Updates to Version 8 of the Motor Accident Guidelines

1.41, Table 1.1.

Proposed premiums calculation guidelines for certain classes of vehicles, to reflect future implementation of new guidelines for taxis and hire vehicles.

1.59, 1.61

Clarification that the Authority is not bound by any of the maximum rates of assumptions if it considers that it would be unreasonable to apply them in the particular circumstances of the case.

2.13-2.14

Provides the definition of discrimination to clarify insurer requirements regarding unfair discrimination in business practices and processes. Unfair discrimination includes both direct and indirect discrimination. Not all discrimination is unfair where it is appropriate to the particular circumstances and justified through evidence, for example, in the calculation of risk.

Also clarifies that insurer obligations regarding reasonable service standards include the provision of equitable access to services for persons with disability.

2.25

Amendment to allow the Authority to nominate a period during which the regulatory relief timeframes for the insurer to transmit an eGreenSlip to RMS will apply.

3.2-3.18

Revised business plan requirements to more clearly outline insurer obligations, and ensure the development of business practices in line with the Act and the Authority’s Customer Service Conduct Principles.

New requirement for insurers to correct errors that are notified through the UCD within particular timeframes.

4.34

If the insurer denies liability for the payment of statutory benefits, its notice must include the claimant’s right to seek independent legal advice, and to make a complaint with the IRO. The notice must also contain a list of all the information relevant to the decision, regardless of whether the information supports the decision, or has previously been provided to the claimant.

4.43

New requirement that the insurer must commence weekly payments of statutory benefits within 10 working days after its decision to accept liability.

4.64, 4.65

Amended end date for COVID-19 emergency requirements regarding fitness for work certificates provided by physiotherapists or psychologists. The end date is now 17 April 2022, and aligned with clause 176 of the Workers Compensation Regulation 2016.

4.98

Clarification that the insurer must make a decision and notify the claimant regarding a request for treatment, rehabilitation, vocational support and attendant care services within 10 days of receipt of the request.

4.98

Where the insurer declines the claimant’s request for treatment, rehabilitation, vocational support, its notice must include information on how a claimant may make a complaint with the Independent Review Office (IRO), including the IRO’s contact details. The notice must also contain a list of all the information relevant to the decision, regardless of whether the information supports the decision, or has previously been provided to the claimant.

4.98

Amended requirement for liability notices in damages claims to align with existing Guidelines for statutory benefits liability notices. The liability notice must contain a list of all the information relevant to the decision, regardless of whether the information supports the decision, or the information has previously been provided to the claimant.

Subclause (a) provides an exception for claims for damages under the Compensation to Relatives Act 1897 if the insurer admits liability for the claim. This is to relieve family members from viewing distressing information.

“Before making a request for further information, the insurer must take into account all relevant information already available, including from a related statutory benefits claim.”

This reflects stakeholder feedback and is intended to reduce unnecessary burden on the claimant.

The insurer must conduct investigations in compliance with Part 15 of the Insurance Council of Australia’s ‘General Insurance Code of Practice 2020’. However, the Guidelines take precedence over the Code to the extent of any inconsistency.

Where the insurer engages an external investigator to conduct the investigation, it must ensure that the investigator holds a valid licence under the Commercial Agents and Private Inquiry Agents Act 2004, and conducts the investigation in compliance with that Act.

Before arranging a medical examination, the insurer must inquire with the injured person’s treating medical, rehabilitation and health service practitioners promptly to try to resolve the issue being investigated. The insurer must provide copies of all documents obtained in this process to the injured person as soon as possible (within 10 working days of receipt) unless the treating medical, rehabilitation or health service practitioner indicates otherwise.

The insurer must ensure that, where possible, investigation reports and recordings are redacted or censored to minimise the likelihood of other individuals being identifiable, and recordings and any other materials collected are securely stored.

7.12, 7.13

Changed requirement for insurers to advise the claimant of their decision to accept or decline conduct of an internal review within seven days of receiving the application.

This deadline was previously flexible.

7.27

New requirement that the insurer must commence payment of statutory benefits where these are payable within 14 days after its internal review decision.

7.28

Additional requirement for internal review notices to include claimant’s right to seek independent legal advice, and to make a complaint with the IRO.

7.37

New requirement that, before the Personal Injury Commission may approve the settlement of a claim for damages, it must be satisfied the claimant understands their entitlement to seek independent legal advice