{"id":"a-2019-12","name":"Motor Accident Injuries Act 2019","slug":"motor-accident-injuries-act-2019","collection":"act","jurisdiction":"act","status":"in_force","isInForce":true,"actNumber":"12 of 2019","makingDate":null,"administeringDepartment":null,"currentVersion":{"id":23958,"registerId":"act-a-2019-12-current","compilationNumber":null,"startDate":"2026-04-01","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name of Act","content":"1 Name of Act\nThis Act is the Motor Accident Injuries Act 2019.\n","sortOrder":0},{"sectionNumber":"3","sectionType":"section","heading":"Dictionary","content":"3 Dictionary\nThe dictionary at the end of this Act is part of this Act.\nNote 1 The dictionary at the end of this Act defines certain terms used in this\nAct, and includes references (signpost definitions) to other terms defined\nelsewhere.\nFor example, the signpost definition ‘personal health information—see\nthe Health Records (Privacy and Access) Act 1997, dictionary.’ means\nthat the term ‘personal health information’ is defined in that dictionary\nand the definition applies to this Act.\nNote 2 A definition in the dictionary (including a signpost definition) applies to\nthe entire Act unless the definition, or another provision of the Act,\nprovides otherwise or the contrary intention otherwise appears (see\nLegislation Act, s 155 and s 156 (1)).\n","sortOrder":1},{"sectionNumber":"4","sectionType":"section","heading":"Notes","content":"4 Notes\nA note included in this Act is explanatory and is not part of this Act.\nNote See the Legislation Act, s 127 (1), (4) and (5) for the legal status of notes.\n\nPreliminary Part 1.1\n","sortOrder":2},{"sectionNumber":"5","sectionType":"section","heading":"Offences against Act—application of Criminal Code etc","content":"5 Offences against Act—application of Criminal Code etc\nOther legislation applies in relation to offences against this Act.\nNote 1 Criminal Code\nThe Criminal Code, ch 2 applies to all offences against this Act (see\nCode, pt 2.1).\nThe chapter sets out the general principles of criminal responsibility\n(including burdens of proof and general defences), and defines terms used\nfor offences to which the Code applies (eg conduct, intention,\nrecklessness and strict liability).\nNote 2 Penalty units\nThe Legislation Act, s 133 deals with the meaning of offence penalties\nthat are expressed in penalty units.\n","sortOrder":3},{"sectionNumber":"6","sectionType":"section","heading":"Objects of Act","content":"6 Objects of Act\nThe main objects of this Act are to—\n(a) ensure benefits are available to support all people injured in\nmotor accidents on a no-fault basis, subject to some exclusions\nand limitations; and\n(b) encourage early and appropriate treatment and care of people\ninjured in motor accidents to achieve optimum recovery and\nreturn to pre-accident levels of activity and work; and\n(c) support people injured in motor accidents to access defined\n(d) promote and encourage the early, quick, cost-effective and just\nresolution of disputes; and\n(e) continue and improve the system of motor accident injury\ninsurance, and the scheme of statutory insurance for uninsured\nand unidentified vehicles, operating in the ACT; and\n(f) keep the costs of motor accident injury insurance at an\naffordable level; and\n\n(g) provide frameworks that allow competition in setting premiums\nfor motor accident injury insurance policies; and\n(h) provide for the licensing and supervision of insurers providing\nmotor accident injury insurance; and\n(i) establish and keep a register of motor accident claims to help the\nadministration of the statutory insurance scheme and the\ndetection of fraud; and\n(j) support and promote the prevention of motor accidents and the\nsafe use of motor vehicles.\n","sortOrder":4},{"sectionNumber":"7","sectionType":"section","heading":"Application of Act","content":"7 Application of Act\n(1) This Act applies to the death or injury of a person that results from a\nmotor accident if the motor accident—\n(a) happened in the ACT on or after the day this Act commenced;\nand\n(b) at least 1 motor vehicle involved in the motor accident had MAI\ncover under this Act at the time of the motor accident.\n(2) For subsection (1) (b), a motor vehicle involved in a motor accident\nis taken to have had MAI cover under this Act at the time of the motor\naccident if—\n(a) an MAI policy was in force for the motor vehicle at that time; or\n(b) at that time, the motor vehicle was owned by—\n(c) a compulsory third-party insurance policy was in force for the\nmotor vehicle under the law of a jurisdiction other than the ACT\nat that time; or\n\nPreliminary Part 1.1\n(d) there is a right of action against the nominal defendant under this\nAct in relation to the motor accident; or\n(e) there would be a right of action against the nominal defendant\nunder this Act in relation to the motor accident if the cause of\nthe motor accident was the fault of the responsible person for, or\nthe driver of, the motor vehicle in the use or operation of the\n\n","sortOrder":5},{"sectionNumber":"8","sectionType":"section","heading":"Meaning of person injured in a motor accident","content":"8 Meaning of person injured in a motor accident\nperson injured in a motor accident means an individual who sustains\na personal injury as a result of a motor accident.\nNote Injured person means a person injured in a motor accident (see dict).\n","sortOrder":6},{"sectionNumber":"9","sectionType":"section","heading":"Meaning of personal injury","content":"9 Meaning of personal injury\npersonal injury means bodily injury and includes—\n(a) psychological or psychiatric injury; and\n(b) damage to spectacles, contact lenses, dentures, hearing aids,\ncrutches, wheelchairs, artificial limbs and prosthetic devices;\nand\n(c) death.\nExamples—psychological or psychiatric injury\nmental or nervous shock\n","sortOrder":7},{"sectionNumber":"10","sectionType":"section","heading":"Meaning of motor accident","content":"10 Meaning of motor accident\nmotor accident means an incident that—\n(a) involves the use or operation of a motor vehicle; and\n(b) causes personal injury to an individual; and\n(c) happens when—\n(i) someone is driving the motor vehicle; or\n\nInjury concepts Division 1.2.1\n(ii) someone or something collides with the motor vehicle; or\n(iii) someone takes action to avoid colliding with the motor\n(iv) the motor vehicle runs out of control.\n","sortOrder":8},{"sectionNumber":"11","sectionType":"section","heading":"Meaning of use motor vehicle","content":"11 Meaning of use motor vehicle\nuse, a motor vehicle, includes the following:\n(a) drive, park or stop the motor vehicle on a road or road related\narea;\n(b) maintain the motor vehicle;\n(c) if the motor vehicle is towing a trailer—use the trailer while\nattached to the vehicle;\n(d) if the motor vehicle is a tow truck towing or carrying an\nuninsured motor vehicle—use or operate the uninsured vehicle\nbeing towed or carried;\n(2) Also, if a trailer towed by a motor vehicle becomes detached from the\nvehicle and runs out of control, the use of the vehicle is taken to\ninclude the trailer while it is running out of control.\n","sortOrder":9},{"sectionNumber":"12","sectionType":"section","heading":"Meaning of permanent impairment","content":"12 Meaning of permanent impairment\npermanent impairment means the loss of, loss of the use of, or\ndamage or malfunction of, any of the following:\n(a) a part of the body;\n(b) a bodily system or function;\n(c) a part of a bodily system or function.\n\n","sortOrder":10},{"sectionNumber":"13","sectionType":"section","heading":"Meaning of whole person impairment (or WPI)","content":"13 Meaning of whole person impairment (or WPI)\nwhole person impairment (or WPI), of a person, means the degree of\npermanent impairment of the whole person resulting from personal\ninjury sustained as a result of a motor accident, expressed as a whole\nnumber percentage.\n","sortOrder":11},{"sectionNumber":"14","sectionType":"section","heading":"Meaning of independent medical examiner (or IME)","content":"14 Meaning of independent medical examiner (or IME)\nindependent medical examiner (or IME) means a doctor who, under\nan arrangement with an authorised IME provider, conducts—\n(a) medical examinations for WPI assessments; and\n(b) SOI assessments.\n","sortOrder":12},{"sectionNumber":"15","sectionType":"section","heading":"Authorisation of IME providers","content":"15 Authorisation of IME providers\n(1) The MAI commission must authorise entities to be IME providers for\nthis Act (authorised IME providers).\n(2) The MAI commission must not authorise an entity to be an\nIME provider unless satisfied that the entity—\n(a) has expertise in arranging—\n(i) medical examinations for WPI assessments; and\n(ii) SOI assessments; and\n(b) has entered into a deed of services with the MAI commission;\nand\n(c) otherwise meets the criteria set out in the MAI guidelines for\nauthorising an entity to be an IME provider.\n(3) The MAI guidelines may make provision for the following:\n(a) criteria for authorising an entity to be an IME provider;\n\nInsurance concepts Division 1.2.2\n(b) operational requirements to be imposed on an authorised\nIME provider;\n(c) fees that may be charged by an authorised IME provider for\nprovision of services for WPI assessments and SOI assessments.\n","sortOrder":13},{"sectionNumber":"Div 1","sectionType":"division","heading":"2.2 Insurance concepts","content":"Division 1.2.2 Insurance concepts\n","sortOrder":14},{"sectionNumber":"16","sectionType":"section","heading":"Meaning of nominal defendant","content":"16 Meaning of nominal defendant\n(1) For this Act, ACTIA is the nominal defendant.\nNote ACTIA—see the dictionary.\n(2) Any action or proceeding by or against the nominal defendant must\nbe taken in the name of the ‘nominal defendant’.\n","sortOrder":15},{"sectionNumber":"17","sectionType":"section","heading":"Meaning of average weekly earnings (or AWE)","content":"17 Meaning of average weekly earnings (or AWE)\naverage weekly earnings (or AWE) means the series of average\nweekly earnings issued by the Australian statistician, prescribed by\n","sortOrder":16},{"sectionNumber":"18","sectionType":"section","heading":"Meaning of AWE indexed for amount","content":"18 Meaning of AWE indexed for amount\nAWE indexed, for an amount, means the amount as adjusted in line\nwith any adjustment in the AWE—\n(a) after the commencement of the provision in which the amount\nappears; and\n(b) on a day (an indexation day) prescribed by regulation for the\namount; and\n\n(c) rounded up to the nearest—\n(i) for an amount referred to in section 96, section 97 or\nsection 103—dollar; or\n(ii) in any other case—whole $10.\n(2) However, if an amount to be AWE indexed would, if adjusted in line\nwith the adjustment (the negative adjustment) to the AWE, become\nsmaller, the amount is not reduced in line with the negative\n(3) An amount that, in accordance with subsection (2), is not reduced\nmay be increased in line with an adjustment in the AWE that would\nincrease the amount only to the extent that the increase, or part of the\nincrease, is not one that would cancel out the effect of the negative\n(4) Subsection (3) does not apply to a negative adjustment once the effect\nof the negative adjustment has been offset against an increase in line\nwith an adjustment in the AWE.\n","sortOrder":17},{"sectionNumber":"19","sectionType":"section","heading":"Indexation of defined benefits and quality of life damages","content":"19 Indexation of defined benefits and quality of life damages\n(1) The MAI commission must, on or before each indexation day for an\namount that is AWE indexed, declare—\n(a) the AWE indexation factor for the amount; and\n(b) the amount as indexed; and\n(c) that the amount as indexed applies on the indexation day for the\namount.\n(2) A declaration under subsection (1) is a notifiable instrument.\nAWE indexation factor, for an amount, means the factor worked out\nfor the amount in the way prescribed by regulation.\nindexation day—see section 18 (1) (b).\n\nDuties in relation to motor accidents Division 1.2.4\n","sortOrder":18},{"sectionNumber":"20","sectionType":"section","heading":"Duty to act in good faith—applicants, claimants and","content":"20 Duty to act in good faith—applicants, claimants and\n(1) This section applies to the following people:\n(a) a licensed insurer;\n(b) an applicant for defined benefits in relation to a motor accident;\n(c) a claimant for a motor accident claim.\n(2) Each person to whom this section applies—\n(a) has a duty to act in good faith in relation to an application for\ndefined benefits or a motor accident claim; and\n(b) must endeavour to finalise the application, or resolve the claim,\nas justly and promptly as possible.\n(3) The duty of an applicant or claimant to act in good faith in relation to\nan application for defined benefits or a motor accident claim includes\n(a) a duty to act honestly and with integrity at all times, and not to\nmislead, in all dealings and communications in relation to the\napplication or claim;\n(b) a duty to disclose, in a timely manner—\n(i) all relevant information in relation to the application or\nclaim, including reports by health practitioners; and\nNote Health practitioner—see the Legislation Act, dictionary,\npt 1.\n(ii) any other information reasonably requested by an insurer\nin relation to the application or claim;\n(c) a duty to do all things reasonably necessary to facilitate the\nresolution of a dispute in relation to the application or claim;\n\n(d) a duty to take all reasonable steps to minimise the loss caused\nby the applicant’s or claimant’s personal injury, including—\n(i) undertaking reasonable and necessary treatment and care,\nrehabilitation and vocational training; and\n(ii) applying for treatment and care benefits as soon as\npracticable after the motor accident or after the applicant\nor claimant becomes aware of the personal injury; and\n(iii) starting or returning to work as soon as practicable after a\nhealth practitioner certifies that the applicant or claimant is\nfit for starting or returning to work.\n(4) The duty of a licensed insurer to act in good faith in relation to an\napplication for defined benefits or a motor accident claim includes the\n(a) a duty to disclose, as soon as practicable, all information that an\napplicant or claimant may reasonably need to understand the\nprocess for applying for defined benefits or making a motor\n(b) a duty to give an applicant information about the applicant’s\nentitlements to defined benefits;\n(c) a duty to keep an applicant or claimant informed at all times\nabout the status or progress of their application or claim;\n(d) a duty to give the applicant or claimant written reasons for all\ndecisions having a material effect on an entitlement to defined\nbenefits or damages;\n(e) a duty to tell an applicant or claimant about the applicant’s or\nclaimant’s right to review of a decision of the insurer;\n(f) a duty to promptly pay any defined benefits to which a person is\nentitled or damages agreed to in settlement of the motor accident\nclaim or ordered by a court.\n\nDuties in relation to motor accidents Division 1.2.4\n(5) If a court or the ACAT is hearing a dispute involving a licensed\ninsurer and an applicant or claimant in relation to an application for\ndefined benefits or a motor accident claim, the court or the ACAT\nmay—\n(a) take into account a duty the insurer, applicant or claimant has\nunder this section; and\n(b) make an order in relation to the exercise of the duty.\n","sortOrder":19},{"sectionNumber":"21","sectionType":"section","heading":"Obligation to cooperate with MAI insurer—responsible","content":"21 Obligation to cooperate with MAI insurer—responsible\nperson and driver\n(1) This section applies if personal injury is caused by a motor accident.\n(2) The responsible person for, or the driver of, a motor vehicle involved\nin the motor accident must comply fully with any reasonable request\nmade by the MAI insurer for the motor vehicle for information in\nrelation to an application for defined benefits or a motor accident\nclaim resulting from the motor accident.\n(3) This section does not apply to a person if the person has a reasonable\nexcuse for failing to comply with the request.\n\n","sortOrder":20},{"sectionNumber":"Part 1","sectionType":"part","heading":"3 Motor accident injuries","content":"Part 1.3 Motor accident injuries\ncommission\nNote The governance of territory authorities, including the MAI commission,\nis regulated by the Financial Management Act 1996 (the FMA), pt 9 as\nwell as the Act that establishes them.\nFor example, the FMA, pt 9 deals with the corporate status of territory\nauthorities and their powers.\n22 Establishment of commission\nThe Motor Accident Injuries Commission is established.\n23 Constitution of commission\nThe commission consists of the MAI commissioner.\n24 Appointment of MAI commissioner\n(1) The Minister must appoint a public servant as the MAI commissioner.\nNote 1 For the making of appointments (including acting appointments), see the\nLegislation Act, pt 19.3.\nNote 2 In particular, an appointment may be made by naming a person or\nnominating the occupant of a position (see Legislation Act, s 207).\n(2) An appointment must be for a term of not longer than 5 years.\nNote A person may be reappointed to a position if the person is eligible to be\nappointed to the position (see Legislation Act, s 208 and dict, pt 1, def\nappoint).\n","sortOrder":21},{"sectionNumber":"25","sectionType":"section","heading":"Functions of MAI commission","content":"25 Functions of MAI commission\nThe MAI commission has the following functions:\n(a) to regulate the licensing of insurers operating under the motor\naccident injuries insurance scheme under this Act, including to\nissue, suspend or cancel licences for insurers and supervise\ninsurers;\n\nMotor accident injuries commission Part 1.3\n(b) to ensure that premiums fully fund the present and likely future\nliability under this Act but are not excessive;\n(c) to keep the insurance industry deed under review and make\nrecommendations for its amendment;\n(d) to monitor insurers’ compliance with their obligations under this\nAct;\nNote A reference to an Act includes a reference to the statutory\ninstruments made or in force under the Act, including any\nregulation (see Legislation Act, s 104).\n(e) to approve or reject MAI premiums and make guidelines in\nrelation to premiums under this Act;\n(f) to provide, or facilitate or regulate the provision of, information\nto the public about the motor accident injuries insurance scheme,\ncauses of motor vehicle accidents, the insurance business,\nlicensed insurers, defined benefits (including applications for\ndefined benefits) and motor accident claims, and dispute\nresolution;\n(g) to manage complaints about the market practices of licensed\ninsurers and the handling practices of insurers in relation to\napplications for defined benefits and motor accident claims;\n(h) to issue, monitor and review the MAI guidelines and other\nstatutory instruments under this Act;\n(i) to monitor, and advise the Minister about, the administration,\nefficiency and effectiveness of the motor accident injuries\ninsurance scheme;\n(j) to investigate any issue affecting the viability of the motor\naccident injuries insurance scheme;\n(k) to support and promote safety in the use of motor vehicles and\nthe prevention of motor accidents;\n\n(l) to develop and coordinate strategies to identify and combat\nfraud in or related to applications for defined benefits and motor\n(m) to keep the motor accident injuries insurance scheme generally\nunder review and make recommendations for its amendment;\n(n) any other function given to the MAI commission under this Act\nor another territory law.\nNote A provision of a law that gives an entity (including a person) a function\n","sortOrder":22},{"sectionNumber":"26","sectionType":"section","heading":"Functions of MAI commissioner","content":"26 Functions of MAI commissioner\nThe MAI commissioner has the functions given to the\nMAI commissioner under this Act or another territory law.\nNote A provision of a law that gives an entity (including a person) a function\n","sortOrder":23},{"sectionNumber":"27","sectionType":"section","heading":"Meaning of staff of the MAI commission","content":"27 Meaning of staff of the MAI commission\nstaff of the MAI commission means—\n(a) staff employed under section 28; and\n(b) consultants and contractors engaged under section 29.\n","sortOrder":24},{"sectionNumber":"28","sectionType":"section","heading":"MAI commission employed staff","content":"28 MAI commission employed staff\n(1) The MAI commission may employ staff on behalf of the Territory.\n(2) The staff must be employed under the Public Sector Management\nAct 1994.\nNote The Public Sector Management Act 1994, div 8.2 applies to the\nMAI commission in relation to the employment of staff (see Public\nSector Management Act 1994, s 152).\n\nMotor accident injuries commission Part 1.3\n","sortOrder":25},{"sectionNumber":"29","sectionType":"section","heading":"MAI commission consultants and contractors","content":"29 MAI commission consultants and contractors\n(1) The MAI commission may, on behalf of the Territory, engage\nconsultants and contractors to assist the commission in exercising its\nfunctions.\n(2) However, the MAI commission must not enter into a contract of\nemployment under this section.\n","sortOrder":26},{"sectionNumber":"30","sectionType":"section","heading":"Delegation by MAI commission","content":"30 Delegation by MAI commission\n(1) The MAI commission may delegate the MAI commission’s functions\nunder this Act or another territory law to—\n(a) a member of staff of the MAI commission; or\n(b) a public employee; or\n(c) a person prescribed by regulation.\nNote 1 Public employee—see the Legislation Act, dictionary, pt 1.\nNote 2 For the making of delegations and the exercise of delegated functions,\n(2) A delegate may subdelegate to a person mentioned in\nsubsection (1) (b) or (c) a function delegated under subsection (1) if\nthe subdelegation is authorised, in writing, by the MAI commission.\n","sortOrder":27},{"sectionNumber":"31","sectionType":"section","heading":"Delegation by MAI commissioner","content":"31 Delegation by MAI commissioner\nThe MAI commissioner may delegate the MAI commissioner’s\nfunctions under this Act or another territory law to—\n(a) a member of staff of the MAI commission; or\n(b) a public employee; or\n(c) a person prescribed by regulation.\nNote 1 Public employee—see the Legislation Act, dictionary, pt 1.\nNote 2 For the making of delegations and the exercise of delegated functions,\n\n","sortOrder":28},{"sectionNumber":"32","sectionType":"section","heading":"MAI commission arrangements for staff and facilities","content":"32 MAI commission arrangements for staff and facilities\nThe MAI commission may arrange with the head of service to use the\nservices of a public servant or Territory facilities.\nNote The head of service may delegate powers in relation to the management\nof public servants to a public servant or another person (see Public Sector\nManagement Act 1994, s 18).\n\nInterpretation—ch 2 Part 2.1\n","sortOrder":29},{"sectionNumber":"Part 2","sectionType":"part","heading":"Motor accident injuries—","content":"Chapter 2 Motor accident injuries—\ndefined benefits\n","sortOrder":30},{"sectionNumber":"33","sectionType":"section","heading":"Meaning of defined benefits","content":"33 Meaning of defined benefits\ndefined benefits means the following benefits:\n(a) income replacement benefits;\n(b) treatment and care benefits;\n(c) quality of life benefits;\n(d) death benefits;\n(e) funeral benefits.\n","sortOrder":31},{"sectionNumber":"34","sectionType":"section","heading":"Meaning of relevant insurer for motor accident","content":"34 Meaning of relevant insurer for motor accident\nrelevant insurer, for a motor accident, means—\n(a) for a single vehicle accident—the insurer of the motor vehicle;\nand\n(b) for a multiple vehicle accident—\n(i) for a no-fault motor accident—the insurer of a motor\nvehicle involved in the accident determined under an\napproved industry arrangement to be the relevant insurer\nfor the accident; or\nNote No-fault motor accident—see s 254.\n\n(ii) for any other case—the insurer of the motor vehicle whose\ndriver or responsible person was most at fault in the motor\nNote See s 40 for provisions relating to interstate relevant insurers.\napproved industry arrangement means an arrangement—\n(a) between licensed insurers and the nominal defendant for\ndetermining the relevant insurer for a motor accident; and\n(b) approved, in writing, by the MAI commission.\ninsurer, of a motor vehicle, means—\n(a) for an insured motor vehicle—the MAI insurer for the motor\n(b) for a motor vehicle insured by an interstate insurer—the\ninterstate insurer; or\nNote Interstate insurer—see the dictionary.\n(c) for an uninsured motor vehicle—the nominal defendant; or\n(d) for an unidentified motor vehicle—the nominal defendant.\n","sortOrder":32},{"sectionNumber":"35","sectionType":"section","heading":"Meaning of full and satisfactory explanation by","content":"35 Meaning of full and satisfactory explanation by\napplicant—ch 2\n(1) For this chapter, a full and satisfactory explanation by an applicant\nfor a delay in applying for defined benefits is a full account of the\nconduct, including the actions, knowledge and belief of the applicant,\nfrom the date of the motor accident until the date of providing the\nexplanation.\n\nInterpretation—ch 2 Part 2.1\n(2) The explanation is not a satisfactory explanation unless a reasonable\nperson in the position of the applicant would have been justified in\nexperiencing the same delay.\nExamples—full and satisfactory explanation\n1 An application for defined benefits in relation to a motor accident is delayed\nbecause a person injured in the motor accident becomes aware of the person’s\ninjury sometime after the motor accident.\n","sortOrder":33},{"sectionNumber":"2","sectionType":"section","heading":"An application for defined benefits in relation to a motor accident is delayed","content":"2 An application for defined benefits in relation to a motor accident is delayed\nbecause a person injured in the motor accident was not aware of the application\nprocess because the person did not receive accurate or timely information\nabout the process.\n3 An application for death benefits is delayed because the appointment of an\nexecutor for the dead person’s estate is delayed.\n4 An application for death benefits is delayed because the dead person’s\npersonal representative delayed in working out whether they were entitled to\nmake the application.\n","sortOrder":34},{"sectionNumber":"36","sectionType":"section","heading":"Meaning of person who died as a result of a motor","content":"36 Meaning of person who died as a result of a motor\naccident\nperson who died as a result of a motor accident means an individual\nwho dies—\n(a) as a result of a personal injury the person sustained as a result of\na motor accident; and\n(b) within 2 years after the date of the motor accident.\nNote Dead person means a person who died as a result of a motor accident\n(see dict).\n\n","sortOrder":35},{"sectionNumber":"38","sectionType":"section","heading":"Person injured in motor accident entitled to defined","content":"38 Person injured in motor accident entitled to defined\nIf a person sustains a personal injury as a result of a motor accident\nin the Territory, defined benefits are payable in relation to the\npersonal injury.\n","sortOrder":36},{"sectionNumber":"39","sectionType":"section","heading":"Defined benefits payable by relevant insurer","content":"39 Defined benefits payable by relevant insurer\nThe defined benefits payable to a person in relation to a personal\ninjury are payable by the relevant insurer for the motor accident.\n","sortOrder":37},{"sectionNumber":"40","sectionType":"section","heading":"Payment of defined benefits by interstate relevant insurer","content":"40 Payment of defined benefits by interstate relevant insurer\n(1) This section applies if the relevant insurer for a motor accident is an\ninterstate insurer (the interstate relevant insurer).\nNote Interstate insurer—see the dictionary.\n(2) The interstate relevant insurer must—\n(a) pay the defined benefits payable as a result of the motor\n(b) enter into an arrangement with a licensed insurer that is an\nassociated entity of the interstate relevant insurer for the\nlicensed insurer to be the relevant insurer for the motor accident;\nor\n(c) enter into an arrangement with the nominal defendant for the\nnominal defendant to manage the payment of the defined\nbenefits on behalf of the interstate relevant insurer.\n\nEntitlement to defined benefits Division 2.2.1\n(3) However, if the insurance policy of an interstate relevant insurer does\nnot provide benefits, on a no-fault basis, to an at-fault driver who\nsustains a personal injury in the motor accident—\n(a) the nominal defendant is the relevant insurer for the motor\naccident for an application for defined benefits made by the\nat-fault driver; and\n(b) the interstate relevant insurer must give the nominal defendant\nany information it has in relation to the at-fault driver’s\napplication for defined benefits.\n(4) If the interstate relevant insurer enters into an arrangement with the\nnominal defendant under subsection (2) (c), the nominal defendant—\n(a) has complete authority to make decisions for the management\nof the payment of the defined benefits; and\n(b) may request an advance from the nominal defendant fund to\nfund the payment of the defined benefits; and\n(c) may charge the interstate relevant insurer a fee for managing the\npayment of the defined benefits.\n(5) The nominal defendant may recover as a debt from the interstate\nrelevant insurer any costs reasonably incurred by the nominal\ndefendant in relation to the management of the payment of the defined\nbenefits.\n(6) The nominal defendant may bring a proceeding for recovery of costs\n\n(7) This section does not affect a right of recovery that the nominal\ndefendant may have, apart from this section, against the responsible\nperson for, or the driver of, the motor vehicle at fault in the motor\nNote An amount recovered under this section by the nominal defendant must\nassociated entity, of an interstate relevant insurer—see the\nCorporations Act, section 50AAA.\n","sortOrder":38},{"sectionNumber":"Div 2","sectionType":"division","heading":"2.2 Limitations and exceptions to","content":"Division 2.2.2 Limitations and exceptions to\n","sortOrder":39},{"sectionNumber":"41","sectionType":"section","heading":"Meaning of driving offence","content":"41 Meaning of driving offence\ndriving offence means an offence against any of the following\nprovisions:\n(a) the Crimes Act 1900, section 20 (Recklessly inflicting grievous\nbodily harm);\n(b) the Criminal Code, section 318 (Taking etc motor vehicle\nwithout consent);\n(c) the Road Transport (Alcohol and Drugs) Act 1977—\n(i) section 19 (Prescribed concentration of alcohol in blood or\nbreath), if the convicting court finds that the concentration\nof alcohol in the person’s blood or breath was at level 3; or\n(ii) section 21 (Prescribed concentration of alcohol and\nprescribed drug in bodily fluid), if the convicting court\nfinds that the concentration of alcohol in the person’s blood\nor breath was at level 3; or\n\n(iii) section 24 (Driving under the influence of intoxicating\nliquor or a drug), if—\n(A) the offence relates to driving under the influence of\nintoxicating liquor; and\n(B) a copy of a certificate or statement under that Act,\nsection 41 (1) (a), (c) or (g) (Evidentiary certificate—\nalcohol-related tests) or section 41AD (Evidentiary\ncertificate—analysis of sample for prescribed\ndrug etc) that is admitted in evidence in a proceeding\nin relation to the offence shows that the concentration\nof alcohol in the person’s blood or breath was\nequivalent to level 3; or\n(iv) section 24A (1) (Use vehicle or animal on road or road\nrelated area under influence of alcohol or drug), if a copy\nof a certificate under that Act, section 41 (1) (g) or\nsection 41AD that is admitted in evidence in a proceeding\nin relation to the offence shows that the concentration of\nalcohol in the person’s blood was equivalent to level 3; or\n(v) section 24A (2) if—\n(A) a copy of a certificate under that Act,\nsection 41 (1) (g) or section 41AD that is admitted in\nevidence in a proceeding in relation to the offence\nshows that the concentration of alcohol in the\nperson’s blood was equivalent to level 3 or level 4; or\n(B) the offence relates to the person being under the\ninfluence of a drug;\n(d) the Road Transport (Safety and Traffic Management)\nAct 1999—\n(i) section 5A (Races, attempts on speed records, speed trials\netc); or\n(ii) section 5B (Improper use of motor vehicle); or\n\n(iii) section 5C (Failing to stop motor vehicle for police); or\n(iv) section 6 (1) (a), (b) or (c) (Negligent driving); or\n(v) section 7 (Furious, reckless or dangerous driving);\n(e) a provision prescribed by regulation.\n","sortOrder":40},{"sectionNumber":"42","sectionType":"section","heading":"Definitions—div 2.2.2","content":"42 Definitions—div 2.2.2\nfound guilty, of an offence—\n(a) includes having the offence taken into account under the Crimes\n(Sentencing) Act 2005, section 57 (Outstanding additional\noffences taken into account in sentencing); but\n(b) does not include having an order made for the offence under the\nCrimes (Sentencing) Act 2005, section 17 (Non-conviction\norders—general).\nlevel, for a concentration of alcohol in blood or breath—see the Road\nTransport (Alcohol and Drugs) Act 1977, dictionary.\noutstanding, for a charge—see the Bail Act 1992, section 9D (6).\n","sortOrder":41},{"sectionNumber":"43","sectionType":"section","heading":"Entitlement limited—uninsured motor vehicle","content":"43 Entitlement limited—uninsured motor vehicle\n(1) This section applies if a person injured in a motor accident was the\nresponsible person for, or the driver of, an uninsured motor vehicle\ninvolved in the motor accident.\n(2) The injured person is entitled to income replacement benefits only\nif—\n(a) the motor accident involved more than 1 motor vehicle and—\n(i) another motor vehicle involved in the motor accident was\nan insured motor vehicle when the accident happened; and\n\n(ii) the other vehicle’s insurer is the relevant insurer for the\n(b) the motor accident—\n(i) involved only 1 motor vehicle; and\n(ii) is a no-fault motor accident; or\n(c) the injured person—\n(i) is the driver of the uninsured motor vehicle; and\n(ii) believed on reasonable grounds that—\n(A) the motor vehicle was an insured motor vehicle when\nthe accident happened; and\n(B) the responsible person for the motor vehicle\nconsented to the injured person driving the vehicle.\n(3) The injured person is entitled to quality of life benefits only if—\n(a) another motor vehicle involved in the motor accident was an\ninsured motor vehicle when the accident happened; and\n(b) the other vehicle’s insurer is the relevant insurer for the motor\n","sortOrder":42},{"sectionNumber":"44","sectionType":"section","heading":"Entitlement limited—single driving offence","content":"44 Entitlement limited—single driving offence\nwith a driving offence in relation to the motor accident.\napplication is suspended for the period the charge is outstanding.\n\n(3) Any entitlement to income replacement benefits or quality of life\nbenefits by the injured person ends—\n(a) if the injured person is convicted or found guilty of the driving\noffence—\n(i) if the injured person does not appeal the conviction or\nfinding of guilt—at the end of the appeal period for the\noffence; or\n(ii) if the injured person appeals the conviction or finding of\nguilt—when the appeal is finalised and the conviction or\nfinding of guilt is upheld; or\nprovided by the police, the injured person is not entitled to income\nreplacement benefits or quality of life benefits.\nNote A decision to declare that an injured person is not entitled to income\nreplacement benefits or quality of life benefits is a reviewable decision\n(see ch 10 and sch 2).\n\n(5) The relevant insurer is not entitled to recover any amount of defined\n","sortOrder":43},{"sectionNumber":"45","sectionType":"section","heading":"No entitlement—multiple driving offences","content":"45 No entitlement—multiple driving offences\nwith 2 or more driving offences in relation to the motor accident.\napplication is suspended for the period a charge is outstanding.\n(3) Any entitlement to income replacement benefits, treatment and care\nbenefits or quality of life benefits by the injured person ends—\n(a) if the injured person is convicted or found guilty of 2 or more\ndriving offences—\n(i) if the injured person does not appeal the convictions or\nfindings of guilt—at the end of the appeal period for the\noffences; or\n(ii) if the injured person appeals the convictions or findings of\nguilt—when the appeal is finalised and the convictions or\nfindings of guilt are upheld; or\n\nprovided by the police, the injured person is not entitled to the defined\nbenefits mentioned in subsection (3).\nNote A decision to declare that an injured person is not entitled to the defined\nbenefits mentioned in s (3) is a reviewable decision (see ch 10 and sch 2).\n(5) If the injured person is convicted or found guilty of only 1 driving\noffence, any entitlement to income replacement benefits or quality of\nlife benefits by the injured person ends—\n(a) if the injured person does not appeal the conviction or finding of\nguilt—at the end of the appeal period for the offence; or\n(b) if the injured person appeals the conviction or finding of guilt—\nwhen the appeal is finalised and the conviction or finding of guilt\nis upheld.\n(6) The relevant insurer is not entitled to recover any amount of defined\n","sortOrder":44},{"sectionNumber":"46","sectionType":"section","heading":"Entitlement limited—injuries self-inflicted","content":"46 Entitlement limited—injuries self-inflicted\nreplacement benefits or quality of life benefits if the injury is an\nintentionally self-inflicted injury.\n(2) If the death of a person who died as a result of a motor accident is\ncaused by an intentionally self-inflicted injury—\n(a) the person’s estate is not entitled to quality of life benefits; and\n(b) a dependant of the person is not entitled to death benefits.\n\n","sortOrder":45},{"sectionNumber":"47","sectionType":"section","heading":"Entitlement limited—detainees and young detainees","content":"47 Entitlement limited—detainees and young detainees\nreplacement benefits or treatment and care benefits during any period\nwhen the person is a detainee or a young detainee.\nNote A person with an injury to which the LTCS Act applies is eligible to\nparticipate in the LTCS scheme even though the person is imprisoned\n(see LTCS Act, s 15 (3)).\ndetainee—see the Corrections Management Act 2007, section 6.\nyoung detainee—see the Children and Young People Act 2008,\nsection 95.\n","sortOrder":46},{"sectionNumber":"48","sectionType":"section","heading":"No entitlement—serious offences","content":"48 No entitlement—serious offences\nwith a serious offence in relation to the motor accident.\napplication is suspended for the period the charge is outstanding.\n(3) Any entitlement to income replacement benefits, treatment and care\nbenefits or quality of life benefits by the injured person ends—\n(a) if the injured person is convicted or found guilty of the serious\noffence—\n(i) if the injured person does not appeal the conviction or\nfinding of guilt—at the end of the appeal period for the\noffence; or\n(ii) if the injured person appeals the conviction or finding of\nguilt—when the appeal is finalised and the conviction or\nfinding of guilt is upheld; or\n\nprovided by the police, the injured person is not entitled to the defined\nbenefits mentioned in subsection (3).\nNote A decision to declare that an injured person is not entitled to the defined\nbenefits mentioned in s (3) is a reviewable decision (see ch 10 and sch 2).\n(5) The relevant insurer is not entitled to recover any amount of defined\nserious offence means an offence against any of the following\nprovisions:\n(a) the Crimes Act 1900—\n(i) section 12 (Murder); or\n(ii) section 15 (Manslaughter); or\n(iii) section 19 (Intentionally inflicting grievous bodily harm);\nor\n\n(iv) section 21 (Wounding); or\n(v) section 29 (Culpable driving of motor vehicle);\n(b) the Road Transport (Alcohol and Drugs) Act 1977—\n(i) section 19 (Prescribed concentration of alcohol in blood or\nbreath), if the convicting court finds that the concentration\nof alcohol in the person’s blood or breath was at level 4; or\n(ii) section 21 (Prescribed concentration of alcohol and\nprescribed drug in bodily fluid), if the convicting court\nfinds that the concentration of alcohol in the person’s blood\nor breath was at level 4; or\n(iii) section 22 (Refusing to provide breath sample); or\n(iv) section 22A (Refusing to provide oral fluid sample); or\n(v) section 22B (Failing to stay for screening test); or\n(vi) section 22C (Refusing to undergo screening test); or\n(vii) section 23 (Refusing blood test etc); or\n(viii) section 24 (Driving under the influence of intoxicating\nliquor or a drug), if—\n(A) the offence relates to driving under the influence of\nintoxicating liquor; and\n(B) a copy of a certificate or statement under that Act,\nsection 41 (1) (a), (c) or (g) (Evidentiary certificate—\nalcohol-related tests) or section 41AD (Evidentiary\ncertificate—analysis of sample for prescribed\ndrug etc) that is admitted in evidence in a proceeding\nin relation to the offence shows that the concentration\nof alcohol in the person’s blood or breath was\nequivalent to level 4; or\n(ix) section 24, if the offence relates to driving under the\ninfluence of a drug; or\n\n(x) section 24A (1) (Use vehicle or animal on road or road\nrelated area under influence of alcohol or drug) if—\n(A) a copy of a certificate under that Act,\nsection 41 (1) (g) or section 41AD that is admitted in\nevidence in a proceeding in relation to the offence\nshows that the concentration of alcohol in the\nperson’s blood was equivalent to level 4; or\n(B) the offence relates to the person being under the\ninfluence of a drug;\n(c) the Road Transport (Safety and Traffic Management)\nAct 1999—\n(i) section 5A (Races, attempts on speed records, speed trials\netc), if the offence is an aggravated offence; or\n(ii) section 7 (Furious, reckless or dangerous driving), if the\noffence is an aggravated offence; or\n(iii) section 8 (Menacing driving);\n(d) a provision prescribed by regulation.\n","sortOrder":47},{"sectionNumber":"49","sectionType":"section","heading":"No entitlement—act of terrorism","content":"49 No entitlement—act of terrorism\n(1) If the MAI commission notifies, in writing, the relevant insurer for a\nmotor accident that the motor accident was caused by, or attributable\nto, an act of terrorism—\n(a) a person injured in the motor accident is not entitled to defined\nbenefits in relation to the injury; and\n(b) the personal representative, or the person who paid or is liable\nto pay the funeral expenses, of a person who died as a result of\nthe motor accident is not entitled to funeral benefits in relation\nto the person’s death; and\n\n(c) the dependants of a person who died as a result of the motor\naccident are not entitled to quality of life benefits or death\nbenefits in relation to the person’s death.\nact of terrorism—\n(a) means an act that—\n(i) causes or threatens to cause death, personal injury or\ndamage to property; and\n(ii) is designed to influence a government or intimidate the\npublic or a section of the public; and\n(iii) is carried out for the purpose of advancing a political,\nreligious, ideological, ethnic or similar cause; but\n(b) does not include a lawful activity or industrial action.\n","sortOrder":48},{"sectionNumber":"50","sectionType":"section","heading":"Entitlement limited—workers compensation claimant","content":"50 Entitlement limited—workers compensation claimant\n(a) is injured in a motor accident; and\n(b) is entitled to defined benefits; and\n(c) makes a claim for compensation under a workers compensation\nscheme in relation to the injury.\n(2) A person’s entitlement to relevant defined benefits ends on the day\nthe person’s claim for workers compensation is—\n(a) accepted; or\n\n(b) otherwise settled in accordance with the workers compensation\nscheme, including on a without prejudice basis.\nExample—par (b)\na licensed insurer under the Workers Compensation Act 1951 settles a claim\nwith the claimant by agreement to make a payment to the claimant without\naccepting liability for the claimant’s injury (see that Act, s 133)\n(3) However, the person’s entitlement to relevant defined benefits is\nrevived if the person’s claim for workers compensation is—\n(a) withdrawn within 13 weeks after the date of the motor accident;\nor\n(b) rejected.\nNote See also the withdrawal requirements under s 73 (4).\n(4) Relevant defined benefits are not payable in relation to any benefits\npaid and not recovered under the workers compensation scheme\nbefore the claim was withdrawn or rejected.\nrelevant defined benefits means the following:\n(a) income replacement benefits;\n(b) treatment and care benefits;\n(c) quality of life benefits.\n","sortOrder":49},{"sectionNumber":"51","sectionType":"section","heading":"When entitlement to certain benefits ends","content":"51 When entitlement to certain benefits ends\n(1) This section applies if a person injured in a motor accident is entitled\nto—\n(a) income replacement benefits; or\n(b) treatment and care benefits.\n\nEnd of entitlement to certain benefits Division 2.2.3\n(2) The person’s entitlement ends on the first occurring of the following:\n(a) the person dies;\n(b) for income replacement benefits—\n(i) the person reaches the pension age plus 2 years; or\n(ii) if, on the date of the motor accident, the person has reached\nthe pension age and is in paid work—2 years after the date\nof the motor accident;\n(c) a motor accident claim for the motor accident is finalised;\n(d) the person obtains a judgment or an agreement for damages in\nrelation to the person’s injury independently of this Act;\n(e) 5 years after the date of the motor accident.\nNote 1 See also s 184, which provides that a foreign national’s entitlement to\ndefined benefits ends in certain circumstances.\nNote 2 See also divs 2.6.2 and 2.6.3, which provide for when a quality of life\nbenefits application is finally dealt with.\nNote 3 Pension age—see the dictionary.\n\nDivision 2.3.1 Communicating with people in relation to motor accidents\nDivision 2.3.1 Communicating with people in\nrelation to motor accidents\n52 Information and support for applicants for defined benefits—\n(1) The MAI guidelines may make provision for information and support\nthat the relevant insurer for a motor accident must give applicants for\ndefined benefits.\n(2) In particular, the MAI guidelines may make provision for the\n(a) the circumstances in which the relevant insurer for a motor\naccident must give support and information to a person injured\nin the motor accident;\n(b) if a person injured in a motor accident contacts an insurer for a\nmotor vehicle involved in the motor accident—the information\nthat must be given to the person about the procedures relating to\napplying for defined benefits, including—\n(i) accessing, completing and submitting an application; and\n(ii) information to be given with an application; and\n(iii) time limits applying to the making of an application; and\n(iv) to whom an application must be given;\nif the injured person can’t work out who is the relevant insurer, that\nthe person give the application to their own insurer\n\nCommunicating with people in relation to motor accidents Division 2.3.1\n(c) the information that must be given with a receipt notice for an\napplication for treatment and care benefits and income\nreplacement benefits, including information about allowable\nexpenses for treatment and care;\nNote See s 60 for when a receipt notice is given.