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ABK v QBE Insurance [2018] NSWDRS CA 037

NSW DISPUTE RESOLUTION SERVICE (NSWDRS)
JurisdictionMiscellaneous Claims Assessment
CatchwordsStatutory benefits – refuse payment of weekly payments – time limits
Legislation CitedMotor Accidents Injury Act (NSW) ss 6.13, 7.36 (5), Schedule 2(3)(k)
Motor Accident Guidelines cl 7.441
Cases CitedN/A
Text CitedN/A
Parties ABK - Claimant
QBE Insurance - Insurer
DisclaimerThis decision has been edited to remove all Unique Personal Identification including the name of the Claimant.

Miscellaneous Claims Assessment Certificate

View the certificate

Issued in accordance with section 7.36(5) of the Motor Accident Injuries Act 2017 and clause 7.441 of the Motor Accident Guidelines

Determination of a matter declared under Schedule 2(3)(k) of the Act to be a miscellaneous claims assessment matter

ClaimantABK
InsurerQBE Insurance
Date of Accident21 June 2018
DRS Reference10046704 Adam Giles
Insurer Claim Number360005378401
DRS Decision MakerAssessor Helen K. Wall
Date of Decision8 November 2018
Conference date and time7 November 2018 at 1:00pm
Conference venue and locationOn the papers
Attendances for ClaimantABK - Claimant
Attendances for InsurerMs Anita Parker - QBE Insurance

The findings of the assessment of this dispute are as follows:

  1. For the purposes of section 6.13 of the Act the insurer is entitled to refuse payment of weekly payments of statutory benefits from 21 June 2018 to 14 August 2018.

A brief statement of my reasons for this determination are attached to this certificate.

Helen K. Wall
Decision Maker,
Dispute Resolution Services
8 November 2018

Reasons for Decision

Issued in accordance with section 7.36(4) of the Motor Accident Injuries Act 2017

Background

This determination relates to a Miscellaneous Claim, which is a reviewable decision under Schedule 2(3)(k) of the Motor Accident Injuries Act 2017, about whether the Insurer is entitled to refuse payment of weekly payments of statutory benefits in accordance with s.6.13 of the Motor Accidents Injuries Act 2017.

1. The Claimant, ABK was injured in a motor vehicle accident on 21 June 2018.

2. QBE Insurer have denied payment of weekly statutory benefits to the Claimant, from any period from 21 June 2018 to 14 August 2018. This is the date QBE alleges the claim was made on them by the Claimant.

3. There was a review of this decision and the internal review certificate of determination was issued on 17 September 2018. The Claimant lodged the dispute which has been allocated to me to determine.

4.In her document dated 23 October 2018, the Claimant explains the chronology as follows:

a. The motor vehicle accident occurred on 21 June 2018.

b. On 21 June 2018 the Claimant attended her general practitioner and obtained a medical certificate.

c.  A few weeks later, the Claimant alleges she rang her third party Insurer of her car (NRMA) and she alleges that she was told by somebody at NRMA since she did not know who the other driver was, that she could not make a claim. QBE contacted NRMA to check if they had any records of the Claimant making a claim on NRMA. NRMA had no records of any contact with the Claimant.

d. She continued to have treatment for her injuries and on 10 August 2018, she did some research through SIRA on the internet and found out that she was able to find the information required to make a claim.

e. She contacted the claims assistance line on 8 August 2018 and rang SIRA again on 14 August 2018 until she knew that the claim had been given to QBE.

f.  QBE confirmed that they received the claim form on 14 August 2018.

g. QBE notified the Claimant that it is entitled to refuse payment of weekly payments of statutory benefits in accordance with s.6.13 of the Act.

5. QBE has denied weekly statutory benefits from 21 June 2018 to the date the claim was made, 14 August 2018.

Conclusion

My determination of the Miscellaneous Claim is as follows:

6. I am satisfied that the Claimant’s claim for statutory benefits was not made within 28 days after the date of the motor vehicle accident.

7. For the purposes of section 6.13 of the Act, the Insurer is entitled to refuse payment of weekly benefits of statutory benefits between 21 June 2018 and 14 August 2018.

8. Effective Date: This determination takes effect on 8 November 2018.

9. No order as to costs.

Helen K. Wall
Decision Maker,
Dispute Resolution Service
8 November 2018