Helen Huang
Special Counsel
CTP Insurance, Insurance
Is clothing destroyed during the course of treatment compensable?
4 March, 2024
In Brief
- Section 3.24 of the Motor Accident Injuries Act 2017 (MAIA) states an injured person is entitled to treatment and care expenses if, in the circumstances, the treatment and care is reasonable and necessary and related to the accident injuries
- The definition of “treatment and care” in s 1.4 of MAIA does not cover the cost of replacing damaged clothing.
Facts
On 1 March 2024, the Personal Injury Commission published its decision in Edwards v Allianz Australia Insurance Limited [2024] NSWPIC 74.
The Claimant was involved in a motor vehicle accident on 1 September 2023.
The Claimant subsequently made a claim for statutory benefits and the Insurer accepted liability for the claim.
Following the accident, the Claimant required treatment at a hospital and the clothes she was wearing were destroyed in the process. She sought to recover the cost of replacing the clothing from the Insurer.
She asserted there is “grey area” within MAIA and the expenses associated with replacing the damaged clothing should be recoverable.
The Insurer declined to reimburse the Claimant because the request did not meet the criteria in Division 3.4 of MAIA.
The Claimant sought an internal review.
The Insurer declined to conduct an internal review because the clothing expenses were not within the definition of “treatment and care” and therefore “not an internally reviewable matter”.
The Claimant commenced proceedings at the Commission asserting the expenses associated with replacing destroyed or damaged clothing constitutes “treatment and care” under MAIA, and those expenses are recoverable by her.
The Insurer disputed the clothing expenses fall within the definition of “treatment and care”.
The Member’s Determination
On a strict interpretation of MAIA, the Member determined on the papers:
- The dispute fell within the terms of Schedule 2 clause 3(n) as a miscellaneous claims assessment matter and was therefore a dispute the Member could determine.
- The definition of “treatment and care” does not include expenses incurred with respect to replacing destroyed or damaged clothing.
- There are no provisions in MAIA for the recovery of expenses such as replacing destroyed or damaged clothing as a result of a motor vehicle accident.
- The Insurer is not liable for the claimed expenses.
Key Learnings
This decision reminds us the definition of treatment and care is found within section 1.4 of the Motor Accident Injuries Act 2017 and Insurers will refer to the relevant legislative provisions in determining any requests in the statutory benefits arena.
If you have a query relating to any of the information in this case note, or would like to discuss a similar matter of your own, please don’t hesitate to get in touch with CTP Insurance Special Counsel Helen Huang today.
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