\n(d) the information that must be given in relation to an application\nfor treatment and care benefits and income replacement benefits\nfor which the relevant insurer has accepted liability, including\n(i) the procedure for obtaining approval for treatment and\ncare;\n(ii) the procedure for reimbursement of treatment and care\nexpenses, domestic services expenses and travel expenses;\n(iii) the evidence the applicant must give the insurer about the\napplicant’s fitness for work, how often the evidence must\nbe given to the insurer and how the applicant must tell the\ninsurer about any change in the applicant’s work\narrangements;\n(e) information to be given to a person injured in a motor accident\nto help the person decide whether the person is eligible for a\nquality of life payment, including information about the\n(i) the WPI needed to be eligible for a quality of life benefit\nor to make a motor accident claim;\n(ii) the procedure for applying for a WPI assessment;\n(iii) the time limits and conditions applying to the making of an\napplication for quality of life benefits;\n\nDivision 2.3.1 Communicating with people in relation to motor accidents\n(f) information to be given to a person who is taken, under\nsection 133 (WPI taken to be 10% in certain circumstances), to\nhave a WPI of 10%, including the following information:\n(i) the time limits for making a motor accident claim;\n(ii) seeking legal advice about whether to make a motor\n(g) information to be given to a person who receives a WPI report\nunder section 157 (WPI 10% or more—injured person entitled\nto make motor accident claim) or section 164 (Final offer\nWPI 10% or more—injured person entitled to make motor\naccident claim) stating that the person’s WPI is at least 10%,\nincluding the following information:\n(i) the consequences of accepting a quality of life benefit;\n(ii) the time limits for making a motor accident claim;\n(iii) seeking legal advice about whether to make a motor\n(h) information to be given to a person injured in a motor accident\nwho receives a notice under section 213 (SOI report—injury has\nsignificant occupational impact) stating that the person is\nentitled to make a motor accident claim in relation to the motor\naccident, including the following information:\n(i) the time limits for making a motor accident claim;\n(ii) seeking legal advice about whether to make a motor\naccident claim.\n(3) The MAI guidelines may make provision for when and how a\nrelevant insurer for a motor accident must give the information\nmentioned in subsection (2) to a person injured in the motor accident.\n\nSubdivision 2.3.2.1 Definitions—pt 2.3\n53 Meaning of information—pt 2.3\ninformation includes a record containing information.\n54 Meaning of authority to disclose personal health\nauthority to disclose personal health information, for a person\ninjured in a motor accident, means an authority—\n(a) signed by or on behalf of the injured person; and\n(b) stating that the injured person consents to the disclosure of\n(i) by any of the following people:\n(A) the injured person’s treating health service provider;\n(B) a member of the injured person’s treating team;\n(C) a health practitioner who conducts an assessment of\nthe injured person’s needs for treatment and care,\nincluding a medical or other examination;\n(D) an authorised IME provider and an independent\nmedical examiner who conducts a WPI assessment of\nthe person;\nNote WPI assessment—see s 143.\n(E) an authorised IME provider and an independent\nmedical examiner or independent assessor who\nconducts an SOI assessment of the person; and\n\n(ii) to a stated insurer; and\nperson’s entitlement to defined benefits; and\n(c) stating that the injured person consents to the disclosure of\n(i) by the stated insurer; and\n(ii) to any of the people mentioned in paragraph (b) (i); and\nperson’s entitlement to defined benefits; and\n(d) stating that the consents operate until the injured person either—\n(i) revokes the authority by notice, in writing, to the stated\n(ii) is no longer entitled to defined benefits in relation to the\nmotor accident.\ntreating health service provider—see the Health Records (Privacy\nand Access) Act 1997, dictionary.\ntreating team—see the Health Records (Privacy and Access)\nAct 1997, dictionary.\n\n","sortOrder":50},{"sectionNumber":"Subdiv 2","sectionType":"subdivision","heading":"3.2.2 Making an application for defined","content":"Subdivision 2.3.2.2 Making an application for defined\n","sortOrder":51},{"sectionNumber":"55","sectionType":"section","heading":"Who may apply for defined benefits?","content":"55 Who may apply for defined benefits?\n(1) Any of the following people may make an application for defined\nbenefits to the relevant insurer for a motor accident:\n(a) a person injured in the motor accident;\nNote The person may be entitled to income replacement benefits,\ntreatment and care benefits and quality of life benefits.\n(b) the dependant of a person who died as a result of the motor\naccident;\nNote The dependant may be entitled to death benefits (see s 169).\n(c) the person who has paid, or is liable to pay, the funeral expenses\nof a person who died as a result of the motor accident.\nNote The person may be entitled to funeral benefits (see s 178).\n(2) The following people may make an application for defined benefits\non behalf of a person mentioned in subsection (1):\n(a) for an applicant for defined benefits who is a person with a legal\n(b) for an applicant for defined benefits mentioned in\nsubsection (1) (b)—the personal representative of the person\nwho died as a result of the motor accident.\nNote Personal representative, of a person who died as a result of a motor\naccident—see the dictionary.\nPerson with a legal disability—see the dictionary.\n\n","sortOrder":52},{"sectionNumber":"56","sectionType":"section","heading":"Application for defined benefits—contents","content":"56 Application for defined benefits—contents\n(1) An application for defined benefits must be made in accordance with\nthe MAI guidelines.\nNote The MAI guidelines are made under s 487.\n(2) The MAI guidelines may make provision for applications, including\nprovision for—\n(a) making an application; and\n(b) to whom an application must be given; and\n(c) the form and contents of an application; and\n(d) the information that must be included with an application; and\n(e) the treatment expenses incurred by an applicant before making\nan application for which the applicant may be reimbursed.\n(3) The MAI guidelines may require the applicant to do 1 or more of the\n(a) provide a police accident notification number or police accident\nreport for the motor accident with the application;\n(b) provide a medical certificate with the application;\n(c) authorise the relevant insurer to obtain information and\ndocuments relevant to the application from stated people;\n(d) authorise the relevant insurer to provide the information and\ndocuments to stated people.\n\n","sortOrder":53},{"sectionNumber":"57","sectionType":"section","heading":"Application for defined benefits—authority to disclose","content":"57 Application for defined benefits—authority to disclose\npersonal health information\n(1) An application for defined benefits made by a person injured in a\nmotor accident must be accompanied by an authority to disclose\npersonal health information.\nNote Authority to disclose personal health information—see s 54.\n(2) Subsection (3) applies if an injured person revokes an authority to\ndisclose personal health information while the injured person is still\nentitled to defined benefits.\n(3) The insurer may suspend the processing of the injured person’s\napplication, or the payment of defined benefits to the injured person,\nuntil the injured person provides, in writing, any information\ndisclosure consents that are reasonably required by the insurer to\nprocess the application or assess or otherwise manage the injured\nperson’s entitlement to defined benefits.\n(4) The MAI guidelines may make provision in relation to the\ncircumstances in which an injured person must give the relevant\ninsurer for a motor accident an information disclosure consent under\nsubsection (3).\ninformation disclosure consent means either of the following:\n(a) a consent, signed by or on behalf of the injured person, to the\ndisclosure of personal health information about the injured\n(i) by any of the following people:\n(A) the injured person’s treating health service provider;\n(B) a member of the injured person’s treating team;\n\n(C) a health practitioner who conducts an assessment of\nthe injured person’s needs for treatment and care,\nincluding a medical or other examination;\n(D) an authorised IME provider and an independent\nmedical examiner who conducts a WPI assessment of\nthe person;\nNote WPI assessment—see s 143.\n(E) an authorised IME provider and an independent\nmedical examiner or independent assessor who\nconducts an SOI assessment of the person; and\n(ii) to a stated insurer; and\nperson’s entitlement to defined benefits;\n(b) a consent, signed by or on behalf of the injured person, to the\ndisclosure of personal health information about the injured\n(i) by the stated insurer; and\n(ii) to any of the people mentioned in paragraph (a) (i); and\nperson’s entitlement to defined benefits.\n\n","sortOrder":54},{"sectionNumber":"58","sectionType":"section","heading":"Meaning of application period—ch 2","content":"58 Meaning of application period—ch 2\napplication period, for an application for defined benefits, means—\n(a) for a person injured in a motor accident—the period of 13 weeks\nbeginning on the date of the motor accident; or\nNote 1 The person may be entitled to income replacement benefits,\ntreatment and care benefits and quality of life benefits.\nNote 2 The person would be able to make an additional later application\nfor quality of life benefits (see s 137).\n(b) for a person who has paid, or is liable to pay, the funeral\nexpenses of a person who died as a result of a motor accident—\nthe period of 13 weeks beginning on the date of the injured\nperson’s death; or\nNote The person may be entitled to funeral benefits (see s 178).\n(c) for the dependant or personal representative of a person who\ndied as a result of a motor accident—the period of 13 weeks\nbeginning on the date of the injured person’s death.\nNote The dead person’s dependants may be entitled to death benefits\n(see s 169).\n\n","sortOrder":55},{"sectionNumber":"59","sectionType":"section","heading":"Application for defined benefits—must be made within","content":"59 Application for defined benefits—must be made within\napplication period\n(1) An application for defined benefits in relation to a motor accident\nmust be made within the application period.\n(2) The relevant insurer for a motor accident may accept an application\nfor defined benefits made after the application period\n(a late application) if—\n(a) the application is made—\n(i) for income replacement benefits or treatment and care\nbenefits, or both—within 2 years after the date of the motor\n(ii) for death benefits and funeral benefits—within 1 year after\nthe date of the injured person’s death; and\n(b) the relevant insurer is satisfied the applicant has a full and\nsatisfactory explanation for the late application.\nNote Full and satisfactory explanation—see s 35.\n(3) The relevant insurer—\n(a) may ask the applicant for additional information in relation to\nthe application; and\n(b) need not make a decision about accepting the application until\nthe insurer receives the additional information.\n(4) However, if the relevant insurer does not respond to the applicant\nabout the applicant’s explanation for the late application within\n28 days after receiving it, the relevant insurer is taken to have\naccepted the application.\n(5) The relevant insurer need not accept an application if the application\nis made after the time stated in subsection (2) (a).\n\n","sortOrder":56},{"sectionNumber":"60","sectionType":"section","heading":"Application for defined benefits—action following receipt","content":"60 Application for defined benefits—action following receipt\n(1) If the relevant insurer for a motor accident receives an application for\ndefined benefits, the relevant insurer must, within the period stated in\nthe MAI guidelines—\n(a) for an application made during the application period—give the\napplicant a written notice (a receipt notice) that includes—\n(i) information about how the applicant may apply for\npayment of allowable expenses; and\n(ii) other information required by the MAI guidelines; or\n(b) for a late application—give the applicant a written notice\n(a late receipt notice) stating that defined benefits will be paid\nto the applicant if the insurer accepts the application; or\n(c) for an application that is incomplete—return the application to\nthe applicant accompanied by a notice (a required additional\ninformation notice) stating the additional information needed to\ncomplete the application and that the application will not be\ndealt with until the relevant insurer receives the additional\ninformation.\n(2) For subsection (1) (c), an application is incomplete if the\napplication—\n(a) is not signed by or on behalf of the applicant; or\n(b) does not include all the information required, under the\nMAI guidelines or a regulation, to be included in the application.\n(3) A receipt notice or late receipt notice must be in the form, and include\nthe information, required by the MAI guidelines.\n\n","sortOrder":57},{"sectionNumber":"61","sectionType":"section","heading":"Meaning of allowable expenses—ch 2","content":"61 Meaning of allowable expenses—ch 2\n(1) In this chapter:\nallowable expenses means expenses an applicant for defined benefits\nmay incur in relation to treatment and care of the applicant’s injury\nwithout the relevant insurer’s approval during the initial period for\nthe application for defined benefits.\ninitial period, for an application for defined benefits, means the\nperiod—\n(a) beginning on the date of the receipt notice for the application;\nand\n(b) ending—\n(i) on the day the relevant insurer makes, or is taken to have\nmade, a final decision to accept or reject liability for the\napplication; or\n(ii) if the insurer transfers the application to another insurer—\n4 weeks after the date of the receipt notice for the\napplication; or\n(iii) if there is a dispute between insurers about liability under\nsection 70—4 weeks after the date of the receipt notice for\nthe application.\n","sortOrder":58},{"sectionNumber":"62","sectionType":"section","heading":"Allowable expenses—relevant insurer must pay","content":"62 Allowable expenses—relevant insurer must pay\nThe relevant insurer for a motor accident must pay an applicant for\ndefined benefits’ allowable expenses if the applicant provides the\nrelevant insurer with a receipt for the allowable expenses.\n\nPayment of allowable expenses Division 2.3.3\n","sortOrder":59},{"sectionNumber":"63","sectionType":"section","heading":"Allowable expenses—MAI guidelines","content":"63 Allowable expenses—MAI guidelines\nThe MAI guidelines may make provision in relation to the allowable\nexpenses for treatment and care for an applicant for defined benefits\nin relation to a motor accident, including provision in relation to the\n(a) the treatment and care for which the applicant may incur\nallowable expenses, including restrictions in relation to the\nExample—restrictions\nthe number of doctor’s appointments an applicant may have\n(b) verifying the injured person’s allowable expenses;\n(c) the period for which allowable expenses are payable;\n(d) the amount of allowable expenses.\n","sortOrder":60},{"sectionNumber":"64","sectionType":"section","heading":"Allowable expenses—relevant insurer later rejects","content":"64 Allowable expenses—relevant insurer later rejects\nliability for defined benefits\n(1) This section applies if a relevant insurer pays an amount of allowable\nexpenses to an applicant.\n(2) If the relevant insurer later rejects liability for defined benefits for the\napplicant, the following applies:\n(a) if the relevant insurer (the first insurer) rejects liability for the\ndefined benefits because another insurer is the relevant insurer\nfor the application—\n(i) the amount of allowable expenses paid is not recoverable\nfrom the applicant; but\n(ii) the first insurer may recover the amount as a debt from the\nother insurer;\n\n(b) if the relevant insurer rejects liability for the defined benefits\nbecause the application was based on false or misleading\ninformation, the insurer may recover the amount of allowable\nexpenses paid as a debt from the applicant.\nDivision 2.3.4 Accepting or rejecting liability for\ndefined benefits\n","sortOrder":61},{"sectionNumber":"65","sectionType":"section","heading":"Relevant insurer must decide liability for defined benefits","content":"65 Relevant insurer must decide liability for defined benefits\n(1) If a relevant insurer for a motor accident receives an application for\ndefined benefits, the relevant insurer must, within 28 days after the\ndate of the receipt notice given to the applicant—\n(a) decide whether the relevant insurer accepts or rejects liability\nfor the defined benefits; and\n(b) give the applicant a notice about the decision.\n(2) If the relevant insurer accepts liability for the defined benefits, the\nrelevant insurer must give the applicant a written notice (a defined\nbenefits notice)—\n(a) stating that the insurer accepts liability for the defined benefits;\nand\n(b) including any information required under the MAI guidelines.\n(3) If the relevant insurer does not accept liability for the defined benefits,\nthe relevant insurer must give the applicant either—\n(a) a written notice (a transfer notice) stating—\n(i) that the insurer does not accept liability for the defined\nbenefits because another insurer is liable; and\n(ii) that the application has been given to another insurer; and\n(iii) the name and contact details of the other insurer; or\nNote Transfers of applications are dealt with in s 69.\n\nAccepting or rejecting liability for defined benefits Division 2.3.4\n(b) a written notice (a rejection notice) stating—\n(i) that the insurer does not accept liability for the defined\n(ii) the reasons for the decision; and\n(iii) how the applicant may dispute the decision.\n(4) If the relevant insurer fails to give the applicant a transfer notice or\nrejection notice within the 28 days, the relevant insurer—\n(a) is taken to have accepted liability for the defined benefits; and\n(b) is liable for the defined benefits; and\n(c) must give the applicant a defined benefits notice.\nNote 1 A decision by a relevant insurer to accept liability does not prevent the\ninsurer from making a later decision to reject the liability (see s 68).\nNote 2 For how documents may be given, see the Legislation Act, pt 19.5.\n(5) This section is subject to section 70 (Dispute about liability for\napplication).\n","sortOrder":62},{"sectionNumber":"66","sectionType":"section","heading":"Accepting liability—payment of defined benefits","content":"66 Accepting liability—payment of defined benefits\n(1) If a relevant insurer accepts liability for defined benefits, the insurer\nmust pay the applicant the defined benefits to which the applicant is\nentitled.\nNote If relevant insurer receives an application for death benefits, the insurer\nmust apply to the ACAT for an order for the payment of the death benefits\nto the dependants (see s 176).\n(2) The MAI guidelines may make provision in relation to the payment\nof defined benefits.\n\n","sortOrder":63},{"sectionNumber":"67","sectionType":"section","heading":"Rejecting liability","content":"67 Rejecting liability\n(1) If a relevant insurer gives an applicant a rejection notice, liability for\nthe application is taken to have been rejected on the day the relevant\ninsurer gives the notice to the applicant.\nNote For how documents may be given, see the Legislation Act, pt 19.5.\n(2) If the relevant insurer rejects liability for defined benefits for any of\nthe following reasons, the relevant insurer may recover as a debt from\nthe applicant any amounts paid to the applicant under this part:\n(a) the applicant was not entitled to defined benefits under either of\nthe following sections when the applicant applied for defined\nbenefits:\n(i) section 45 (No entitlement—multiple driving offences);\n(ii) section 48 (No entitlement—serious offences);\n(b) information in the application is false or misleading;\n(c) information the applicant gave a doctor or other health\npractitioner in relation to the applicant’s injury is false or\nmisleading;\n(d) information the applicant gave the police or a lawyer in relation\nto the motor accident is false or misleading.\n(3) This section is subject to section 69 (Transferring application to\nanother insurer).\n","sortOrder":64},{"sectionNumber":"68","sectionType":"section","heading":"Insurer may change decision about accepting or rejecting","content":"68 Insurer may change decision about accepting or rejecting\nliability\n(1) A decision by a relevant insurer to accept liability for defined benefits\ndoes not prevent the insurer from making a later decision to reject the\nliability.\nNote Section 65 (3) applies to a later decision to reject liability.\n\nTransfer of application to another insurer Division 2.3.5\n(2) However, if a relevant insurer later rejects liability, the insurer may\nonly recover amounts paid to the applicant under this part from a\nrelevant insurer who later accepts liability for the defined benefits.\n(3) A decision by a relevant insurer to reject liability for defined benefits\ndoes not prevent the insurer from making a later decision to accept\nthe liability.\nDivision 2.3.5 Transfer of application to another\n","sortOrder":65},{"sectionNumber":"69","sectionType":"section","heading":"Transferring application to another insurer","content":"69 Transferring application to another insurer\n(1) This section applies if the relevant insurer for a motor accident (the\nfirst insurer) intends to reject liability for defined benefits because\nanother insurer (the second insurer) appears to be liable for the\n(2) Before the first insurer gives the applicant a transfer notice under\nsection 65 (Relevant insurer must decide liability for defined\nbenefits), the first insurer must give the second insurer the applicant’s\napplication for defined benefits, and any information the applicant\ngave the first insurer in relation to the application.\n(3) The application is taken to have been given to the second insurer on\nthe date it was given to the first insurer.\n(4) If, after assessing the application, the second insurer decides to accept\nliability for the application, as soon as practicable, but not later than\n28 days after the date of the receipt notice given to the applicant by\nthe first insurer—\n(a) the first insurer must give the applicant the transfer notice; and\n(b) the second insurer must tell the applicant—\n(i) about the decision to accept liability for the application;\nand\n\nDivision 2.3.5 Transfer of application to another insurer\n(ii) that the applicant must give the second insurer an authority\nto disclose personal health information.\nNote Authority to disclose personal health information—\nsee s 54.\n(5) Liability for the application is taken to have been transferred to the\nsecond insurer when the applicant receives notification of the second\ninsurer’s decision under subsection (4).\n(6) The first insurer may recover the following amounts as a debt from\nthe second insurer:\n(a) any amounts of the applicant’s allowable expenses already paid;\n(b) the cost of managing the application.\n","sortOrder":66},{"sectionNumber":"70","sectionType":"section","heading":"Dispute about liability for application","content":"70 Dispute about liability for application\n(a) the relevant insurer for a motor accident (the first insurer)\nintends to reject liability for the application because another\ninsurer (the second insurer) appears to be the relevant insurer\nfor the motor accident; and\n(b) the second insurer disputes its liability for the application.\n(2) The first insurer—\n(a) must not give the applicant a transfer notice; and\n(b) must give the MAI commission written notice of the dispute.\n(3) If the first insurer gives the MAI commission a notice under\nsubsection (2) (b)—\n(a) section 65 (Relevant insurer must decide liability for defined\nbenefits) does not apply in relation to the application until the\ndispute is resolved; and\n\nMiscellaneous—pt 2.3 Division 2.3.6\n(b) the first insurer must notify the applicant—\n(i) about the dispute; and\n(ii) that the first insurer continues to be liable for the\napplicant’s allowable expenses; and\n(iii) that the first insurer is liable for the applicant’s treatment\nand care benefits, income replacement benefits and funeral\nbenefits in accordance with this chapter until the dispute is\nresolved.\n(4) The dispute must be dealt with in accordance with the insurance\nindustry deed.\n(5) If the second insurer is found to be liable for the application, the first\ninsurer may recover the following amounts as a debt from the second\ninsurer:\n(a) any amounts of the applicant’s allowable expenses already paid;\n(b) any defined benefits already paid;\n(c) the cost of managing and disputing the application.\n(6) If the second insurer is found to be liable for the application, the\nsecond insurer must not dispute a decision the first insurer made in\nrelation to any amounts paid to the applicant by the first insurer.\n","sortOrder":67},{"sectionNumber":"71","sectionType":"section","heading":"Fraudulent applications or requests","content":"71 Fraudulent applications or requests\nreceives—\n(a) an application for defined benefits from a person injured in the\n\n(b) a request for reimbursement of expenses for treatment and care\nfor an applicant that are incurred before the application is made\nor while the application is being considered; or\n(c) a request from a provider of treatment and care for payment of\ntreatment and care provided to an applicant.\n(2) If the relevant insurer reasonably suspects that information in the\napplication or request is false or misleading, the relevant insurer may\nrefuse to—\n(a) accept liability for the application; or\n(b) reimburse the applicant; or\n(c) pay the provider.\nNote 1 It is an offence to make a false or misleading statement, give false or\nNote 2 The insurer may recover from the applicant any costs reasonably incurred\nbecause of the applicant’s fraudulent conduct (see s 349).\n(3) However, if the relevant insurer later establishes that the information\nin the application or request is not false or misleading, the relevant\ninsurer must—\n(a) reimburse the applicant for the expenses incurred; or\n(b) pay the provider for the treatment and care.\n(4) Despite subsection (2), if the relevant insurer has not made a decision\nto accept or reject liability for the application, the relevant insurer\nmust pay the applicant’s allowable expenses.\n","sortOrder":68},{"sectionNumber":"72","sectionType":"section","heading":"Recovery of amounts paid for defined benefits","content":"72 Recovery of amounts paid for defined benefits\n(a) the relevant insurer for a motor accident pays an amount under\nthis part to an applicant for defined benefits; and\n\nMiscellaneous—pt 2.3 Division 2.3.6\n(b) the insurer was not liable for the amount.\n(2) The relevant insurer may recover as a debt from the applicant any\namount for which the relevant insurer was not liable under this part.\n(3) If the relevant insurer rejects an application for defined benefits\nbecause the applicant’s injury was not a result of the motor accident,\nthe relevant insurer is not entitled to recover as a debt any amount\npaid to the applicant before the application was rejected unless the\napplication was fraudulent or included information that was false or\nmisleading.\n","sortOrder":69},{"sectionNumber":"73","sectionType":"section","heading":"Application for defined benefits—notification of claim","content":"73 Application for defined benefits—notification of claim\n(a) an application for defined benefits (the defined benefits\napplication) is made under this part—\n(i) by a person injured in a motor accident; or\n(ii) in relation to the injured person; and\n(b) a claim for compensation under a workers compensation scheme\n(the workers compensation claim) is made in relation to the\ninjury.\nNote There is no requirement for both an application for defined benefits and\na claim for workers compensation to be made in relation to a motor\n(2) The claimant for the workers compensation claim must give the\nrelevant insurer written notice about the following:\n(a) that the workers compensation claim has been made;\n(b) whether liability for the workers compensation claim has been\naccepted or rejected;\n(c) any amounts paid to or on behalf of the claimant under the\nworkers compensation claim.\n\n(3) The notice must be given to the relevant insurer—\n(a) if the workers compensation claim is made before the defined\nbenefits application—when the defined benefits application is\nmade; or\n(b) if the workers compensation claim is made after the defined\nbenefits application—within 3 business days after the workers\ncompensation claim is made.\n(4) However, if the person withdraws the workers compensation claim\nwithin 13 weeks after the date of the motor accident, the person must\ngive the relevant insurer for the motor accident written notice of the\nwithdrawal—\n(a) if the workers compensation claim is withdrawn before the\ndefined benefits application is made—when the defined benefits\napplication is made; or\n(b) if the workers compensation claim is withdrawn after the\ndefined benefits application is made—within 3 business days\nafter the workers compensation claim is withdrawn.\n(5) If a relevant insurer receives a notice under subsection (2) or (4), the\nrelevant insurer may get information about the workers compensation\nclaim from the insurer for the workers compensation claim.\nNote A person’s entitlement to certain defined benefits ends on the day a\nworkers compensation claim is accepted, however may be revived if the\nperson’s workers compensation claim is withdrawn within 13 weeks after\nthe date of the motor accident or if the claim is rejected (see s 50 (3)).\n\nPart 2.4 Defined benefits—income\nreplacement benefits\nDivision 2.4.1 Income replacement benefits—\nimportant concepts\n74 Definitions—pt 2.4\nfitness for work certificate—see section 104.\nself-employed—a person is self-employed if the person derives\nincome from providing labour, skills or knowledge to a business\ncarried on by the person.\nunpaid leave, from paid work, includes—\n(a) unpaid parental leave; and\n(b) unpaid leave for more than 52 weeks.\n","sortOrder":70},{"sectionNumber":"75","sectionType":"section","heading":"Meaning of income replacement benefit payment—pt 2.4","content":"75 Meaning of income replacement benefit payment—pt 2.4\nincome replacement benefit payment, for an injured person, means\nincome replacement benefits payable under the following:\n(a) section 96 (Amount of income replacement benefits—first\npayment period);\n(b) section 97 (Amount of income replacement benefits—second\npayment period).\n\n","sortOrder":71},{"sectionNumber":"76","sectionType":"section","heading":"Meaning of gross income—pt 2.4","content":"76 Meaning of gross income—pt 2.4\nFor this part, gross income, of an injured person who is an\nemployee—\n(a) includes the following:\n(i) any amount paid to the injured person as wages, bonuses,\ncommissions or allowances;\n(ii) any amount paid to the injured person as overtime;\n(iii) any amount paid to the injured person as penalty payments\nfor shift work;\n(iv) any amount paid to the injured person if the person was on\npaid leave;\n(v) any amount otherwise payable to the injured person under\na voluntary salary sacrifice arrangement;\n(vi) any amount paid for loss of income under a workers\ncompensation scheme; but\n(b) does not include the following:\n(i) any contribution paid or payable on behalf of the person by\nthe person’s employer to a superannuation scheme for the\nbenefit of the person;\n(ii) any redundancy or voluntary early retirement payment\nreceived by the person from the person’s employer;\n(iii) any amount paid for unused leave on termination of\nemployment;\n(iv) any other amount paid as a lump sum as a consequence of\ntermination of employment;\n(v) any allowance or benefit prescribed by regulation received\nby the person from the person’s employer.\n\n","sortOrder":72},{"sectionNumber":"77","sectionType":"section","heading":"Meaning of net income—pt 2.4","content":"77 Meaning of net income—pt 2.4\nnet income, of an injured person who is self-employed, means the net\nincome the person derives, or will derive, from carrying on a business,\nto the extent that the income is attributable to labour, skills or\nknowledge the person provides, or will provide, to the business.\n","sortOrder":73},{"sectionNumber":"78","sectionType":"section","heading":"Meaning of paid work—pt 2.4","content":"78 Meaning of paid work—pt 2.4\n(1) For this part, a person is in paid work if the person is engaged in any\nwork for remuneration or other financial benefit—\n(a) whether as an employee, a self-employed individual or\notherwise; and\n(b) whether the person was in full-time or part-time work; and\n(c) whether or not the person was on paid leave.\nNote The injured person’s pre-injury weekly income is worked out under s 81,\ns 82, s 83 or s 84.\n(2) The MAI guidelines may make provision for what is, or is not, taken\nto be paid work.\n","sortOrder":74},{"sectionNumber":"79","sectionType":"section","heading":"Meaning of capable of being in paid work—pt 2.4","content":"79 Meaning of capable of being in paid work—pt 2.4\n(1) For this part, a person injured in a motor accident is capable of being\nin paid work if, on the date of the motor accident—\n(a) the person—\n(i) is not in paid work; but\n(ii) had been in paid work for at least 260 hours in the 52 weeks\nimmediately before the date of the motor accident; or\nNote The injured person’s pre-injury weekly income is worked out\nunder s 83.\n\n(b) the person is receiving a weekly payment or other payment in\nrelation to loss of income under this Act or the Workers\nCompensation Act 1951 (or a corresponding law of a State or\nanother Territory); or\nNote The person’s pre-injury weekly income is worked out under s 84.\n(c) the person—\n(i) was on unpaid leave from paid work immediately before\nthe date of the motor accident; and\n(ii) anticipated returning to paid work on a date after the motor\nNote The person’s pre-injury earning capacity is worked out under s 85.\n(d) the person has entered into an arrangement with an employer or\nother person to undertake employment or to start business as a\nself-employed person on the date of the motor accident or a\nstated date after the date of the motor accident; or\nNote The person’s pre-injury earning capacity is worked out under s 86.\n(e) the person—\n(i) is at least 15 years old; and\n(ii) is enrolled in a course of studies as a full-time student; and\n(iii) expects to be in paid work after completing—\n(A) the course; or\n(B) if the person was in secondary school—the final year\nof secondary school.\nNote The person’s pre-injury earning capacity is worked out under s 87.\n(2) The MAI guidelines may make provision in relation to the matters to\nbe taken into account for determining whether an injured person is\ncapable, or not capable, of being in paid work.\n\n","sortOrder":75},{"sectionNumber":"80","sectionType":"section","heading":"Meaning of pre-injury income","content":"80 Meaning of pre-injury income\npre-injury income, for an injured person, means the person’s\npre-injury weekly income or pre-injury earning capacity.\n","sortOrder":76},{"sectionNumber":"81","sectionType":"section","heading":"Meaning of pre-injury weekly income—ongoing employee","content":"81 Meaning of pre-injury weekly income—ongoing employee\nor fixed term contractor\npre-injury weekly income, for an ongoing employee or fixed term\ncontractor, means—\n(a) the average weekly amount of the sum of the following amounts\nfrom all paid work undertaken by the person in the 52 weeks\nimmediately before the date of the motor accident:\n(ii) the person’s net income as a self-employed person; or\n(b) if the person had a recent change in employment\ncircumstances—the average weekly amount of the person’s\ngross income for the period—\n(i) starting on the date of the change; and\n(ii) ending on the day before the date of the motor accident.\neligible fixed term contractor means a fixed term contractor who, at\nthe time of the motor accident, had at least 26 weeks remaining on\ntheir contract.\nongoing employee or fixed term contractor means a person injured\nin a motor accident who was, on the date of the motor accident\nengaged in ongoing employment or under a fixed term contract.\n\nrecent change in employment circumstances, for an ongoing\nemployee or eligible fixed term contractor, means a change that—\n(a) happened during the 52 weeks immediately before the date of\nthe motor accident; and\n(b) was a significant change in the person’s employment\ncircumstances that resulted in the person regularly earning, or\nbecoming entitled to earn, more on a weekly basis.\nExamples—significant change\n1 the person started work with a new employer\n2 the person returned to work following unpaid leave of at least 8 weeks\n3 the person increased their normal number of hours of work\n4 the person received an increase in income based on the person’s work\nperformance\n","sortOrder":77},{"sectionNumber":"82","sectionType":"section","heading":"Meaning of pre-injury weekly income—self-employed","content":"82 Meaning of pre-injury weekly income—self-employed\npre-injury weekly income, for a self-employed person, means the\naverage weekly amount of the sum of the following amounts from all\npaid work undertaken by the person in the 52 weeks immediately\nbefore the date of the motor accident:\n(a) the person’s gross income as an employee;\n(b) the person’s net income as a self-employed person.\n(2) If, as a result of the injured person’s injury, the injured person engages\nsomeone (a hiree) to perform the injured person’s work, the amount\npaid to the hiree may be taken into account for working out the\nperson’s pre-injury weekly income.\nself-employed person means a person injured in a motor accident who\nwas, on the date of the motor accident, self-employed.\n\n","sortOrder":78},{"sectionNumber":"83","sectionType":"section","heading":"Meaning of pre-injury weekly income—casual worker","content":"83 Meaning of pre-injury weekly income—casual worker\npre-injury weekly income, for a casual worker, means the higher of\n(a) the average weekly amount of the sum of the following amounts\nfrom all paid work undertaken by the person in the 52 weeks\nimmediately before the date of the motor accident:\n(ii) the person’s net income as a self-employed person;\n(b) if the person worked the 260 hours in the 13 weeks immediately\nbefore the date of the motor accident or is unable to give\nevidence of the person’s income in the 52 weeks immediately\nbefore the date of the motor accident—the average weekly\namount of the sum of the following amounts from all paid work\nundertaken by the person in the 13 weeks:\n(ii) the person’s net income as a self-employed person.\ncasual worker means a person injured in a motor accident who—\n(a) was not, on the date of the motor accident—\n(i) an ongoing employee or fixed term contractor; or\n(ii) a self-employed person; but\n(b) was in paid work for at least 260 hours in the 52 weeks\nimmediately before the date of the motor accident.\n\n","sortOrder":79},{"sectionNumber":"84","sectionType":"section","heading":"Meaning of pre-injury weekly income—person receiving","content":"84 Meaning of pre-injury weekly income—person receiving\nworkers compensation\npre-injury weekly income, for a person receiving workers\ncompensation, means the average weekly amount of the sum of the\nfollowing amounts from all paid work undertaken by the person in\nthe 52 weeks immediately before the date of the motor accident:\n(a) the person’s gross income as an employee;\n(b) the person’s net income as a self-employed person.\nNote The MAI guidelines may make provision in relation to the matters to be\ntaken into account to determine an injured person’s pre-injury weekly\nincome or pre-injury earning capacity (see s 88).\nperson receiving workers compensation means a person injured in a\nmotor accident who was, on the date of the motor accident, receiving\na weekly payment or other payment in relation to loss of income\nunder a workers compensation scheme.\n","sortOrder":80},{"sectionNumber":"85","sectionType":"section","heading":"Meaning of pre-injury earning capacity—person on","content":"85 Meaning of pre-injury earning capacity—person on\nunpaid leave\npre-injury earning capacity, for a person on unpaid leave, means the\naverage weekly amount of the person’s gross income from paid\nwork—\n(a) in the 52 weeks immediately before the person started the\nunpaid leave; or\n(b) if the person had a significant change in circumstances in\nrelation to their paid work in the 52 weeks immediately before\nthe person started the unpaid leave—for the period—\n(i) starting on the date the significant change happened; and\n\n(ii) ending on the day before the person started the unpaid\nleave.\nExamples—significant change\n1 the person started work with a new employer\n2 the person returned to work following unpaid leave of at least 8 weeks\n3 the person increased their normal number of hours of work\n4 the person received an increase in income based on the person’s work\nperformance\nperson on unpaid leave means a person injured in a motor accident\nwho—\n(a) was on unpaid leave from paid work on the date of the motor\n(b) anticipated returning to paid work on a date after the motor\n","sortOrder":81},{"sectionNumber":"86","sectionType":"section","heading":"Meaning of pre-injury earning capacity—person with new","content":"86 Meaning of pre-injury earning capacity—person with new\nwork arrangement\npre-injury earning capacity, for a person with a new work\narrangement, means the weekly amount of the following agreed to be\npaid to the injured person under the arrangement:\n(a) if the person will be an employee under the arrangement—the\nperson’s gross income as an employee;\n(b) if the person will be self-employed under the arrangement—the\nperson’s net income as a self-employed person.\n\nperson with a new work arrangement means a person injured in a\nmotor accident who, on the date of the motor accident—\n(a) has an arrangement—\n(i) with an employer or other person to undertake\nemployment; or\n(ii) to start business as a self-employed person on or after the\ndate of the motor accident; but\n(b) is not any of the following:\n(i) an ongoing employee mentioned in section 81;\n(ii) a self-employed person mentioned in section 82;\n(iii) a casual worker mentioned in section 83;\n(iv) an apprentice, trainee or young person mentioned in\nsection 99;\n(v) a person mentioned in section 84 receiving workers\ncompensation;\n(vi) a person mentioned section 85 on unpaid leave;\n(vii) a full-time student mentioned in section 87.\n","sortOrder":82},{"sectionNumber":"87","sectionType":"section","heading":"Meaning of pre-injury earning capacity—full-time student","content":"87 Meaning of pre-injury earning capacity—full-time student\npre-injury earning capacity, for a full-time student, means the\nweekly amount the student would have received if—\n(a) the student had been employed in the occupation for which the\nstudent would be qualified on completion of the course of\nstudies in which the student is a full-time student; or\n\nIncome replacement benefits—entitlement Division 2.4.2\n(b) if the person is a full-time student at a secondary school—the\nstudent had been employed on successfully completing the\nfinal year of secondary school.\nfull-time student means a person injured in a motor accident who, on\nthe date of the motor accident—\n(a) was at least 15 years old; and\n(b) was enrolled in a course of studies as a full-time student; and\n(c) expected to be in paid work after completing—\n(i) the course; or\n(ii) if the person was in secondary school—the final year of\nsecondary school.\n","sortOrder":83},{"sectionNumber":"88","sectionType":"section","heading":"Pre-injury weekly income and pre-injury earning","content":"88 Pre-injury weekly income and pre-injury earning\ncapacity—MAI guidelines\nThe MAI guidelines may make provision in relation to the matters to\nbe taken into account to determine an injured person’s pre-injury\nweekly income or pre-injury earning capacity.\nDivision 2.4.2 Income replacement benefits—\n","sortOrder":84},{"sectionNumber":"89","sectionType":"section","heading":"Who is entitled to income replacement benefits?","content":"89 Who is entitled to income replacement benefits?\n(1) A person injured in a motor accident is entitled to income replacement\nbenefits if, on the date of the motor accident—\n(a) the person was at least 15 years old; and\n(b) the person was—\n(i) in paid work; or\n\nDivision 2.4.2 Income replacement benefits—entitlement\n(ii) capable of being in paid work.\nNote 1 Paid work includes paid leave from paid work—see s 78.\nNote 2 An injured person who is self-employed when the motor accident\nhappened is in paid work—see s 78.\n(2) The MAI guidelines may make provision in relation to entitlement to\nincome replacement benefits.\n(3) This section is subject to the following:\n(a) division 2.2.2 (Limitations and exceptions to entitlement);\n(b) section 90 (Limited entitlement to income replacement\nbenefits—pension-aged injured person);\n(c) section 91 (No entitlement to income replacement benefits—\ndeath of injured person);\n(d) section 92 (No entitlement to income replacement benefits—\ndamages already paid).\n","sortOrder":85},{"sectionNumber":"90","sectionType":"section","heading":"Limited entitlement to income replacement benefits—","content":"90 Limited entitlement to income replacement benefits—\npension-aged injured person\n(1) This section applies to a person injured in a motor accident if, on the\ndate of the accident, the person was the pension age, or older.\n(2) The injured person is entitled to income replacement benefits only if,\non the date of the motor accident, the person was in paid work.\nNote 1 See s 101 for the period for which income replacement benefits are\npayable for the injured person.\nNote 2 Pension age—see the dictionary.\n\n","sortOrder":86},{"sectionNumber":"91","sectionType":"section","heading":"No entitlement to income replacement benefits—death of","content":"91 No entitlement to income replacement benefits—death of\nreplacement benefits if the person is dead.\n(2) However, subsection (1) does not affect an entitlement to income\nreplacement benefits that accrued before the injured person’s death.\n","sortOrder":87},{"sectionNumber":"92","sectionType":"section","heading":"No entitlement to income replacement benefits—","content":"92 No entitlement to income replacement benefits—\ndamages already paid\nA person injured in a motor accident is not entitled to income\nreplacement benefits if an insurer has already paid damages for the\nloss of income under a motor accident claim for the motor accident.\nDivision 2.4.3 Income replacement benefits—\npayments\n","sortOrder":88},{"sectionNumber":"93","sectionType":"section","heading":"Definitions—div 2.4.3","content":"93 Definitions—div 2.4.3\nfirst payment period means the period of 13 weeks beginning on the\ndate of the motor accident.\npost-injury earning capacity, of an injured person, means the weekly\namount the person has the capacity to earn in paid work for which the\nperson is reasonably suited because of the person’s education,\ntraining and experience, based on the person’s fitness for work in that\npaid work as decided by the relevant insurer under section 100 (1)\n(Injured person’s post-injury earning capacity).\nsecond payment period means the period—\n(a) beginning on the day after the end of the first payment period;\nand\n(b) ending 5 years after the date of the motor accident.\n\n","sortOrder":89},{"sectionNumber":"94","sectionType":"section","heading":"Meaning of AWE adjusted—div 2.4.3","content":"94 Meaning of AWE adjusted—div 2.4.3\n(1) In this division:\nAWE adjusted, for an injured person’s pre-injury income, means the\nperson’s income as adjusted in line with any adjustment in the\nAWE—\n(a) after the date of the motor accident in which the person sustained\nthe personal injury; and\n(b) on a day (an adjustment day) prescribed by regulation for the\npre-injury income; and\n(c) rounded up to the nearest dollar.