement to statutory benefits for treatment and care will need to address s 3.24 of the MAI Act, that is, whether the transportation for social outings relate to the injury caused by the accident and are reasonable and necessary in the circumstances. These will be medical assessment matters to be determined by a Medical Assessor or assessors in accordance with Division 7.5 of the MAI Act.
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