Helen Huang
Special Counsel
CTP Insurance, Insurance
When do I get paid my statutory benefits?
13 July, 2024
In Brief
- Section 6.13(1) of the Motor Accident Injuries Act 2017 (MAIA) provides a claim for statutory benefits must be made within 3 months after the date of the motor accident to which the claim relates.
- Section 6.13(2) of MAIA provides that if a claim for statutory benefits is not made within 28 days after the date of the motor accident, weekly payments of statutory benefits are not payable for any period before the claim is made, unless permitted by the regulations.
- Clause 8A of the Motor Accident Injuries Regulation 2017 (MAIR) only allows weekly payments to be backdated to the date of the accident where the claim is made within 3 months of the accident and the Claimant has a full and satisfactory explanation for not making the claim for statutory benefits within 28 days.
- Section 2.30(2) of MAIA provides that a claim cannot be made against the Nominal Defendant unless due inquiry and search has been made to establish the identity of the motor vehicle concerned.
Facts
On 12 July 2024, the Personal Injury Commission published its decision in Najjar v Insurance Australia Limited t/as NRMA Insurance [2024] NSWPIC 328.
The Claimant was involved in a motor vehicle accident on 7 October 2023. The at-fault vehicle was unidentified.
The Claimant did not lodge an Application for Personal Injury Benefits (APIB) with the Nominal Defendant until 24 November 2023, over seven weeks after the accident.
On 7 December 2023, the Nominal Defendant notified the Claimant that the Claimant was required to conduct due inquiry and search into the identity of the at-fault vehicle.
On 1 March 2024, the Claimant provided both particulars of inquiry and search and an explanation for his delay in lodging his APIB.
The Nominal Defendant immediately accepted the explanation for delay.
The Claimant argued that his weekly benefits should be back-date to the date his APIB was lodged (24 November 2023).
The Insurer asserted the Claimant was only entitled to weekly benefits from the date he satisfied the requirement to provide due inquiry and search into the identity of the at-fault vehicle (1 March 2024).
The matter proceeded to a dispute before the Commission.
The Member’s Determination
The Member determined:
- The legislation is clear and makes no provision for the exercise of any discretion.
- A claim for statutory benefits made against the Nominal Defendant requires a claim form to be served together with details of inquiry and search.
- Until both these requirements have been met then no claim is made.
- Until the Claimant provided details of his inquiry and search on 1 March 2024, his claim was in breach of s 6.13(1) of MAIA and was non-compliant.
- Therefore, the Claimant was not entitled to payment of statutory benefits until after 1 March 2024.
Key Learnings
This decision highlights a claim for statutory benefits made against the Nominal Defendant requires a claim form to be served together with details of inquiry and search. The claim is not fully compliant until due inquiry and search is conducted.
The decision in Najjar highlights the importance of the compliance date.
Clause 8A of the Motor Accident Injuries Regulation 2017 allows weekly benefits to be back-dated to the date of the accident where the claim is late and the Claimant has provided a full and satisfactory explanation for delay. However, pursuant to clause 8A(1)(a), the clause only applies where the claim is made within 3 months of the accident.
In this dispute, the claim was not compliant until due inquiry and search was completed (1 March 2024), which is more than 3 months after the motor accident (7 October 2023). As such, clause 8A did not assist the Claimant.
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.