\n(2) However, if an amount to be AWE adjusted would, if adjusted in line\nwith the adjustment (the negative adjustment) to the AWE, become\nsmaller, the amount is not reduced in line with the negative\n(3) An amount that, in accordance with subsection (2), is not reduced\nmay be increased in line with an adjustment in the AWE that would\nincrease the amount only to the extent that the increase, or part of the\nincrease, is not one that would cancel out the effect of the negative\n(4) Subsection (3) does not apply to a negative adjustment once the effect\nof the negative adjustment has been offset against an increase in line\nwith an adjustment in the AWE.\nExample—adjustments\nOn 30 September 2020, Penny has pre-injury income of $1 500 per week. Penny’s\nentitlement to income replacement benefits started on 15 June 2020.\nThe adjustment days prescribed for pre-injury income are 1 April and 1 October.\nThe AWE last published before 1 October 2020 (for May 2020) is $1 884.30. The\nAWE published for November 2019 (being 6 months before May 2020) is\n$1 856.80.\nThe AWE adjustment factor for Penny’s pre-injury income is calculated as follows:\n$1 884.30 ÷ $1 856.0 = 1.015 (rounded to 3 decimal places).\n\nThe amount of Penny’s pre-injury income on the 1 October 2020 adjustment date\nis calculated as follows:\n$1 500 × 1.015 = $1 522.50.\nPenny’s benefit from the adjustment date of 1 October 2020 is $1 522.50, rounded\nto $1 523.\n","sortOrder":90},{"sectionNumber":"95","sectionType":"section","heading":"Adjustment of pre-injury income","content":"95 Adjustment of pre-injury income\n(1) The MAI commission must, on or before each adjustment day for\npre-injury income, declare—\n(a) the AWE adjustment factor for the pre-injury income; and\n(b) that the AWE adjustment factor applies on the adjustment day.\n(2) A declaration under subsection (1) is a notifiable instrument.\nadjustment day—see section 94 (1) (b).\nAWE adjustment factor, for an amount, means the factor worked out\nfor the amount in the way prescribed by regulation.\n","sortOrder":91},{"sectionNumber":"96","sectionType":"section","heading":"Amount of income replacement benefits—first payment","content":"96 Amount of income replacement benefits—first payment\n(1) An injured person entitled to income replacement benefits is entitled\nto the amount each week worked out as follows for the first payment\nperiod:\n(P − A) × N\nA means the amount of the injured person’s post-injury earning\ncapacity.\nN means—\n(a) if P is $100 AWE indexed or less—1.0; or\n(b) if P is more than $100 AWE indexed but less than $800\nAWE indexed—1.0 + SG/100 ; or\n\n(c) if P is $800 AWE indexed or more—0.95.\nExample—working out N, par (b)\nKristin is injured in a motor accident on 1 March 2021. Because of her\ninjuries, Kristin is unable to return to her part-time job as a teacher’s assistant\nat Lyneham Primary School for 8 weeks following the accident. Kristin does\nnot perform any other paid work during the 8 weeks.\nKristin gives the relevant insurer for the motor accident a letter from her\nemployer stating that Kristin’s annual salary at the time of the motor accident\nwas $36 500 and that Kristin had been a part-time employee at Lyneham\nPrimary School for 18 months before the accident.\nThe relevant insurer for the motor accident calculates Kristin’s gross income\nfor the 52 weeks before the accident as follows:\n$36 500 x 364\nKristin’s gross income for the 52 weeks before the motor accident is $36 400\nand her pre-injury income is $700.\nKristin also gives the relevant insurer a copy of the last payslip she received\nfrom her employer before the motor accident, which shows that employer\ncontributions were payable to her chosen superannuation fund for the\n52 weeks before the motor accident. The superannuation charge number for\nthe 2020-21 year is 9.5%.\nIn working out the amount of income replacement benefits Kristin is entitled\nto each week, N is calculated as follows:\nN = 1 + 9.5\nN is therefore 1.095. Using the formula set out in subsection (1), the amount\nof income replacement benefits payable to Kristen for each week during the\nfirst payment period after the motor accident that Kristin is entitled to income\nreplacement benefits is calculated as follows:\n$700 x 1.095 = $766.50\n\nP means—\n(a) if the injured person’s pre-injury income AWE adjusted is\n$2 250 AWE indexed or less—the amount of the injured\nperson’s pre-injury income AWE adjusted; or\n(b) if the injured person’s pre-injury income AWE adjusted is more\nthan $2 250 AWE indexed—$2 250 AWE indexed.\nSG, for the factor N, paragraph (b), means—\n(a) if superannuation contributions were paid or payable to a\nsuperannuation scheme on behalf of the injured person by an\nemployer of the injured person during the 52 weeks before the\nmotor accident—the superannuation guarantee charge number\nset out in the Superannuation Guarantee (Administration)\nAct 1992 (Cwlth), section 19 (2) for the year in which the\ncontributions were paid or payable; or\n(b) if no superannuation contributions were paid or payable to a\nsuperannuation scheme on behalf of the injured person by an\nemployer of the injured person during the 52 weeks before the\nmotor accident—0.\n","sortOrder":92},{"sectionNumber":"97","sectionType":"section","heading":"Amount of income replacement benefits—second","content":"97 Amount of income replacement benefits—second\npayment period\n(1) An injured person entitled to income replacement benefits is entitled\nto the amount each week worked out as follows for the second\npayment period:\n(P − A) × N\nA means the amount of the injured person’s post-injury earning\ncapacity.\n\nN means—\n(a) if P is $100 AWE indexed or less—1.0; or\n(b) if P is more than $100 AWE indexed but less than $800\nAWE indexed—1.0 + SG/100; or\n(c) if P is at least $800 AWE indexed and not more than $1 000\nAWE indexed—0.95; or\n(d) if P is more than $1 000 AWE indexed—0.8.\nP means—\n(a) if the injured person’s pre-injury income AWE adjusted is\n$2 250 AWE indexed or less—the amount of the injured\nperson’s pre-injury income AWE adjusted; or\n(b) if the injured person’s pre-injury income AWE adjusted is more\nthan $2 250 AWE indexed—$2 250 AWE indexed.\nSG, for the factor N, paragraph (b)—see section 96 (2).\n","sortOrder":93},{"sectionNumber":"98","sectionType":"section","heading":"Amount of income replacement benefits—injured person","content":"98 Amount of income replacement benefits—injured person\nreceiving workers compensation\n(1) This section applies if an injured person receives a weekly payment\nor other payment in relation to loss of income under a workers\ncompensation scheme (a workers compensation payment) for any\nperiod to which the person is entitled to income replacement benefits.\n(2) For each week that the injured person receives the workers\ncompensation payment, the amount of the income replacement\nbenefit payment to which the person is entitled for that week is\nreduced by the amount of the workers compensation payment.\n\n","sortOrder":94},{"sectionNumber":"99","sectionType":"section","heading":"Payment of increments—apprentice, trainee or young","content":"99 Payment of increments—apprentice, trainee or young\n(1) This section applies if a person injured in a motor accident is, on the\ndate of the motor accident—\n(a) at least 15 years old but less than 21 years old; and\n(b) one of the following circumstances applies to the person:\n(i) the person is an apprentice;\n(ii) the person is employed under a contract of service for\nwhich the person is required to undergo training,\ninstruction or examination for the purpose of becoming\nqualified in the occupation to which the contract relates;\n(iii) under the person’s conditions of employment, the person’s\npre-injury weekly income would have increased if the\nperson had continued in that employment because the\n(A) attained a particular age; or\n(B) completed a particular period of service or course of\ntraining.\n(2) For any week after the date of the motor accident in relation to which\nthe person is entitled to an income replacement benefit payment, the\npayment must be calculated on the basis that the person’s pre-injury\nweekly income is the weekly income the person is likely to have been\nentitled to for that week.\n(3) The MAI guidelines may make provision in relation to the matters to\nbe taken into account for determining the weekly income the person\nis likely to have been entitled to had the motor accident not happened\nand had the person continued in the employment.\n\nconditions of employment, for an injured person, includes conditions\napplying to the person’s employment under an award or industrial\nagreement.\n","sortOrder":95},{"sectionNumber":"100","sectionType":"section","heading":"Injured person’s post-injury earning capacity","content":"100 Injured person’s post-injury earning capacity\n(1) The relevant insurer for a motor accident may make a decision about\nan injured person’s post-injury earning capacity, including for the\npurpose of assessing the person’s fitness for work as a result of the\nperson’s injury.\n(2) An injured person’s fitness for work must be determined having\nregard to the following:\n(a) the nature of the person’s injury and the likely process of\nrecovery;\n(b) treatment and care needs, including the likelihood that treatment\nand care will enhance earning capacity and any temporary\nincapacity that may result from treatment and care;\n(c) any income the person receives from engaging in employment\nafter the motor accident;\n(d) any fitness for work certificates the person provides.\n(3) The MAI guidelines may make provision for the matters to be taken\ninto account by a relevant insurer and the procedures for determining\nan injured person’s post-injury earning capacity.\n","sortOrder":96},{"sectionNumber":"101","sectionType":"section","heading":"Income replacement benefits—period payable","content":"101 Income replacement benefits—period payable\n(a) a relevant insurer accepts liability under section 65 (Relevant\ninsurer must decide liability for defined benefits) for an\napplication for defined benefits for a person injured in a motor\n\n(b) the injured person is entitled to income replacement benefits.\n(2) The period for which income replacement benefits are payable—\n(a) starts on the start date for the injured person; and\n(b) ends—\n(i) if a person to whom section 90 (Limited entitlement to\nincome replacement benefits—pension-aged injured\nperson) applies is in paid work on the date of the motor\naccident—2 years after the date of the motor accident; or\n(ii) in any other case—\n(A) 2 years after the person reaches the pension age; or\n(B) 5 years after the date of the motor accident.\nNote Pension age—see the dictionary.\n(3) The start date for an ongoing employee or fixed term contractor,\nself-employed person, casual worker or person receiving workers\ncompensation is—\nof the motor accident; or\n(i) 28 days before the date of the late application; or\nthe date of the motor accident.\n(4) The start date for a person on unpaid leave is—\nthe person anticipated returning to paid work; or\n\n(i) the later of the following:\n(A) the date the person anticipated returning to paid work;\n(B) 28 days before the date of the late application; or\nthe date the person anticipated returning to paid work.\n(5) The start date for a person with a new work arrangement or a\nfull-time student is—\nthe person anticipated starting work with an employer or starting\nbusiness as a self-employed person; or\n(i) the later of the following:\n(A) the date the person anticipated starting work with an\nemployer or starting business as a self-employed\nperson;\n(B) 28 days before the date of the late application; or\nthe date the person anticipated starting work with an\nemployer or starting business as a self-employed person.\n(6) The MAI guidelines may make provision for the kinds of\ncircumstances that may be exceptional circumstances for\nsubsections (3) to (5).\n\ncasual worker—see section 83 (2).\nfull-time student—see section 87 (2).\nongoing employee or fixed term contractor—see section 81 (2).\nperson on unpaid leave—see section 85 (2).\nperson receiving workers compensation—see section 84 (2).\nperson with a new work arrangement—see section 86 (2).\nself-employed person—see section 82 (3).\n","sortOrder":97},{"sectionNumber":"102","sectionType":"section","heading":"Income replacement benefits—payable fortnightly","content":"102 Income replacement benefits—payable fortnightly\n(1) Income replacement benefit payments are payable to an injured\nperson every 14 days after the start date for the injured person.\nstart date, for an injured person, means the start date for the person\nworked out under section 101.\n","sortOrder":98},{"sectionNumber":"103","sectionType":"section","heading":"Income replacement benefits—interim weekly payments","content":"103 Income replacement benefits—interim weekly payments\n(a) a person injured in a motor accident is entitled to be paid income\nreplacement benefits; and\n(b) the relevant insurer for the motor accident has asked the injured\nperson for additional information to decide the amount of the\nincome replacement benefit payment to which the person is\nentitled.\n\n(2) The relevant insurer may pay the injured person an amount\n(an interim weekly payment) until whichever of the following\nhappens first:\n(a) the person gives the insurer the additional information;\n(b) 28 days after the day the insurer asks for the additional\ninformation;\n(c) 13 weeks after the date of the motor accident.\n(3) The amount of the interim weekly payment is the percentage of\n$2 250 AWE indexed prescribed by regulation.\n(4) On request by the injured person, the relevant insurer may, but need\nnot, pay the person a lower interim weekly payment.\n(5) An interim weekly payment is payable every 14 days after the start\ndate for the injured person.\n(6) The MAI guidelines may make provision in relation to interim\nweekly payments.\nstart date, for an injured person, means the start date for the injured\nperson worked out under section 101.\n\nDivision 2.4.4 Income replacement benefits—injured\nperson’s obligations\n","sortOrder":99},{"sectionNumber":"104","sectionType":"section","heading":"Requirement for evidence in relation to fitness for work","content":"104 Requirement for evidence in relation to fitness for work\netc\n(1) An injured person receiving income replacement benefit payments\nmust give the relevant insurer for the motor accident the following\ninformation in relation to the period for which the person is receiving\nthe payments:\n(a) a certificate in relation the person’s fitness for work (a fitness\nfor work certificate) for the stated period;\n(b) if the person has previously given the insurer a fitness for work\ncertificate—a declaration signed by or on behalf of the person\nabout whether the person has undertaken any paid work since\ngiving the insurer the previous fitness for work certificate\n(a work declaration).\nNote 1 For how documents may be given, see the Legislation Act, pt 19.5.\nNote 2 It is an offence to make a false or misleading statement, give false or\n(2) A fitness for work certificate has no effect to the extent that it applies\nto a period more than 13 weeks before the date of the certificate.\n(3) The MAI guidelines may make provision in relation to the following:\n(a) the form and contents of fitness for work certificates and work\ndeclarations;\n(b) who is to give a fitness for work certificate;\n(c) the period to which a fitness for work certificate may apply;\n\nDivision 2.4.4 Income replacement benefits—injured person’s obligations\n(d) when a fitness for work certificate or work declaration must be\ngiven;\n(e) the consequences of failing to give an insurer a fitness for work\ncertificate or work declaration.\n","sortOrder":100},{"sectionNumber":"105","sectionType":"section","heading":"Suspension of benefit payments—failure to comply with","content":"105 Suspension of benefit payments—failure to comply with\nrequest for assessment\n(1) This section applies if the relevant insurer for a motor accident makes\na reasonable request that an injured person undergo a medical or other\nexamination to assess the person’s fitness for work.\n(2) If the injured person fails without reasonable excuse to comply with\nthe request, the relevant insurer may suspend the injured person’s\nbenefit payments for the period that the failure to comply continues.\nNote An injured person’s entitlement to income replacement benefits may also\nbe suspended if the person fails to undergo treatment and care stated in\nthe person’s recovery plan (see s 124).\n(3) If the relevant insurer decides to suspend the injured person’s benefit\npayments, the insurer must give the injured person written notice\n(a suspension notice) stating—\n(b) the actions the injured person may take to avoid the benefit\n(4) A suspension notice must be given at least 2 weeks before the date\nthe suspension takes effect.\n\n(5) The MAI guidelines may make provision in relation to the following:\n(a) the conduct of medical and other examinations under this\nsection;\n(b) the information a health practitioner may ask a person injured in\na motor accident for in relation to a medical or other examination\nof the person by the health practitioner under this section;\n(c) the information a health practitioner may ask the relevant insurer\nfor a motor accident in relation to a medical or other examination\nof a person injured in the motor accident by the health\npractitioner under this section;\n(d) the circumstances in which the relevant insurer for a motor\naccident may ask for a medical or other examination of a person\ninjured in the motor accident under this section.\n","sortOrder":101},{"sectionNumber":"106","sectionType":"section","heading":"Offence—failure to notify changed circumstances","content":"106 Offence—failure to notify changed circumstances\n(a) an injured person receives income replacement benefits from an\n(b) the insurer tells the person they must notify the insurer about any\nchange in circumstances within the prescribed period after the\nchange happens.\n(2) The injured person commits an offence if—\n(a) the person has a change in circumstances; and\n(b) the person fails to notify the insurer about the change in\ncircumstances within the prescribed period after the change\nhappens.\n\nDivision 2.4.4 Income replacement benefits—injured person’s obligations\n(3) A regulation may prescribe how notice under subsection (2) (b) must\nbe given.\nchange in circumstances—a person receiving income replacement\nbenefits has a change in circumstances if—\n(a) the person returns to or starts paid work; or\n(b) if the person is in paid work—the amount of income the person\nreceives for the work changes.\nprescribed period means—\n(a) 10 business days; or\n(b) if a regulation prescribes a different period—the different\n","sortOrder":102},{"sectionNumber":"107","sectionType":"section","heading":"Notice required to reduce or stop income replacement","content":"107 Notice required to reduce or stop income replacement\nbenefit payments\n(a) a person injured in a motor accident has been receiving income\nreplacement benefit payments from an insurer for at least\n4 weeks; and\n(b) the insurer decides to reduce or stop paying the payments\nbecause the person is no longer entitled to the payments or the\namount of the payments.\n(2) This section does not apply in the following circumstances:\n(a) the insurer reduces or stops the income replacement benefit\npayments because the injured person returns to work or has a\nchange in the amount of income the person receives from paid\nwork;\n\n(b) the income replacement benefit payments have been suspended\nunder—\n(i) section 105 (Suspension of benefit payments—failure to\ncomply with request for assessment); or\n(ii) section 121 (3) (Assessment of injured person’s injuries);\nor\n(iii) section 124A (Recovery plan—suspension of benefits);\n(c) the injured person’s most recent fitness for work certificate\nexpires.\n(3) The insurer must give the injured person written notice, stating—\n(a) the reasons for the decision; and\n(b) the date the decision takes effect (being at least 2 weeks after the\nnotice is given to the person); and\n(c) that the injured person may seek internal review of the decision\nunder part 2.10 (Defined benefits—dispute resolution).\n(4) A notice under subsection (3) must be given at least 2 weeks before\nthe insurer reduces or stops the injured person’s income replacement\nbenefit payments.\n(5) If the insurer fails to give the injured person written notice of a\ndecision to which this section applies in the way required by this\nsection, the person may recover from the insurer the amount of any\nincome replacement benefit payments not received as a result of the\ninsurer’s decision.\n\nDivision 2.4.5 Income replacement benefits—miscellaneous\nDivision 2.4.5 Income replacement benefits—\n108 Income replacement benefits not commutable to lump\nsum\n(1) The relevant insurer for a motor accident must not commute income\nreplacement benefits to which an injured person is, or may be, entitled\nto a lump sum payment.\n(2) This section is subject to section 184 (Lump sum payment of certain\ndefined benefits—foreign nationals).\n","sortOrder":103},{"sectionNumber":"109","sectionType":"section","heading":"Employer reimbursement for paid leave","content":"109 Employer reimbursement for paid leave\n(1) An injured person entitled to income replacement benefits may ask\nthe relevant insurer for the motor accident to reimburse the person’s\nemployer for the cost of leave payments made to the person for leave\ntaken as a result of the person’s injury.\n(2) The amount reimbursed under subsection (1) must not be more than\nthe amount of the income replacement benefit payments to which the\ninjured person is entitled.\n\nPreliminary Division 2.5.1\nPart 2.5 Defined benefits—treatment and\ncare benefits\nDivision 2.5.1 Preliminary\n110 Meaning of treatment and care\ntreatment and care, of a person injured in a motor accident—\n(a) means any of the following:\n(i) medical treatment (including mental health treatment and\npharmaceutical treatment);\n(ii) dental treatment;\n(iii) rehabilitation;\n(iv) ambulance transportation;\n(v) respite care;\n(vi) attendant care services;\n(vii) aids and appliances;\n(viii) prostheses;\n(ix) education and vocational training;\n(x) home and transport modification;\n(xi) workplace and educational facility modifications;\n(xii) any other kinds of treatment, care, support or services\nprescribed by regulation; but\n(b) does not include excluded treatment and care.\n\nattendant care services, for a person injured in a motor accident,\nmeans services that aim to give the person assistance with everyday\ntasks.\nExamples\n• domestic services\n• home maintenance\n• nursing\n• personal assistance\nexcluded treatment and care means treatment, care, support or\nservices of a kind prescribed by regulation.\n","sortOrder":104},{"sectionNumber":"111","sectionType":"section","heading":"Meaning of rehabilitation","content":"111 Meaning of rehabilitation\nrehabilitation, of a person injured in a motor accident, means the\nprocess of enabling or attempting to enable the person to attain and\nmaintain—\n(a) the maximum level of independent living; and\n(b) full physical, mental, social and vocational ability; and\n(c) full inclusion and participation in all aspects of life.\nDivision 2.5.2 Treatment and care benefits—\n","sortOrder":105},{"sectionNumber":"112","sectionType":"section","heading":"Who is entitled to treatment and care benefits?","content":"112 Who is entitled to treatment and care benefits?\n(1) A person injured in a motor accident is entitled to treatment and care\nbenefits for the following:\n(a) treatment and care expenses;\n\nTreatment and care benefits—entitlement Division 2.5.2\n(b) domestic services expenses;\n(c) travel expenses.\n(a) section 45 (No entitlement—multiple driving offences);\n(b) section 47 (Entitlement limited—detainees and young\ndetainees);\n(c) section 48 (No entitlement—serious offences);\n(d) section 49 (No entitlement—act of terrorism);\n(e) section 50 (Entitlement limited—workers compensation\nclaimant);\n(f) section 116 (No entitlement to treatment and care benefits—\nallowable expenses already paid);\n(g) section 117 (No entitlement to treatment and care benefits—\ndamages already paid);\n(h) section 118 (No entitlement to treatment and care benefits—\nLTCS scheme participant);\n(i) section 119 (Treatment and care benefits not payable in certain\ncircumstances).\n","sortOrder":106},{"sectionNumber":"113","sectionType":"section","heading":"Meaning of treatment and care expenses—ch 2","content":"113 Meaning of treatment and care expenses—ch 2\ntreatment and care expenses, for a person injured in a motor\naccident—\n(a) means expenses incurred by the injured person in providing for\nthe injured person’s treatment and care; but\n\n(b) does not include expenses incurred for treatment and care—\n(i) that was not reasonable and necessary; or\nNote Section 120 deals with deciding whether treatment and care\nis reasonable and necessary.\n(ii) that did not relate to a personal injury sustained in the\n(iii) for which the injured person has not paid and is not liable\nto pay.\nExample—par (iii)\nnursing care or domestic services provided by a domestic partner or\nparent on a gratuitous basis\n","sortOrder":107},{"sectionNumber":"114","sectionType":"section","heading":"Meaning of domestic services expenses—pt 2.5","content":"114 Meaning of domestic services expenses—pt 2.5\ndomestic services expenses, for a person injured in a motor accident,\nmeans the reasonable and necessary expenses incurred by the injured\nperson in employing another person to provide domestic services to\nthe injured person’s dependants if—\n(a) the injured person provided those domestic services to the\ndependants before the motor accident happened; and\n(b) the dependants are not able to undertake the domestic services\nbecause of their age, or physical or mental incapacity.\nNote 1 Section 128 sets out the period for which defined benefits to which an\ninjured person is entitled are payable.\nNote 2 Defined benefits are not payable in relation to domestic services provided\nto a dependant of the injured person for which the injured person has not\npaid and is not liable to pay (see s 113 (b) (iii)).\n\nTreatment and care benefits—entitlement Division 2.5.2\ndependant, of a person injured in a motor accident, means any of the\nfollowing who were wholly or partly dependent on the injured person\nwhen the motor accident happened:\n(a) a domestic partner of the injured person;\n(b) a parent, step-parent or grandparent of the injured person;\n(c) a child, step-child, grandchild or step-grandchild of the injured\nperson;\n(d) a sibling, half-sibling or step-sibling of the injured person;\n(e) an uncle, aunt, niece or nephew of the injured person;\n(f) any other person who was a member of the injured person’s\nhousehold when the motor accident happened;\n(g) an unborn child of the injured person at the time of the motor\naccident who is born after the accident.\n","sortOrder":108},{"sectionNumber":"115","sectionType":"section","heading":"Meaning of travel expenses—pt 2.5","content":"115 Meaning of travel expenses—pt 2.5\ntravel expenses, for a person injured in a motor accident, means the\nreasonable and necessary travel and accommodation expenses\nincurred by the injured person and a parent or other carer\naccompanying the injured person in relation to travel undertaken to\nundergo treatment and care.\n","sortOrder":109},{"sectionNumber":"116","sectionType":"section","heading":"No entitlement to treatment and care benefits—allowable","content":"116 No entitlement to treatment and care benefits—allowable\nexpenses already paid\ncare benefits for allowable expenses if an insurer has already paid for\nthe allowable expenses.\n\n","sortOrder":110},{"sectionNumber":"117","sectionType":"section","heading":"No entitlement to treatment and care benefits—damages","content":"117 No entitlement to treatment and care benefits—damages\nalready paid\ncare benefits for the following expenses if an insurer has already paid\nfor the expenses under a motor accident claim for the motor accident:\n(a) treatment and care expenses;\n(b) domestic services expenses;\n(c) travel expenses.\n","sortOrder":111},{"sectionNumber":"118","sectionType":"section","heading":"No entitlement to treatment and care benefits—","content":"118 No entitlement to treatment and care benefits—\nLTCS scheme participant\ncare benefits if the person is a participant in the LTCS scheme in\nrelation to the injury.\nNote 1 Also, common law damages for treatment and care are not available for\nLTCS scheme participants (see s 250).\nNote 2 LTCS Act—see the dictionary.\n","sortOrder":112},{"sectionNumber":"119","sectionType":"section","heading":"Treatment and care benefits not payable in certain","content":"119 Treatment and care benefits not payable in certain\ncircumstances\nTreatment and care benefits are not payable to a person injured in a\nmotor accident in relation to the following:\n(a) treatment and care that an insurer has paid for under an\narrangement for direct payment with the provider of the\n(b) ambulance transportation, if the injured person is not liable for\nthe cost of the transportation.\n\nTreatment and care benefits—assessment Division 2.5.3\n","sortOrder":113},{"sectionNumber":"120","sectionType":"section","heading":"Deciding whether treatment and care is reasonable and","content":"120 Deciding whether treatment and care is reasonable and\nnecessary\nIn deciding whether treatment and care for an injured person is\nreasonable and necessary, the relevant insurer for the motor accident\nmust consider the following:\n(a) whether the treatment and care is reasonable and necessary in\nthe circumstances;\n(b) whether the treatment and care—\n(i) is directly related to the person’s injury; and\n(ii) is appropriate for the injury; and\n(iii) will benefit the person;\n(c) the appropriateness of a provider of the treatment and care;\n(d) whether the treatment and care is cost effective;\n(e) the MAI guidelines.\nDivision 2.5.3 Treatment and care benefits—\nassessment\n","sortOrder":114},{"sectionNumber":"121","sectionType":"section","heading":"Assessment of injured person’s injuries","content":"121 Assessment of injured person’s injuries\n(1) The relevant insurer for a motor accident may require a person injured\nin the motor accident to attend a health practitioner for an assessment\nof the injured person’s needs for treatment and care, including a\nmedical or other examination.\nNote 1 An injured person must include an authority to disclose personal health\ninformation with the person’s application—see s 57.\nNote 2 Authority to disclose personal health information—see s 54.\nNote 3 Health practitioner—see the Legislation Act, dictionary, pt 1.\n(2) The injured person must comply with any reasonable request made\nby the relevant insurer in relation to the assessment.\n\nDivision 2.5.3 Treatment and care benefits—assessment\n(3) If the injured person fails, without reasonable excuse, to comply with\nthe relevant insurer’s request, the relevant insurer may suspend either\nor both of the following until the person complies with the request:\n(a) the person’s treatment and care benefits;\n(b) the person’s income replacement benefit payments.\n(4) If the relevant insurer decides to suspend the injured person’s\ntreatment and care benefits and income replacement benefits, the\ninsurer must give the injured person written notice (a suspension\nnotice) stating—\n(b) the actions the injured person may take to avoid the benefits or\n(5) A suspension notice must be given at least 2 weeks before the date\nthe suspension takes effect.\n(6) The MAI guidelines may make provision in relation to the conduct of\nassessments under this section.\n\nDivision 2.5.4 Treatment and care benefits—\nrecovery plans\n","sortOrder":115},{"sectionNumber":"122","sectionType":"section","heading":"Meaning of recovery plan—pt 2.5","content":"122 Meaning of recovery plan—pt 2.5\nrecovery plan, for an injured person, means a plan that—\n(a) is prepared by the relevant insurer for the motor accident; and\n(b) provides for the management and coordination of the injured\nperson’s treatment and care.\n","sortOrder":116},{"sectionNumber":"123","sectionType":"section","heading":"Treatment and care benefits—recovery plan","content":"123 Treatment and care benefits—recovery plan\n(a) the relevant insurer for a motor accident is satisfied a person\ninjured in the motor accident is entitled to treatment and care\n(b) because of a personal injury the injured person sustained as a\nresult of the motor accident, the injured person is unable to\nundertake the duties and activities the injured person\nparticipated in before the motor accident.\n(2) However, this section does not apply if the injured person is able to\nresume the duties and activities the injured person participated in\nbefore the motor accident within 28 days after receiving a receipt\nnotice or a late receipt notice.\n(3) The relevant insurer must—\n(a) give the injured person and the injured person’s doctor a draft of\na recovery plan proposed for the injured person; and\n(b) allow the injured person and the injured person’s doctor a\nreasonable opportunity to consider the draft.\n\n(4) The relevant insurer may include in the recovery plan any\nrecommendations by the injured person’s doctor for treatment and\ncare that is reasonable and necessary.\n(5) The relevant insurer must give the injured person and the injured\nperson’s doctor a final version of the recovery plan within 28 days (or\nany longer time stated in the MAI guidelines) after the day—\n(a) the relevant insurer gives the injured person a receipt notice or\nlate receipt notice for the person’s application for defined\nbenefits; or\n(b) if the injured person is admitted to hospital within 2 days after\nthe motor accident happened and remains in hospital for a\ncontinuous period of at least 3 weeks—the person is discharged\nfrom hospital.\n","sortOrder":117},{"sectionNumber":"124","sectionType":"section","heading":"Recovery plan—content","content":"124 Recovery plan—content\nA recovery plan for a person injured in a motor accident must—\n(a) state the treatment and care approved by the relevant insurer as\nreasonable and necessary treatment and care for the injured\n(b) include a statement to the effect that the injured person’s\nentitlement to the following may be suspended if the injured\nperson unreasonably fails to undergo the treatment and care\nstated in the recovery plan:\n(i) treatment and care benefits;\n(ii) income replacement benefits.\n\n","sortOrder":118},{"sectionNumber":"124A","sectionType":"section","heading":"Recovery plan—suspension of benefits","content":"124A Recovery plan—suspension of benefits\n(1) If an injured person fails, without reasonable excuse, to undergo the\ntreatment and care stated in the person’s recovery plan, the relevant\ninsurer may suspend either or both of the following until the person\nundergoes the treatment and care:\n(a) the person’s treatment and care benefits;\n(b) the person’s income replacement benefit payments.\n(2) If the relevant insurer decides to suspend the injured person’s benefit\nor payment, the insurer must give the injured person written notice\n(a suspension notice) stating—\n(b) the actions the injured person may take to avoid the benefits or\n(3) A suspension notice must be given to the injured person at least\n2 weeks before the date the suspension takes effect.\n(4) The MAI guidelines may provide for the matters that must be taken\ninto consideration by an insurer in deciding to suspend an injured\nperson’s benefits or payments.\n","sortOrder":119},{"sectionNumber":"125","sectionType":"section","heading":"Recovery plan—MAI guidelines","content":"125 Recovery plan—MAI guidelines\nThe MAI guidelines may make provision in relation to recovery\nplans, including provision for the following:\n(a) the time within which a recovery plan must be given to an\ninjured person and the injured person’s doctor;\n\n(b) approval of treatment and care, and treatment and care expenses,\nunder a recovery plan;\n(c) information to be considered by the relevant insurer for a motor\naccident when developing a recovery plan for an injured person;\n(d) the minimum requirements for a recovery plan;\n(e) the obligations an injured person has under a recovery plan;\n(f) the obligations the relevant insurer for a motor accident has\nunder a recovery plan.\n","sortOrder":120},{"sectionNumber":"126","sectionType":"section","heading":"Recovery plan—treatment and care not in recovery plan","content":"126 Recovery plan—treatment and care not in recovery plan\n(1) If the relevant insurer for a motor accident gives a person injured in\nthe motor accident a recovery plan—\n(a) the injured person must apply to the relevant insurer for approval\nto undergo treatment and care that is not mentioned in the\nrecovery plan; and\n(b) the relevant insurer is not liable for treatment and care expenses\nincurred in relation to treatment and care the injured person\nundergoes without the relevant insurer’s approval.\n(2) The relevant insurer may approve treatment and care that is not\nmentioned in the recovery plan if the relevant insurer is satisfied on\nreasonable grounds that the treatment and care—\n(a) is reasonable and necessary in the circumstances; and\n(b) will assist with the injured person’s recovery or management of\nthe person’s injury.\n\n","sortOrder":121},{"sectionNumber":"127","sectionType":"section","heading":"Recovery plan—review","content":"127 Recovery plan—review\n(1) If the relevant insurer for a motor accident gives a person injured in\nthe motor accident a recovery plan, the relevant insurer must review\nthe recovery plan—\n(a) at least once every 13 weeks after the plan is given to the injured\n(b) if there is a material change in the person’s condition,\ncircumstances or treatment outcomes.\n(2) The injured person—\n(a) must tell the relevant insurer as soon as practicable if the person\nis unable to comply with the person’s recovery plan; and\n(b) may ask the relevant insurer for a new recovery plan.\n(3) If the relevant insurer proposes to amend the recovery plan, the\nrelevant insurer must give the injured person and the injured person’s\ndoctor a reasonable opportunity to consider the proposed\namendments.\n(4) The relevant insurer may include in the amended recovery plan any\nrecommendations by the injured person’s doctor for treatment and\ncare that is reasonable and necessary.\n\nDivision 2.5.5 Treatment and care benefits—\npayment\n","sortOrder":122},{"sectionNumber":"128","sectionType":"section","heading":"Treatment and care benefits—period payable","content":"128 Treatment and care benefits—period payable\n(1) This section applies if a relevant insurer accepts liability under\nsection 65 for an application for defined benefits.\n(2) The period for which treatment and care benefits are payable—\n(a) starts on—\n(i) the date of the motor accident, if—\n(A) the insurer accepts liability for an application made\nduring the application period; or\n(B) the insurer accepts liability for a late application and\nis satisfied on reasonable grounds that there are\nexceptional circumstances justifying the earlier\npayment of treatment and care benefits; or\n(ii) if the insurer accepts liability for a late application and is\nnot satisfied under paragraph (a) (i) (B)—the date that is\n13 weeks before the date of the application; and\n(b) ends 5 years after the date of the motor accident.\n(3) The MAI guidelines may make provision for the kinds of\ncircumstances that may be exceptional circumstances for\nsubsection (2).\n","sortOrder":123},{"sectionNumber":"129","sectionType":"section","heading":"Payment of treatment and care benefits","content":"129 Payment of treatment and care benefits\n(1) The relevant insurer for a motor accident must pay the treatment and\ncare expenses, domestic services expenses and travel expenses of an\ninjured person entitled to treatment and care benefits.\nNote 1 Domestic services expenses—see s 114.\nNote 2 Travel expenses—see s 115.\n\nTreatment and care benefits—payment Division 2.5.5\n(2) The MAI guidelines may make provision in relation to verifying the\ninjured person’s treatment and care expenses, domestic services\nexpenses and travel expenses, including verifying that—\n(a) the expenses were incurred; and\n(b) the treatment and care for which the expenses were incurred was\ngiven; and\n(c) the injury for which the treatment and care was given resulted\nfrom the motor accident.\n(3) The MAI guidelines may make provision in relation to the\ncircumstances in which the relevant insurer may make a payment\nunder this section for treatment and care benefits before the expense\nfor the benefit is incurred.\ntreatment and care expenses, of person injured in a motor accident,\nmeans the expenses incurred by the person that are—\n(a) approved by the relevant insurer for the motor accident; or\n(b) set out in the person’s recovery plan.\n","sortOrder":124},{"sectionNumber":"130","sectionType":"section","heading":"Treatment and care benefits not commutable to lump","content":"130 Treatment and care benefits not commutable to lump\nsum\n(1) The relevant insurer for a motor accident must not commute treatment\nand care benefits to which an injured person is, or may be, entitled to\na lump sum payment.\n(2) This section is subject to section 184 (Lump sum payment of certain\ndefined benefits—foreign nationals).\n\n","sortOrder":125},{"sectionNumber":"131","sectionType":"section","heading":"Treatment and care benefits—MAI guidelines","content":"131 Treatment and care benefits—MAI guidelines\nThe MAI guidelines may make provision in relation to the following:\n(a) treatment and care that is considered reasonable and necessary\nfor a person injured in a motor accident;\n(b) the maximum amount of defined benefits payable for stated\n(c) verifying that the treatment and care a person injured in a motor\naccident receives is reasonable and necessary;\n(d) verifying that the costs of treatment and care a person injured in\na motor accident receives is reasonable and necessary;\n(e) the information a health practitioner may ask a person injured in\na motor accident for in relation to an assessment of the person\nby the health practitioner under section 121 (Assessment of\ninjured person’s injuries);\n(f) the information a health practitioner may ask the relevant insurer\nfor a motor accident for in relation to an assessment of a person\ninjured in the motor accident by the health practitioner under\nsection 121;\n(g) the circumstances in which the relevant insurer for a motor\naccident may ask for a medical assessment of a person injured\nin the motor accident under section 121;\n(h) payment of expenses in relation to reasonable and necessary\ntreatment and care provided by any of the following:\n(i) a public hospital;\n(ii) an ambulance service;\n(iii) a provider of a service relating to treatment and care that\nbulk bills for the service;\n\nTreatment and care benefits—payment Division 2.5.5\n(i) the principles to be followed by health practitioners in relation\nto the provision of treatment and care for people injured in motor\naccidents.\n\nPart 2.6 Defined benefits—quality of life\n","sortOrder":126},{"sectionNumber":"132","sectionType":"section","heading":"Who is entitled to quality of life benefits?","content":"132 Who is entitled to quality of life benefits?\n(1) A person injured in a motor accident is entitled to quality of life\nbenefits if the personal injury sustained in the motor accident results\nin at least 5% WPI.\n(a) section 43 (Entitlement limited—uninsured motor vehicle);\n(b) section 44 (Entitlement limited—single driving offence);\n(c) section 45 (No entitlement—multiple driving offences);\n(d) section 46 (Entitlement limited—injuries self-inflicted);\n(e) section 48 (No entitlement—serious offences);\n(f) section 49 (No entitlement—act of terrorism);\n(g) section 50 (Entitlement limited—workers compensation\nclaimant);\n(h) section 134 (No entitlement to quality of life benefits—foreign\nnational living outside Australia);\n(i) section 135 (No entitlement to quality of life benefits—benefits\nalready paid);\n(j) section 136 (No entitlement to quality of life benefits—damages\nalready paid).\n\nQuality of life benefits—entitlement Division 2.6.1\n","sortOrder":127},{"sectionNumber":"133","sectionType":"section","heading":"WPI taken to be 10% in certain circumstances","content":"133 WPI taken to be 10% in certain circumstances\n(1) A person injured in a motor accident is taken to have a WPI of 10%\nfor this Act if the person—\n(a) was a child on the date of the motor accident; and\n(b) 4 years and 6 months after the date of the motor accident—\n(i) is receiving treatment and care benefits in relation to the\nperson’s injury and meets the requirements prescribed by\nregulation; or\n(ii) is a participant in the LTCS scheme in relation to the\nperson’s injury.\nNote The MAI guidelines may make provision about the information that may\nbe given to a person mentioned in s (1) about the time limits for making\na motor accident claim and seeking legal advice about whether to make a\nmotor accident claim (see s 52 (2) (f)).\n(2) Subsection (1) does not prevent a person mentioned in that subsection\nfrom making a quality of life benefits application under division 2.6.2\n(Quality of life benefits—application).\n(3) If a WPI assessment is carried out in relation to an injured person\nmentioned in subsection (1), the assessment may increase, but not\nreduce, the injured person’s assessed WPI.\n","sortOrder":128},{"sectionNumber":"134","sectionType":"section","heading":"No entitlement to quality of life benefits—foreign national","content":"134 No entitlement to quality of life benefits—foreign national\nliving outside Australia\nbenefits if the injured person is a foreign national living permanently\noutside Australia.\n\n","sortOrder":129},{"sectionNumber":"135","sectionType":"section","heading":"No entitlement to quality of life benefits—benefits already","content":"135 No entitlement to quality of life benefits—benefits already\npaid\nbenefits if the injured person has already received quality of life\nbenefits in relation to the motor accident.\n","sortOrder":130},{"sectionNumber":"136","sectionType":"section","heading":"No entitlement to quality of life benefits—damages","content":"136 No entitlement to quality of life benefits—damages\nalready paid\nbenefits if the injured person has been awarded quality of life\ndamages in a proceeding for a motor accident claim for the motor\n","sortOrder":131},{"sectionNumber":"137","sectionType":"section","heading":"Quality of life benefits application","content":"137 Quality of life benefits application\n(1) A person may apply to the relevant insurer for a motor accident for\nquality of life benefits (a quality of life benefits application) if the\ninsurer accepts, or is taken to have accepted, liability for defined\nbenefits under section 65.\n(2) The quality of life benefits application must be made—\n(a) not earlier than 26 weeks after the date of the motor accident;\nand\n(b) not later than 4 years and 6 months after the date of the motor\n(3) A quality of life benefits application must—\n(a) request that the relevant insurer refer the injured person to an\nauthorised IME provider for a WPI assessment; and\n(b) include the details required by the MAI guidelines; and\n\n(c) be accompanied by the documents required by the\nMAI guidelines.\n(4) To remove any doubt, if a person makes a quality of life benefits\napplication—\n(a) the relevant insurer must refer the injured person to an\nauthorised IME provider for a first WPI assessment in\naccordance with this division; and\nNote If a person has injuries to more than 1 body system, the WPI\nassessment of each body system may be carried out by different\nmedical examiners or combined in accordance with the WPI\nassessment guidelines (see s 151).\n(b) the injured person may arrange for a private medical examiner\nto carry out a second or subsequent WPI assessment only in\naccordance with section 158 (Second WPI report).