Key changes to the Motor Accident Guidelines impacting on claims management

 

The Guidelines run into 255 pages. This article is limited to an examination of those Guidelines relating to Parts 4 (Claims), 5 (Soft Tissue & Minor Psychological Injuries) and 7 (Dispute Resolution). Some of the amendments correct grammatical or other errors of a minor nature and will not be addressed here.

Communicating with Claimants

New rules applicable to communications with claimants are found in clause 4.8. In short, insurers must communicate directly with claimants (or their "friends" in limited cases) even where the claimant is legally represented. That position only reverses when a dispute arises and comes before the Dispute Resolution Service.

Time for making a claim – unidentified, uninsured & interstate vehicles

Clause 4.12 provides that where the at fault vehicle is unidentified or uninsured, a statutory benefits claim must be made on the Authority within 28 days after the accident before the claimant is entitled to weekly benefits from the day after the accident.

Clause 4.13 provides that where an insurer directly receives a claim in respect of which the insurer of the at fault vehicle is not a licensed insurer in NSW, the insurer must notify the Authority of the claim as soon as possible.

Minor Injury decisions

Clause 5.6 provides that a diagnosis for the purpose of a minor injury decision should be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer. This would appear to limit the circumstances where a "diagnosis" can be made by claims staff or rehabilitation staff based on medical certificates or other records. Arguably, if the records are sufficiently comprehensive and reflect an appropriate clinical assessment by a medical practitioner or psychologist, there is nothing to preclude an insurer from concluding that a minor injury has been sustained.

Time limits on review of decisions by Merit Reviewers & requests for correction of obvious errors by Claims Assessors

Clause 7.236 increases the time limit on any review application from 21 days to 28 days from the date of the decision by a Merit reviewer. Clause 7.501 provides that any request to have an obvious error corrected must be made within 21 calendar days of the date the Certificate is issued. The Guidelines had previously been silent on this time limit.

For more information

Andrew Gorman, Principal
McCabe Curwood
+61 2 8231 6282
andrew.gorman@mccabecurwood.com.au