Sami v Insurance Australia Limited ACN 000 016 722 Trading as NRMA Insurance (Motor Accident Injuries)

Sami sought a review of the respondent’s decision to deny liability for certain treatment expenses related to injuries sustained in a motor accident. The dispute was heard and determined by the Civil and Administrative Tribunal of New South Wales (NCAT). The primary issue for the Tribunal was whether the expenses incurred by Sami were reasonable and necessary for the treatment of injuries suffered as a result of the motor accident.

The Tribunal considered whether the expenses in question related to injuries or exacerbations that arose from the accident. Regarding the MRI scan of the cervical spine and the facet joint injections, the Tribunal found that the respondent’s decision to deny liability should be set aside and remitted for reconsideration. This was because the MRI scan results and any relevant medical opinions were not available at the time of the original decision. The Tribunal found that the respondent must pay for the MRI scan as it was directly related to the applicant’s claim.

In contrast, the Tribunal affirmed the respondent’s decision to deny liability for the orthopaedic specialist review of the right knee and the purchase of a portable exercise bike. The Tribunal concluded that these expenses did not relate directly to injuries or exacerbations caused by the motor accident. The Tribunal also ordered that the respondent pay the cost of the MRI scan and provided the parties with opportunities to submit further information regarding any costs incurred by the applicant.

The final orders of the Tribunal required the respondent to reconsider certain expenses in light of new evidence, affirmed the denial of other expenses, and mandated the payment of the MRI scan cost. The Tribunal also outlined a process for the applicant to submit an itemised statement of costs, allowing the respondent to respond before the Tribunal makes a final costs order.