\n","sortOrder":132},{"sectionNumber":"138","sectionType":"section","heading":"Insurer believes injuries stable and permanent","content":"138 Insurer believes injuries stable and permanent\nimpairment\n(b) reasonably believes that—\n(i) the person’s injuries have stabilised; and\n(ii) the person is likely to have a permanent impairment as a\nresult of the injuries.\nIME provider for a WPI assessment.\n\n","sortOrder":133},{"sectionNumber":"139","sectionType":"section","heading":"Insurer believes injuries stable but no permanent","content":"139 Insurer believes injuries stable but no permanent\nimpairment\n(b) reasonably believes that—\n(i) the person’s injuries have stabilised; but\n(ii) the person is not likely to have a permanent impairment as\na result of the injuries.\n(2) The relevant insurer must give the injured person a written notice\ntelling the person—\n(a) that the insurer believes—\n(i) the person’s injuries have stabilised; but\n(ii) the person is not likely to have a permanent impairment as\na result of the injuries; and\n(b) the reasons for the belief; and\n(c) that the insurer will not refer the person for a WPI assessment\nunless the person—\n(i) confirms the request for the assessment; and\n(ii) pays an excess payment to the insurer for the assessment.\n(3) If the injured person confirms the request for a WPI assessment, in\nwriting, and pays the excess payment, the relevant insurer must refer\nthe person to an authorised IME provider for a WPI assessment.\n(4) If the injured person’s WPI is greater than 0%, the relevant insurer\nmust reimburse the person for the amount of the excess payment.\n(5) The excess payment is the higher of—\n(a) $500 AWE indexed; and\n\n(b) 25% of the fee payable for the WPI assessment.\n","sortOrder":134},{"sectionNumber":"140","sectionType":"section","heading":"Insurer believes injuries not stabilised—up to 4 years","content":"140 Insurer believes injuries not stabilised—up to 4 years\n6 months after motor accident\n(b) reasonably believes that the person’s injuries have not stabilised;\nand\n(c) it is less than 4 years and 6 months after the date of the motor\n(2) The relevant insurer must give the injured person a written notice\ntelling the person—\n(a) that the insurer believes the person’s injuries have not stabilised;\nand\n(b) the reasons for the belief; and\n(c) that the insurer recommends that the WPI assessment be delayed\nuntil the injuries have stabilised; and\n(d) that the injured person may request a WPI assessment be carried\nout immediately but the insurer will not pay for a further\nassessment if the assessment confirms that person’s injuries\nhave not stabilised.\n(3) If the injured person requests a WPI assessment be carried out\nimmediately, the relevant insurer must refer the injured person to an\nauthorised IME provider for a WPI assessment.\n\n","sortOrder":135},{"sectionNumber":"141","sectionType":"section","heading":"WPI assessment 4 years 6 months after motor accident","content":"141 WPI assessment 4 years 6 months after motor accident\n(a) the relevant insurer for a motor accident receives a quality of life\nbenefits application from a person injured in the accident and—\n(i) section 138 applies to the person; or\n(ii) section 140 applies to the person; or\n(iii) both of the following apply:\n(A) the person is receiving income replacement benefits\nor, because of the circumstances prescribed by\nregulation, would have been eligible to receive\nincome replacement benefits;\n(B) the person’s injuries may have a significant\noccupational impact on the person’s ability to\nundertake employment; and\n(i) the person has not had a WPI assessment in relation to the\ninjuries; or\n(ii) a WPI assessment has confirmed that the person’s injuries\nhave not stabilised; and\n(c) it is 4 years and 6 months after the date of the motor accident.\nIME provider for a WPI assessment.\n(3) If the WPI assessment states that the injured person’s injuries have\nnot stabilised—\n(a) the assessment must estimate the person’s WPI; and\n\n(b) for a person who is not a person mentioned in subsection (4)—\nthe estimated WPI is taken to be the person’s WPI.\nNote If more than 1 WPI assessment is carried out in relation to the injured\nperson, payment of the assessments must be in accordance with the MAI\nguidelines (see s 147 (3)).\n(4) Subsections (5) and (6) apply if—\n(a) either of the following applies:\n(i) if separate reports from an independent medical examiner\nassess an injured person’s physical injuries and\npsychological injuries—the higher estimated WPI is at\nleast 5%;\n(ii) if only 1 WPI report from an independent medical\nexaminer assesses an injured person’s WPI—the estimated\nWPI is at least 5%; and\n(b) the injured person is entitled to make a motor accident claim in\n(5) The relevant insurer for the motor accident must, within 14 days after\nreceiving the WPI report about the injured person, give the injured\n(a) including a copy of the report; and\n(b) telling the person that the person must, within 26 weeks after\n(i) accept the estimated WPI as the person’s WPI; or\n(ii) make a motor accident claim and apply to stay a\nproceeding on the claim until the person’s injuries have\nstabilised; and\n\n(c) telling the person that if the person decides to take the action\nmentioned in paragraph (b) (ii)—\n(i) the person must notify the relevant insurer when the\nperson’s injuries have stabilised; and\n(ii) that the relevant insurer will refer the person to an\nauthorised IME provider for a second WPI assessment; and\n(iii) that the person is liable for the costs of the second WPI\nassessment; and\n(iv) that if the WPI report from the second WPI assessment\nassesses the person’s WPI as less than 10%, the person is\nnot entitled to proceed with the motor accident claim and\nis liable for their own costs in relation to the claim.\n(6) The injured person must make a decision under subsection (5) within\n26 weeks after the date the person is notified of the person’s estimated\nWPI.\nNote If the injured person’s estimated WPI is taken to be the person’s WPI,\ndiv 2.6.3 and ch 3 apply to the person.\n(7) If the injured person does not notify the insurer within the 26 weeks,\nthe injured person is taken to have accepted the estimated WPI as the\nperson’s WPI.\n(8) The relevant insurer must take all reasonable steps to notify the\nas stated in the notice under subsection (5) within the 26 weeks.\n1 including information in the written notice under s (5) about the consequences\nof failing to notify the insurer within the 26 weeks\n(9) If the injured person refuses to have a WPI assessment, the person’s\nquality of life benefits application is taken to have been finally dealt\nwith.\n\n","sortOrder":136},{"sectionNumber":"142","sectionType":"section","heading":"WPI assessment—injured person’s injuries stabilised","content":"142 WPI assessment—injured person’s injuries stabilised\n(1) This section applies if an injured person to whom section 141 (4)\napplies—\n(a) makes a motor accident claim in relation to the motor accident;\nand\n(b) applies to stay a proceeding on the claim until the person’s\ninjuries have stabilised.\n(2) The injured person must tell the relevant insurer for the motor\naccident, in writing, that the person’s injuries have stabilised.\n(3) The relevant insurer must refer the injured person to an authorised\nIME provider for a second WPI assessment.\n(4) The injured person is liable for the costs of the second WPI\nassessment.\nNote The IME provider must give the WPI report about the assessment to the\nrelevant insurer (see s 152).\n(5) If the WPI report assesses the injured person’s WPI as 10% or more,\nthe injured person is entitled to proceed with the motor accident\n(6) If the WPI report assesses the injured person’s WPI as less than 10%,\nthe relevant insurer must, within 14 days after receiving the report,\ngive the injured person a written notice—\n(a) stating that the person—\n(i) is not entitled to proceed with the motor accident claim;\nand\n(ii) is liable for their own costs in relation to the motor accident\n(iii) is not entitled to a further WPI assessment; and\n(iv) is not entitled to an SOI assessment; and\n\n(c) telling the person that the person must, within 28 days after\nreceiving the notice, notify the insurer, in writing, whether they\naccept the offer.\n(7) If the injured person does not notify the relevant insurer within the\n(8) The relevant insurer must take all reasonable steps to notify the\nas stated in the notice under subsection (6) within the 28 days.\n1 including information in the written notice under s (6) about the consequences\n2 sending the injured person a reminder notice before the end of the 28 days\n(9) If the injured person accepts (or is taken to accept) the offer—\n(b) the relevant insurer must pay to the person the amount of quality\nof life benefits payable for their WPI under division 2.6.4.\nDivision 2.6.3 Quality of life benefits—\nWPI assessment\n","sortOrder":137},{"sectionNumber":"143","sectionType":"section","heading":"Meaning of WPI assessment","content":"143 Meaning of WPI assessment\nWPI assessment, of a person injured in a motor accident, means an\nassessment to evaluate and report on the person’s injuries to\ndetermine the person’s WPI as a result of the injuries.\n\n","sortOrder":138},{"sectionNumber":"144","sectionType":"section","heading":"Meaning of WPI report","content":"144 Meaning of WPI report\nWPI report means a written report, by an independent medical\nexaminer or private medical examiner, of an injured person’s\nWPI assessment that—\n(a) states the examiner’s assessment of the injured person’s WPI;\nand\n(b) complies with the WPI assessment guidelines.\n","sortOrder":139},{"sectionNumber":"145","sectionType":"section","heading":"Meaning of private medical examiner—div 2.6.3","content":"145 Meaning of private medical examiner—div 2.6.3\nprivate medical examiner, for an injured person, means a doctor\nwho—\n(a) meets the requirements under the WPI assessment guidelines to\nconduct WPI assessments; and\n(b) has qualifications and experience relevant to the nature of the\ninjured person’s injuries.\n","sortOrder":140},{"sectionNumber":"146","sectionType":"section","heading":"WPI assessment guidelines","content":"146 WPI assessment guidelines\n(1) The MAI commission must make guidelines (the WPI assessment\nguidelines) for WPI assessments.\n(2) The WPI assessment guidelines—\n(a) must explain how a person’s whole person impairment is\nassessed; and\n(b) may state procedures and principles to be followed in making a\nWPI assessment including assessing whether—\n(i) a person’s injuries have stabilised; and\n\n(ii) the person is likely to have a permanent impairment as a\nresult of the injuries; and\n(c) may apply, adopt or incorporate a law of another jurisdiction or\ninstrument as in force from time to time.\nNote A reference to an instrument includes a reference to a provision of\nan instrument (see Legislation Act, s 14 (2)).\n(3) The Legislation Act, section 47 (6) does not apply in relation to a law\nor instrument applied, adopted or incorporated under\nsubsection (2) (c).\nNote A law or instrument applied, adopted or incorporated under s (2) (c) does\nnot need to be notified under the Legislation Act because s 47 (6) does\nnot apply (see Legislation Act, s 47 (7)).\n(4) The WPI assessment guidelines are a disallowable instrument.\n","sortOrder":141},{"sectionNumber":"147","sectionType":"section","heading":"Arrangement of WPI assessment","content":"147 Arrangement of WPI assessment\n(1) This section applies if an injured person is referred to an authorised\nIME provider for a WPI assessment under—\n(a) section 138 (Insurer believes injuries stable and permanent\nimpairment); or\n(b) section 139 (Insurer believes injuries stable but no permanent\nimpairment); or\n(c) section 140 (Insurer believes injuries not stabilised—up to\n4 years 6 months after motor accident); or\n(d) section 141 (WPI assessment 4 years 6 months after motor\naccident); or\n(e) section 142 (WPI assessment—injured person’s injuries\nstabilised).\n(2) The IME provider must arrange for 1 or more independent medical\nexaminers to carry out a WPI assessment of the injured person.\n\n(3) The MAI guidelines may make provision in relation to the procedure\nfor arranging a WPI assessment of an injured person, including—\n(a) selecting an IME provider; and\n(b) the time within which the assessment must be arranged; and\n(c) arrangements for payment of the assessment.\n","sortOrder":142},{"sectionNumber":"148","sectionType":"section","heading":"WPI assessment—provision of information","content":"148 WPI assessment—provision of information\n(1) This section applies if an authorised IME provider arranges for an\nindependent medical examiner to carry out a WPI assessment of an\ninjured person.\n(2) The injured person must give the authorised IME provider and\nindependent medical examiner—\n(a) all information in the injured person’s possession that is relevant\nto the WPI assessment; and\n(b) any other information the authorised IME provider or\nindependent medical examiner reasonably requires for the\nWPI assessment.\n(3) The relevant insurer for the motor accident must give the authorised\nIME provider and independent medical examiner—\n(a) all information in the insurer’s possession that is relevant to the\nWPI assessment; and\n(b) any other information the authorised IME provider or\nindependent medical examiner reasonably requires for the\nWPI assessment.\n(4) The information must be given to the authorised IME provider and\nindependent medical examiner at least 10 days before the day the\nindependent medical examiner is to carry out the WPI assessment.\n\n(5) The independent medical examiner may decline to carry out the\nWPI assessment if the injured person or the insurer fails to give any\ninformation reasonably required by the authorised IME provider or\nindependent medical examiner.\n","sortOrder":143},{"sectionNumber":"149","sectionType":"section","heading":"WPI assessment—WPI assessment guidelines","content":"149 WPI assessment—WPI assessment guidelines\nA WPI assessment of an injured person must be carried out—\n(a) in accordance with the WPI assessment guidelines; and\n(b) by—\n(i) an independent medical examiner who is—\n(A) trained as required by the WPI assessment guidelines;\nand\n(B) selected by an authorised IME provider to conduct the\nassessment; or\n(ii) if the injured person may arrange for a private medical\nexaminer to carry out a WPI assessment—a private\nmedical examiner selected by the person.\n","sortOrder":144},{"sectionNumber":"150","sectionType":"section","heading":"WPI assessment—both physical and psychological","content":"150 WPI assessment—both physical and psychological\ninjuries\n(1) This section applies if an injured person sustains both a physical\ninjury and a primary psychological injury resulting from a motor\n(2) The injured person may request separate WPI assessments of—\n(a) the physical injury; and\n(b) the primary psychological injury.\n(3) However, the injured person may request a WPI assessment of the\nprimary psychological injury only if the person has received—\n(a) mental health treatment for the injury; and\n\n(b) a notice, in writing, from a psychiatrist or clinical psychologist\nthat the psychiatrist or clinical psychologist reasonably believes\nthe person is likely to have a permanent psychological injury\nresulting from the motor accident.\n(4) To remove any doubt—\n(a) a WPI assessment of a physical injury may take into account a\nsecondary psychological injury; but\n(b) a WPI assessment of a primary psychological injury must not\ntake into account a secondary psychological injury.\n(5) The relevant insurer for the motor accident is only liable for the costs\nof 1 WPI assessment for each kind of injury.\nprimary psychological injury—\n(a) means an injury that is—\n(i) a psychological or psychiatric disorder, including the\nphysiological effect of a psychological or psychiatric\ndisorder on the nervous system, that results directly from a\n(ii) diagnosed by a psychiatrist or clinical psychologist; but\n(b) does not include a psychological or psychiatric disorder that\nresults from a physical injury resulting from a motor accident.\nExample—psychological injury resulting from a motor accident\npost-traumatic stress disorder as a result of witnessing the motor accident\nsecondary psychological injury means an injury that is—\n(a) a psychological or psychiatric disorder that results from a\nphysical injury resulting from a motor accident; and\n\n(b) diagnosed by a psychiatrist or clinical psychologist.\nExample—psychological injury that results from physical injury\ndepression and anxiety as a result of ongoing pain from the physical injury\n","sortOrder":145},{"sectionNumber":"151","sectionType":"section","heading":"WPI assessment—multiple body systems affected","content":"151 WPI assessment—multiple body systems affected\n(1) If an injured person has injuries to more than 1 body system—\n(a) a WPI assessment of each affected body system may be made;\nand\n(b) each WPI assessment may be carried out by a different\nindependent medical examiner; and\n(c) the WPI assessments of each physical body system may be\ncombined in accordance with the WPI assessment guidelines to\ndecide the injured person’s WPI for the person’s physical\n(d) the WPI assessments for a primary psychological injury must be\nconducted in accordance with the WPI guidelines to decide the\nperson’s WPI for their psychological injuries.\ninjury, to a person’s body system, includes a primary psychological\ninjury to the person.\nprimary psychological injury—see section 150 (6).\n","sortOrder":146},{"sectionNumber":"152","sectionType":"section","heading":"WPI report to be prepared","content":"152 WPI report to be prepared\n(1) An independent medical examiner who carries out a WPI assessment\nof an injured person must give a WPI report about the assessment to\nthe IME provider who arranged the assessment.\n(2) The IME provider must give the WPI report to the relevant insurer\nfor the motor accident.\n\n(3) The WPI assessment guidelines may make provision for the\nrequirements for a WPI report, including the time within which a\nWPI report must be given.\n","sortOrder":147},{"sectionNumber":"153","sectionType":"section","heading":"WPI—both physical and psychological injuries","content":"153 WPI—both physical and psychological injuries\n(a) a WPI assessment of an injured person’s physical injuries and\npsychological injuries has been carried out; and\n(b) the WPI for each kind of injury is assessed at more than 0%.\n(2) The relevant insurer for the motor accident may take into account the\nWPI for each kind of injury to determine the amount of quality of life\nbenefits the insurer may offer the injured person.\n","sortOrder":148},{"sectionNumber":"154","sectionType":"section","heading":"WPI less than 5%—insurer may make offer","content":"154 WPI less than 5%—insurer may make offer\n(a) if separate WPI reports from an independent medical examiner\ninjuries—the higher WPI assessment assesses the person’s WPI\nas less than 5%; or\n(b) if only 1 WPI report from an independent medical examiner\nassesses an injured person’s WPI—the person’s WPI is assessed\nas less than 5%.\n(2) The relevant insurer for the motor accident must give the injured\n\n(b) if there are separate WPI reports for the person’s physical and\npsychological injuries, and the insurer considers that it is\nappropriate to make an offer to the person—offering the person\nthe amount of quality of life benefits payable for their\nWPI under division 2.6.4 (Quality of life benefits—amount\npayable); and\n(3) The relevant insurer for the motor accident must give the notice to the\n(4) If the injured person does not notify the insurer, and give the insurer\nhave accepted—\n(a) if the relevant insurer has made an offer—the offer; and\n(b) if the relevant insurer has not made an offer—each report stated\nin the notice under subsection (2).\n\n(5) The relevant insurer must take all reasonable steps to notify the\nnotice under subsection (2) within the 26 weeks.\n1 including information in the written notice under s (2) about the consequences\n(6) If the injured person accepts (or is taken to accept) the offer or the\nreport, the person’s application for quality of life benefits is taken to\nhave been finally dealt with.\n","sortOrder":149},{"sectionNumber":"155","sectionType":"section","heading":"WPI 5% to 9%—insurer must make offer","content":"155 WPI 5% to 9%—insurer must make offer\n5% but not more than 9%.\n(b) the person’s WPI is assessed as at least 5% but not more\nthan 9%.\n\n(5) If the injured person does not notify the insurer, and give the insurer\nhave accepted the offer.\n\n(6) The relevant insurer must take all reasonable steps to notify the\nnotice under subsection (3) within the 26 weeks.\n1 including information in the written notice under s (3) about the consequences\n(7) If the injured person accepts (or is taken to accept) the offer—\n(b) the amount of quality of life benefits payable for their\nWPI under division 2.6.4 must be paid by the relevant insurer to\n","sortOrder":150},{"sectionNumber":"156","sectionType":"section","heading":"WPI 10% or more—injured person not entitled to make","content":"156 WPI 10% or more—injured person not entitled to make\nmotor accident claim\n10%; but\n(c) the injured person is not entitled to make a motor accident claim\n(b) the person’s WPI is assessed as at least 10%; but\n\n(c) the injured person is not entitled to make a motor accident claim\n(5) If the injured person does not notify the insurer, and give the insurer\nhave accepted the offer.\n\n(6) The relevant insurer must take all reasonable steps to notify the\nnotice under subsection (3) within the 26 weeks.\n1 including information in the written notice under s (3) about the consequences\n(7) If the injured person accepts (or is taken to accept) the offer—\n(b) the amount of quality of life benefits payable for their\nWPI under division 2.6.4 must be paid by the relevant insurer to\n","sortOrder":151},{"sectionNumber":"157","sectionType":"section","heading":"WPI 10% or more—injured person entitled to make motor","content":"157 WPI 10% or more—injured person entitled to make motor\naccident claim\n10%; and\n(c) the injured person is entitled to make a motor accident claim in\n(b) the person’s WPI is assessed as at least 10%; and\n\n(c) the injured person is entitled to make a motor accident claim in\n(c) explaining the consequences of accepting the offer, including—\n(i) that the person is entitled to make a motor accident claim\nin relation to the motor accident; and\n(ii) that if the person accepts the offer and makes a motor\naccident claim, the person is not entitled to damages for\nloss of quality of life under chapter 5 (Motor accident\ninjuries—common law damages); and\n(d) telling the person that the person must, by the due date—\n\n(5) If the injured person accepts the offer—\n(a) the injured person’s application for quality of life benefits is\ntaken to have been finally dealt with; and\nof quality of life benefits payable for their WPI under\n(6) If the injured person does not notify the insurer, and give the insurer\nthe second WPI report, by the due date, the injured person’s—\n(a) application for quality of life benefits is taken to have been\nfinally dealt with; and\n(b) entitlement to quality of life benefits in relation to the motor\naccident ends.\n(7) The relevant insurer must take all reasonable steps to notify the\ninjured person about the due date and the consequences of failing to\nnotify the insurer as stated in the notice under subsection (3) by the\ndue date.\n1 including information in the written notice under s (3) about the due date and\nthe consequences of failing to notify the insurer by the due date\n2 sending the injured person a reminder notice before the due date\ncomplying notice of claim—see section 257.\ndue date means the later of—\n(a) 5 years after the date of the motor accident; and\n(b) 26 weeks after the person receives the notice; and\n\n(c) if the injured person gives a complying notice of claim—\n6 weeks after the date the claim is finally decided.\n","sortOrder":152},{"sectionNumber":"158","sectionType":"section","heading":"Second WPI report","content":"158 Second WPI report\n(1) This section applies if an injured person notifies the relevant insurer\nfor the motor accident under section 154, section 155, section 156 or\nsection 157 that they disagree with the WPI report (the first\nWPI report) and wish to have a second WPI assessment carried out.\n(2) The injured person may arrange for a private medical examiner to\ncarry out a second WPI assessment.\n(3) The private medical examiner must carry out the second\nWPI assessment in accordance with the WPI assessment guidelines.\n(4) The private medical examiner must prepare a WPI report about the\nsecond WPI assessment (the second WPI report) and give it to the\ninjured person.\n(5) The injured person may give a copy of the second WPI report to the\nrelevant insurer.\n(6) The relevant insurer must reimburse the injured person for the amount\nof the second WPI assessment if—\n(a) the first WPI report assesses the person’s WPI as less than 10%;\nand\n(b) the second WPI report assesses the person’s WPI as at least\n10%; and\n(c) the person makes a motor accident claim in relation to the motor\n(7) The MAI guidelines may make provision in relation to the following:\n(a) the relevant insurer’s responsibilities in relation to the second\nWPI report;\n\n(b) the time limits that apply to an offer of quality of life benefits\nmade in response to the second WPI report.\n","sortOrder":153},{"sectionNumber":"159","sectionType":"section","heading":"Second WPI report—original WPI may be affirmed or","content":"159 Second WPI report—original WPI may be affirmed or\nincreased\n(a) the relevant insurer for a motor accident receives—\n(i) if separate first WPI reports are provided for the injured\nperson’s physical injuries and psychological injuries—at\nleast 1 second WPI report; or\n(ii) if only 1 first WPI report is provided—a second WPI\nreport; and\n(b) the assessment of WPI in the second WPI report is higher than\nin the first WPI report.\n(2) The relevant insurer may—\n(a) give a copy of the second WPI report to the IME provider that\narranged the first WPI report and the independent medical\nexaminer who carried out the WPI assessment to which the first\nWPI report relates; and\n(b) request the IME provider to arrange a review of the\nfirst WPI report.\n(3) The MAI guidelines may make provision in relation to the time limit\nfor giving the second WPI report to the IME provider and the\nindependent medical examiner.\n(4) An independent medical examiner may, in response to the second\nWPI report—\n(a) affirm the original assessment of the injured person’s WPI; or\n(b) increase the assessment of the injured person’s WPI.\n\n(5) The IME provider must give the relevant insurer written notice of the\naffirmation or increase (a notice of affirmation or increase).\n(6) If the independent medical examiner increases the assessment of the\ninjured person’s WPI, the relevant insurer is bound by the increased\nassessment.\n","sortOrder":154},{"sectionNumber":"160","sectionType":"section","heading":"Final offer WPI","content":"160 Final offer WPI\nreceives a second WPI report about an injured person.\n(2) The relevant insurer must decide a WPI to determine the final offer\nto make to the injured person (the final offer WPI).\n(3) The final offer WPI must be not less than—\n(a) if the insurer has not requested the IME provider to arrange a\nreview of the first WPI report under section 159—the\nWPI assessed in the first WPI report; or\n(b) if the insurer has requested the IME provider to arrange a review\nof the first WPI report under section 159—the affirmed or\nincreased assessment of WPI stated in the notice of affirmation\nor increase.\n","sortOrder":155},{"sectionNumber":"161","sectionType":"section","heading":"Final offer WPI less than 5%","content":"161 Final offer WPI less than 5%\n(1) If the relevant insurer for a motor accident decides an injured person’s\nfinal offer WPI is less than 5%, the relevant insurer must, within the\nstated time, give the person a written notice—\n(b) telling the person—\n\nWPI was determined.\nor\n\n","sortOrder":156},{"sectionNumber":"162","sectionType":"section","heading":"Final offer WPI 5% to 9%","content":"162 Final offer WPI 5% to 9%\n(1) If the relevant insurer for a motor accident decides an injured person’s\nfinal offer WPI is at least 5% but not more than 9%, the relevant\ninsurer must, within the stated time, give the person a written notice—\n(b) telling the person—\n(d) telling the person that the person must, within 28 days after\nreceiving the notice, notify the insurer, in writing, whether\nthey—\n(2) If the injured person does not notify the relevant insurer within the\n\n(3) The relevant insurer must take all reasonable steps to notify the\nas stated in the notice under subsection (1) within the 28 days.\n1 including information in the written notice under s (1) about the consequences\n2 sending the injured person a reminder notice before the end of the 28 days\n(4) If the injured person accepts (or is taken to accept) the offer—\nor\n\n","sortOrder":157},{"sectionNumber":"163","sectionType":"section","heading":"Final offer WPI 10% or more—injured person not entitled","content":"163 Final offer WPI 10% or more—injured person not entitled\nto make motor accident claim\n(a) the relevant insurer for a motor accident decides an injured\nperson’s final offer WPI is at least 10%; but\n(b) the injured person is not entitled to make a motor accident claim\n(2) The relevant insurer must, within the stated time, give the person a\nwritten notice—\n(b) telling the injured person—\n\n(d) telling the person that the person must, within 28 days after\nreceiving the notice, notify the insurer, in writing, whether\nthey—\n(3) If the injured person does not notify the relevant insurer within the\n(4) The relevant insurer must take all reasonable steps to notify the\nas stated in the notice under subsection (2) within the 28 days.\n1 including information in the written notice under s (2) about the consequences\n2 sending the injured person a reminder notice before the 28 days\n(5) If the injured person accepts (or is taken to accept) the offer—\n\nor\n","sortOrder":158},{"sectionNumber":"164","sectionType":"section","heading":"Final offer WPI 10% or more—injured person entitled to","content":"164 Final offer WPI 10% or more—injured person entitled to\nmake motor accident claim\n(a) the relevant insurer for a motor accident decides an injured\nperson’s final offer WPI is at least 10%; and\n\n(b) the injured person is entitled to make a motor accident claim in\n(2) The relevant insurer must, within the stated time, give the person a\nwritten notice—\n(b) telling the injured person—\n(d) explaining the consequences of accepting the offer, including—\n(i) that the person is entitled to make a motor accident claim\nin relation to the motor accident; and\n(ii) that if the person accepts the offer and makes a motor\naccident claim, the person is not entitled to damages for\nloss of quality of life under chapter 5; and\n(e) telling the person that the person must notify the insurer, in\nwriting, by the due date, whether they—\n\n(3) If the injured person accepts the offer—\n(4) If the injured person does not notify the insurer by the due date, the\ninjured person’s—\n(a) application for quality of life benefits is taken to have been\nfinally dealt with; and\n(b) entitlement to quality of life benefits in relation to the motor\naccident ends.\n(5) The relevant insurer must take all reasonable steps to notify the\ninjured person about the due date and the consequences of failing to\nnotify the insurer as stated in the notice under subsection (2) by the\ndue date.\n1 including information in the written notice under s (2) about the due date and\nthe consequences of failing to notify the insurer by the due date\n2 sending the injured person a reminder notice before the due date\ncomplying notice of claim—see section 257.\ndue date means the later of—\n(a) 5 years after the date of the motor accident; and\n(b) 26 weeks after the person receives the notice; and\n(c) if the injured person gives a complying notice of claim—\n6 weeks after the date the claim is finally decided.\n\n(a) if separate WPI reports were provided for the injured person’s\nrequested the IME provider arrange a review of only 1 report\n(b) if separate first WPI reports were provided for the injured\nperson’s physical injuries and psychological injuries and the\ninsurer requested the IME provider arrange a review of both\nreports under section 159—14 days after receiving the IME\nprovider’s notice of affirmation or increase for both reports; or\n(c) if only 1 first WPI report was provided and the insurer requested\nthe IME provider arrange a review under section 159—14 days\nafter receiving the IME provider’s notice of affirmation or\nincrease; or\n","sortOrder":159},{"sectionNumber":"165","sectionType":"section","heading":"WPI assessment—relevant insurer to pay","content":"165 WPI assessment—relevant insurer to pay\n(1) The relevant insurer for a motor accident is liable for the costs of a\nWPI assessment, unless otherwise provided in this part.\n(2) If section 151 does not apply, the relevant insurer is only liable for\nthe costs of—\n(a) 1 WPI assessment of the person’s physical injuries; and\n\n(b) if the person may request a WPI assessment of the person’s\nprimary psychological injury under section 150—1 WPI\nassessment of the person’s primary psychological injury.\n(3) If section 151 applies, the relevant insurer is only liable for the costs\nof 1 WPI assessment for each affected body system.\ninjury, to a person’s body system, includes a primary psychological\ninjury to the person.\nprimary psychological injury—see section 150 (6).\n","sortOrder":160},{"sectionNumber":"166","sectionType":"section","heading":"Effect of certain WPI assessments on motor accident","content":"166 Effect of certain WPI assessments on motor accident\nclaim\nDespite the Limitation Act 1985, section 16AA (Motor accident\nclaims), a person injured in a motor accident who has had a WPI\nassessment has 3 months from whichever of the following dates\napplies to make a motor accident claim:\n(a) if the injured person receives a notice under section 141 (5)\n(WPI assessment 4 years 6 months after motor accident)—the\ndate that is 26 weeks after the date of the notice;\n(b) if the injured person receives a notice under section 157 (3)\n(WPI 10% or more—injured person entitled to make motor\naccident claim) or section 164 (2) (Final offer WPI 10% or\nmore—injured person entitled to make motor accident claim)—\nthe due date for the notice.\n\nQuality of life benefits—amount payable Division 2.6.4\nDivision 2.6.4 Quality of life benefits—amount\npayable\n","sortOrder":161},{"sectionNumber":"167","sectionType":"section","heading":"Amount of quality of life benefits payable","content":"167 Amount of quality of life benefits payable\n(1) The amount of quality of life benefits payable to a person injured in\na motor accident is the amount stated in table 167—\npsychological injuries—as at the date of the later WPI report; or\n(b) if there is only 1 WPI report—as at the date of the WPI report;\nor\n(c) if a WPI report is reviewed under section 159 (4) (Second WPI\nreport—original WPI may be affirmed or increased)—\n(i) if separate WPI reports for the person’s physical and\npsychological injuries are reviewed—as at the date of the\nnotice of affirmation or increase of the later review; or\n(ii) if only 1 WPI report is reviewed—as at the date of the\nnotice of affirmation or increase.\nTable 167 Amount of quality of life benefits payable\nitem\nWPI %\namount payable\n1 less than 5% nil\n2 5% $7 000 AWE indexed\n3 6% to 10% $7 000 AWE indexed + [(W–5) x $2 100 AWE indexed]\n4 11% to 20% $17 500 AWE indexed + [(W–10) x $2 450 AWE indexed]\n5 21% to 50% $42 000 AWE indexed + [(W–20) x $2 800 AWE indexed]\n6 51% to 99% $126 000 AWE indexed + [(W–50) x $4 480 AWE indexed]\n7 100% $350 000 AWE indexed\n\nDivision 2.6.4 Quality of life benefits—amount payable\nW means WPI/100% x 100.\nif a person’s WPI is 8%, the corresponding W is 8\n\nPreliminary Division 2.7.1\nDivision 2.7.1 Preliminary\n","sortOrder":162},{"sectionNumber":"168","sectionType":"section","heading":"Meaning of dependant—pt 2.7","content":"168 Meaning of dependant—pt 2.7\ndependant, of a person who died as a result of a motor accident,\nmeans someone who was, when the person died—\n(a) a dependent child of the person; or\n(b) a domestic partner of the person; or\n(c) a dependent former domestic partner of the person.\ndependent child, of a person, means someone who is—\n(a) either—\n(i) a child of the person (including a child born after the\nperson’s death), whether or not living with the person as a\nmember of the person’s family; or\n(ii) a grandchild or step child of the person, living with the\nperson as a member of the person’s family; and\n(b) 1 or more of the following:\n(i) under 18 years old;\n(ii) a full-time student and under 25 years old;\n(iii) a person with a disability and wholly or partly financially\ndependent on the person.\n\ndependent former domestic partner, of a person, means a former\ndomestic partner of the person who is wholly or partly financially\ndependent on the person.\ndisability, in relation to a person—see the Disability Services\nAct 1991, dictionary.\n","sortOrder":163},{"sectionNumber":"169","sectionType":"section","heading":"Who is entitled to death benefits?","content":"169 Who is entitled to death benefits?\n(1) A dependant of a person who died as a result of a motor accident is\nentitled to death benefits in relation to the person’s death.\nNote Person who died as a result of a motor accident—see s 36.\n(a) section 46 (Entitlement limited—injuries self-inflicted);\n(b) section 49 (No entitlement—act of terrorism);\n(c) section 170 (No entitlement to death benefits—death of foreign\nnational outside Australia);\n(d) section 171 (No entitlement to death benefits—conduct making\nup offence);\n(e) section 172 (No entitlement to death benefits—quality of life\nbenefits or damages already paid);\n(f) section 173 (No entitlement to death benefits—death benefits\npaid under workers compensation scheme).\n","sortOrder":164},{"sectionNumber":"170","sectionType":"section","heading":"No entitlement to death benefits—death of foreign","content":"170 No entitlement to death benefits—death of foreign\nnational outside Australia\n(b) the person is a foreign national; and\n\nDeath benefits—entitlement Division 2.7.2\n(c) the person’s death happens outside Australia.\n(2) A dependant of the person is not entitled to death benefits in relation\nto the person’s death.\n","sortOrder":165},{"sectionNumber":"171","sectionType":"section","heading":"No entitlement to death benefits—conduct making up","content":"171 No entitlement to death benefits—conduct making up\noffence\n(b) a coroner establishes that conduct the person engaged in, in\nrelation to the motor accident, made up the physical elements\nconsisting of conduct of—\n(i) 2 or more driving offences; or\n(ii) a serious offence.\n(2) A dependant of the person is not entitled to death benefits in relation\nto the person’s death.\nserious offence—see section 48 (6).\n","sortOrder":166},{"sectionNumber":"172","sectionType":"section","heading":"No entitlement to death benefits—quality of life benefits","content":"172 No entitlement to death benefits—quality of life benefits\nor damages already paid\nA dependant of a person who died as a result of a motor accident is\nnot entitled to death benefits in relation to the person’s death if the\nperson received—\n(a) quality of life benefits in relation to the motor accident; or\n(b) quality of life damages in relation to the motor accident.\n\n","sortOrder":167},{"sectionNumber":"173","sectionType":"section","heading":"No entitlement to death benefits—death benefits paid","content":"173 No entitlement to death benefits—death benefits paid\n(b) death benefits (other than funeral expenses) are paid under a\nworkers compensation scheme for the benefit of a dependant of\n(2) The dependant is not entitled to death benefits in relation to the\nperson’s death.\n(3) If the dependant has been paid death benefits under this part, the\ninsurer is entitled to recover the death benefits from the dependant.\n","sortOrder":168},{"sectionNumber":"174","sectionType":"section","heading":"Amount of death benefits payable","content":"174 Amount of death benefits payable\nThe following amounts of death benefits are payable to the\ndependants of a person who died as a result of a motor accident:\n(a) if, at the date of the motor accident, the dead person had a\ndomestic partner or dependent former domestic partner—\n$190 000 AWE indexed;\n(b) if, at the date of the motor accident, the dead person had—\n(i) only 1 dependent child—$40 000 AWE indexed; or\n(ii) only 2 dependent children—$80 000 AWE indexed; or\n(iii) only 3 dependent children—$120 000 AWE indexed; or\n(iv) 4 or more dependent children—$160 000 AWE indexed.\n\nDeath benefits—payment Division 2.7.4\n","sortOrder":169},{"sectionNumber":"175","sectionType":"section","heading":"Death benefits—income replacement benefits and","content":"175 Death benefits—income replacement benefits and\ntreatment and care benefits still payable\n(a) the relevant insurer for a motor accident accepts liability for an\napplication for death benefits in relation to a dead person for the\n(b) before the person died, the person was entitled to—\n(i) income replacement benefits; or\n(ii) treatment and care benefits.\n(2) The relevant insurer—\n(a) is not entitled to recover any amount of income replacement\nbenefits or treatment and care benefits already paid to the\n(b) must pay to the person’s estate any amount of income\nreplacement benefits or treatment and care benefits to which the\nperson was entitled and had not received when the person died.\n","sortOrder":170},{"sectionNumber":"176","sectionType":"section","heading":"Payment of death benefits—application to ACAT","content":"176 Payment of death benefits—application to ACAT\nreceives an application for death benefits from—\n(a) the dependant of a person who died as a result of the motor\n(b) if the dependant is a person with a legal disability—the\ndependant’s guardian; or\n(c) the personal representative of a person who died as a result of\n\n(2) The relevant insurer must apply to the ACAT for an order for the\npayment of the death benefits to the dependants.\n(3) The application must be made after the later of the following:\n(a) 5 business days after the day the relevant insurer accepts\nliability for an application for death benefits received under\nsubsection (1);\n(b) 28 days after the day the relevant insurer gives notice to a\ndependant for additional information in relation to the\napplication for death benefits.\n(4) The MAI guidelines may make provision in relation to the following:\n(a) the procedures to be undertaken in relation to processing an\napplication for death benefits;\n(b) the information to be given to the ACAT with an application\nunder subsection (2).\n","sortOrder":171},{"sectionNumber":"177","sectionType":"section","heading":"Payment of death benefits—ACAT orders","content":"177 Payment of death benefits—ACAT orders\n(1) On application under section 176, the ACAT must decide—\n(a) whether to make an order for payment of death benefits; and\n(b) if the ACAT makes an order under paragraph (a)—\n(i) the amount of death benefits the ACAT considers\nappropriate for each dependant; and\n(ii) any other matter the ACAT considers relevant for the\nmaking of the order.\n(2) However, the order must not be for more than an amount stated in\nsection 174 (Amount of death benefits payable).\n\nDeath benefits—payment Division 2.7.4\n(3) In considering an application under section 176, the ACAT may—\n(a) consider any relevant matter; and\n(b) ask for additional information in relation to the application.\nNote 1 The ACAT may inform itself in any way it considers appropriate in the\ncircumstances (see ACT Civil and Administrative Tribunal Act 2008,\ns 26).\nNote 2 See s 370 for when a licensed insurer must comply with an order of the\nACAT.\n\nPart 2.8 Defined benefits—funeral benefits\nPart 2.8 Defined benefits—funeral\n178 Who is entitled to funeral benefits?\n(1) The person who has paid, or is liable to pay, the funeral expenses of\na person who died as a result of a motor accident is entitled to funeral\nbenefits for funeral expenses for the dead person.\nNote The funeral benefits must be paid as soon as possible (see Legislation\nAct, s 151B).\n(2) This section is subject to—\n(a) section 49 (No entitlement—act of terrorism); and\n(b) section 179 (No entitlement to funeral benefits—death of\nforeign national outside Australia); and\n(c) section 180 (No entitlement to funeral benefits—funeral\nexpenses paid under workers compensation scheme).\nfuneral expenses, for a dead person, includes the cost of transporting\nthe dead person’s body to a place in Australia outside the ACT, or\noutside Australia.\n","sortOrder":172},{"sectionNumber":"179","sectionType":"section","heading":"No entitlement to funeral benefits—death of foreign","content":"179 No entitlement to funeral benefits—death of foreign\nnational outside Australia\n(b) the person is a foreign national; and\n(c) the person’s death happens outside Australia.\n\nDefined benefits—funeral benefits Part 2.8\n(2) The person who has paid, or is liable to pay, the funeral expenses is\nnot entitled to funeral benefits in relation to the person’s death.\n","sortOrder":173},{"sectionNumber":"180","sectionType":"section","heading":"No entitlement to funeral benefits—funeral expenses paid","content":"180 No entitlement to funeral benefits—funeral expenses paid\n(b) funeral expenses in relation to the person are paid under a\nworkers compensation scheme.\n(2) The person who has paid, or is liable to pay, the funeral expenses is\nnot entitled to funeral benefits in relation to the person’s death.\n(3) If the person who has paid, or is liable to pay, the funeral expenses\nhas been paid funeral benefits under this part, the insurer is entitled\nto recover from the person the lesser of—\n(a) the amount of the funeral expenses paid under the workers\ncompensation scheme; and\n(b) the amount of the funeral benefits paid under this part.\n","sortOrder":174},{"sectionNumber":"181","sectionType":"section","heading":"Funeral benefits—maximum amount payable","content":"181 Funeral benefits—maximum amount payable\nThe maximum amount of funeral benefits payable is\n$15 000 AWE indexed.\n","sortOrder":175},{"sectionNumber":"182","sectionType":"section","heading":"Funeral benefits—MAI guidelines","content":"182 Funeral benefits—MAI guidelines\nThe MAI guidelines may make provision in relation to funeral\nbenefits, including what expenses may be included as funeral\nbenefits.\n\nPart 2.9 Defined benefits—Australians living overseas and foreign nationals\nPart 2.9 Defined benefits—Australians\nliving overseas and foreign\nnationals\n","sortOrder":176},{"sectionNumber":"183","sectionType":"section","heading":"Periodic payment of defined benefits—Australians living","content":"183 Periodic payment of defined benefits—Australians living\noverseas\n(a) an insurer must pay defined benefits to a person; and\n(b) the person is an Australian living overseas.\n(2) The insurer must pay the amount of treatment and care benefits and\nincome replacement benefits to which the Australian living overseas\nis entitled under this chapter in the form of regular instalments\n(periodic payments).\n(3) The periodic payments must be deposited into an account the\nAustralian living overseas has with an authorised deposit-taking\ninstitution.\nNote Authorised deposit-taking institution—see the Legislation Act,\ndictionary, pt 1.\n(4) The insurer must not commute defined benefits to which the\nAustralian living overseas is, or may be, entitled to a lump sum\npayment.\n(5) The MAI guidelines may make provision for determining the\n(a) the period for which an Australian living overseas must live\noutside Australia to be eligible for periodic payments\n(the eligibility period);\n(b) the amount and frequency of periodic payments payable to an\nAustralian living overseas.