Issued under section 7.13(4) of the Motor Accident Injuries Act 2017
|The Reviewable Decision|
|Reviewable decision-maker||Jeanette Woollacott|
|Date of Reviewable decision||3 September 2018|
|Nature of Reviewable decision||Whether the Insurer is entitled to refuse payment of statutory benefits in accordance with section 3.35 of the Act|
|The Merit Review|
|Merit Reviewer||Jeanette Woollacott|
|Date of Merit Review Certificate||7 November 2018|
Merit Reviewer’s Determination
This determination relates to a merit review matter, which is a reviewable decision under Schedule 2(1) (s) of the Motor Accident Injuries Act 2017 (the Act).
The merit review matter is about whether the Insurer is entitled to refuse payment of statutory benefits in accordance with section 3.35 of the Act, on the basis that the claimant failed to comply with a request by the Insurer under section 3.35(4) of the Act to make a claim for workers compensation.
My determination of the Merit Review is as follows:
- The reviewable decision is set aside and the following decision is made in substitution for the reviewable decision:
- The Insurer may not refuse statutory benefits under Part 3 of the Act on the basis that the insurer did not have reasonable grounds that workers compensation is or may be payable in accordance with s.35(4) of the Act and did not communicate its decision in accordance with the obligations under section 6.3(3) of the Act.
- The Insurer requires the claimant to make a claim for workers compensation for the injury with the relevant workers compensation insurer, in accordance with section 3.35(4) of the Act, within 14 days of the date on which the claimant receives this determination.
- Effective Date: This determination takes effect from 17 August 2018.
A brief statement of my reasons for this determination are attached to this certificate.
Merit Reviewer, Dispute Resolution Service