\n\nDefined benefits—Australians living overseas and foreign nationals Part 2.9\nAustralian living overseas means a person injured in a motor\naccident who—\n(a) is an Australian citizen or permanent resident of Australia; and\n(b) lives outside Australia; and\n(c) has lived outside Australia for at least the eligibility period\n(if any); and\n(d) intends to live outside Australia permanently or for an extended\ntime.\n","sortOrder":177},{"sectionNumber":"184","sectionType":"section","heading":"Lump sum payment of certain defined benefits—foreign","content":"184 Lump sum payment of certain defined benefits—foreign\nnationals\n(a) an insurer must pay treatment and care benefits or income\nreplacement benefits to a person injured in a motor accident; and\n(b) the injured person is a foreign national; and\n(c) the injured person intends to leave Australia permanently before\nthe end of the period for which the benefits are payable.\n(2) Before the injured person leaves Australia permanently, the injured\n(a) must notify the insurer that the person intends to leave Australia\npermanently; and\n(b) may apply to the insurer for the payment of a lump sum (a lump\nsum payment) to cover the person’s future entitlement to\ndefined benefits.\n(3) The insurer must continue to pay the injured person the defined\nbenefits to which the person is entitled until the day the person leaves\nAustralia permanently.\n\nPart 2.9 Defined benefits—Australians living overseas and foreign nationals\n(4) If the insurer receives an application under subsection (2) (b), the\ninsurer must—\n(a) calculate the amount of the lump sum payable to the person; and\n(b) notify the injured person, in writing, about the amount\ncalculated.\n(5) If the amount calculated under subsection (4) (a) is less than $10 000,\nthe injured person is not entitled to a lump sum payment.\n(6) If the amount calculated under subsection (4) (a) is $10 000 or more,\nthe insurer must pay the injured person the lump sum payment.\n(7) The lump sum may be calculated and made after the injured person\nleaves Australia permanently.\n(8) The injured person’s entitlement to defined benefits ends—\n(a) on the day the injured person leaves Australia permanently,\nif the injured person—\n(i) does not tell the insurer that the person intends to leave\nAustralia permanently; or\n(ii) tells the insurer that the person intends to leave Australia\npermanently but does not apply for a lump sum payment;\nor\n(iii) applies for a lump sum payment but the amount of the lump\nsum is less than $10 000; or\n(b) if the insurer pays the injured person a lump sum payment—the\nday the injured person receives the lump sum payment.\n(9) The injured person’s entitlement to defined benefits is not revived if\nthe person returns to Australia.\n\nDefined benefits—Australians living overseas and foreign nationals Part 2.9\n(10) The MAI guidelines may make provision for determining the\n(a) the eligibility of an injured person who is a foreign national to a\nlump sum payment;\n(b) the amounts to be included when calculating the amount of a\nlump sum and how the amount of the lump sum is to be\ncalculated.\n(11) If the injured person makes a motor accident claim in relation to the\nmotor accident, the amount of the lump sum payment must be taken\ninto account when assessing damages for the motor accident claim.\n\nPart 2.10 Defined benefits—dispute\nresolution\n","sortOrder":178},{"sectionNumber":"185","sectionType":"section","heading":"Definitions—pt 2.10","content":"185 Definitions—pt 2.10\ninsurer, in relation to an application for defined benefits, means the\ninsurer of a motor vehicle involved in a motor accident to which the\napplication relates.\ninternal review notice—see section 191 (1) (b).\ninsurer, of a motor vehicle—see section 34 (2).\n","sortOrder":179},{"sectionNumber":"186","sectionType":"section","heading":"Definitions—div 2.10.2","content":"186 Definitions—div 2.10.2\ninternally reviewable decision means a decision of an insurer—\n(a) mentioned in schedule 1, part 1.1, column 3 under a provision\nof this Act mentioned in column 2 in relation to the decision; or\n(b) prescribed by regulation.\ninternal review, of an insurer’s internally reviewable decision, means\na review of the decision, carried out by the insurer under this part.\n\nInternal review of insurer’s decisions Division 2.10.2\n","sortOrder":180},{"sectionNumber":"187","sectionType":"section","heading":"Internal review—application","content":"187 Internal review—application\n(1) The following people may apply to an insurer for internal review of\nan internally reviewable decision the insurer has made about an\napplication for defined benefits:\n(a) an applicant for defined benefits;\n(b) if an applicant for defined benefits is a person with a legal\n(c) if the dependant of a person who died as a result of the motor\naccident is a person with a legal disability—the dependant’s\nguardian;\n(d) the personal representative of a person who died as a result of\n(2) An application for internal review must be made within 28 days\nafter—\n(a) the date of the internally reviewable decision; or\n(b) if the insurer has not made the internally reviewable decision\nwithin the time required under this Act—the end of the time\nrequired for making the decision.\n(3) However, an application for internal review may be made after the\n28 days (a late application) if—\n(a) the applicant satisfies the insurer that they have a full and\nsatisfactory explanation for the delay; and\n(b) the MAI guidelines provide for a late application to be made\nwithin a longer period; and\n(c) the late application is made within the longer period.\n\n(4) For subsection (3) (a), a full and satisfactory explanation by an\napplicant for a delay is a full account of the conduct, including the\nactions, knowledge and belief of the applicant, beginning on the date\nof the internally reviewable decision until the date of providing the\nexplanation.\n(5) The explanation is not a satisfactory explanation unless a reasonable\nperson in the circumstances explained by the applicant would have\nbeen justified in delaying the application.\n","sortOrder":181},{"sectionNumber":"188","sectionType":"section","heading":"Conduct of internal review—MAI guidelines","content":"188 Conduct of internal review—MAI guidelines\n(1) The MAI guidelines may make provision for the internal review of\ninternally reviewable decisions, including applications for internal\nreview.\n(2) An application for internal review, and the conduct of the review,\nmust comply with the MAI guidelines.\n","sortOrder":182},{"sectionNumber":"189","sectionType":"section","heading":"Internal review—application does not stay decision","content":"189 Internal review—application does not stay decision\nA request for internal review of an internally reviewable decision\ndoes not operate to stay the decision or otherwise prevent action being\ntaken based on the decision.\n","sortOrder":183},{"sectionNumber":"190","sectionType":"section","heading":"Internal review—information to be considered","content":"190 Internal review—information to be considered\n(1) The applicant must give the insurer the information the insurer\nrequests and reasonably requires for the internal review.\n(2) An internal reviewer may consider information that was not provided\nbefore the decision being reviewed was made.\n\nInternal review of insurer’s decisions Division 2.10.2\n","sortOrder":184},{"sectionNumber":"191","sectionType":"section","heading":"Internal review—decision","content":"191 Internal review—decision\n(1) An insurer must, within 10 business days after receiving an\napplication for internal review of an internally reviewable decision—\n(a) decide to—\n(i) affirm the decision; or\n(ii) amend the decision; or\n(iii) set aside the decision and make a substitute decision; and\n(b) give the applicant written notice of the decision (an internal\nreview notice) that includes the following:\n(i) the reasons for the decision;\n(ii) information about how the applicant may apply for\nexternal review of the decision.\n(2) However, the MAI guidelines may provide for particular\ncircumstances in which the 10 business days may be extended.\n(3) A decision by the insurer under subsection (1) takes effect on the day\nthe internally reviewable decision was made.\n(4) A regulation may prescribe—\n(a) additional information an internal review notice may or must\ncontain; and\n(b) any document or thing that must accompany a notice; and\n(c) anything else in relation to a notice.\n\n","sortOrder":185},{"sectionNumber":"192","sectionType":"section","heading":"Meaning of ACAT reviewable decision—div 2.10.3","content":"192 Meaning of ACAT reviewable decision—div 2.10.3\nACAT reviewable decision means a decision of an insurer—\n(a) mentioned in schedule 1, part 1.2, column 3 under a provision\nof this Act mentioned in column 2 in relation to the decision; or\n(b) prescribed by regulation.\n","sortOrder":186},{"sectionNumber":"193","sectionType":"section","heading":"ACAT review—application","content":"193 ACAT review—application\n(1) The following people may apply to the ACAT for external review of\nan ACAT reviewable decision on a question of law or fact:\n(a) an applicant for defined benefits;\n(b) if an applicant for defined benefits is a person with a legal\n(c) if the dependant of a person who died as a result of the motor\naccident is a person with a legal disability—the dependant’s\nguardian;\n(d) the personal representative of a person who died as a result of\nthe motor accident;\n(e) the insurer of a motor vehicle involved in the motor accident.\n\n(2) An application for external review of an ACAT reviewable decision\nmust be made within—\n(a) 28 days after the day the applicant for external review is given\nan internal review notice in relation to the ACAT reviewable\ndecision; or\n(b) if the applicant for external review is not given an internal\nreview notice in relation to the ACAT reviewable decision—\n28 days after the applicant becomes aware of the decision; or\n(c) if a regulation prescribes a different time within which to make\nan application—the prescribed time.\nNote 1 For how to make an application to the ACAT, see the ACT Civil and\nAdministrative Tribunal Act 2008, s 10.\nNote 2 For how documents may be given, see the Legislation Act, pt 19.5.\n","sortOrder":187},{"sectionNumber":"194","sectionType":"section","heading":"Time for making application when no decision made","content":"194 Time for making application when no decision made\nunder s 191\n(a) an insurer is required to make a decision under section 191\n(Internal review—decision) (a section 191 decision) in relation\nto an application for internal review of an internally reviewable\ndecision; and\n(b) the insurer has not made the section 191 decision within the time\nrequired under section 191 (1), or any further time allowed\nunder the MAI guidelines; and\n(c) the applicant for internal review may apply to the ACAT for\nreview of the internally reviewable decision.\n(2) An application for review of the internally reviewable decision may\nbe made within 28 days after the end of the period mentioned in\nsubsection (1) (b).\n\n","sortOrder":188},{"sectionNumber":"195","sectionType":"section","heading":"External review—ACAT to notify insurer etc","content":"195 External review—ACAT to notify insurer etc\nAs soon as practicable after receiving an application for external\nreview of an ACAT reviewable decision, the ACAT must give written\nnotice of the application to—\n(a) if the applicant is an applicant for defined benefits—the insurer\nwho made the decision; or\n(b) if the applicant is the insurer of a motor vehicle involved in the\nmotor accident—\n(i) the applicant for defined benefits; and\n(ii) the insurer who made the decision.\n","sortOrder":189},{"sectionNumber":"196","sectionType":"section","heading":"External review—application does not stay decision","content":"196 External review—application does not stay decision\nAn application for external review of an ACAT reviewable decision\ndoes not operate to stay the decision or otherwise prevent action being\ntaken based on the decision.\nNote The ACAT may order a stay of the ACAT reviewable decision (see ACT\nCivil and Administrative Tribunal Act 2008, s 53).\n","sortOrder":190},{"sectionNumber":"197","sectionType":"section","heading":"External review—decision","content":"197 External review—decision\n(1) In deciding an application for external review of an ACAT\nreviewable decision, the ACAT must, by order—\n(a) affirm the decision; or\n(b) amend the decision; or\n(c) set aside the decision and—\n(i) make a substitute decision; or\n(ii) remit the matter for reconsideration by the insurer that\nmade the decision (the decision-maker) in accordance with\nany direction of the ACAT.\n\n(2) In deciding the application for external review, the ACAT must only\nconsider the information that was available to the decision-maker\nwhen the decision was made.\n(3) However, the ACAT may, on application by a party, give the party\nleave to present information or evidence that was not reasonably\navailable to the decision-maker when the decision was made.\na medical report for an examination undertaken, but not reported on, when the\ndecision was made\n(4) A regulation may prescribe conditions for allowing additional\ninformation or evidence to be presented under subsection (3).\n","sortOrder":191},{"sectionNumber":"198","sectionType":"section","heading":"External review—costs of proceedings","content":"198 External review—costs of proceedings\n(1) The ACAT may order a party to pay the costs of the other party\narising from an application for external review of an ACAT\nreviewable decision.\n(2) However, the ACAT must not award the costs of, or incidental to, an\napplication for external review against an injured person if—\n(a) the injured person made the application in good faith; and\n(b) the ACAT is satisfied that the applicant has an arguable basis\nfor the application.\n(3) The ACAT may be satisfied an applicant has an arguable basis for an\napplication for external review if the applicant appears in person.\n(4) A regulation may prescribe the following:\n(a) when an order under subsection (1) may be made;\n(b) what may be considered to be a disbursement;\n(c) the maximum amount that can be awarded for particular costs;\n\n(d) the maximum amount of costs that can be awarded in relation to\nan application for external review of an ACAT reviewable\ndecision.\ncosts include disbursements.\n","sortOrder":192},{"sectionNumber":"199","sectionType":"section","heading":"External review—effect of decision","content":"199 External review—effect of decision\n(1) This section applies if the ACAT makes an order under section 197\n(External review—decision) in relation to an ACAT reviewable\ndecision (other than an order under section 197 (1) (c) (ii)).\n(2) The order—\n(a) is taken to be the decision of the decision-maker who made the\nACAT reviewable decision; and\n(b) takes effect—\n(i) for an order relating to an application for external review\nof an internally reviewable decision—on the day the\ninternally reviewable decision was made, unless the ACAT\notherwise orders; and\n(ii) in any other case—on the day the externally reviewable\ndecision was made, unless the ACAT otherwise orders.\n(3) If the ACAT orders the payment of a defined benefit to an applicant\nfor defined benefits, the relevant insurer for the application must pay\nthe applicant the amount of defined benefits owing to the applicant.\n\n","sortOrder":193},{"sectionNumber":"200","sectionType":"section","heading":"External review—time for appeal","content":"200 External review—time for appeal\n(1) This section applies to an application for external review of an ACAT\nreviewable decision under the ACT Civil and Administrative Tribunal\nAct 2008, section 79 (Appeals within tribunal) to appeal the ACAT’s\ndecision under section 197 (External review—decision).\n(2) The application must be made within 28 days after the date of the\nACAT reviewable decision.\n","sortOrder":194},{"sectionNumber":"201","sectionType":"section","heading":"No monetary limit on jurisdiction of ACAT","content":"201 No monetary limit on jurisdiction of ACAT\n(1) The ACAT is not, in exercising jurisdiction conferred on it by this\npart, limited in the amount of money that it may order to be paid.\n(2) This section is subject to—\n(a) section 198 (External review—costs of proceedings); and\n(b) any other provision under this Act relating to an amount payable\nin relation to a defined benefit.\n","sortOrder":195},{"sectionNumber":"202","sectionType":"section","heading":"Inconsistency between Act and ACAT Act, pt 4A","content":"202 Inconsistency between Act and ACAT Act, pt 4A\nThis part prevails if there is an inconsistency between this part and\nthe ACT Civil and Administrative Tribunal Act 2008, part 4A\n(Administrative review).\n\n","sortOrder":196},{"sectionNumber":"203","sectionType":"section","heading":"Legal costs and fees payable by applicants and insurers","content":"203 Legal costs and fees payable by applicants and insurers\n(1) A regulation may prescribe the legal costs and fees payable by\napplicants and insurers in relation to applications for defined benefits\n(including in relation to dispute resolution).\n(2) If a legal cost or fee is prescribed under subsection (1), a lawyer who\nprovides a service to which the cost or fee relates to an applicant or\ninsurer in relation to an application for defined benefits is only\nentitled to be paid, or to recover, the prescribed cost or fee for the\nservice.\n","sortOrder":197},{"sectionNumber":"204","sectionType":"section","heading":"Defined benefits information service","content":"204 Defined benefits information service\n(1) The MAI commission may approve an entity (other than an\nindividual) to provide a defined benefits information service for this\nAct.\n(2) The MAI guidelines may make provision in relation to defined\nbenefits information services, including—\n(a) the form and content of applications for approval to provide a\ndefined benefits information service; and\n(b) the application process; and\n(c) the qualifications required of providers; and\n(d) the duration and conditions of approvals; and\n(e) the information services to be provided.\n(3) To remove any doubt, nothing in this section prevents a lawyer from\nproviding advice about defined benefits in the course of providing\nlegal services.\nlegal services—see the Legal Profession Act 2006, dictionary.\n\nSignificant occupational impact of injuries—important concepts Part 3.1\nChapter 3 Motor accident injuries—\nsignificant occupational impact\nPart 3.1 Significant occupational impact\nof injuries—important concepts\n205 Meaning of significant occupational impact\nsignificant occupational impact (or SOI), of an injured person’s\ninjury on the person’s ability to undertake employment—an injury\nsustained by a person injured in a motor accident has a significant\noccupational impact on the person’s ability to undertake employment\nif the person—\n(a) either—\n(i) is prevented from performing the work the person\nperformed before the motor accident; or\n(ii) has reduced capacity to perform the work the person\nperformed before the motor accident; and\n(i) is unable, or has limited ability, to undertake training in\nanother area of work; or\n(ii) cannot undertake appropriate alternative employment.\n","sortOrder":198},{"sectionNumber":"206","sectionType":"section","heading":"Meaning of independent assessor","content":"206 Meaning of independent assessor\nindependent assessor—\n(a) means a person who conducts SOI assessments under an\narrangement with an authorised IME provider; but\n\n","sortOrder":199},{"sectionNumber":"Part 3","sectionType":"part","heading":"1 Significant occupational impact of injuries—important concepts","content":"Part 3.1 Significant occupational impact of injuries—important concepts\n(b) does not include a person prescribed by regulation.\n","sortOrder":200},{"sectionNumber":"207","sectionType":"section","heading":"Meaning of SOI assessment and SOI report","content":"207 Meaning of SOI assessment and SOI report\nSOI assessment, of a person injured in a motor accident, means an\nassessment to evaluate and report on whether the person’s injury has\na significant occupational impact on the person’s ability to undertake\nemployment.\nSOI report means a written report, by an independent medical\nexaminer or independent assessor, of an injured person’s injury\nthat—\n(a) states whether the person’s injury has a significant occupational\nimpact on the person’s ability to undertake employment; and\n(b) complies with the SOI assessment guidelines.\n","sortOrder":201},{"sectionNumber":"208","sectionType":"section","heading":"SOI assessment guidelines","content":"208 SOI assessment guidelines\n(1) The MAI commission must make guidelines (the SOI assessment\nguidelines) for SOI assessments.\n(2) The SOI assessment guidelines may—\n(a) state procedures and principles to be followed in making an\nSOI assessment; and\n(b) apply, adopt or incorporate a law of another jurisdiction or\ninstrument as in force from time to time.\nNote A reference to an instrument includes a reference to a provision of\nan instrument (see Legislation Act, s 14 (2)).\n\nSignificant occupational impact of injuries—important concepts Part 3.1\n(3) The Legislation Act, section 47 (6) does not apply in relation to a law\nor instrument applied, adopted or incorporated under\nsubsection (2) (b).\nNote A law or instrument applied, adopted or incorporated under s (2) (b) does\nnot need to be notified under the Legislation Act because s 47 (6) does\nnot apply (see Legislation Act, s 47 (7)).\n(4) The SOI assessment guidelines are a disallowable instrument.\n\n","sortOrder":202},{"sectionNumber":"209","sectionType":"section","heading":"SOI assessment 4 years 6 months after motor accident","content":"209 SOI assessment 4 years 6 months after motor accident\n(a) a person injured in a motor accident is receiving income\nreplacement benefits or, because of the circumstances\nprescribed by regulation, would have been eligible to receive\nincome replacement benefits; and\n(b) the person made a quality of life benefits application and—\n(i) if separate WPI reports from an independent medical\nexaminer assess the person’s physical injuries and\npsychological injuries—the higher WPI assessment\nassesses the person’s WPI as less than 10%; or\n(ii) if only 1 WPI report from an independent medical\nexaminer assesses the person’s WPI—the person’s WPI is\nless than 10%; and\n(c) the relevant insurer has not previously referred the injured\nperson to an authorised IME provider under this section for an\nSOI assessment in relation to the injuries; and\n(d) 4 years and 6 months has passed since the date of the motor\n(e) the person consents to the relevant insurer referring the injured\nperson to an authorised IME provider for an SOI assessment.\nIME provider for an SOI assessment.\n(3) The relevant insurer for a motor accident is liable for the costs of an\nSOI assessment, unless otherwise provided in this chapter.\n\nSOI assessments Part 3.2\n","sortOrder":203},{"sectionNumber":"210","sectionType":"section","heading":"Arrangement of SOI assessment","content":"210 Arrangement of SOI assessment\n(1) This section applies if an injured person is referred to an authorised\nIME provider for an SOI assessment under section 209.\n(2) The IME provider must arrange for the SOI assessment to be carried\nout—\n(a) by 1 or more independent medical examiners or independent\nassessors who are trained as required by the SOI assessment\nguidelines; and\n(b) in accordance with the SOI assessment guidelines.\n(3) The MAI guidelines may make provision in relation to the procedure\nfor arranging an SOI assessment of an injured person, including—\n(a) selecting an IME provider; and\n(b) the time within which the assessment must be arranged; and\n(c) arrangements for payment of the assessment.\n","sortOrder":204},{"sectionNumber":"211","sectionType":"section","heading":"SOI assessment—provision of information","content":"211 SOI assessment—provision of information\n(1) This section applies if an authorised IME provider arranges for an\nindependent medical examiner or independent assessor to carry out\nan SOI assessment of an injured person.\n(2) The injured person must give the authorised IME provider and the\nperson carrying out the assessment (the assessor)—\n(a) all information in the injured person’s possession that is relevant\nto the SOI assessment; and\n(b) any other information the authorised IME provider or assessor\nreasonably requires for the SOI assessment.\n\n(3) The relevant insurer for the motor accident must give the authorised\nIME provider and the assessor—\n(a) all information in the insurer’s possession that is relevant to the\nSOI assessment; and\n(b) a copy of any WPI reports in the insurer’s possession; and\n(c) any other information the authorised IME provider or assessor\nreasonably requires for the SOI assessment.\n(4) The information must be given to the authorised IME provider and\nthe assessor at least 10 days before the day the assessor is to carry out\nthe SOI assessment.\n(5) The assessor may decline to carry out the SOI assessment if the\ninjured person or the insurer fails to give any information reasonably\nrequired by the authorised IME provider or assessor.\n","sortOrder":205},{"sectionNumber":"212","sectionType":"section","heading":"SOI report to be prepared","content":"212 SOI report to be prepared\n(1) An independent medical examiner or independent assessor who\ncarries out an SOI assessment of an injured person must give an\nSOI report about the assessment to the IME provider who arranged\nthe assessment.\n(2) The IME provider must give the SOI report to the relevant insurer for\n(3) The SOI assessment guidelines may make provision for the\nrequirements for an SOI report, including the time within which an\nSOI report must be given.\n","sortOrder":206},{"sectionNumber":"213","sectionType":"section","heading":"SOI report—injury has significant occupational impact","content":"213 SOI report—injury has significant occupational impact\n(a) a relevant insurer refers an injured person to an authorised IME\nprovider for an SOI assessment; and\n\nSOI assessments Part 3.2\n(b) the authorised IME provider arranges for an independent\nmedical examiner or independent assessor to carry out an\nSOI assessment of the person; and\n(c) an SOI report from the independent medical examiner or\nindependent assessor confirms the person’s injury has a\nsignificant occupational impact on the person’s ability to\nundertake employment.\n(2) The injured person—\n(a) is taken to have a WPI of 10% for this Act; and\n(b) is entitled to make a motor accident claim in relation to the\nmotor accident.\n(3) Subsection (2) does not prevent a person mentioned in that subsection\nfrom reviving a quality of life benefits application.\n(4) The relevant insurer for the motor accident must, within 14 days after\nreceiving the SOI report, give the injured person a written notice—\n(a) including a copy of the report and the WPI report, if any; and\n(b) stating that—\n(i) the person is taken to have a WPI of 10% for this Act; and\n(ii) the person is entitled to make a motor accident claim in\n","sortOrder":207},{"sectionNumber":"214","sectionType":"section","heading":"SOI report—no significant occupational impact","content":"214 SOI report—no significant occupational impact\n(1) This section applies if an SOI report of an injured person confirms\nthat the injured person’s injury has not had a significant occupational\nimpact on the person’s ability to undertake employment.\n(2) The relevant insurer for the motor accident must, within 14 days after\nreceiving the SOI report, give the injured person a written notice—\n(a) including a copy of the report; and\n\n(b) stating that the person may apply to the ACAT for a review of\nthe SOI report.\n\nSOI reports—ACAT review Part 3.3\n","sortOrder":208},{"sectionNumber":"215","sectionType":"section","heading":"SOI report—no significant occupational impact—ACAT","content":"215 SOI report—no significant occupational impact—ACAT\nreview\n(1) If an injured person receives a notice under section 214 in relation to\nan SOI report, the injured person may apply to the ACAT for review\nof the report.\n(2) An application for review of the SOI report must be made within\n14 days after the day the injured person received the notice.\n(3) The independent medical examiner or independent assessor who\ncarries out the SOI assessment of the injured person must not be—\n(a) named as a respondent to an application made under\nsubsection (1); or\n(b) joined as a party to an application made under subsection (1).\n","sortOrder":209},{"sectionNumber":"216","sectionType":"section","heading":"Review of SOI report—ACAT to notify insurer etc","content":"216 Review of SOI report—ACAT to notify insurer etc\nAs soon as practicable after receiving an application for review of an\nSOI report under section 215, the ACAT must give written notice of\nthe application to—\n(a) the IME provider that arranged the SOI assessment to which the\nSOI report relates; and\n(b) the relevant insurer for the motor accident.\n\n","sortOrder":210},{"sectionNumber":"217","sectionType":"section","heading":"Review of SOI report—IME provider to give ACAT","content":"217 Review of SOI report—IME provider to give ACAT\n(1) This section applies if an IME provider receives a notice under\nsection 216 in relation to an application for review of an SOI report.\n(2) The IME provider must, within 14 days after receiving the notice,\ngive the ACAT all information in the provider’s possession that was\nused in carrying out the SOI assessment to which the SOI report\nrelates.\n","sortOrder":211},{"sectionNumber":"218","sectionType":"section","heading":"ACAT review—decision","content":"218 ACAT review—decision\n(1) In deciding an application for review of an SOI report of a person\ninjured in a motor accident, the ACAT must, by order—\n(a) affirm the SOI report; or\n(b) set aside the SOI report and make an order confirming that the\ninjured person’s injury has had a significant occupational impact\non the person’s ability to undertake employment.\n(2) In deciding the application for review, the ACAT must only consider\nthe information that was available to the independent medical\nexaminer or independent assessor when the SOI assessment to which\nthe SOI report relates was carried out.\n(3) However, the ACAT may, on application by a party, give the party\nleave to present information or evidence that was not reasonably\navailable to the independent medical examiner or independent\nassessor when the SOI assessment was carried out.\na medical report for an examination undertaken, but not reported on, when the\nSOI assessment was carried out\n(4) If the ACAT makes an order under subsection (1), the order takes\neffect on the date the ACAT makes the order, unless the ACAT\notherwise orders.\n\nSOI reports—ACAT review Part 3.3\n(5) To remove any doubt, if the ACAT makes an order under\nsubsection (1) (b), section 213 applies as if the decision of the ACAT\nis an SOI report from an independent medical examiner or\nindependent assessor.\n(6) A regulation may prescribe conditions for allowing additional\ninformation or evidence to be presented under subsection (3).\n","sortOrder":212},{"sectionNumber":"219","sectionType":"section","heading":"Effect of ACAT order affirming SOI report","content":"219 Effect of ACAT order affirming SOI report\n(1) This section applies if the ACAT makes an order under\nsection 218 (1) (a) affirming an SOI report in relation to a person\ninjured in a motor accident.\n(2) The relevant insurer for the motor accident must pay the injured\nperson the amount of quality of life benefits payable to the person\nunder section 167 (Amount of quality of life benefits payable).\nNote The amount of quality of life benefits payable under s 167 depends on the\ninjured person’s WPI, as assessed under s 141 or div 2.6.3.\n\nPart 3.4 Significant occupational impact of injuries—miscellaneous\nPart 3.4 Significant occupational impact\nof injuries—miscellaneous\n220 Effect of SOI assessment on motor accident claim\nDespite the Limitation Act 1985, section 16AA (Motor accident\nclaims), a person injured in a motor accident who has had an SOI\nassessment has 3 months from the latest of the following dates to\nmake a motor accident claim in relation to the motor accident:\n(a) if the injured person receives a notice under section 213 (4)\n(SOI report—injury has significant occupational impact)—the\ndate of the notice;\n(b) if the ACAT makes an order under section 218 (1) (b)—\n(i) if no appeal from the order is made—the date the appeal\nperiod for the order ends; or\n(ii) if an appeal from the order is made—the date the appeal is\nfinally decided.\n\n","sortOrder":213},{"sectionNumber":"Part 4","sectionType":"part","heading":"Payment of future medical","content":"Chapter 4 Payment of future medical\ntreatment expenses\n","sortOrder":214},{"sectionNumber":"221","sectionType":"section","heading":"Definitions—ch 4","content":"221 Definitions—ch 4\nfuture treatment payment—see section 222 (2).\nmedical treatment means medical treatment prescribed by regulation.\n","sortOrder":215},{"sectionNumber":"222","sectionType":"section","heading":"Application for future treatment payment","content":"222 Application for future treatment payment\n(1) This section applies to a person injured in a motor accident if—\n(a) at the relevant date for the motor accident, the person is\nreceiving treatment and care benefits for treatment and care\nexpenses related to medical treatment; and\n(b) has, immediately before the relevant date for the motor accident,\nbeen receiving medical treatment continuously for at least\n2 years and 6 months; and\n(c) was not the driver at fault, or is not taken to be the driver at fault,\nin the motor accident; and\n(d) is not entitled to make a motor accident claim.\n(2) The injured person may apply to the relevant insurer for the motor\naccident for payment of an amount (a future treatment payment) to\ncover expenses for approved medical treatment the person receives—\n(a) after the person’s entitlement to defined benefits for treatment\nand care ends; and\n(b) not later than 10 years after the date of the motor accident.\n\n(3) The application must be made—\n(a) not earlier than the relevant date for the motor accident; and\n(b) not later than 5 years after the date of the motor accident.\napproved medical treatment, for a person injured in a motor accident,\nmeans medical treatment that is of the same kind that—\n(a) the person received in the 6-month period following the\n4th anniversary of the motor accident; and\n(b) the relevant insurer for the motor accident has paid or agreed to\npay.\ncontinuous—an injured person is receiving medical treatment\ncontinuously if the injured person is receiving medical treatment at\nleast monthly.\nexpenses, of an injured person, does not include expenses for medical\ntreatment—\n(a) received before the date of the application; or\n(b) for which the relevant insurer has previously refused to pay.\nExample—par (b)\nthe medical treatment was not reasonable and necessary in the circumstances\nrelevant date, for a motor accident, means the date that is 4 years and\n6 months after the date of the motor accident.\n\n","sortOrder":216},{"sectionNumber":"223","sectionType":"section","heading":"Future treatment payment—assessment and calculation","content":"223 Future treatment payment—assessment and calculation\nIf the relevant insurer for a motor accident receives an application\nunder section 222, the insurer must—\n(a) assess—\n(i) whether the applicant’s approved medical treatment, and\nthe costs of the medical treatment, are reasonable and\nnecessary; and\n(ii) the period for which the applicant will need the approved\nmedical treatment; and\n(b) consider the opportunities available to the applicant for\ninvesting a future treatment payment; and\n(c) calculate the amount payable to the applicant; and\nExample—calculation of amount payable\nA person injured in a motor accident receives the following continuous\nmedical treatment in the 6 months before the relevant date for the motor\naccident:\n• 2 appointments at 3-monthly intervals with a medical specialist;\n• 2 appointments at 3-monthly intervals with a physiotherapist;\n• 2 appointments at 3-monthly intervals with a psychiatrist.\nFor the purposes of calculating the amount payable to the person, if they\ncontinue to require treatment with the 3 health practitioners after their\nentitlement to treatment and care benefits ends, expenses for the 3 health\npractitioners may be included in the calculation.\n(d) within 2 months after the day the application is made, give the\napplicant a written notice that includes the following:\n(i) the amount calculated;\n(ii) information about how the amount was calculated,\nincluding what information was considered in calculating\nthe amount;\n\n(iii) a statement to the effect that the amount calculated relates\nonly to expenses for approved medical treatment the\napplicant receives—\n(A) after the person’s entitlement to defined benefits for\ntreatment and care ends; and\n(B) not later than 10 years after the date of the motor\naccident;\n(iv) a statement to the effect that—\n(A) the applicant may agree to the amount calculated or\nnegotiate with the insurer for a different amount; and\n(B) if the applicant negotiates with the insurer for a\ndifferent amount—the applicant may rely on medical\ninformation the applicant sought for the purposes of\nthe negotiation; and\n(C) an amount agreed to under this section (including a\nnegotiated amount) applies only to future medical\ntreatment.\n","sortOrder":217},{"sectionNumber":"224","sectionType":"section","heading":"No agreement on future treatment payment—application","content":"224 No agreement on future treatment payment—application\nto ACAT\n(1) If the relevant insurer for a motor accident and an injured person who\nreceives a notice under section 223 are unable to agree on the future\ntreatment payment, the insurer or injured person may apply to the\nACAT for—\n(a) a determination of the future treatment payment; and\n(b) an order for payment of the future treatment payment.\n(2) The MAI guidelines may make provision in relation to the\ninformation to be given to the ACAT with an application under\nsubsection (1).\n\n","sortOrder":218},{"sectionNumber":"225","sectionType":"section","heading":"Decision about future treatment payment—ACAT orders","content":"225 Decision about future treatment payment—ACAT orders\n(1) On application under section 224, the ACAT must—\n(a) decide the future treatment payment the ACAT considers\nappropriate for the injured person; and\n(b) order the relevant insurer to pay the future treatment payment to\nthe injured person.\n(2) In deciding the future treatment payment, the ACAT—\n(a) must consider—\n(i) evidence about the injured person’s medical treatment; and\n(ii) the opportunities available to the injured person for\ninvesting the payment; and\n(b) may—\n(i) consider any other relevant matter; and\n(ii) ask for additional information in relation to the application.\n","sortOrder":219},{"sectionNumber":"226","sectionType":"section","heading":"Future treatment payment—costs of proceedings","content":"226 Future treatment payment—costs of proceedings\n(1) The ACAT may order a party to pay the costs of the other party\narising from an application under section 224.\n(2) A regulation may prescribe the following:\n(a) when an order under subsection (1) may be made;\n(b) what may be considered a disbursement;\n(c) the maximum amount that can be awarded for particular costs;\n\n(d) the maximum amount of costs that can be awarded in relation to\nan application under section 224.\ncosts include disbursements.\n","sortOrder":220},{"sectionNumber":"227","sectionType":"section","heading":"Future treatment payment—no monetary limit on","content":"227 Future treatment payment—no monetary limit on\njurisdiction of ACAT\n(1) The ACAT is not, in exercising jurisdiction conferred on it by this\nchapter, limited in the amount of the future treatment payment it may\norder to be paid.\n(2) This section is subject to section 226.\n\n","sortOrder":221},{"sectionNumber":"Part 5","sectionType":"part","heading":"Motor accident injuries—","content":"Chapter 5 Motor accident injuries—\ncommon law damages\n","sortOrder":222},{"sectionNumber":"228","sectionType":"section","heading":"Meaning of motor accident claim","content":"228 Meaning of motor accident claim\nmotor accident claim—\n(a) means a claim for damages for personal injury caused by a motor\n(b) for a fatal injury, includes a claim by the dead person’s\ndependants or estate.\n","sortOrder":223},{"sectionNumber":"229","sectionType":"section","heading":"Meaning of claimant for motor accident claim","content":"229 Meaning of claimant for motor accident claim\nclaimant, for a motor accident claim, means—\n(a) a person who makes, or is entitled to make, the motor accident\nclaim; or\n(b) in relation to rehabilitation, medical treatment or loss suffered—\nthe injured person to whom the motor accident claim relates.\n","sortOrder":224},{"sectionNumber":"230","sectionType":"section","heading":"Meaning of respondent for motor accident claim—ch 5","content":"230 Meaning of respondent for motor accident claim—ch 5\nrespondent, for a motor accident claim—\n(a) means a person against whom a claimant makes the motor\naccident claim; and\n\n(b) includes—\n(i) if the person mentioned in paragraph (a) is not the insurer\nfor the motor accident claim—the insurer for the motor\naccident claim; and\n(ii) a person added as a later respondent under the Civil Law\n(Wrongs) Act 2002, section 55 (Claimant may add later\nrespondents).\n","sortOrder":225},{"sectionNumber":"231","sectionType":"section","heading":"Meaning of insured person for motor accident claim","content":"231 Meaning of insured person for motor accident claim\ninsured person, for a motor accident claim, means—\n(a) an MAI insured person; or\n(b) a person for whose acts and omissions the nominal defendant is\nliable under section 326 (Nominal defendant liable—uninsured\nmotor vehicle).\n","sortOrder":226},{"sectionNumber":"232","sectionType":"section","heading":"Meaning of insurer for motor accident claim","content":"232 Meaning of insurer for motor accident claim\ninsurer, of a motor vehicle, for a motor accident claim means—\n(a) for an insured motor vehicle—the MAI insurer for the motor\n(b) for a motor vehicle insured by an interstate insurer—the\ninterstate insurer; or\n(c) for an uninsured motor vehicle—the nominal defendant; or\n(d) for an unidentified motor vehicle—the nominal defendant.\ninsurer, of a person, for a motor accident claim means—\n(a) for an MAI insured person—the MAI insurer for the person; or\n(b) in any other case—the nominal defendant.\n\n","sortOrder":227},{"sectionNumber":"233","sectionType":"section","heading":"Defined benefit payment etc—no effect on liability under","content":"233 Defined benefit payment etc—no effect on liability under\nmotor accident claim\nThe acceptance, or deemed acceptance, of liability for an application\nfor defined benefits, or payment of defined benefits, by an insurer in\nrelation to a motor accident—\n(a) is not an admission of liability in relation to the motor accident;\nand\n(b) does not in any way prejudice or affect a claim or proceeding\narising out of the motor accident.\n","sortOrder":228},{"sectionNumber":"234","sectionType":"section","heading":"Insured person not to admit liability, settle or make","content":"234 Insured person not to admit liability, settle or make\npayments\n(1) An insured person must not, without the written agreement of the\nperson’s insurer—\n(a) admit liability in relation to a motor accident claim; or\n(b) settle, or offer to settle, a motor accident claim; or\n(c) make a payment, or offer or promise to make a payment, in\nrelation to a motor accident claim.\n(2) A contract, offer or promise made in contravention of this section\ndoes not bind the insurer.\n(3) This section does not prevent an insured person from providing a\npolice officer with information reasonably required to prepare a\nreport about a motor accident.\n(4) An insured person who contravenes this section does not incur civil\nliability to an insurer.\n\n","sortOrder":229},{"sectionNumber":"235","sectionType":"section","heading":"Power of insurer to act for insured","content":"235 Power of insurer to act for insured\n(1) If a motor accident claim is made against an insured person, the\nperson’s insurer—\n(a) must carry out the negotiations and legal proceedings related to\nthe motor accident claim; and\n(b) may compromise or settle the motor accident claim and legal\nproceedings related to the motor accident claim; and\n(c) may act for the insured person in any other way for the motor\naccident claim.\n(2) The insured person must sign any documents necessary to give effect\nto this section and, if the insured person does not sign or is dead,\nabsent or cannot be found, the insurer may sign for the insured person.\n(3) Nothing said or done by an insurer in relation to a motor accident\nclaim, or legal proceedings related to a motor accident claim, is an\nadmission of liability in, or otherwise prejudices or affects, another\nclaim or proceedings arising out of the same circumstances.\n","sortOrder":230},{"sectionNumber":"236","sectionType":"section","heading":"Nominal defendant may deal with motor accident claims","content":"236 Nominal defendant may deal with motor accident claims\n(1) If a motor accident claim is made against the nominal defendant, the\nnominal defendant may deal with the motor accident claim, and any\nproceeding relating to the motor accident claim, in the way the\nnominal defendant considers appropriate including—\n(a) settling or compromising the motor accident claim; and\n(b) bringing and prosecuting a proceeding under this Act for the\nmotor accident claim and settling or compromising the\nproceeding.\n(2) The nominal defendant must give the MAI commission the reports\nthat the MAI commission reasonably requires about anything done by\nthe nominal defendant under this section.\n\n","sortOrder":231},{"sectionNumber":"237","sectionType":"section","heading":"Insurer may intervene in proceeding","content":"237 Insurer may intervene in proceeding\nAn insurer may apply to the court to be joined as a party to a\nproceeding brought against a defendant who is insured under an\nMAI policy with the insurer in order to argue that in the\ncircumstances of the case it has no obligations under the policy to\nindemnify the defendant.\n","sortOrder":232},{"sectionNumber":"238","sectionType":"section","heading":"Motor accident claim—notification of claim made under","content":"238 Motor accident claim—notification of claim made under\nworkers compensation scheme\n(a) a claimant makes a motor accident claim in relation to a motor\n(b) the claimant has made a claim for compensation under a workers\ncompensation scheme (the workers compensation claim) in\nrelation to personal injury or death caused by the motor accident.\n(2) The claimant must, at the time of making a motor accident claim, give\nthe insurer for the motor accident claim notice that the workers\ncompensation claim has been made.\n(3) The claimant must give the insurer for the motor accident claim\nwritten notice about the following:\n(a) the name and address of the insurer for the workers\ncompensation claim;\n(b) whether liability for the workers compensation claim has been\naccepted or rejected;\n(c) any amounts paid to or on behalf of the claimant under the\nworkers compensation claim.\n(4) If the insurer for the motor accident claim receives a notice under\nsubsection (3), the insurer may get information about the workers\ncompensation claim from the insurer for the workers compensation\n\n","sortOrder":233},{"sectionNumber":"239","sectionType":"section","heading":"Award of damages—requirements","content":"239 Award of damages—requirements\n(1) An award of damages in a motor accident claim may be made only if\nthe injured person to whom the motor accident claim relates—\n(a) has made a quality of life benefits application under\ndivision 2.6.2 (Quality of life benefits—application) and\neither—\n(i) an assessment has been conducted by an independent\nmedical examiner under division 2.6.3 (Quality of life\nbenefits—WPI assessment) and the person has been\nassessed as having a WPI of at least 10% as a result of the\n(ii) the insurer has decided the person has a WPI of at least\n10% and has made a final offer WPI; or\n(b) is a foreign national who has—\n(i) received a lump sum payment under a lump sum agreement\nunder section 184 (6) (Lump sum payment of certain\ndefined benefits—foreign nationals); and\n(ii) been assessed as having a WPI of at least 10% as a result\nof the accident; and\n(iii) the assessment—\n(A) was conducted by a private medical examiner in\naccordance with the WPI assessment guidelines; but\n(B) was not conducted under division 2.6.3 (Quality of\nlife benefits—WPI assessment); or\n\nThreshold for damages Part 5.2\n(c) is taken, under section 133 (WPI taken to be 10% in certain\ncircumstances) or section 213 (2) (a) (SOI report—injury has\nsignificant occupational impact), to have a WPI of 10% as a\nresult of the accident; or\nNote For procedures for a claim for a personal injury suffered by a child,\nsee the Limitation Act 1985, s 30A (Special provision for injuries\nto children).\n(d) has made a successful claim for workers compensation benefits\nin relation to the injury and either—\n(i) been assessed as having a WPI of at least 10% as a result\nof the motor accident; or\n(ii) is taken, under section 213 (2) (a), to have a WPI of 10%\nas a result of the accident; or\n(e) has died as a result of the accident.\nNote Person who died as a result of a motor accident—see s 36.\n(2) Subsection (1) does not prevent a motor accident claim from being\nsettled at any time.\n(3) For this section, a person has been assessed as having a WPI of at\nleast 10% as a result of the accident if—\n(a) if separate WPI reports assess the person’s physical injuries and\npsychological injuries—the higher WPI assessment assesses the\nperson’s WPI as at least 10%; or\n(b) if only 1 WPI report assesses the person’s WPI—the person’s\nWPI assessment assesses the person’s WPI as at least 10%.\nNote If an injured person has physical and psychological injuries, a WPI\nassessment of a physical injury may take into account a secondary\npsychological injury (see s 150 (4)).\nprivate medical examiner—see section 145.\n\nsuccessful claim for workers compensation benefits, by an injured\nperson in relation to an injury, means a claim by the person for\nworkers compensation benefits that—\n(a) has been made at least 26 weeks before the date—\n(i) the person gives a notice of claim to the insurer for the\nmotor accident claim; or\n(ii) a WPI assessment is carried out on the person; and\n(b) has been—\n(i) accepted by the insurer for the claim; or\n(ii) otherwise settled with the insurer for the claim in\naccordance with the workers compensation scheme,\nincluding on a without prejudice basis; and\nExample—subpar (ii)\na licensed insurer under the Workers Compensation Act 1951 settles a\nclaim with the claimant by agreement to make a payment to the\nclaimant without accepting liability for the claimant’s injury (see\nthat Act, s 133)\n(c) has not been withdrawn by the injured person.\n\nWPI assessment—claimant receiving workers compensation Part 5.3\nPart 5.3 WPI assessment—claimant\nreceiving workers compensation\n","sortOrder":234},{"sectionNumber":"240","sectionType":"section","heading":"Application—pt 5.3","content":"240 Application—pt 5.3\n(1) This part applies to a person injured in a motor accident if the\n(a) has made a successful claim for workers compensation benefits\nin relation to the injury; and\n(b) has given the respondent a notice of claim under the Civil Law\n(Wrongs) Act 2002, section 51 (Notice of claim).\nNote The Civil Law (Wrongs) Act 2002, s 51 (3) sets out the period\nwithin which a notice of claim must be given to the respondent to\nthe claim.\n(2) This part does not apply to a person injured in a motor accident who\nhas made a successful claim for workers compensation benefits in\nrelation to the injury if—\n(a) the person has been assessed as having a WPI of at least 10% as\na result of the motor accident; and\n(b) the assessment—\n(i) was conducted by a private medical examiner in\naccordance with the WPI assessment guidelines; but\n(ii) was not conducted under division 2.6.3 (Quality of life\nbenefits—WPI assessment).\nprivate medical examiner—see section 145.\nsuccessful claim for workers compensation benefits, by an injured\nperson in relation to an injury—see section 239 (4).\n\nPart 5.3 WPI assessment—claimant receiving workers compensation\n","sortOrder":235},{"sectionNumber":"241","sectionType":"section","heading":"WPI assessment—application and assessment","content":"241 WPI assessment—application and assessment\n(1) The injured person may apply to the insurer for the motor accident\nclaim for an assessment of the person’s WPI.\n(2) The insurer for the motor accident claim must, within the period\nstated in the MAI guidelines, give the injured person a written notice\n(an acknowledgment notice) acknowledging receipt of the\n(3) Division 2.6.2 (Quality of life benefits—application) and\ndivision 2.6.3 (Quality of life benefits—WPI assessment) apply to the\napplication and assessment as if—\n(a) the application were a quality of life benefits application; and\n(b) a reference to the relevant insurer were a reference to the insurer\nfor the motor accident claim; and\n(c) a reference in section 137 (1) (Quality of life benefits\napplication) to an insurer accepting liability were a reference to\nreceiving an acknowledgment notice; and\n(d) a reference in section 141 (1) (a) (ii) (A) (WPI assessment\n4 years 6 months after motor accident) to income replacement\nbenefits were a reference to payments for the loss of income\nunder a workers compensation scheme.\n(4) However, the following provisions do not apply:\n(a) section 154 (2) (b) (WPI less than 5%—insurer may make\noffer);\n(b) section 155 (3) (b), (5) and (7) (WPI 5% to 9%—insurer must\nmake offer);\n(c) section 156 (3) (b), (5) and (7) (WPI 10% or more—injured\nperson not entitled to make motor accident claim);\n(d) section 157 (3) (b), (c), (5) and (6) (WPI 10% or more—injured\nperson entitled to make motor accident claim);\n\nWPI assessment—claimant receiving workers compensation Part 5.3\n(e) section 161 (1) (c) (Final offer WPI less than 5%);\n(f) section 162 (1) (c), (d) (i), (2) and (4) (Final offer WPI 5% to\n9%);\n(g) section 163 (2) (c), (d) (i), (3) and (5) (Final offer WPI 10% or\nmore—injured person not entitled to make motor accident\nclaim);\n(h) section 164 (2) (c), (d), (e) (i), (3) and (4) (Final offer WPI 10%\nor more—injured person entitled to make motor accident claim).\nNote An injured person to whom this part applies is not entitled to receive\nincome replacement benefits, treatment and care benefits or quality of life\nbenefits (see s 50).\n(5) If the injured person makes an application under subsection (1),\na reference to income replacement benefits in section 209 (1) (a)\n(SOI assessment 4 years 6 months after motor accident) is taken to be\na reference to payments for the loss of income under a workers\ncompensation scheme.\n\nPart 5.4 Damages for claims—exclusions\nand limitations\nNote 1 The Civil Law (Wrongs) Act 2002, part 7.1 (Damages for personal\ninjuries—exclusions and limitations) also applies to motor accident\nclaims. It includes, for example—\n• provisions excluding liability if conduct was an indictable offence;\nand\n• presumptions about contributory negligence if the injured person\nwas intoxicated, relied on an intoxicated person or was not wearing\na seatbelt; and\n• limitations on damages for loss of earnings.\nNote 2 A claimant who is a dependant, or personal representative, of a person\nwho has died as a result of a motor accident injury may have a cause of\naction under the Civil Law (Wrongs) Act 2002.\n","sortOrder":236},{"sectionNumber":"242","sectionType":"section","heading":"Quality of life damages—general","content":"242 Quality of life damages—general\n(1) A claimant for a motor accident claim who is the injured person to\nwhom the claim relates may be awarded damages for non-economic\nloss (quality of life damages) only in accordance with—\n(a) if the claimant was a child on the date of the motor accident—\nsection 244; or\n(b) in any other case—section 243.\nnon-economic loss includes the following:\n(a) pain and suffering;\n(b) loss of amenities of life;\n(c) loss of expectation of life;\n(d) disfigurement.\n\n","sortOrder":237},{"sectionNumber":"243","sectionType":"section","heading":"Quality of life damages—amount that may be awarded","content":"243 Quality of life damages—amount that may be awarded\n(1) The amount of quality of life damages that may be awarded to a\nclaimant is—\n(a) the amount stated in table 243 as at the date of the WPI report\nthat the claimant relies on for the motor accident claim; and\n(b) an additional amount that is not more than 20% of the amount\nawarded under paragraph (a) if the court considers that the WPI\nreport that the claimant relies on for the motor accident claim\ndid not take into account a particular injury, or a particular effect\non the claimant’s quality of life.\nExample—particular effect on claimant’s quality of life\nchronic pain\nTable 243 Amount of quality of life damages payable\nitem\nWPI %\namount payable\n1 10% $25 000 AWE indexed\n2 11% to 20% $25 000 AWE indexed + [(W–10) x $3 500 AWE indexed]\n3 21% to 50% $60 000 AWE indexed + [(W–20) x $4 000 AWE indexed]\n4 51% to 99% $180 000 AWE indexed + [(W–50) x $6 400 AWE indexed]\n5 100% $500 000 AWE indexed\n(2) However, the court must not award an additional amount under\nsubsection (1) (b) if the claimant is awarded damages for the\nparticular injury or particular effect on the claimant’s quality of life\nunder another head of damages.\n(3) The maximum amount that may be awarded to the claimant for\nquality of life damages and additional damages is $600 000 AWE\nindexed.\n\nW means WPI/100% x 100.\nif a person’s WPI is 10%, the corresponding W is 10\n","sortOrder":238},{"sectionNumber":"244","sectionType":"section","heading":"Quality of life damages—amount that may be awarded for","content":"244 Quality of life damages—amount that may be awarded for\nchildren\n(1) This section applies to a claimant who was a child on the date of the\nmotor accident in which the claimant was injured.\n(2) The maximum amount that may be awarded to the claimant for\nquality of life damages is $600 000 AWE indexed.\n","sortOrder":239},{"sectionNumber":"245","sectionType":"section","heading":"Quality of life damages—none if quality of life benefits","content":"245 Quality of life damages—none if quality of life benefits\nreceived\nQuality of life damages may not be awarded to a person injured in a\nmotor accident if the person has received quality of life benefits in\n","sortOrder":240},{"sectionNumber":"246","sectionType":"section","heading":"Damages for loss of earnings—none in first year","content":"246 Damages for loss of earnings—none in first year\nDamages may not be awarded in a motor accident claim for any loss\nof earnings of the claimant in the first year after the motor accident.\nNote Damages for loss of earnings are also limited under the Civil Law\n(Wrongs) Act 2002, s 98.\n","sortOrder":241},{"sectionNumber":"247","sectionType":"section","heading":"Recovery of defined benefits if claimant receives","content":"247 Recovery of defined benefits if claimant receives\ndamages\n(1) This section applies if a claimant—\n(a) receives defined benefits in relation to an injury suffered in a\n\n(b) is awarded damages in a motor accident claim in relation to the\nclaimant’s injuries.\nNote The claimant may not be awarded damages for any loss of earnings in the\nfirst year after the motor accident (see s 246).\n(2) The relevant insurer for the motor accident is entitled to deduct from\nthe damages the lesser of—\n(a) the amount of any defined benefits (other than income\nreplacement benefits received by the claimant in the first year\nafter the motor accident) received by the person; and\n(b) the amount of the damages awarded.\nNote The relevant insurer may also recover the amount of defined benefits\nreceived by an injured person if the injured person obtains a judgment or\nagreement for damages independently of this Act in relation to the injury\n(see s 253).\n(3) However, the relevant insurer is not entitled to recover any amount\nthat has been recovered under a provision of part 6.10 (MAI insurer\nand nominal defendant may recover costs incurred).\nNote If an insurer has recovered costs under a provision of pt 6.10, the insurer\nis not entitled to recover the costs under this section (see s 342).\n","sortOrder":242},{"sectionNumber":"248","sectionType":"section","heading":"Damages for compensation paid under workers","content":"248 Damages for compensation paid under workers\n(1) This section applies if a claimant—\n(a) receives compensation under a workers compensation scheme\nin relation to a person’s injuries or death; and\n(b) is awarded damages in a motor accident claim in relation to the\nperson’s injuries or death; and\n(c) because of the award of damages, is liable to repay the\ncompensation received.\n\n(2) The award of damages must include damages equal to the amount of\ncompensation received by the person under the workers\ncompensation scheme.\n","sortOrder":243},{"sectionNumber":"249","sectionType":"section","heading":"Gratuitous care—no damages","content":"249 Gratuitous care—no damages\nDamages may not be awarded in a motor accident claim for treatment,\ncare, support or services provided to a claimant for which the claimant\nhas not paid and is not liable to pay.\nnursing care provided by a domestic partner or parent on a gratuitous basis\n","sortOrder":244},{"sectionNumber":"250","sectionType":"section","heading":"Treatment and care—damages not available for","content":"250 Treatment and care—damages not available for\nLTCS participants\n(1) This section applies to a person who is a participant in the\nLTCS scheme in relation to a motor accident injury.\n(2) An award of damages or an offer of settlement (including a\nmandatory final offer) made to the person in relation to the motor\naccident injury must not include an amount for the person’s treatment\nand care needs, or any excluded treatment and care, that—\n(a) relate to the motor accident injury; and\n(b) arise while the person is a participant in the LTCS scheme.\nNote Treatment and care needs, of a participant in the LTCS scheme—see the\n(3) This section applies—\n(a) whether or not the treatment and care needs are assessed\ntreatment and care needs under the LTCS Act; and\n(b) whether or not the LTCS commissioner is required to make a\npayment in relation to the treatment and care needs; and\n\n(c) whether or not the treatment, care, support or services provided\nin connection with the treatment and care needs is provided\nwithout charge on a gratuitous basis.\nexcluded treatment and care—see the LTCS Act, section 9.\n","sortOrder":245},{"sectionNumber":"251","sectionType":"section","heading":"Treatment and care—damages not available for","content":"251 Treatment and care—damages not available for\nLTCS scheme foreign national participants\n(a) is a foreign national participant in the LTCS scheme in relation\nto a motor accident injury; and\n(b) receives a lump sum under a lump sum agreement with the\nLTCS commissioner in relation to the motor accident injury.\n(2) An award of damages or an offer of settlement (including a\nmandatory final offer) made to the person in relation to the motor\naccident injury must not include an amount for the person’s treatment\nand care needs, or any excluded treatment and care, that—\n(a) relate to the motor accident injury; and\n(i) arose while the person was a participant in the\nLTCS scheme; or\n(ii) arise after the person receives the lump sum under the lump\nsum agreement.\nNote Treatment and care needs, of a participant in the LTCS scheme—see the\n\n(3) This section applies—\n(a) whether or not the treatment and care needs are assessed\ntreatment and care needs under the LTCS Act; and\n(b) whether or not the LTCS commissioner is required to make a\npayment in relation to the treatment and care needs; and\n(c) whether or not the treatment, care, support or services provided\nin connection with the treatment and care needs is provided\nwithout charge on a gratuitous basis.\nexcluded treatment and care—see the LTCS Act, section 9.\nforeign national participant, in the LTCS scheme—see the\nLTCS Act, section 30B (5).\nlump sum agreement—see the LTCS Act, section 30B (1).\n","sortOrder":246},{"sectionNumber":"252","sectionType":"section","heading":"Wrongful death claims","content":"252 Wrongful death claims\nDamages awarded in a motor accident claim to relatives or the estate\nof a person who died as a result of a motor accident must be reduced\nby the amount of any death benefits or quality of life benefits paid\nunder chapter 2 in relation to the dead person.\n\nDamages independently of Act Part 5.5\nPart 5.5 Damages independently of Act\n","sortOrder":247},{"sectionNumber":"253","sectionType":"section","heading":"Repayment of defined benefits if person receives","content":"253 Repayment of defined benefits if person receives\ndamages independently of Act\n(a) is injured in a motor accident; and\n(b) receives defined benefits in relation to the injury; and\n(c) obtains a judgment or agreement for damages independently of\nthis Act (the independent damages) in relation to the injury.\n(2) The relevant insurer for the motor accident is entitled to recover from\nthe person the lesser of—\n(a) the amount of defined benefits received by the person; and\n(b) the amount of the independent damages.\nNote The injured person’s entitlement to defined benefits ends when the\njudgment is entered or agreement for damages is made (see s 51).\n\n","sortOrder":248},{"sectionNumber":"254","sectionType":"section","heading":"Meaning of no-fault motor accident","content":"254 Meaning of no-fault motor accident\nno-fault motor accident means a motor accident not caused by the\nfault of—\n(a) the responsible person for, or the driver of, any motor vehicle\ninvolved in the accident in the use or operation of the vehicle; or\n(b) any other person.\nExamples—no-fault motor accident\n1 an accident that happens as the result of a driver who has a cerebrovascular\naccident or heart attack\n2 an accident that happens as the result of a driver colliding with a kangaroo that\nhops onto the road\n","sortOrder":249},{"sectionNumber":"255","sectionType":"section","heading":"Presumption of no-fault motor accident","content":"255 Presumption of no-fault motor accident\nIn a proceeding based on a motor accident claim, an averment by the\nclaimant that the motor accident was a no-fault motor accident is\nevidence of that fact unless there is evidence to the contrary.\n","sortOrder":250},{"sectionNumber":"256","sectionType":"section","heading":"Working out driver at fault in no-fault motor accident","content":"256 Working out driver at fault in no-fault motor accident\n(1) This section applies if a person is injured in a no-fault motor accident.\n(2) For the purposes of making a motor accident claim—\n(a) if the motor accident was a single vehicle accident—the driver\nof the motor vehicle is taken—\n(i) to be the driver at fault; and\n(ii) to have breached their duty of care to the injured person;\nand\n\nNo-fault motor accidents Part 5.6\n(b) if the motor accident was a multiple vehicle accident—the driver\nof the motor vehicle whose act or omission caused the accident\nis taken—\n(i) to be the driver at fault; and\n(ii) to have breached their duty of care to the injured person.\nExample—act or omission causing no-fault multiple vehicle accident\na driver has a heart attack and, as a consequence, crashes into other vehicles\nNote Single vehicle accident and multiple vehicle accident—see the\n\nPart 5.7 Court proceedings on motor\naccident claims\nNote The pre-court procedures set out in the Civil Law (Wrongs) Act 2002, ch 5\napply to a motor accident claim under this chapter.\n","sortOrder":251},{"sectionNumber":"257","sectionType":"section","heading":"Definitions—pt 5.7","content":"257 Definitions—pt 5.7\ncomplying notice of claim means a notice of claim given under the\nCivil Law (Wrongs) Act 2002, section 51 or section 55.\ncontributor, to a motor accident claim, means a person the respondent\nadded as a contributor under the Civil Law (Wrongs) Act 2002,\nsection 57.\nparty, to a motor accident claim, means a claimant, respondent or\ncontributor.\n","sortOrder":252},{"sectionNumber":"Div 5","sectionType":"division","heading":"7.2 Compulsory conferences before court","content":"Division 5.7.2 Compulsory conferences before court\nproceedings\n","sortOrder":253},{"sectionNumber":"258","sectionType":"section","heading":"Compulsory conference","content":"258 Compulsory conference\n(1) Before a claimant for a motor accident claim brings a court\nproceeding based on the claim, the parties to the claim must have a\nconference (the compulsory conference).\n(2) However, if the claimant brings a proceeding based on the claim, and\napplies to stay the proceeding, under section 141 (5) (WPI assessment\n4 years 6 months after motor accident), the parties to the claim must\nhave a compulsory conference before the proceeding can proceed.\nNote The Civil Law (Wrongs) Act 2002, s 79 (Need for urgent proceeding)\napplies to a claimant in relation to a motor accident claim.\n\nCompulsory conferences before court proceedings Division 5.7.2\n(3) Any party may call the compulsory conference—\n(a) at a time and place agreed by each party; or\n(b) if more than 6 months has passed since the respondent received,\nor is taken to have received, the claimant’s complying notice of\nclaim—at a reasonable time and place nominated by the party\ncalling the conference.\n(4) On application by a party, the court may decide the time and place for\nthe compulsory conference and make any other orders the court\nconsiders appropriate.\n(5) The parties may, by agreement, change the time or place for holding\nthe compulsory conference or adjourn the conference from time to\ntime and from place to place.\n(6) The compulsory conference may be conducted, if the parties agree,\nby telephone or another form of communication allowing\ncontemporaneous and continuous communication between the\nparties.\n","sortOrder":254},{"sectionNumber":"259","sectionType":"section","heading":"Compulsory conference may be dispensed with","content":"259 Compulsory conference may be dispensed with\n(1) On application by 1 or more of the parties for the motor accident\nclaim, the court may dispense with the compulsory conference for\ngood reason and make any other orders the court considers\nappropriate.\n(2) In considering whether to dispense with the compulsory conference,\nthe court must take into account the extent of compliance by the\nparties with their obligations for the motor accident claim.\n","sortOrder":255},{"sectionNumber":"260","sectionType":"section","heading":"Compulsory conference with mediator","content":"260 Compulsory conference with mediator\n(1) A compulsory conference may be held with a mediator if—\n(a) each party for the motor accident claim agrees; and\n\nDivision 5.7.2 Compulsory conferences before court proceedings\n(b) each party for the motor accident claim agrees, in writing, about\nhow costs of the mediation are to be apportioned between the\nparties.\n(2) The mediator must be a person who is independent of the parties.\n(3) The mediator must be decided by agreement by each party.\n(4) However, if the parties are unable to agree on a mediator not later\nthan 30 days after the date for the compulsory conference is decided,\nany party may apply to the registrar of the court for the registrar to\ndecide the mediator.\n","sortOrder":256},{"sectionNumber":"261","sectionType":"section","heading":"Procedures before compulsory conference","content":"261 Procedures before compulsory conference\n(1) At least 7 days before the compulsory conference is to be held, each\nparty for the motor accident claim must give each other party—\n(a) a copy of each document that is relevant to the claim that has not\nyet been given to the other party; and\n(b) a statement verifying that all relevant documents in the\npossession of the party or the party’s lawyer have been given as\nrequired; and\n(c) details of the party’s legal representation; and\n(d) if the party has legal representation—a certificate of readiness\nsigned by the party’s lawyer.\n(2) However, on application by a party, the court may exempt the party\nfrom an obligation to give material to another party before trial if\nsatisfied that—\n(a) giving the material would alert a person reasonably suspected of\nfraud to the suspicion; or\n(b) there is some other good reason why the material should not be\ngiven.\n\nCompulsory conferences before court proceedings Division 5.7.2\ncertificate of readiness, by a party to a motor accident claim, means\na certificate stating that—\n(a) the party is in all respects ready for the compulsory conference;\nand\n(b) the party has obtained all investigative material required for the\ntrial, including witness statements from each person (other than\nexpert witnesses) the party intends to call as a witness at the trial;\nand\n(c) the party has obtained medical or other expert reports from each\nperson the party proposes to call as an expert witness at the trial;\nand\n(d) the party has fully complied with the party’s obligations to give\nthe other parties material relevant to the claim; and\n(e) the party’s lawyer has given the party a costs statement.\ncosts statement, by a party’s lawyer, means a statement containing—\n(a) details of the legal costs (clearly identifying costs that are legal\nfees and costs that are disbursements) payable by the party to the\nparty’s lawyer up to the completion of the compulsory\nconference; and\n(b) an estimate of the party’s likely legal costs (clearly identifying\ncosts that are legal fees and costs that are disbursements) if the\nclaim proceeds to trial and is decided by the court; and\n(c) a statement of the consequences to the party, in terms of costs,\nin each of the following cases:\n(i) if the amount of the damages awarded by the court is equal\nto, or more than, the claimant’s mandatory final offer;\n\n(ii) if the amount of the damages awarded by the court is less\nthan the claimant’s mandatory final offer but equal to, or\nmore than, the respondent’s mandatory final offer;\n(iii) if the amount of the damages awarded by the court is equal\nto, or less than, the respondent’s mandatory final offer.\n","sortOrder":257},{"sectionNumber":"262","sectionType":"section","heading":"Attendance and participation at compulsory conference","content":"262 Attendance and participation at compulsory conference\n(1) Each conference participant must, unless the participant has a\nreasonable excuse—\n(a) attend the compulsory conference; and\n(b) actively take part in an attempt to settle the motor accident\nconference participant means—\n(a) the claimant or the claimant’s guardian; and\n(b) a person authorised by a respondent or contributor to settle the\nmotor accident claim on the respondent’s or contributor’s\nbehalf.\n","sortOrder":258},{"sectionNumber":"263","sectionType":"section","heading":"Mandatory final offers—requirement","content":"263 Mandatory final offers—requirement\n(1) This section applies if, for a motor accident claim—\n(a) the compulsory conference has been dispensed with under\nsection 259; or\n(b) the claim is not settled at the compulsory conference.\n(2) The claimant and the respondent for the motor accident claim must\nexchange written final offers (each of which is a mandatory final\noffer).\n\nMandatory final offers Division 5.7.3\n(3) A mandatory final offer for a claimant to whom section 133 (WPI\ntaken to be 10% in certain circumstances) must identify how much of\nthe offer is for quality of life damages.\n","sortOrder":259},{"sectionNumber":"264","sectionType":"section","heading":"Mandatory final offers may be dispensed with","content":"264 Mandatory final offers may be dispensed with\nThe court may, on application by the claimant or respondent for the\nmotor accident claim, dispense with the obligation to exchange\nmandatory final offers.\n","sortOrder":260},{"sectionNumber":"265","sectionType":"section","heading":"Timing of mandatory final offers","content":"265 Timing of mandatory final offers\n(1) If the court has not dispensed with the obligation to exchange\nmandatory final offers, mandatory final offers for a motor accident\nclaim must be exchanged—\n(a) if the compulsory conference has been dispensed with—not later\nthan 14 days after the day the conference was dispensed with; or\n(b) if the claim is not settled at the compulsory conference—at the\nend of the conference.\n(2) A mandatory final offer remains open for 14 days.\n","sortOrder":261},{"sectionNumber":"266","sectionType":"section","heading":"Working out costs for mandatory final offers","content":"266 Working out costs for mandatory final offers\n(1) A mandatory final offer for $50 000 or less must be exclusive of any\namount for costs.\n(2) If a mandatory final offer is for $50 000 or less but for more than\n$30 000, and is accepted, costs must be worked out and paid in the\nway prescribed by regulation.\n(3) If a mandatory final offer is for $30 000 or less, and is accepted—\n(a) for a claimant who was a child at the time of the motor accident\nor holds a Commonwealth concession card when the offer is\naccepted—costs (including disbursements) must not exceed\n$5 000; or\n(b) in any other case—costs must be $0.\n\nCommonwealth concession card means any of the following cards:\n(a) a current health care card issued under the Social Security\nAct 1991 (Cwlth);\n(b) a current pensioner concession card issued under the Social\nSecurity Act 1991 (Cwlth);\n(c) a current pensioner concession card issued in relation to a\npension under the Veterans’ Entitlements Act 1986 (Cwlth) or\nthe Military Rehabilitation and Compensation Act 2004\n(Cwlth);\n(d) a current gold card;\n(e) a card prescribed by regulation.\ngold card means a card known as the Repatriation Health Card—For\nAll Conditions that evidences a person’s eligibility, under the\nVeterans’ Entitlements Act 1986 (Cwlth) or the Military\nRehabilitation and Compensation Act 2004 (Cwlth), to be provided\nwith treatment for all injuries or diseases.\n","sortOrder":262},{"sectionNumber":"267","sectionType":"section","heading":"Court proceedings not to begin if mandatory final offer","content":"267 Court proceedings not to begin if mandatory final offer\nopen\n(1) A claimant for a motor accident claim must not begin a court\nproceeding based on the claim if a mandatory final offer for the claim\nremains open.\n(2) If a claimant brings a court proceeding based on a motor accident\nclaim, the claimant must, at the beginning of the proceeding, file in\nthe court a sealed envelope containing a copy of the claimant’s\nmandatory final offer.\n(3) The respondent must, before or at the time of filing a defence, file in\nthe court a sealed envelope containing a copy of the respondent’s\nmandatory final offer.\n\n(4) The court must not read the mandatory final offers until the court has\ndecided the claim.\n(5) However, the court must have regard to the mandatory final offers if\nmaking a decision about interest or costs.\n","sortOrder":263},{"sectionNumber":"268","sectionType":"section","heading":"Time limit for beginning proceeding—general","content":"268 Time limit for beginning proceeding—general\n(1) This section applies if a claimant for a motor accident claim does not\nbegin a court proceeding based on the claim in accordance with the\ntime limits in—\n(a) section 269 (Time limit—compulsory conference); or\n(b) section 270 (Time limit—no compulsory conference); or\n(c) section 271 (Time limit—no mandatory final offers).\n(2) The claimant may still begin the proceeding but the court may order\nthe claimant to pay the respondent’s costs caused by the delay.\n(3) The respondent may apply to the court for an order deciding a time\nby which the claimant must begin the proceeding.\n(4) If the claimant does not begin a proceeding in accordance with an\norder made under subsection (3), the motor accident claim is barred.\n","sortOrder":264},{"sectionNumber":"269","sectionType":"section","heading":"Time limit—compulsory conference","content":"269 Time limit—compulsory conference\n(a) the parties to a motor accident claim have had a compulsory\nconference; and\n(b) the obligation to exchange mandatory final offers has not been\ndispensed with.\n\n(2) The claimant may begin a court proceeding based on the motor\naccident claim not later than—\n(a) 60 days after the end of the compulsory conference; or\n(b) a later day—\n(i) agreed by the parties not later than 60 days after the end of\nthe compulsory conference; or\n(ii) decided by the court on application by the claimant not\nlater than 60 days after the end of the compulsory\nconference.\n","sortOrder":265},{"sectionNumber":"270","sectionType":"section","heading":"Time limit—no compulsory conference","content":"270 Time limit—no compulsory conference\n(a) the compulsory conference for the parties to a motor accident\nclaim has been dispensed with; but\n(b) the obligation to exchange mandatory final offers has not been\ndispensed with.\n(2) The claimant may begin a court proceeding based on the motor\naccident claim—\n(a) by the due date; or\n(b) before a later day—\n(i) agreed by the parties not later than the due date; or\n(ii) decided by the court on application by the claimant not\nlater than the due date.\n\ndue date means the day that is 60 days after the later of the following:\n(a) 6 months after the respondent received, or is taken to have\nreceived, the claimant’s complying notice of claim;\n(b) the day the compulsory conference was dispensed with.\n","sortOrder":266},{"sectionNumber":"271","sectionType":"section","heading":"Time limit—no mandatory final offers","content":"271 Time limit—no mandatory final offers\n(1) This section applies if a court dispenses with the obligation to\nexchange mandatory final offers.\n(2) A claimant may begin a court proceeding based on the motor accident\nclaim not later than the day decided by the court when, or after, the\ncourt dispenses with the obligation.\n","sortOrder":267},{"sectionNumber":"272","sectionType":"section","heading":"Insurer to be joint or sole defendant","content":"272 Insurer to be joint or sole defendant\n(b) the respondent is an insured person or an insurer for the claim.\n(2) The claimant must bring the proceeding against the insured person\nand the insurer as joint defendants.\n(3) However, the claimant may bring a proceeding against the insurer\nalone if—\n(a) the insured person cannot be identified; or\n(b) the insured person is dead; or\n(c) it is impracticable to give the insured person a legal document.\n\n(4) If judgment is given in favour of the claimant on the motor accident\nclaim for the personal injury, the judgment must be given against the\ninsurer and not the insured person, and, if the proceeding involves\nother claims (unrelated to the personal injury), a separate judgment\nmust be given on the other claims.\n(5) It is not a defence to a proceeding under this section if the insurer\nproves that—\n(a) an MAI policy was obtained by fraud, or a material\nmisstatement or nondisclosure; or\n(b) the insured person is in breach of a contractual or statutory\nobligation.\n","sortOrder":268},{"sectionNumber":"273","sectionType":"section","heading":"Procedure if respondent is insurer","content":"273 Procedure if respondent is insurer\n(b) the respondent is an insured person or an insurer.\n(2) If the motor accident claim lies against 2 or more insurers, all insurers\nbecome defendants to the proceeding, but the respondents’ claim\nmanager continues to represent all insurers in the proceeding unless\nthe court gives leave allowing 1 or more of the insurers to be\nseparately represented.\n(3) If a motor accident claim lies against 2 or more insurers, and a legal\ndocument related to a proceeding based on the motor accident claim\nis given to the respondents’ claim manager, all insurers are taken to\nhave been given the legal document.\n(4) If a legal document related to a proceeding based on a motor accident\nclaim is given to the insurer, the insured person is also taken to have\nbeen given the legal document.\n\nrespondents’ claim manager—see the Civil Law (Wrongs) Act 2002,\nsection 56.\n","sortOrder":269},{"sectionNumber":"274","sectionType":"section","heading":"Exclusion of summary judgment on the basis of","content":"274 Exclusion of summary judgment on the basis of\nadmissions\n(1) In a court proceeding based on a motor accident claim, summary\njudgment is not to be given on the basis of the defendant’s\nadmissions.\n(2) However, this section does not prevent a court from giving a\njudgment by consent.\n","sortOrder":270},{"sectionNumber":"275","sectionType":"section","heading":"Insurer’s right to call and cross-examine insured person","content":"275 Insurer’s right to call and cross-examine insured person\n(b) the respondent is, or includes, an insurer.\n(2) The insurer may—\n(a) call the insured person as a witness; and\n(b) with the court’s leave, cross-examine the insured person.\n","sortOrder":271},{"sectionNumber":"276","sectionType":"section","heading":"Costs—awards of damages over $50 000","content":"276 Costs—awards of damages over $50 000\n(1) This section applies if a court awards more than\n$50 000 AWE indexed in damages in a proceeding (other than an\nappellate proceeding) based on a motor accident claim.\n\n(2) If the amount of damages is equal to or more than a mandatory final\noffer made by the claimant, the claimant may apply to the court for\nan order that the respondent pay the claimant’s costs on a party and\nparty basis up to the day the offer was made, and on an indemnity\nbasis from that day.\n(3) If the amount of damages is less than a mandatory final offer made\nby the respondent, the respondent may apply to the court for an order\nthat—\n(a) the respondent pay the claimant’s costs on a party and party\nbasis up to the day the offer was made; and\n(b) the claimant pay the respondent’s costs on an indemnity basis\nfrom that day.\n(4) Also, the court may make an award of costs on an indemnity basis to\ncompensate a party for costs resulting from a failure by another party\nto comply with a procedural obligation under this part.\nDivision 5.7.5 Judgment for noncompliance with\ntime limits\n","sortOrder":272},{"sectionNumber":"277","sectionType":"section","heading":"Definitions—div 5.7.5","content":"277 Definitions—div 5.7.5\ncompliance notice—see section 278.\nenforcing party—see section 278.\nlate party—see section 278.\nrelevant notice claim—see section 279.\nrequired thing, under a compliance notice, means the thing required\nto be done under the notice.\n\nJudgment for noncompliance with time limits Division 5.7.5\n","sortOrder":273},{"sectionNumber":"278","sectionType":"section","heading":"Notice time limit not complied with","content":"278 Notice time limit not complied with\n(a) for a motor accident claim—\n(i) the court has dispensed with the obligation to exchange\nmandatory final offers under section 264; or\n(ii) the time for exchanging mandatory final offers under\nsection 265 has closed; and\n(b) a party (the late party) to the motor accident claim fails to do\nsomething required to be done within a time limit for doing the\nthing under this chapter.\n(2) However, this section does not apply if—\n(a) the late party is the claimant; and\n(b) the claimant is not legally represented in relation to the claim.\n(3) Another party to the motor accident claim (the enforcing party) may\ngive the late party a notice (the compliance notice) requiring the late\nparty to do the required thing not later than 7 days after the day the\nlate party receives the compliance notice.\n","sortOrder":274},{"sectionNumber":"279","sectionType":"section","heading":"Thing not done within 7-day period—claimant as","content":"279 Thing not done within 7-day period—claimant as\nenforcing party\n(a) an enforcing party has given a late party a compliance notice;\nand\n(b) the late party does not do the required thing within the 7-day\nperiod in the notice; and\n(c) the enforcing party is the claimant to the motor accident claim\n(the relevant notice claim) to which the notice relates.\n\n(2) The enforcing party may, not later than 14 days after the day the 7-day\nperiod ends, apply to the court for an order—\n(a) if the claimant has not started a proceeding based on the relevant\nnotice claim—giving the claimant leave to begin the proceeding;\nand\n(b) giving judgment in the proceeding in favour of the claimant\nagainst the respondent.\n","sortOrder":275},{"sectionNumber":"280","sectionType":"section","heading":"Thing not done within 7-day period—respondent as","content":"280 Thing not done within 7-day period—respondent as\nenforcing party\n(a) an enforcing party has given a late party a compliance notice;\nand\n(b) the late party does not do the required thing within the 7-day\nperiod in the notice; and\n(c) the enforcing party is the respondent to the relevant notice claim.\n(2) The enforcing party may, not later than 14 days after the day the 7-day\nperiod ends, apply to the court for an order—\n(a) if the claimant has not started a proceeding based on the relevant\nnotice claim—that the claimant is barred from beginning the\nproceeding; or\n(b) giving judgment in the proceeding in favour of the respondent\nagainst the claimant.\n\nJudgment for noncompliance with time limits Division 5.7.5\n","sortOrder":276},{"sectionNumber":"281","sectionType":"section","heading":"Thing not done within 7-day period—court may make","content":"281 Thing not done within 7-day period—court may make\norders\n(1) On application for judgment under section 279 or section 280, the\ncourt may make the orders sought.\n(2) In considering the application, the court must not make an order\nagainst the late party if the party establishes that the party had a\nreasonable excuse for failing to do the required thing within the 7-day\n","sortOrder":277},{"sectionNumber":"282","sectionType":"section","heading":"Court orders in favour of claimant","content":"282 Court orders in favour of claimant\n(1) This section applies if the court makes an order giving judgment in\nfavour of the claimant against the respondent under section 279.\n(2) The court must order—\n(a) if the claimant and respondent have each made a written offer to\nthe other party—damages worked out by adding the claimant’s\nlast written offer to the respondent’s last written offer and\ndividing the total by 2; or\n(b) if 1 of the parties has not made a written offer—damages to be\nassessed by the court.\n(3) The court must order the respondent to pay the claimant’s costs on an\nindemnity basis from the day the complying notice of claim was\nreceived by the respondent’s insurer.\n\n","sortOrder":278},{"sectionNumber":"283","sectionType":"section","heading":"Court orders in favour of respondent","content":"283 Court orders in favour of respondent\n(1) This section applies if the court makes an order giving judgment in\nfavour of the respondent against the claimant under section 280.\n(2) Unless the court otherwise orders, the claimant must pay the\nrespondent’s costs of the proceeding including the costs of the\n\nOther matters Part 5.8\nPart 5.8 Other matters\n","sortOrder":279},{"sectionNumber":"284","sectionType":"section","heading":"Legal costs and fees payable by claimants and insurers","content":"284 Legal costs and fees payable by claimants and insurers\n(1) A regulation may prescribe the legal costs and fees payable by\nclaimants and insurers in relation to motor accident claims.\n(2) If a legal cost or fee is prescribed under subsection (1), a lawyer who\nprovides a service to which the cost or fee relates to a claimant or\ninsurer in relation to a motor accident claim is only entitled to be paid,\nor to recover, the prescribed cost or fee for the service.\n","sortOrder":280},{"sectionNumber":"285","sectionType":"section","heading":"Effect of payments under LTCS Act on limitation period","content":"285 Effect of payments under LTCS Act on limitation period\n(1) To remove any doubt, a payment made by the LTCS commissioner\nunder the LTCS Act does not, for the Limitation Act 1985, section 32\n(Confirmation), confirm a cause of action under this Act.\npayment, by the LTCS commissioner, means a payment that is made\nvoluntarily or in accordance with a requirement under the LTCS Act.\n\n","sortOrder":281},{"sectionNumber":"Part 6","sectionType":"part","heading":"Motor accident injuries","content":"Chapter 6 Motor accident injuries\ninsurance\n","sortOrder":282},{"sectionNumber":"286","sectionType":"section","heading":"Definitions—Act","content":"286 Definitions—Act\ninsurance industry deed—see section 359.\ninsured motor vehicle means a motor vehicle, or other thing, insured\nunder an MAI policy.\nNote The motor vehicles and other things insured under an MAI policy are\nmentioned in s 290.\nMAI insured person, for an MAI policy, means a person who is\ninsured under the MAI policy.\nNote The people insured under an MAI policy are mentioned in s 291.\nMAI insurer—see section 287.\nmotor accident injuries policy (or MAI policy) means an insurance\npolicy that complies with part 6.3.\n","sortOrder":283},{"sectionNumber":"287","sectionType":"section","heading":"Meaning of MAI insurer","content":"287 Meaning of MAI insurer\nMAI insurer means—\n(a) for an insured motor vehicle that—\n(i) is a registered motor vehicle—the insurer selected as the\nMAI insurer for the motor vehicle under—\n(A) section 298 (Selecting for registered vehicle—first\nregistration); or\n\nImportant concepts Part 6.1\n(B) section 299 (Selecting for registered vehicle—\nrenewal of registration); or\n(ii) has a valid trader’s plate attached—the insurer selected\nunder section 300 (Selecting for motor vehicle with\ntrader’s plate) as the MAI insurer for a motor vehicle to\nwhich the trader’s plate may be attached; or\n(iii) is a light rail vehicle—the insurer selected as the\nMAI insurer for the light rail vehicle under section 301\n(Selecting for light rail vehicle); or\n(b) for a trailer or other thing that is—\n(i) mentioned in section 290 (d) (Vehicles and other things\ninsured under MAI policy)—the insurer for the motor\nvehicle to which the trailer or thing is attached or becomes\ndetached; or\n(ii) prescribed by regulation under section 290 (e)—the entity\nprescribed by regulation; or\n(c) for an MAI insured person—the MAI insurer for the\nMAI policy under which the person is insured; or\n(d) for an MAI policy—the MAI insurer that issued the policy.\n","sortOrder":284},{"sectionNumber":"288","sectionType":"section","heading":"Application to Territory and Commonwealth motor","content":"288 Application to Territory and Commonwealth motor\nvehicles\n(1) A requirement under this Act for an MAI policy does not apply in\nrelation to a motor vehicle owned by—\n(a) the Territory or a territory authority; or\n(b) the Commonwealth or a Commonwealth authority.\n\n(2) However, the Territory, territory authority, Commonwealth or\nCommonwealth authority is, for a motor vehicle for which an\nMAI policy is not in force—\n(a) under the same liabilities as a licensed insurer would be under if\nthe insurer had issued an MAI policy for the vehicle; and\n(b) under the same obligation as a licensed insurer would be under\nin relation to providing benefits, on a no-fault basis, to people\nwho sustain personal injury caused by a motor accident if the\ninsurer had issued an MAI policy for the vehicle; and\n(c) has the same rights as a licensed insurer would have if the\ninsurer had issued an MAI policy for the vehicle.\n\nCompulsory motor accident injuries insurance Part 6.2\nPart 6.2 Compulsory motor accident\ninjuries insurance\n","sortOrder":285},{"sectionNumber":"289","sectionType":"section","heading":"Offence—use uninsured motor vehicle on road or road","content":"289 Offence—use uninsured motor vehicle on road or road\nrelated area\n(1) A person commits an offence if—\n(a) the person uses, or permits or allows a person to use, a motor\nvehicle on a road or road related area; and\n(b) the vehicle is not an insured motor vehicle.\nNote 1 Road and road related area are defined in the dictionary.\nUse, a vehicle, is defined in s 11 and includes provisions about trailers.\n(2) This section does not apply to a person who uses, or permits or allows\na person to use, a motor vehicle on a road or road related area if—\n(a) there is an unregistered vehicle permit in force for the vehicle;\nor\n(b) the registration provisions do not apply to the vehicle because of\nthe Road Transport (Vehicle Registration) Regulation 2000,\npart 2.2 (Vehicles not subject to registration provisions); or\n(c) the vehicle is exempted from this section by regulation; or\n(d) the motor vehicle is owned by—\n(ii) the Commonwealth or a Commonwealth authority.\n\nPart 6.2 Compulsory motor accident injuries insurance\n(3) It is a defence to a prosecution for an offence against this section if\nthe defendant establishes that, at the time the motor vehicle was used\non the road or road related area, the defendant believed on reasonable\ngrounds that the vehicle was an insured motor vehicle.\nNote A trailer does not need to be separately insured (see s 290 and ss 325\nto 328).\n\n","sortOrder":286},{"sectionNumber":"290","sectionType":"section","heading":"Vehicles and other things insured under MAI policy","content":"290 Vehicles and other things insured under MAI policy\nAn MAI policy insures—\n(a) a registered motor vehicle; and\n(b) a motor vehicle with a valid trader’s plate attached; and\n(c) a light rail vehicle; and\n(d) a trailer or other thing that—\n(i) is attached to a motor vehicle mentioned in paragraphs (a)\nto (c); or\n(ii) becomes detached from a motor vehicle mentioned in\nparagraphs (a) to (c) and runs out of control; and\n","sortOrder":287},{"sectionNumber":"291","sectionType":"section","heading":"People insured under MAI policy","content":"291 People insured under MAI policy\nAn MAI policy insures—\n(a) a person who uses an insured motor vehicle; and\n(b) anyone else who is vicariously liable for the person’s use of the\ninsured motor vehicle; and\n(c) anyone else prescribed by regulation; and\n(d) if a person mentioned in paragraphs (a) to (c) is dead—the\nperson’s estate.\n\n","sortOrder":288},{"sectionNumber":"292","sectionType":"section","heading":"Risks covered by MAI policy","content":"292 Risks covered by MAI policy\n(1) An MAI policy—\n(a) insures against liability for personal injury caused by a motor\n(b) provides benefits, on a no-fault basis, to people who sustain\npersonal injury caused by a motor accident.\nNote If an MAI insurer is a relevant insurer for a motor accident under ch 2,\ndefined benefits to which a person is entitled under that chapter in relation\nto the motor accident are payable by the MAI insurer (see s 39).\n(2) Subsection (1) (b) is subject to part 2.2 (Defined benefits—\nentitlement).\n","sortOrder":289},{"sectionNumber":"293","sectionType":"section","heading":"Risks not covered by MAI policy","content":"293 Risks not covered by MAI policy\n(1) An MAI policy does not insure against the risk of any of the\n(a) liability to pay compensation under the Workers Compensation\nAct 1951 (or a corresponding law of a State or another territory);\n(b) liability that may be incurred under an agreement unless the\nliability would have arisen without the agreement;\n(c) liability for personal injury, damage or loss that is attributable to\nan act that has been notified, in writing, by the MAI commission\nto be an act of terrorism;\n(d) liability for personal injury, damage or loss—\n(i) that arises independently of a wrongful act or omission; or\n(ii) in relation to a motor accident claim—to the extent that the\npersonal injury, loss or damage is attributable to the injured\nperson’s own wrongful act or omission;\n(e) liability to pay exemplary, punitive or aggravated damages;\n\n(f) liability to pay damages for a personal injury that arises\ngradually from a series of incidents;\n(g) liability to pay the treatment, care and support costs of a\nparticipant in the LTCS scheme;\n(h) any other liability prescribed by regulation.\n(2) To remove any doubt, an MAI policy does not insure the responsible\nperson for, or the driver of, a motor vehicle if—\n(a) the motor vehicle is in an area that is subject to a declaration\nunder the Road Transport (General) Act 1999, section 12\n(Power to include or exclude areas in road transport legislation)\nthat has the effect of disapplying this Act; or\n(b) the motor vehicle is subject to a declaration under the Road\nTransport (General) Act 1999, section 13 (Power to exclude\nvehicles, persons or animals from road transport legislation) that\nhas the effect of disapplying this Act; or\n(c) the responsible person or driver is subject to a declaration under\nthe Road Transport (General) Act 1999, section 13 that has the\neffect of disapplying this Act.\nact of terrorism—\n(a) means an act that—\n(i) causes or threatens to cause death, personal injury or\ndamage to property; and\n(ii) is designed to influence a government or intimidate the\npublic or a section of the public; and\n\n(iii) is carried out for the purpose of advancing a political,\nreligious, ideological, ethnic or similar cause; but\n(b) does not include a lawful activity or industrial action.\n","sortOrder":290},{"sectionNumber":"294","sectionType":"section","heading":"Licensed insurer not to decline etc to issue MAI policy","content":"294 Licensed insurer not to decline etc to issue MAI policy\nA licensed insurer cannot repudiate, or decline to issue or renew, an\nMAI policy.\n","sortOrder":291},{"sectionNumber":"295","sectionType":"section","heading":"MAI insurer to indemnify MAI insured people","content":"295 MAI insurer to indemnify MAI insured people\n(1) An MAI policy is binding on the MAI insurer for the MAI policy.\n(2) The MAI insurer for an MAI policy is, despite any other law, liable\nto indemnify each MAI insured person for the MAI policy for the\nliability that the policy purports to insure against.\n(3) To remove any doubt, the reference to any other law in subsection (2)\ndoes not include a reference to—\n(a) section 293 (Risks not covered by MAI policy); or\n(b) a declaration made under either of the following provisions of\nthe Road Transport (General) Act 1999:\n(i) section 12 (Power to include or exclude areas in road\ntransport legislation);\n(ii) section 13 (Power to exclude vehicles, persons or animals\nfrom road transport legislation).\n","sortOrder":292},{"sectionNumber":"296","sectionType":"section","heading":"MAI policy not affected by transfer etc of vehicle or","content":"296 MAI policy not affected by transfer etc of vehicle or\ntrader’s plate\n(1) An MAI policy for an insured motor vehicle is not affected by a\nchange in who is the responsible person for the vehicle.\n\n(2) An MAI policy for a registered motor vehicle is not affected by a\ntransfer of the registration of the vehicle.\nNote Registration of a vehicle may be transferred under the Road Transport\n(Vehicle Registration) Regulation 2000, pt 4.2.\n(3) An MAI policy for a motor vehicle with a valid trader’s plate attached\nis not affected by a transfer of the trader’s plate.\nNote A trader’s plate may be transferred under the Road Transport (Vehicle\nRegistration) Regulation 2000, s 100.\n(4) If the road transport authority becomes aware of any of the following\nchanges in relation to an insured motor vehicle, the road transport\nauthority must tell the MAI insurer for the motor vehicle about the\nchange:\n(a) a change in who is the responsible person for the vehicle;\n(b) a change in registration details of the vehicle;\n(c) a change of person to whom a valid trader’s plate is issued.\n","sortOrder":293},{"sectionNumber":"297","sectionType":"section","heading":"MAI policy not affected by errors etc","content":"297 MAI policy not affected by errors etc\n(1) The validity of an MAI policy is not affected by an error of the road\ntransport authority, or an error of a licensed insurer, in relation to the\npolicy.\n(2) The validity of an MAI policy is not affected by payment of an\nincorrect MAI premium for the policy.\n(3) A licensed insurer who has been paid an incorrect MAI premium may\nrecover any outstanding amount as a debt owing to the insurer.\n\n","sortOrder":294},{"sectionNumber":"298","sectionType":"section","heading":"Selecting for registered vehicle—first registration","content":"298 Selecting for registered vehicle—first registration\nIf a person applies to the road transport authority for registration of a\nmotor vehicle, the person must also—\nmotor vehicle for the period of registration; and\nMAI policy for the period of registration.\n","sortOrder":295},{"sectionNumber":"299","sectionType":"section","heading":"Selecting for registered vehicle—renewal of registration","content":"299 Selecting for registered vehicle—renewal of registration\nIf a registered operator of a registered motor vehicle applies for\nrenewal of registration of the motor vehicle, the registered operator\nmust also—\nmotor vehicle for the period of renewed registration; and\nMAI policy for the period of renewed registration.\n","sortOrder":296},{"sectionNumber":"300","sectionType":"section","heading":"Selecting for motor vehicle with trader’s plate","content":"300 Selecting for motor vehicle with trader’s plate\nIf a person applies to the road transport authority for a trader’s plate,\nthe person must also—\nlicensed insurer to be the MAI insurer for an MAI policy for a\nmotor vehicle to which the trader’s plate may be attached for the\nperiod for which the trader’s plate is issued; and\n\nSelecting an MAI insurer Part 6.4\nMAI policy for the period for which the trader’s plate is issued.\nNote 1 Trader’s plates are issued under the Road Transport (Vehicle\nRegistration) Regulation 2000, s 88.\nNote 2 MAI premiums are decided under pt 6.7.\n","sortOrder":297},{"sectionNumber":"301","sectionType":"section","heading":"Selecting for light rail vehicle","content":"301 Selecting for light rail vehicle\n(1) Before each insurance period for which a rail transport operator for a\nlight rail vehicle intends to use the vehicle on a road or road related\narea, the operator must—\n(a) tell the road transport authority about—\n(i) the intention; and\n(ii) if there is no MAI policy in force for the light rail vehicle—\nthe unique identification number displayed on the light rail\nvehicle by the rail transport operator; and\n(b) select, in a way approved by the road transport authority, a\nlight rail vehicle for the insurance period; and\n(c) pay to the road transport authority the MAI premium for the\nMAI policy for the insurance period.\ninsurance period, for a light rail vehicle, means—\n(a) a period of 12 months beginning on 1 November; or\n(b) if the light rail vehicle is to start operating on a road or road\nrelated area on a day other than 1 November in a calendar year—\na period of less than 12 months beginning on the day after the\nMAI premium is paid and ending on 31 October.\n\n","sortOrder":298},{"sectionNumber":"302","sectionType":"section","heading":"When MAI policy takes effect—registered motor vehicles","content":"302 When MAI policy takes effect—registered motor vehicles\nIf the road transport authority registers or renews the registration of a\nmotor vehicle, an MAI policy comes into force for the motor vehicle\nwhen the registration or renewal of registration takes effect.\n","sortOrder":299},{"sectionNumber":"303","sectionType":"section","heading":"MAI policy in effect while insurer on risk—registered","content":"303 MAI policy in effect while insurer on risk—registered\nmotor vehicles\nAn MAI policy for a registered motor vehicle is in force for the period\nfor which the MAI insurer is on risk under—\n(a) section 304 (Insurer on risk—period of registration); or\n(b) section 305 (Insurer on risk—period of grace).\n","sortOrder":300},{"sectionNumber":"304","sectionType":"section","heading":"Insurer on risk—period of registration","content":"304 Insurer on risk—period of registration\n(1) The MAI insurer of a registered motor vehicle is on risk for the period\nof registration of the motor vehicle.\n(2) However, if the registration is renewed before the previous period of\nregistration ends—\n(a) the old insurer is on risk until the previous period of registration\nends; and\n(b) the new insurer comes on risk immediately after the previous\nperiod of registration ends.\n(3) The MAI insurer ceases to be on risk if the MAI policy is cancelled.\nNote Cancellation of MAI policies for a registered motor vehicle is dealt with\nin s 311.\n\nLength of MAI policy Part 6.5\n","sortOrder":301},{"sectionNumber":"305","sectionType":"section","heading":"Insurer on risk—period of grace","content":"305 Insurer on risk—period of grace\n(1) If the registration of a motor vehicle is renewed during the period of\ngrace—\n(a) the old insurer is on risk until midnight on the day the\nregistration is renewed; and\n(b) the new insurer comes on risk immediately after midnight on the\nday the registration is renewed and is on risk for the period of\nrenewed registration.\n(2) If the registration is renewed after the period of grace ends—\n(a) the new insurer comes on risk at the time the renewal of\nregistration is effected; and\n(b) the motor vehicle is not an insured motor vehicle from the end\nof the previous period of registration until the renewal of\nregistration takes effect.\n(3) An MAI insurer ceases to be on risk if the MAI policy is cancelled.\nNote Cancellation of MAI policies for a registered motor vehicle is dealt with\nin s 311.\nperiod of grace means the 14 days after the registration, or renewal\nof registration, of a motor vehicle ends.\nNote There is no period of grace following the cancellation or surrender of\nregistration or a renewal of registration of a motor vehicle.\n","sortOrder":302},{"sectionNumber":"306","sectionType":"section","heading":"When MAI policy takes effect—trader’s plates","content":"306 When MAI policy takes effect—trader’s plates\nIf the road transport authority issues a trader’s plate to a person, an\nMAI policy comes into force for a motor vehicle to which the trader’s\nplate is attached—\n(a) when the trader’s plate is attached to the motor vehicle; and\n(b) only if the trader’s plate is a valid trader’s plate.\n\n","sortOrder":303},{"sectionNumber":"307","sectionType":"section","heading":"MAI policy in effect while insurer on risk—trader’s plates","content":"307 MAI policy in effect while insurer on risk—trader’s plates\n(1) An MAI policy for a motor vehicle with a valid trader’s plate attached\nis in force for the period for which the MAI insurer is on risk under\nthis section.\n(2) The MAI insurer of the motor vehicle is on risk for the period for\nwhich the valid trader’s plate is attached to the motor vehicle.\n(3) The MAI insurer ceases to be on risk if the trader’s plate is detached\nfrom the vehicle.\n(4) The MAI insurer ceases to be on risk if the MAI policy is cancelled.\nNote Cancellation of MAI policies for a motor vehicle with a trader’s plate\nattached is dealt with in s 312.\n","sortOrder":304},{"sectionNumber":"308","sectionType":"section","heading":"When MAI policy takes effect—light rail vehicles","content":"308 When MAI policy takes effect—light rail vehicles\nIf a rail transport operator for a light rail vehicle pays the road\ntransport authority an MAI premium for an MAI policy for the light\nrail vehicle, the MAI policy comes into force—\n(a) on the next 1 November; or\n(b) if there is no MAI policy in force for the light rail vehicle when\nthe MAI premium is paid—on the day after the day payment is\nmade.\n","sortOrder":305},{"sectionNumber":"309","sectionType":"section","heading":"MAI policy in effect while insurer on risk—light rail","content":"309 MAI policy in effect while insurer on risk—light rail\nvehicles\n(1) An MAI policy for a light rail vehicle is in force for the period for\nwhich the MAI insurer is on risk under this section.\n(2) The MAI insurer of the light rail vehicle is on risk for the insurance\nperiod for the light rail vehicle.\n\nLength of MAI policy Part 6.5\n(3) The MAI insurer ceases to be on risk if the MAI policy is cancelled.\nNote Cancellation of MAI policies for a light rail vehicle is dealt with in s 313.\ninsurance period—see section 301 (2).\n\n","sortOrder":306},{"sectionNumber":"310","sectionType":"section","heading":"MAI insurer cannot cancel MAI policy","content":"310 MAI insurer cannot cancel MAI policy\nAn MAI insurer has no power to cancel an MAI policy.\n","sortOrder":307},{"sectionNumber":"311","sectionType":"section","heading":"MAI policy cancellation—registered vehicles","content":"311 MAI policy cancellation—registered vehicles\nAn MAI policy for a registered motor vehicle is cancelled if the\nregistration of the motor vehicle is cancelled.\nNote If the registration is surrendered, the registration is then cancelled—see\nthe Road Transport (Vehicle Registration) Regulation 2000, s 83.\n","sortOrder":308},{"sectionNumber":"312","sectionType":"section","heading":"MAI policy cancellation—trader’s plates","content":"312 MAI policy cancellation—trader’s plates\n(1) An MAI policy for a motor vehicle with a trader’s plate attached is\ncancelled if—\n(a) the road transport authority requires the person to whom the\ntrader’s plate was issued to return the plate to the authority under\neither of the following provisions of the Road Transport\n(Vehicle Registration) Regulation 2000:\n(i) section 89 (Recall of trader’s plates);\n(ii) section 101 (Return of trader’s plate); or\n(b) the trader’s plate is surrendered to the road transport authority\nunder the Road Transport (Vehicle Registration)\nRegulation 2000, section 102.\n(2) However, the MAI policy is not cancelled if the person returns the\ntrader’s plate and the road transport authority issues a replacement\ntrader’s plate to the person under the Road Transport (Vehicle\nRegistration) Regulation 2000, section 89 (3).\n\nCancellation of MAI policies Part 6.6\n","sortOrder":309},{"sectionNumber":"313","sectionType":"section","heading":"MAI policy cancellation—light rail vehicles","content":"313 MAI policy cancellation—light rail vehicles\n(1) An MAI policy for a light rail vehicle is cancelled if the accreditation\nof the rail transport operator for the light rail vehicle is cancelled or\nsurrendered.\nNote A rail transport operator’s accreditation may be cancelled or surrendered\nunder the Rail Safety National Law (ACT), s 73 or s 75.\naccreditation, of a rail transport operator, means accreditation by the\nOffice of the National Rail Safety Regulator under the Rail Safety\nNational Law (ACT).\n\n","sortOrder":310},{"sectionNumber":"314","sectionType":"section","heading":"Meaning of MAI premium","content":"314 Meaning of MAI premium\nMAI premium, for an MAI policy, means the insurance premium\napproved for the policy under—\n(a) section 319 (MAI commission to approve or reject premiums);\nor\n(b) section 320 (MAI commission may reconsider rejected\n(c) section 321 (Mediation of rejected premiums); or\n(d) section 322 (Arbitration of unresolved premiums).\n","sortOrder":311},{"sectionNumber":"315","sectionType":"section","heading":"Premium that can be charged by licensed insurer","content":"315 Premium that can be charged by licensed insurer\nA licensed insurer may charge a premium for an MAI policy only if\nthe premium is the MAI premium.\n","sortOrder":312},{"sectionNumber":"316","sectionType":"section","heading":"Premiums—MAI guidelines","content":"316 Premiums—MAI guidelines\nThe MAI guidelines may make provision for premiums for\nMAI policies, including provision for—\n(a) how MAI premiums are to be worked out and the factors to be\ntaken into account in working out MAI premiums; and\n(b) requiring licensed insurers to state how they have worked out\nMAI premiums; and\n(c) any additional information the MAI commission may require\nlicensed insurers to give to the MAI commission—\n(i) with an application for approval of a premium; or\n\n(ii) to justify MAI premiums they have already given to the\nMAI commission for approval.\nExample—additional information\nfor estimated investment income—the verification of assumptions, estimated\nprofit, capital allocation to MAI insurance business\nNote 1 The MAI guidelines are made under s 487.\nNote 2 It is a condition of an MAI insurer licence that the licensed insurer must\n","sortOrder":313},{"sectionNumber":"317","sectionType":"section","heading":"Licensed insurer to apply for approval of premiums","content":"317 Licensed insurer to apply for approval of premiums\n(1) A licensed insurer must apply to the MAI commission for approval\nof premiums the licensed insurer proposes to charge for MAI policies\nthe licensed insurer intends to issue—\n(a) after the defined period after the licensed insurer’s premiums\nwere last approved by the MAI commission; or\n(b) if the MAI commission, by written notice (an approval notice),\nrequires the licensed insurer to apply for the approval.\n(2) If a licensed insurer receives an approval notice, the licensed insurer\nmust make the application not later than 28 days after the day the\nlicensed insurer receives the approval notice.\nNote 1 The MAI guidelines may state the additional information the\nMAI commission may require licensed insurers to give to the\nMAI commission with the application (see s 316).\nNote 2 It is a condition of an MAI insurer licence that the licensed insurer must\ndefined period means—\n(a) 1 year; or\n(b) if the MAI commission allows a longer period of time—the\nlonger period allowed by the MAI commission.\n\n","sortOrder":314},{"sectionNumber":"318","sectionType":"section","heading":"Criteria to approve or reject premium","content":"318 Criteria to approve or reject premium\n(1) This section applies if the MAI commission is deciding whether to\napprove or reject a premium under—\n(a) section 317 (Licensed insurer to apply for approval of\n(b) section 320 (MAI commission may reconsider rejected\n(c) section 321 (Mediation of rejected premiums); or\n(d) section 322 (Arbitration of unresolved premiums).\n(2) The MAI commission may reject a premium for an MAI policy only\nif the MAI commission considers that—\n(a) having regard to actuarial advice and to other relevant financial\ninformation available to the MAI commission—\n(i) the premium will not fully fund the present and likely\nfuture liability under this Act of the licensed insurer; or\n(ii) the premium is excessive; or\n(b) the premium does not comply with the MAI guidelines.\n(3) An MAI premium will fully fund the present and likely future liability\nunder this Act of a licensed insurer if the MAI premium is\nsufficient—\n(a) to pay all acquisition and policy administration expenses of the\n(b) to provide an amount of money that together with anticipated\ninvestment income is equal to the best estimate of the cost of—\n(i) applications for defined benefits (in inflated dollars) at the\nassumed date of payment; and\n\n(ii) motor accident claims plus motor accident claim settlement\nexpenses (in inflated dollars) at the assumed date of\nsettlement; and\n(c) to provide a profit margin in excess of all applications for\ndefined benefits and motor accident claims, costs and expenses\nthat represents an adequate return on capital invested and\ncompensation for the risk taken; and\n(d) to provide for other matters that a prudent insurer should, in all\nthe circumstances, make provision for.\n(4) For subsection (3) (b) and (c), the cost of motor accident claims does\nnot include the treatment, care and support costs of a participant in\nthe LTCS scheme.\n","sortOrder":315},{"sectionNumber":"319","sectionType":"section","heading":"MAI commission to approve or reject premiums","content":"319 MAI commission to approve or reject premiums\nIf a licensed insurer applies to the MAI commission for approval of a\npremium for an MAI policy, the MAI commission must, within\n6 weeks after receiving the application from the licensed insurer—\n(a) approve or reject the premium; and\n(b) tell the licensed insurer—\n(i) about the decision; and\n(ii) the reasons for the decision.\nNote For what must be included in a statement of reasons, see the\nLegislation Act, s 179.\n\n","sortOrder":316},{"sectionNumber":"320","sectionType":"section","heading":"MAI commission may reconsider rejected premiums","content":"320 MAI commission may reconsider rejected premiums\n(1) If the MAI commission rejects a premium for an MAI policy (the\noriginal decision), the licensed insurer may ask the MAI commission\nto reconsider the rejected premium.\n(2) Until the rejected premium is reconsidered, the MAI commission\nmay ask an actuary to decide a provisional premium for the\nMAI policy.\n(3) A provisional premium has effect, until the MAI commission makes\na decision under subsection (4) in relation to the original decision, as\nif the provisional premium were an MAI premium.\n(4) The MAI commission must, within 28 days after receiving the request\nfor reconsideration—\n(a) reconsider the original decision; and\n(b) approve or reject the premium; and\nNote Criteria for approving or rejecting the premium are in s 318.\n(c) tell the licensed insurer—\n(i) about the decision; and\n(ii) the reasons for the decision.\nNote For what must be included in a statement of reasons, see the\nLegislation Act, s 179.\n","sortOrder":317},{"sectionNumber":"321","sectionType":"section","heading":"Mediation of rejected premiums","content":"321 Mediation of rejected premiums\n(1) If the MAI commission rejects a premium for an MAI policy under\nsection 320, the matter must be mediated under this section by an\naccredited mediator.\n(2) The mediator must be a person who is independent of the\nMAI commission and the licensed insurer.\n(3) The mediator must be decided by agreement between the\nMAI commission and the licensed insurer.\n\n(4) The fees and expenses of the mediator must be paid—\n(a) as agreed between the MAI commission and the licensed\n(b) if there is no agreement, by each of them in equal proportions.\n(5) If, as a result of the mediation, the MAI commission and the licensed\ninsurer reach an agreement in relation to the premium, the\nMAI commission must, in writing to the mediator and the insurer,\napprove or reject the premium in accordance with the agreement.\nNote Criteria for approving or rejecting the premium are in s 318.\naccredited mediator means a person who is entered as a mediator in\nthe register of nationally accredited mediators maintained by the\nMediator Standards Board.\nMediator Standards Board means the incorporated body registered\nunder the Corporations Act as the Mediator Standards Board Limited\nACN 145 829 812.\n","sortOrder":318},{"sectionNumber":"322","sectionType":"section","heading":"Arbitration of unresolved premiums","content":"322 Arbitration of unresolved premiums\n(1) If the MAI commission rejects a premium for an MAI policy under\nsection 321, the matter must be arbitrated under this section.\n(2) The Commercial Arbitration Act 2017 applies to the arbitration,\nsubject to this Act.\n(3) The arbitral tribunal for the matter is—\n(a) if the MAI commission and the licensed insurer agree on an\narbitrator—the agreed arbitrator; or\n(b) if the MAI commission and the licensed insurer do not agree on\nan arbitrator—the arbitrator worked out under the Commercial\nArbitration Act 2017.\n\n(4) However, if the matter has been arbitrated by an agreed arbitrator for\n7 days and the parties cannot reach agreement, an arbitrator appointed\nunder the Commercial Arbitration Act 2017 must arbitrate the matter.\n(5) The arbitral tribunal may approve a premium for an MAI policy only\nif the premium is, in the arbitral tribunal’s opinion, sufficient to fully\nfund the present and likely future liability under this Act of the\nlicensed insurer and is not excessive.\nNote Criteria for deciding whether an MAI premium will fully fund the present\nand likely future liability under this Act of a licensed insurer are in s 318.\n(6) A regulation may provide for the arbitration of matters.\narbitral tribunal—see the Commercial Arbitration Act 2017,\n","sortOrder":319},{"sectionNumber":"323","sectionType":"section","heading":"Licensed insurer to report on profit margins","content":"323 Licensed insurer to report on profit margins\n(1) A licensed insurer must tell the MAI commission—\n(a) the profit margin on which each MAI premium charged by the\nlicensed insurer is based; and\n(b) the actuarial basis for working out the profit margin.\n(2) The MAI commission must assess—\n(a) the profit margin; and\n(b) the actuarial basis on which the profit margin is worked out.\n\n","sortOrder":320},{"sectionNumber":"324","sectionType":"section","heading":"Nominal defendant liable—unregistered vehicle permits","content":"324 Nominal defendant liable—unregistered vehicle permits\n(b) at the time of the motor accident, an unregistered vehicle permit\nis in force for the motor vehicle involved in the motor accident;\nand\n(c) the motor accident happened anywhere in Australia.\nif—\npersonal injury if—\n(a) at the time the motor accident happened—\n(i) the land on which the motor accident happened was an area\nthat was not a road but was open to or used by the public\nfor driving, riding or parking vehicles; and\n(ii) the person injured was a trespasser on the land; or\nNote The area described in subpar (i) is a road related area (see dict,\ndef road related area, par (a) (iv)).\n(b) the motor vehicle is owned by—\n\n(c) at the time the motor accident happened—\n(i) the motor vehicle was registered under—\n(A) the law of a State other than the ACT; or\n(B) a law of the Commonwealth; and\n(ii) the motor vehicle was—\n(A) covered under a policy of motor accident injury\ninsurance; or\n(B) subject to coverage under a compulsory motor vehicle\nor trailer accident compensation scheme of that State\nor of the Commonwealth; or\n(d) a regulation prescribes that, in the circumstances, the nominal\ndefendant is not liable in relation to the personal injury.\nNote The nominal defendant is also not liable for the risks mentioned in s 293.\n","sortOrder":321},{"sectionNumber":"325","sectionType":"section","heading":"Meaning of uninsured motor vehicle","content":"325 Meaning of uninsured motor vehicle\n(1) For this Act:\nuninsured motor vehicle—\n(a) means a motor vehicle for which there is no MAI policy in force;\nand\n(b) includes a trailer that—\n(i) is attached to an uninsured motor vehicle; or\n(ii) runs out of control after becoming accidentally detached\nfrom an uninsured motor vehicle; and\n(c) includes anything else prescribed by regulation; but\n(d) does not include—\n(i) a motor vehicle for which an unregistered vehicle permit is\nin force; or\n\n(ii) an unregistered, uninsured motor vehicle that is designed\nto be driven for recreational purposes on an area that is not\na road or road related area.\nExample—subpar (ii)\na quad bike\n(2) To remove any doubt, it does not matter whether a trailer mentioned\nin subsection (1), definition of uninsured motor vehicle,\nparagraph (b) is registered.\n","sortOrder":322},{"sectionNumber":"326","sectionType":"section","heading":"Nominal defendant liable—uninsured motor vehicle","content":"326 Nominal defendant liable—uninsured motor vehicle\n(b) at the time of the motor accident, the motor vehicle involved in\nthe motor accident—\n(i) had a sufficient connection with the ACT; and\n(ii) was an uninsured motor vehicle; and\n(c) the motor accident happened anywhere in Australia.\nNote The circumstances in which a motor vehicle has a sufficient connection\nwith the ACT may be prescribed by regulation (see s (4)).\nif—\n\npersonal injury if—\n(a) at the time the motor accident happened—\n(i) the land on which the motor accident happened was an area\nthat was not a road but was open to or used by the public\nfor driving, riding or parking vehicles; and\n(ii) the person injured was a trespasser on the land; or\nNote The area described in subpar (i) is a road related area (see dict,\ndef road related area, par (a) (iv)).\n(b) the uninsured motor vehicle is owned by—\n(c) at the time the motor accident happened—\n(i) the uninsured motor vehicle was registered under—\n(A) the law of a State other than the ACT; or\n(B) a law of the Commonwealth; and\n(ii) the uninsured motor vehicle was—\n(A) covered under a policy of motor accident injury\ninsurance; or\n(B) subject to coverage under a compulsory motor vehicle\nor trailer accident compensation scheme of that State\nor of the Commonwealth; or\n(d) a regulation prescribes that, in the circumstances, the nominal\ndefendant is not liable in relation to the personal injury.\nNote The nominal defendant is also not liable for the risks mentioned in s 293.\n\n(4) A regulation may prescribe the circumstances in which a motor\nvehicle has a sufficient connection with the ACT.\nmotor vehicle means a motor vehicle that—\n(a) is exempt from registration; or\n(b) if not exempt from registration—must be registered to allow its\nlawful use or operation on a road or road related area in the ACT\nand—\n(i) was at the time of manufacture capable of registration; or\n(ii) was at the time of manufacture, with minor adjustments,\ncapable of registration; or\n(iii) was previously capable of registration but is no longer\ncapable of registration because the motor vehicle is in\ndisrepair.\n","sortOrder":323},{"sectionNumber":"327","sectionType":"section","heading":"Meaning of unidentified motor vehicle","content":"327 Meaning of unidentified motor vehicle\nunidentified motor vehicle—\n(a) means a motor vehicle that cannot be identified after reasonable\ninquiry and search; and\n(b) includes a trailer that—\n(i) is attached to an unidentified motor vehicle; or\n(ii) runs out of control after becoming accidentally detached\nfrom an unidentified motor vehicle; and\n(c) includes anything else prescribed by regulation; but\n\n(d) does not include a motor vehicle that is designed to be driven for\nrecreational purposes on an area that is not a road or road related\narea.\nExample—par (d)\na quad bike\n(2) To remove any doubt, it does not matter whether a trailer mentioned\nin subsection (1), definition of unidentified motor vehicle,\nparagraph (b) is registered.\n(3) The inquiry or search may be proved orally or by affidavit of the\nperson who made the inquiry or search.\n","sortOrder":324},{"sectionNumber":"328","sectionType":"section","heading":"Nominal defendant liable—unidentified motor vehicle","content":"328 Nominal defendant liable—unidentified motor vehicle\n(b) the motor vehicle involved in the motor accident is an\nunidentified motor vehicle; and\n(c) the motor accident happened in the ACT.\nif—\n\npersonal injury if, at the time the motor accident happened—\n(a) the land on which the motor accident happened was an area that\nwas not a road but was open to or used by the public for driving,\nriding or parking vehicles; and\n(b) the person injured was a trespasser on the land.\nNote 1 The area described in par (a) is a road related area (see dict, def road\nrelated area, par (a) (iv)).\nNote 2 The nominal defendant is also not liable for the risks mentioned in s 293.\n\n","sortOrder":325},{"sectionNumber":"329","sectionType":"section","heading":"Nominal defendant to pay defined benefits and motor","content":"329 Nominal defendant to pay defined benefits and motor\naccident claims from nominal defendant fund\n(1) The nominal defendant must pay the following amounts out of the\nnominal defendant fund:\n(a) the amount of any defined benefits payable under chapter 2\n(Motor accident injuries—defined benefits) by the nominal\ndefendant as the relevant insurer for a motor accident;\n(b) the amount of any costs or expenses incurred by the nominal\ndefendant in relation to an application for defined benefits under\nchapter 2;\npayment of fees for a consultant or claims manager engaged under this part\nin relation to an application for defined benefits\n(c) an amount payable in satisfaction of a motor accident claim\nmade, or judgment obtained, under—\n(i) section 324 (Nominal defendant liable—unregistered\nvehicle permits); or\n(ii) section 326 (Nominal defendant liable—uninsured motor\nvehicle); or\n(iii) section 328 (Nominal defendant liable—unidentified\nmotor vehicle);\n(d) the amount of any costs or expenses incurred by the nominal\ndefendant for a motor accident claim or judgment.\n(2) The nominal defendant is not personally liable to pay an amount\nmentioned in subsection (1).\n\n","sortOrder":326},{"sectionNumber":"330","sectionType":"section","heading":"Establishment of nominal defendant fund","content":"330 Establishment of nominal defendant fund\n(1) The MAI commission must establish a fund (the nominal defendant\nfund).\n(2) The following must be paid into the nominal defendant fund:\n(a) any penalties or penalty interest imposed under this Act, other\nthan a penalty imposed under part 7.6A (Financial penalties);\n(b) amounts received or recovered by or on behalf of the nominal\ndefendant under this Act;\nNote The nominal defendant may recover amounts under the following\nsections:\n(a) s 348 (Insurer may recover costs if motor vehicle\ndefective);\n(b) s 349 (Insurer may recover costs if fraud);\n(c) s 350 (Nominal defendant may recover costs from\nresponsible person or driver at fault);\n(d) s 424 (Nominal defendant may recover from insolvent\ninsurer).\n(c) amounts collected under section 331;\n(d) UVP liability contributions paid under section 333;\n(e) interest from time to time accruing from the investment of the\nnominal defendant fund;\n(f) amounts required to be paid into the nominal defendant fund\nunder this or another Act.\n(3) The following must be paid from the nominal defendant fund:\n(a) amounts required to be paid from the fund under section 329;\n(b) any amount requested under section 40 (Payment of defined\nbenefits by interstate relevant insurer);\n(c) all other amounts required to be paid from the fund under this or\nanother Act.\n\n(4) The MAI commission may invest money in the nominal defendant\nfund which is not immediately required for the fund—\n(a) in any way that the Treasurer is authorised to invest money\nunder the Financial Management Act 1996; or\n(b) in any other way approved by the Minister and the Treasurer.\n","sortOrder":327},{"sectionNumber":"331","sectionType":"section","heading":"Collections for nominal defendant fund","content":"331 Collections for nominal defendant fund\n(1) The MAI commission must, each financial year, collect an amount\nfor the nominal defendant fund—\n(a) from the people and funds prescribed by regulation; and\n(b) in accordance with the arrangements prescribed by regulation.\n(2) The MAI commission may decide the amount to be collected for a\nfinancial year.\n(3) The MAI commission must not decide an amount for a financial year\nif the MAI commission considers that satisfactory arrangements have\nbeen made for that year (under the insurance industry deed or\notherwise) by licensed insurers to meet—\n(a) applications for defined benefits; and\n(b) motor accident claims made against the nominal defendant.\nNote The insurance industry deed is dealt with in pt 7.2.\n","sortOrder":328},{"sectionNumber":"332","sectionType":"section","heading":"MAI commission must decide UVP liability contribution","content":"332 MAI commission must decide UVP liability contribution\n(1) The MAI commission must decide an amount (the UVP liability\ncontribution) to be paid to fund the present and likely future liability\nunder this Act of the nominal defendant for—\n(a) claims in relation to unregistered vehicle permits; and\n(b) applications for defined benefits in relation to unregistered\nvehicle permits.\n\n(2) The MAI guidelines may make provision in relation to UVP liability\ncontributions, including provision for the following:\n(a) how UVP liability contributions are to be worked out;\n(b) the factors to be taken into account in working out UVP liability\ncontributions.\n","sortOrder":329},{"sectionNumber":"333","sectionType":"section","heading":"UVP liability contribution to be paid with unregistered","content":"333 UVP liability contribution to be paid with unregistered\nvehicle permit\nIf a person applies to the road transport authority for an unregistered\nvehicle permit for a motor vehicle, the person must also pay to the\nroad transport authority the UVP liability contribution for the period\nof the permit.\nNote 1 Unregistered vehicle permits are issued under the Road Transport\n(Vehicle Registration) Act 1999, s 7.\nNote 2 UVP liability contributions paid to the road transport authority under this\nsection must be paid into the nominal defendant fund (see s 330).\n","sortOrder":330},{"sectionNumber":"334","sectionType":"section","heading":"Accounts for nominal defendant fund","content":"334 Accounts for nominal defendant fund\n(1) The nominal defendant must keep a separate account in the nominal\ndefendant fund for meeting the liabilities of the nominal defendant.\nNote The nominal defendant is liable for uninsured or unidentified motor\nvehicles (see pt 6.8) and for insolvent insurers (see pt 7.10).\n(2) The nominal defendant must keep accounts for—\n(a) amounts paid into the nominal defendant fund under\nsection 330; and\n(b) amounts withdrawn from the nominal defendant fund.\n(3) Accounts kept of amounts withdrawn from the nominal defendant\nfund must show the reason why each amount is withdrawn.\n\n","sortOrder":331},{"sectionNumber":"335","sectionType":"section","heading":"Audit of nominal defendant fund","content":"335 Audit of nominal defendant fund\n(1) The nominal defendant must have the accounts of the nominal\ndefendant fund for a financial year audited by a recognised auditor as\nsoon as practicable after the end of the financial year.\n(2) The nominal defendant must give the auditor’s report and audited\naccounts to the MAI commission as soon as practicable after the end\nof the financial year to which the report relates.\n","sortOrder":332},{"sectionNumber":"336","sectionType":"section","heading":"Assessment of financial position of nominal defendant","content":"336 Assessment of financial position of nominal defendant\nfund\n(1) Each year, the nominal defendant must—\n(a) assess the nominal defendant fund’s financial position; and\n(b) give a written copy of the assessment to the MAI commission.\n(2) In assessing the nominal defendant fund’s financial position, the\nnominal defendant—\n(a) must take into account—\n(i) the written advice of an actuary engaged by the nominal\ndefendant about existing and expected liabilities of the\nfund; and\n(ii) the fund’s assets; and\n(b) may take into account any other information that, in the nominal\ndefendant’s opinion, is relevant to an assessment of the nominal\ndefendant fund’s financial position.\n\n","sortOrder":333},{"sectionNumber":"337","sectionType":"section","heading":"Nominal defendant may engage consultants including","content":"337 Nominal defendant may engage consultants including\nclaims manager\n(1) The nominal defendant may engage consultants.\n(2) Without limiting subsection (1), the nominal defendant may engage\nan entity (a claims manager) to manage personal injuries in relation\nto which—\n(a) applications may be, or have been, made to the nominal\ndefendant under chapter 2 (Motor accident injuries—defined\nbenefits); or\n(b) claims may be, or have been, made against the nominal\ndefendant fund under chapter 6 (Motor accident injuries\ninsurance).\n(3) To remove any doubt, the nominal defendant may engage a claims\nmanager who is a claims manager for another fund managed by the\nACTIA.\nan entity engaged as a claims manager for the default insurance fund under the\nWorkers Compensation Act 1951\nNote ACTIA—see the dictionary.\n(4) However, the nominal defendant must not engage an entity under\nsubsection (2) unless satisfied that the entity has the experience and\nexpertise necessary to exercise the functions of a claims manager.\n(5) The conditions of a consultant’s engagement are the conditions\nagreed between the nominal defendant and the consultant.\n(6) To remove any doubt, this section does not give the nominal\ndefendant the power to enter into a contract of employment.\n\n","sortOrder":334},{"sectionNumber":"338","sectionType":"section","heading":"Claims manager’s functions","content":"338 Claims manager’s functions\n(1) This section applies if the nominal defendant engages a claims\nmanager to manage—\n(a) an application for defined benefits; or\n(b) a motor accident claim.\n(2) A claims manager may do the following in relation to an application\nfor defined benefits:\n(a) investigate the application;\n(b) approve the application;\n(c) refuse to approve the application;\n(d) ask for additional information in relation to the application;\n(e) if the applicant was covered at the time of injury by an\nMAI policy issued by a licensed insurer—exercise any right of\nthe insurer arising from, or in relation to, the policy;\n(f) anything prescribed by regulation.\n(3) A claims manager may do the following in relation to a motor\naccident claim:\n(a) investigate the claim;\n(b) negotiate the terms of settlement of the claim, either by payment\nof a lump sum or by weekly payments in accordance with this\nAct;\n(c) if the claimant was covered at the time of injury by an\nMAI policy issued by a licensed insurer—exercise any right of\nthe insurer arising from, or in relation to, the policy;\n(d) anything prescribed by regulation.\n\n(4) Subsection (3) does not authorise a claims manager to—\n(a) pay an amount to satisfy a claim; or\n(b) recover an amount owed to a licensed insurer against whom a\nclaim is made under this Act.\n(5) A claims manager may also exercise any other function given to the\nclaims manager under this Act or any other territory law.\nNote 1 A reference to an Act includes a reference to the statutory instruments\nNote 2 A provision of a law that gives an entity (including a person) a function\n","sortOrder":335},{"sectionNumber":"339","sectionType":"section","heading":"Delegation by nominal defendant","content":"339 Delegation by nominal defendant\nThe nominal defendant may delegate the nominal defendant’s\nfunctions under this Act or any other territory law to a public servant\nor a consultant engaged under this Act (including a claims manager).\nNote For the making of delegations and the exercise of delegated functions,\n","sortOrder":336},{"sectionNumber":"340","sectionType":"section","heading":"Information and assistance by insurer to nominal","content":"340 Information and assistance by insurer to nominal\ndefendant\n(1) The nominal defendant may, by written notice given to an insurer,\nrequire the insurer to do 1 or more of the following:\n(a) give the nominal defendant stated information and assistance\nthat the nominal defendant reasonably considers necessary for\nthe exercise of the nominal defendant’s functions;\ninformation about the health of an applicant or claimant given to the insurer\nby the applicant or claimant\n\n(b) give the nominal defendant stated documents in the insurer’s\npossession or control that the nominal defendant reasonably\nconsiders necessary for the exercise of the nominal defendant’s\nfunctions;\n(c) execute stated documents that the nominal defendant reasonably\nconsiders necessary for the insurer to execute for the exercise of\nthe nominal defendant’s functions.\n(2) An insurer must take all reasonable steps to comply with a\nrequirement of the nominal defendant under subsection (1).\nNote 1 The Legislation Act, s 170 deals with the application of the privilege\nagainst self-incrimination.\n(3) An offence against this section is a strict liability offence.\ninsurer means a licensed insurer and an interstate insurer.\n\nPreliminary Division 6.10.1\nPart 6.10 MAI insurer and nominal\ndefendant may recover costs\nincurred\n","sortOrder":337},{"sectionNumber":"Div 6","sectionType":"division","heading":"10.1 Preliminary","content":"Division 6.10.1 Preliminary\n","sortOrder":338},{"sectionNumber":"341","sectionType":"section","heading":"Meaning of costs—pt 6.10","content":"341 Meaning of costs—pt 6.10\ncosts, when used in reference to the costs of an insurer for a motor\naccident claim, includes—\n(a) the amount paid out by the insurer on the claim to the claimant\nor for the claimant’s benefit, including the cost to the insurer of\npaying the claimant’s reasonable and necessary treatment and\ncare; and\n(b) the amounts paid by the insurer in investigating the claim and of\nlitigation related to the claim, but not the insurer’s general\nadministration costs.\ncosts, when used in reference to the costs of an insurer for an\napplication for defined benefits by a person injured in a motor\naccident, includes—\n(a) the amount paid out by the insurer on the application to the\napplicant or for the applicant’s benefit, including the cost to the\ninsurer of paying the applicant’s reasonable and necessary\ntreatment and care; and\nNote Treatment and care needs are dealt with in pt 2.5.\n(b) the amounts paid by the insurer in deciding the application.\n\n","sortOrder":339},{"sectionNumber":"342","sectionType":"section","heading":"Insurer may only recover costs once","content":"342 Insurer may only recover costs once\nAn insurer is not entitled to recover costs under a provision of this\npart if the insurer has already recovered the costs under another\nprovision.\n","sortOrder":340},{"sectionNumber":"343","sectionType":"section","heading":"Proceeding to recover costs","content":"343 Proceeding to recover costs\nA proceeding by an insurer under a provision of this part may be\nbrought separately or by way of a third-party proceeding.\n","sortOrder":341},{"sectionNumber":"344","sectionType":"section","heading":"MAI insurer may recover $2 000 if MAI premium fraud","content":"344 MAI insurer may recover $2 000 if MAI premium fraud\n(b) the MAI insured person deliberately avoided paying the correct\nMAI premium for the MAI policy by making a statement in\nrelation to the issue of the policy that the MAI insured person\nknew was false or misleading in a material particular.\n(2) The MAI insurer may recover as a debt from the MAI insured\n(a) if the costs reasonably incurred by the MAI insurer for an\napplication for defined benefits, or a motor accident claim, in\nrelation to the motor accident are not more than $2 000—the\ntotal of the amount paid and costs incurred; or\n\nMAI insurers Division 6.10.2\n(b) if the costs reasonably incurred by the MAI insurer for an\napplication for defined benefits, or a motor accident claim, in\nrelation to the motor accident are more than $2 000—$2 000 or\nanother amount prescribed by regulation.\nNote 1 An MAI policy insures against the risk of liability for personal injury\nNote 2 Costs include reasonable and necessary treatment and care (see s 341).\nNote 3 It is an offence to make a false or misleading statement, give false or\n","sortOrder":342},{"sectionNumber":"345","sectionType":"section","heading":"MAI insurer may recover costs if no authority to use","content":"345 MAI insurer may recover costs if no authority to use\nvehicle\n(b) the MAI insured person was, at the time of the motor accident,\nusing the motor vehicle—\n(i) without the authority of the responsible person for the\nvehicle; and\n(ii) without lawful justification or excuse; and\n(iii) without reasonable grounds for believing that the\nMAI insured person had the authority of the responsible\nperson, or lawful justification or excuse, for using the\n(2) The insurer may recover as a debt from the MAI insured person any\ncosts reasonably incurred by the insurer for a motor accident claim\nfor the personal injury.\n\n","sortOrder":343},{"sectionNumber":"346","sectionType":"section","heading":"MAI insurer may recover costs if injury intentional","content":"346 MAI insurer may recover costs if injury intentional\n(b) the MAI insured person intended to injure the claimant or\nsomeone else.\n(2) The MAI insurer may recover as a debt from the MAI insured person\nany costs reasonably incurred by the MAI insurer for a motor accident\n","sortOrder":344},{"sectionNumber":"347","sectionType":"section","heading":"MAI insurer may recover costs if driver using alcohol or","content":"347 MAI insurer may recover costs if driver using alcohol or\ndrugs\n(b) the MAI insured person was the driver of the motor vehicle at\nthe time of the motor accident; and\n(c) the MAI insured person was, at the time of the motor accident,\nunable to exercise effective control of the motor vehicle because\nof the MAI insured person’s ingestion of—\n(i) alcohol; or\n(ii) a non-medicinal drug or a combination of non-medicinal\ndrugs; or\n(iii) a combination of alcohol and 1 or more non-medicinal\ndrugs; and\n(d) a motor accident claim is made in relation to the motor accident.\n\nMAI insurer and nominal defendant Division 6.10.3\n(2) The MAI insurer may recover as a debt from the MAI insured person\nany costs reasonably incurred by the MAI insurer for a motor accident\nclaim for the personal injury if the costs are reasonably attributable to\nthe MAI insured person’s inability to exercise effective control of the\nnon-medicinal drug means a drug other than a drug genuinely and\nlawfully ingested for medical or therapeutic purposes.\n","sortOrder":345},{"sectionNumber":"348","sectionType":"section","heading":"Insurer may recover costs if motor vehicle defective","content":"348 Insurer may recover costs if motor vehicle defective\ninsured person; and\n(b) the motor accident is attributable wholly or partly to a defect in\na motor vehicle; and\n(c) the defect arose from the wrongful act or omission of the\nmanufacturer or a person who carries on a business of repairing\nmotor vehicles (the repairer).\n(2) The insurer may recover as a debt from the manufacturer or repairer\nthe proportion of the costs reasonably incurred by the insurer for a\nmotor accident claim for the personal injury that reasonably reflects\nthe percentage of the manufacturer’s or repairer’s responsibility for\n\n(3) However, it is a defence for the manufacturer or repairer to prove that\nthe insured person for the motor vehicle drove the motor vehicle with\nknowledge of the defect and its likely effect.\nNote 1 An MAI policy insures against the risk of liability for personal injury\nNote 2 An amount recovered under this section by the nominal defendant must\n","sortOrder":346},{"sectionNumber":"349","sectionType":"section","heading":"Insurer may recover costs if fraud","content":"349 Insurer may recover costs if fraud\n(1) This section applies if an applicant for defined benefits, or a claimant\nfor a motor accident claim, in relation to a motor accident is convicted\nor found guilty of an offence against a provision mentioned in the\nCriminal Code, part 3.3 (Fraudulent conduct) or part 3.4 (False or\nmisleading statements, information and documents) in relation to the\napplication or claim.\n(2) The insurer for the motor accident may recover from the applicant or\nclaimant any costs reasonably incurred by the insurer because of the\napplicant’s or claimant’s conduct.\nNote An amount recovered under this section by the nominal defendant must\n(3) A regulation may prescribe—\n(a) the maximum amount an insurer may recover in relation to an\napplication for defined benefits or a motor accident claim if the\napplicant for defined benefits or the claimant for the motor\naccident claim has been convicted or found guilty of an offence\nmentioned in subsection (1); and\n(b) the amounts the insurer must not recover in relation to the\napplication for defined benefits or the motor accident claim; and\n(c) the requirements for recovering the amounts.\n\nNominal defendant Division 6.10.4\n","sortOrder":347},{"sectionNumber":"350","sectionType":"section","heading":"Nominal defendant may recover costs from responsible","content":"350 Nominal defendant may recover costs from responsible\nperson or driver at fault\n(a) personal injury is caused by a motor accident; and\n(b) the motor accident is caused by the act or omission of the\nresponsible person for, or the driver of, of a motor vehicle\ninvolved in the accident.\n(2) The nominal defendant may recover as a debt from the responsible\nperson for, or the driver of, the motor vehicle, or both, any costs\nreasonably incurred by the nominal defendant for a motor accident\n(3) However, the nominal defendant is not entitled to recover an amount\nthe motor vehicle, if the motor accident is a no-fault motor accident.\nNote No-fault motor accident—see s 254.\n(4) Also, the nominal defendant is not entitled to recover an amount\nthe motor vehicle, for treatment and care benefits or death benefits\nthat the responsible person or driver is entitled to under chapter 2\n(Motor accident injuries—defined benefits).\n","sortOrder":348},{"sectionNumber":"351","sectionType":"section","heading":"Nominal defendant may recover costs from responsible","content":"351 Nominal defendant may recover costs from responsible\nperson or driver—uninsured or unidentified motor vehicle\n(1) This section applies if personal injury is caused by a motor accident\ninvolving—\n(a) an uninsured motor vehicle that is not a light rail vehicle; or\n\n(b) an unidentified motor vehicle.\nNote The nominal defendant is liable in relation to uninsured motor vehicles\n(see s 326) and unidentified motor vehicles (see s 328).\n(2) The nominal defendant may recover as a debt from the responsible\nperson for, or the driver of, the motor vehicle, or both, any costs\nreasonably incurred by the nominal defendant for a motor accident\n(3) However, the nominal defendant is not entitled to recover an amount\nthe motor vehicle, if at the time of the motor accident, the vehicle—\n(a) was not required to be registered; or\n(b) was exempt from registration; or\n(c) if required to be registered—was not required to be insured\nunder this Act.\n(4) Also, the nominal defendant is not entitled to recover an amount\nthe motor vehicle, for treatment and care benefits or death benefits\nthat the responsible person or driver is entitled to under chapter 2\n(Motor accident injuries—defined benefits).\n(5) It is a defence to a proceeding under this section against the\nresponsible person for the motor vehicle if the responsible person\nproves that—\n(a) the motor vehicle was driven without the authority of the\nresponsible person; or\n(b) the responsible person believed on reasonable grounds that the\nmotor vehicle was insured.\n\nNominal defendant Division 6.10.4\n(6) It is a defence to a proceeding under this section against the driver of\nthe motor vehicle if the driver proves that the driver believed on\nreasonable grounds that—\n(a) the driver had the responsible person’s consent to drive the\nmotor vehicle; and\n(b) the motor vehicle was insured.\n(7) The nominal defendant may bring a proceeding for recovery of costs\n(8) This section does not affect a right of recovery the nominal defendant\nmay have, apart from this section, against the insured person.\nNote An amount recovered under this section must be paid into the nominal\ndefendant fund (see s 330).\n","sortOrder":349},{"sectionNumber":"352","sectionType":"section","heading":"Nominal defendant may recover costs from rail transport","content":"352 Nominal defendant may recover costs from rail transport\noperator\n(1) This section applies if personal injury is caused by a motor accident\ninvolving an uninsured light rail vehicle.\nNote The nominal defendant is liable in relation to uninsured light rail vehicles\n(see s 326).\n(2) The nominal defendant may recover as a debt from the rail transport\noperator for the light rail vehicle any costs reasonably incurred by the\nnominal defendant for a motor accident claim for the personal injury.\n(3) The nominal defendant may bring a proceeding for recovery of costs\n\n(4) This section does not affect a right of recovery that the nominal\ndefendant may have, apart from this section, against the rail transport\noperator.\nNote An amount recovered under this section must be paid into the nominal\ndefendant fund (see s 330).\n","sortOrder":350},{"sectionNumber":"353","sectionType":"section","heading":"Nominal defendant—access to territory information etc","content":"353 Nominal defendant—access to territory information etc\nThe nominal defendant is entitled to have access to information and\nmaterials in the possession of the Territory that may be relevant to the\nrecovery of costs that the nominal defendant is entitled to recover\nunder this part.\n\nMAI insurer licences—preliminary Part 7.1\n","sortOrder":351},{"sectionNumber":"Part 7","sectionType":"part","heading":"1 MAI insurer licences—","content":"Part 7.1 MAI insurer licences—\npreliminary\n","sortOrder":352},{"sectionNumber":"354","sectionType":"section","heading":"Definitions—Act","content":"354 Definitions—Act\nlicensed insurer means a corporation that holds an MAI insurer\nMAI insurer licence means a licence to carry on business as an\nMAI insurer.\n","sortOrder":353},{"sectionNumber":"355","sectionType":"section","heading":"Meaning of former licensed insurer—ch 7","content":"355 Meaning of former licensed insurer—ch 7\nformer licensed insurer means an entity that was, at any time, a\nlicensed insurer but is no longer a licensed insurer.\n","sortOrder":354},{"sectionNumber":"356","sectionType":"section","heading":"Offences—unlicensed insurer issues MAI policy","content":"356 Offences—unlicensed insurer issues MAI policy\n(a) issues an MAI policy; and\n(b) is not a licensed insurer.\n(2) A person commits an offence if the person—\n(a) purports to issue an MAI policy; and\n\nPart 7.1 MAI insurer licences—preliminary\n(b) is not a licensed insurer.\n","sortOrder":355},{"sectionNumber":"357","sectionType":"section","heading":"Unlicensed insurer liable for MAI policy","content":"357 Unlicensed insurer liable for MAI policy\nIf a person who is not a licensed insurer issues an MAI policy, the\nMAI policy is not annulled or affected only because the person is not\na licensed insurer.\n","sortOrder":356},{"sectionNumber":"358","sectionType":"section","heading":"MAI insurer licence register","content":"358 MAI insurer licence register\n(1) The MAI commission must keep a register of—\n(a) the name of each corporation that is—\n(i) issued with an MAI insurer licence; or\n(ii) refused an MAI insurer licence; and\n(b) for each MAI insurer licence issued by the MAI commission,\nthe following details:\n(i) any condition imposed on the licence;\n(ii) any suspension of the licence;\n(iii) any cancellation of the licence;\n(iv) any transfer of the licence; and\n(c) anything else prescribed by regulation.\n(2) The MAI commission may keep any other details in the register that\nthe MAI commission considers appropriate.\n\nMAI insurer licences—insurance industry deed Part 7.2\nPart 7.2 MAI insurer licences—insurance\nindustry deed\n","sortOrder":357},{"sectionNumber":"359","sectionType":"section","heading":"Meaning of insurance industry deed","content":"359 Meaning of insurance industry deed\ninsurance industry deed means a deed that—\n(a) is between—\n(i) the Territory; and\n(ii) the nominal defendant; and\n(iii) licensed insurers; and\n(b) regulates the conduct of MAI insurance business of licensed\ninsurers and matters incidental to—\n(i) the conduct of MAI insurance business of licensed\ninsurers; and\n(ii) the motor accident injury insurance scheme under this Act.\n","sortOrder":358},{"sectionNumber":"360","sectionType":"section","heading":"What may be included in insurance industry deed","content":"360 What may be included in insurance industry deed\n(1) The insurance industry deed may include provisions for each of the\n(a) the requirements for licensed insurers to make disclosures and\nreports to the MAI commission in accordance with stated\nstandards and requirements;\n(b) the apportionment of liability, and sharing of costs, between\nlicensed insurers;\n\nPart 7.2 MAI insurer licences—insurance industry deed\n(c) the appointment of a person to arbitrate disputes between 2 or\nmore licensed insurers about—\n(i) an application for defined benefits, including a dispute\nabout who is the relevant insurer for a motor accident; or\n(ii) a motor accident claim;\n(d) the sharing of information between MAI insurers for the mutual\nbenefit of insurers;\n(e) the monitoring and management of applications for defined\nbenefits and motor accident claims under MAI policies;\n(f) direction and guidance in relation to deciding the relevant\ninsurer for motor accident claims and applications for defined\nbenefits, including entering into arrangements to determine—\n(i) which insurer will accept an application for defined\nbenefits and be the relevant insurer in relation to the\napplication; and\n(ii) the most at-fault vehicle in a multiple vehicle accident;\n(g) direction and guidance for licensed insurers about managing,\nmonitoring and measuring the effectiveness of defined benefits\nfor injured applicants;\n(h) regulation, in any other way, of the conduct of MAI insurance\nbusiness of licensed insurers under the motor accident injury\ninsurance scheme under this Act.\n(2) A regulation may prescribe—\n(a) what may or must be included in the insurance industry deed;\nand\n(b) anything else about the content of the insurance industry deed.\n\nMAI insurer licences—issue Part 7.3\n","sortOrder":359},{"sectionNumber":"361","sectionType":"section","heading":"MAI insurer licence—eligibility","content":"361 MAI insurer licence—eligibility\nA corporation is eligible for an MAI insurer licence only if the\ncorporation—\n(a) is authorised under the Insurance Act 1973 (Cwlth) to carry on\ninsurance business; and\n(b) agrees, in writing, to be a party to the insurance industry deed\nwhile the corporation holds an MAI insurer licence.\n","sortOrder":360},{"sectionNumber":"362","sectionType":"section","heading":"MAI insurer licence—application","content":"362 MAI insurer licence—application\n(1) A corporation may apply to the MAI commission for an MAI insurer\n(2) The application must comply with the requirements prescribed by\n(3) The MAI commission may, in writing, ask the applicant to give the\nMAI commission additional information that the MAI commission\nreasonably needs to decide the application, including the following:\n(a) details of the shareholders, directors and other managers of the\napplicant;\n(b) any previous returns and accounts under—\n(i) the Corporations Act; and\n(ii) the Financial Sector (Collection of Data) Act 2001\n(Cwlth); and\n(iii) the Insurance Act 1973 (Cwlth);\n(c) details of reinsurance arrangements to which the applicant is a\nparty;\nNote Reinsurance arrangements are further dealt with in s 405.\n\n(d) a draft business plan.\nNote Business plans are dealt with in pt 7.9.\n(4) The MAI commission need not decide whether the corporation is\neligible for an MAI insurer licence if—\n(a) the corporation’s application does not comply with a\nrequirement prescribed by regulation; or\n(b) the corporation does not give the MAI commission information\nrequested under subsection (3).\n","sortOrder":361},{"sectionNumber":"363","sectionType":"section","heading":"MAI insurer licence—decision on application","content":"363 MAI insurer licence—decision on application\n(1) On an application by a corporation for an MAI insurer licence, the\nMAI commission must—\n(a) issue the licence; or\n(b) refuse to issue the licence.\nNote 1 A decision to refuse to issue an MAI insurer licence is a reviewable\nNote 2 An MAI insurer licence is subject to the conditions mentioned in pt 7.4.\n(2) The MAI commission must refuse to issue an MAI insurer licence\nif—\n(a) the commission is not satisfied that the applicant would, or\nwould be able to, properly exercise the functions of a licensed\ninsurer if issued with a licence; or\n(b) the applicant does not comply with a requirement prescribed by\nNote A decision to refuse to issue an MAI insurer licence is a reviewable\n\nMAI insurer licences—issue Part 7.3\n(3) In deciding whether the applicant would not, or would not be able to,\nproperly exercise the functions of a licensed insurer if issued with an\nMAI insurer licence, the MAI commission must consider the\n(a) the paid-up share capital and reserves of the applicant;\n(b) the constitution of the applicant (if any);\n(c) the reinsurance arrangements of the applicant;\n(d) whether issuing the licence will contribute to the efficiency of\nthe motor accidents injury insurance scheme under this Act\ngenerally;\n(4) In deciding the application, the MAI commission may consider\nanything else the MAI commission considers appropriate.\n(5) If the MAI commission proposes to issue an MAI insurer licence to a\ncorporation, the MAI commission must, at least 14 days before the\nlicence is issued, tell all licensed insurers about the proposal and the\nname of the corporation.\n(6) Failure by the MAI commission to comply with subsection (5) does\nnot affect the validity of a corporation’s MAI insurer licence.\nNote Power given by a law to make a decision includes power to reverse or\n","sortOrder":362},{"sectionNumber":"364","sectionType":"section","heading":"MAI insurer licence—term","content":"364 MAI insurer licence—term\nAn MAI insurer licence—\n(a) takes effect on the day stated in the licence; and\n(b) continues in force until it is cancelled.\n\n","sortOrder":363},{"sectionNumber":"365","sectionType":"section","heading":"Compliance with certain provisions","content":"365 Compliance with certain provisions\ncomplies with the following provisions:\n(a) section 66 (Accepting liability—payment of defined benefits);\n(b) section 315 (Premium that can be charged by licensed insurer);\n(c) section 317 (Licensed insurer to apply for approval of\npremiums);\n(d) section 401 (Licensed insurer to have business plan);\n(e) section 402 (Licensed insurer to comply with business plan);\n(f) section 403 (Licensed insurer to revise business plan);\n(g) section 405 (Reinsurance arrangements of licensed insurers);\n(h) section 412A (Notice of reportable conduct).\n","sortOrder":364},{"sectionNumber":"366","sectionType":"section","heading":"Compliance with MAI guidelines","content":"366 Compliance with MAI guidelines\ncomplies with the MAI guidelines.\n","sortOrder":365},{"sectionNumber":"366A","sectionType":"section","heading":"Compliance with directions and remediation plans","content":"366A Compliance with directions and remediation plans\ncomplies with the following:\n(a) any direction given to the insurer by the MAI commission under\nsection 394G;\n(b) any remediation plan approved by the MAI commission under\nsection 394I (5) (a).\n\n","sortOrder":366},{"sectionNumber":"367","sectionType":"section","heading":"Prompt management of applications for defined benefits","content":"367 Prompt management of applications for defined benefits\nmanages applications for defined benefits promptly.\n","sortOrder":367},{"sectionNumber":"368","sectionType":"section","heading":"Early payment of treatment and care","content":"368 Early payment of treatment and care\npay for the reasonable and necessary treatment and care for injured\npeople as soon as practicable.\n(2) A licensed insurer is taken not to have contravened the condition\nmentioned in subsection (1) if the insurer establishes that—\n(a) the insurer gave a report to the MAI commission within a\nreasonable period after the condition is contravened; and\n(b) the report sets out reasonable grounds for justifying the\n","sortOrder":368},{"sectionNumber":"369","sectionType":"section","heading":"Resolution of motor accident claims","content":"369 Resolution of motor accident claims\nresolve motor accident claims as soon as practicable.\n(2) A licensed insurer is taken not to have contravened the condition\nmentioned in subsection (1) if the insurer establishes that—\n(a) the insurer gave a report to the MAI commission within a\nreasonable period after the condition is contravened; and\n(b) the report sets out reasonable grounds for justifying the\n\n","sortOrder":369},{"sectionNumber":"370","sectionType":"section","heading":"Compliance with ACAT orders","content":"370 Compliance with ACAT orders\ncomplies with an order of the ACAT made in relation to a decision\nunder this Act not later than 14 days after—\n(a) if no appeal from the order is made—the appeal period for the\norder has ended; or\n(b) if an appeal from the order is made—the appeal has been finally\ndecided.\nappeal means an appeal from a decision of the ACAT under the ACT\nCivil and Administrative Tribunal Act 2008, section 79 (Appeals\nwithin tribunal) or section 86 (Appeals to Supreme Court).\nappeal period means the period mentioned in section 200 (2)\n(External review—time for appeal).\n","sortOrder":370},{"sectionNumber":"371","sectionType":"section","heading":"Protected information","content":"371 Protected information\nadopts measures to ensure that a person who is or has been employed\nby the insurer does not disclose protected information about a person,\notherwise than in accordance with this Act or another territory law,\nor the insurance industry deed.\nprotected information, about a person—\n(a) means information about a person that is disclosed to, or\nobtained by, a licensed insurer because of the exercise of a\nfunction under this Act by the licensed insurer or a person\nemployed by the licensed insurer; and\n\n","sortOrder":371},{"sectionNumber":"372","sectionType":"section","heading":"Provision of information to MAI commission","content":"372 Provision of information to MAI commission\ngives the MAI commission the information prescribed by regulation\nin relation to—\n(a) applications for defined benefits; and\n(b) motor accident claims; and\n(c) profits.\n","sortOrder":372},{"sectionNumber":"373","sectionType":"section","heading":"Dealing with complaints","content":"373 Dealing with complaints\ndeal with complaints in an expedient manner.\n","sortOrder":373},{"sectionNumber":"374","sectionType":"section","heading":"Licensed insurer’s conduct and practices","content":"374 Licensed insurer’s conduct and practices\nIt is a condition of an MAI insurer licence that the licensed insurer’s\nconduct and practices are consistent with—\n(a) the licensed insurer’s duty under section 20 (4) (Duty to act in\ngood faith—applicants, claimants and insurers) to act in good\nfaith; and\n(b) the objects of this Act.\n","sortOrder":374},{"sectionNumber":"375","sectionType":"section","heading":"Licensed insurer’s measures and policies","content":"375 Licensed insurer’s measures and policies\nadopts measures and policies, and ways of monitoring the\neffectiveness of adopted measures and policies, to ensure that staff of\nthe licensed insurer—\n(a) act fairly and without prejudice when dealing with injured\npeople and their representatives; and\n(b) treat injured people and their representatives with dignity and\nrespect; and\n\n(c) give information that is consistent with this Act.\n","sortOrder":375},{"sectionNumber":"376","sectionType":"section","heading":"Compliance with MAI commission conditions","content":"376 Compliance with MAI commission conditions\ncomply with an MAI commission condition included on the insurer’s\n","sortOrder":376},{"sectionNumber":"377","sectionType":"section","heading":"MAI commission conditions—power to include","content":"377 MAI commission conditions—power to include\nconditions\n(1) The MAI commission may include 1 or more of the following\nconditions (an MAI commission condition) on an MAI insurer\nlicence:\n(a) a condition for ensuring compliance with the obligations of the\n(b) a condition for ensuring that MAI premiums for MAI policies\nare sufficient to meet applications for defined benefits and motor\n(c) a condition for ensuring general efficiency in relation to—\n(i) applications for defined benefits; and\n(ii) motor accident claims and payments;\n(d) a condition relating to the provision of information about—\n(i) applications for defined benefits; and\n(ii) motor accident claims; and\n(iii) profits;\n\n(e) a condition prescribed by regulation.\nNote 1 Power given by a law to make a decision includes power to reverse or\nNote 2 If the MAI commission is unable, under s 397 (3), to cancel a licence\nbecause the commission is not satisfied the insurer’s liabilities have been\nappropriately dealt with, the commission may, instead, impose a\ncondition on the licence that prohibits the insurer from issuing any further\nMAI policies (see s 397 (4)).\n(2) An MAI commission condition may be included on an MAI insurer\nlicence—\n(a) when the licence is issued; or\n(b) by amending the licence.\n(3) The MAI commission may amend or revoke an MAI commission\ncondition included on an MAI insurer licence.\nNote A decision by the MAI commission under s (2) or (3) is a reviewable\n(4) If the MAI commission amends a licensed insurer’s licence under\nsubsection (2) or (3), the MAI commission must tell the insurer about\nthe amendment as soon as practicable, but not later than 30 days after\nthe day the MAI commission decides the amendment.\n(5) This section is subject to section 378.\n","sortOrder":377},{"sectionNumber":"378","sectionType":"section","heading":"MAI insurer licence—prohibited conditions","content":"378 MAI insurer licence—prohibited conditions\n(1) An MAI insurer licence must not be subject to any of the following\nconditions:\n(a) a condition that gives, or is likely to give, a competitive\nadvantage to a licensed insurer over another licensed insurer;\n(b) a condition that requires a licensed insurer to obtain a share of\nthe insurance market.\n\n(2) A condition mentioned in subsection (1) has no effect.\n","sortOrder":378},{"sectionNumber":"379","sectionType":"section","heading":"Offence—contravening licence condition","content":"379 Offence—contravening licence condition\n(a) is a licensed insurer; and\n(b) contravenes a condition of the person’s MAI insurer licence.\n(2) This section does not apply to a condition mentioned in section 378.\nNote 1 Contravention of a licence condition is also a ground for the following:\n(a) suspension of the MAI insurer licence (see s 383);\n(b) the MAI commission to apply to the ACAT for an occupational\ndiscipline order in relation to the licensed insurer (see pt 7.6).\n","sortOrder":379},{"sectionNumber":"380","sectionType":"section","heading":"Contravention of licence condition does not affect","content":"380 Contravention of licence condition does not affect\nMAI policy\nIf an MAI insurer issues an MAI policy in contravention of a\ncondition of their MAI insurer licence, the MAI policy is not annulled\nor affected only because the MAI insurer is in contravention of the\ncondition.\n","sortOrder":380},{"sectionNumber":"381","sectionType":"section","heading":"Offence—unlicensed insurer contravening licence","content":"381 Offence—unlicensed insurer contravening licence\ncondition\n(a) the person is not a licensed insurer; and\n(b) the person engages in conduct that would, if the person was a\nlicensed insurer, contravene a condition of an MAI insurer\nlicence; and\n\n(c) the condition relates to a motor accident.\n\nPart 7.5 MAI insurer licences—\nsuspension\n","sortOrder":381},{"sectionNumber":"382","sectionType":"section","heading":"Meaning of suspended insurer—pt 7.5","content":"382 Meaning of suspended insurer—pt 7.5\nsuspended insurer means an insurer whose MAI insurer licence is\nsuspended under section 385 (Licence suspension).\n","sortOrder":382},{"sectionNumber":"383","sectionType":"section","heading":"Grounds for licence suspension—contraventions","content":"383 Grounds for licence suspension—contraventions\n(1) Each of the following is a ground for suspending a licensed insurer’s\n(a) the insurer has contravened this Act;\n(b) the insurer has contravened a condition of the MAI insurer\nlicence;\n(c) the insurer has contravened the insurance industry deed.\n(2) However, if the MAI commission is satisfied that the contravention\ncould be remedied not later than 21 days after the day the\ncontravention happened, the MAI commission must not suspend the\nlicence under section 385 until at least 21 days after the day the\ncontravention happened.\nNote The grounds in s (1) are also grounds for the MAI commission to apply\nto the ACAT for an occupational discipline order in relation to the\nlicensed insurer (see pt 7.6).\n\n","sortOrder":383},{"sectionNumber":"384","sectionType":"section","heading":"Grounds for licence suspension—other grounds","content":"384 Grounds for licence suspension—other grounds\nEach of the following is a ground for suspending a licensed insurer’s\n(a) the insurer is not authorised under the Insurance Act 1973\n(Cwlth) to carry on insurance business;\n(b) any of the following is appointed over all or part of the assets,\nor undertaking, of the insurer:\n(i) a provisional liquidator or liquidator;\n(ii) a receiver or receiver and manager;\n(iii) a trustee;\n(c) the insurer is given a direction under the Insurance Act 1973\n(Cwlth), part 9 (Directions);\n(d) an inspector is appointed to investigate the affairs of the insurer\nunder the Insurance Act 1973 (Cwlth), part 5 (Investigations of\ngeneral insurers etc);\n(e) the MAI commission receives a report under section 407 (Audit\nof accounting records and compliance with MAI guidelines) and\nbelieves on reasonable grounds that the insurer is, or is likely to\nbecome, unable to meet its liabilities under this Act or under\nMAI policies issued by the insurer;\n(f) the insurer defaults in the payment of principal or interest of\nmore than $100 000 under any debenture, or series of\ndebentures, issued by the insurer, unless the default occurs\nbecause the insurer genuinely disputes its liability to make the\npayment;\n\n(g) the insurer enters into, or resolves to enter into any of the\nfollowing, other than for a reconstruction or amalgamation on\nterms that have been approved by the MAI commission:\n(i) an arrangement, composition or compromise with its\ncreditors;\n(ii) a transfer for the benefit of its creditors;\n(h) a proceeding is commenced to sanction an arrangement,\ncomposition, compromise or transfer mentioned in\nparagraph (g), other than for a reconstruction or amalgamation\non terms that have been approved by the MAI commission;\n(i) an application (other than a frivolous or vexatious application)\nor order is made for the winding up or dissolution of the insurer,\nother than for a reconstruction or amalgamation on terms that\nhave been approved by the MAI commission;\n(j) a resolution is passed for the winding up or dissolution of the\ninsurer, other than for a reconstruction or amalgamation on\nterms that have been approved by the MAI commission;\n(k) there is a change in the effective control of the insurer;\n(l) the insurer becomes a subsidiary of a corporation of which it was\nnot a subsidiary when the licence was issued;\n(m) the MAI commission believes on reasonable grounds that the\ninsurer has failed to comply with a condition imposed on the\ninsurer’s authority to carry on insurance business under the\nInsurance Act 1973 (Cwlth);\n(n) a person claiming to be a creditor of the insurer gives the insurer\na demand requiring the insurer to pay an amount of more than\n$100 000, and the insurer fails to pay the amount, or secure or\ncompound for it to the satisfaction of the person, within 3 weeks\nafter the demand is given;\n\n(o) an execution or other process issued on a judgment, decree or\norder of a court in favour of a creditor of the insurer is returned\nunsatisfied, completely or partly, and the amount unsatisfied is\nmore than $100 000;\n(p) the insurer agrees to the suspension.\nNote A licensed insurer, or former licensed insurer, commits an offence if any\nof the events or things mentioned in this section, other than paragraph (e),\nparagraph (m) or paragraph (p), happens and the person does not tell the\nMAI commission about it (see s 416).\n","sortOrder":384},{"sectionNumber":"385","sectionType":"section","heading":"Licence suspension","content":"385 Licence suspension\n(1) If the MAI commission believes on reasonable grounds that a ground\nfor suspending a licensed insurer’s MAI insurer licence exists, the\nMAI commission may suspend the licence by giving the licensed\ninsurer written notice of the suspension (a suspension notice).\nNote A decision by the MAI commission to suspend an MAI insurer licence is\na reviewable decision (see ch 10 and sch 2).\n(2) The suspension notice must state—\n(a) that the licence is suspended on and from—\n(i) the day the insurer is given the notice; or\n(ii) if the suspension notice states a later date—the day stated\nin the notice; and\n(b) the ground for the suspension.\nNote Power given by a law to make a decision includes power to reverse or\n\n","sortOrder":385},{"sectionNumber":"386","sectionType":"section","heading":"Ending licence suspension","content":"386 Ending licence suspension\n(1) The MAI commission may end the suspension of an MAI insurer\nlicence only if the MAI commission believes on reasonable grounds\nthat the licensed insurer is able to comply with the requirements that\nwould be imposed on the insurer if it were issued with a licence for\nthe first time.\n(2) If the MAI commission ends a suspension, the MAI commission must\ngive a written notice to the licensed insurer stating when the\nsuspension ends.\n","sortOrder":386},{"sectionNumber":"387","sectionType":"section","heading":"Offence—issuing MAI policy if licence suspended","content":"387 Offence—issuing MAI policy if licence suspended\n(a) the person is a licensed insurer; and\n(b) the person’s MAI insurer licence is suspended; and\n(c) the person issues an MAI policy.\nMaximum penalty: 100 penalty units\n","sortOrder":387},{"sectionNumber":"388","sectionType":"section","heading":"Effect of suspension on existing liabilities—suspended","content":"388 Effect of suspension on existing liabilities—suspended\n(1) The suspension of an insurer’s MAI insurance licence does not\naffect—\n(a) liabilities incurred, or accruing, before the date of suspension;\nor\n(b) the suspended insurer’s liabilities under MAI policies that came\ninto force before the date of suspension.\n\n(2) The suspended insurer is subject to this Act and the insurance industry\ndeed in the same way, and to the same extent, as a licensed insurer\nuntil all the suspended insurer’s liabilities for MAI insurance business\nhave been fully satisfied.\n","sortOrder":388},{"sectionNumber":"389","sectionType":"section","heading":"Suspended insurer selected after suspension","content":"389 Suspended insurer selected after suspension\n(1) If a suspended insurer is selected under part 6.4 (Selecting an MAI\ninsurer) to be the MAI insurer for an MAI policy, the MAI\ncommissioner must allocate another insurer under subsection (3) or\n(4) to be the MAI insurer for the MAI policy.\n(2) The MAI commission—\n(a) must consult with the remaining licensed insurers about their\ncapacity to underwrite the suspended insurer’s MAI policies;\nand\n(b) may consult with any insurer the MAI commission considers\nmay be appropriate to become a licensed insurer; and\n(c) must have regard to the result of any consultation with APRA\nrelevant to the matter.\n(3) The MAI commission must randomly allocate the MAI policies to the\nremaining licensed insurers in proportion to their shares of the market\nfor MAI insurance.\n(4) However, the MAI commission must not allocate MAI policies, if—\n(a) the MAI commission decides that the remaining licensed\ninsurers do not have capacity to underwrite the MAI policies; or\n(b) an insurer mentioned in subsection (2) (b) becomes a licensed\n\nPart 7.6 MAI insurer licences—\noccupational discipline\n390 Meaning of licensed insurer—pt 7.6\n391 MAI commission may choose occupational discipline\ninstead of prosecution\nIn regulating the operation of licensed insurers, the MAI commission\nmay, but need not, choose to apply to the ACAT for an occupational\ndiscipline order in relation to licensed insurers rather than pursuing a\nprosecution under this Act if the MAI commission believes on\nreasonable grounds it would be in the public interest to do so.\nNote The MAI commission may apply to the ACAT under s 393.\n","sortOrder":389},{"sectionNumber":"392","sectionType":"section","heading":"Grounds for occupational discipline","content":"392 Grounds for occupational discipline\n(1) Each of the following is a ground for occupational discipline in\nrelation to a licensed insurer:\n(a) the licensed insurer has contravened this Act;\n(b) the licensed insurer has contravened a condition of the\nMAI insurer licence;\n(c) the licensed insurer has contravened the insurance industry\ndeed;\n(d) the licensed insurer has contravened, or is contravening, an\noccupational discipline order;\n(e) the licensed insurer’s MAI insurer licence was obtained by fraud\nor mistake;\n\nMAI insurer licences—occupational discipline Part 7.6\n(f) another ground prescribed by regulation.\n(2) However, subsection (1) (a), (b) and (c) apply to a former licensed\ninsurer only in relation to anything that happened while the person\nwas licensed.\nNote The grounds in s (1) (a), (b) and (c) are also the grounds for licence\nsuspension under s 383.\n","sortOrder":390},{"sectionNumber":"393","sectionType":"section","heading":"Applications to ACAT for occupational discipline","content":"393 Applications to ACAT for occupational discipline\nIf the MAI commission believes on reasonable grounds that a ground\nfor occupational discipline exists in relation to a licensed insurer, the\nMAI commission may apply to the ACAT for an occupational\ndiscipline order in relation to the licensed insurer.\n","sortOrder":391},{"sectionNumber":"394","sectionType":"section","heading":"Occupational discipline orders","content":"394 Occupational discipline orders\n(1) This section applies if the ACAT may make an occupational\ndiscipline order in relation to a licensed insurer.\nNote The ACT Civil and Administrative Tribunal Act 2008, s 65 sets out when\nthe ACAT may make an occupational discipline order.\n(2) In addition to any other occupational discipline order that the ACAT\nmay make, the ACAT may require the licensed insurer to pay an\namount of not more than $100 000 to the Territory or someone else.\nNote The ACT Civil and Administrative Tribunal Act 2008, s 66 sets out other\noccupational discipline orders the ACAT may make.\n(3) However, if a licensed insurer is convicted of an offence under\nsection 379 (Offence—contravening licence condition) in relation to\nan act or omission, the ACAT must not make an occupational\ndiscipline order requiring the licensed insurer to pay an amount to the\nTerritory or someone else in relation to the same act or omission.\n\n(4) If the ACAT orders a licensed insurer to pay an amount, the amount\nmust be paid into the nominal defendant fund.\n\nFinancial penalties Part 7.6A\n","sortOrder":392},{"sectionNumber":"394A","sectionType":"section","heading":"Definitions—pt 7.6A","content":"394A Definitions—pt 7.6A\nfinancial penalty notice—see section 394D (3).\nground for financial penalty—see section 394B.\nminor contravention means conduct by a licensed insurer that\nconstitutes a ground for financial penalty that does not involve a\nserious contravention.\nserious contravention means conduct by a licensed insurer that\nconstitutes a ground for financial penalty that involves any of the\n(a) dishonest or misleading conduct by the licensed insurer;\n(b) underpayment or delay in paying defined benefits by the\n(c) failure by the licensed insurer to ensure protected information is\ndisclosed only in accordance with section 371;\n(d) failure by the licensed insurer to comply with an order of the\nACAT made for this Act;\n","sortOrder":393},{"sectionNumber":"394B","sectionType":"section","heading":"Meaning of ground for financial penalty—pt 7.6A","content":"394B Meaning of ground for financial penalty—pt 7.6A\nFor this part, each of the following is a ground for financial penalty\nin relation to a licensed insurer:\n(a) the licensed insurer has contravened this Act;\n(b) the licensed insurer has contravened a condition of the MAI\ninsurer licence;\n\n(c) the licensed insurer has contravened the insurance industry\ndeed.\n","sortOrder":394},{"sectionNumber":"394C","sectionType":"section","heading":"Notice of proposed financial penalty","content":"394C Notice of proposed financial penalty\n(1) The MAI commission may propose to impose a financial penalty on\nthe insurer if the commission is satisfied that—\n(a) a ground for financial penalty exists in relation to the insurer;\nand\n(b) the imposition of the financial penalty is in the public interest.\n(2) The MAI commission must give the insurer a written notice about the\nproposed financial penalty (a show cause notice) stating—\n(a) the grounds on which the commission is proposing to impose a\nfinancial penalty; and\n(b) whether the proposed financial penalty is for a minor or serious\ncontravention; and\n(c) the amount of the proposed financial penalty; and\n(d) that the insurer may give the commission a written submission\nabout the proposed financial penalty not later than—\n(i) for a minor contravention—15 business days after the day\nthe insurer is given the notice; or\n(ii) for a serious contravention—20 business days after the day\nthe insurer is given the notice; or\n(iii) if the commission agrees to a longer period—the agreed\n","sortOrder":395},{"sectionNumber":"394D","sectionType":"section","heading":"Imposing financial penalties","content":"394D Imposing financial penalties\n(1) The MAI commission may impose a financial penalty on a licensed\ninsurer if the commission—\n(a) has given the insurer a show cause notice; and\n\nFinancial penalties Part 7.6A\n(b) has considered any written submission given by the insurer in\naccordance with section 394C (2) (d); and\n(c) has considered the matters prescribed by regulation; and\n(d) is satisfied that—\n(i) a ground for financial penalty exists in relation to the\n(ii) the imposition of the financial penalty is—\n(A) in the public interest; and\n(B) appropriate taking into account the nature of the\n(2) A financial penalty must not be more than—\n(a) for a minor contravention—$20 000; or\n(b) for a serious contravention—$100 000.\n(3) If the MAI commission imposes a financial penalty on a licensed\ninsurer, the commission must give the insurer a notice (a financial\npenalty notice) stating—\n(a) that the commission has decided to impose a financial penalty\non the insurer; and\n(b) the amount of the financial penalty; and\n(c) the grounds on which the penalty is being imposed; and\n(d) that the notice is a financial penalty notice under this section;\nand\n(e) for a serious contravention—that the insurer may request a\nmediation under section 394E if the insurer disagrees with the\nfinancial penalty; and\n(f) that the penalty must be paid to the MAI commission in\naccordance with section 394F.\n\nshow cause notice—see section 394C (2).\n","sortOrder":396},{"sectionNumber":"394E","sectionType":"section","heading":"Mediation for serious contravention financial penalty","content":"394E Mediation for serious contravention financial penalty\nnotice\n(1) If the MAI commission imposes a financial penalty on a licensed\ninsurer for a serious contravention, the insurer may make a written\nrequest to the commission for the matter to be mediated.\n(2) A request under subsection (1) must be made within 10 business days\nafter the day the insurer is given the financial penalty notice.\n(3) A mediation under this section must be mediated by an accredited\nmediator.\n(4) The mediator must be—\n(a) a person who is independent of the MAI commission and the\n(b) decided by agreement between the MAI commission and the\n(5) The fees and expenses of the mediator must be paid—\n(a) as agreed between the MAI commission and the licensed\n(b) if there is no agreement—by each of them in equal proportions.\n(6) After mediation, the MAI commission must give the mediator and the\nlicensed insurer a written notice that—\n(a) if the commission and insurer reach an agreement—confirms,\nvaries or withdraws the financial penalty notice in accordance\nwith the agreement; or\n(b) if no agreement is reached—confirms the financial penalty\nnotice.\n\naccredited mediator—see section 321 (6).\n","sortOrder":397},{"sectionNumber":"394F","sectionType":"section","heading":"Payment of financial penalty","content":"394F Payment of financial penalty\n(1) This section applies if the MAI commission imposes a financial\npenalty on a licensed insurer under section 394D (2).\n(2) The licensed insurer must pay the financial penalty to the MAI\ncommission not later than 15 business days after the later of—\n(a) if the insurer requests a mediation under section 394E—the day\nthe financial penalty is confirmed or varied under section 394E\n(6); and\n(b) in any other case—the day the financial penalty notice is given\nto the insurer.\n(3) A financial penalty may be recovered as a debt payable to the MAI\ncommission.\nNote An amount owing under a law may be recovered as a debt in a court of\ncompetent jurisdiction or the ACAT (see Legislation Act, s 177).\nPart 7.6B MAI insurer licences—directions\nto licensed insurers\n","sortOrder":398},{"sectionNumber":"394G","sectionType":"section","heading":"Directions to licensed insurers—general","content":"394G Directions to licensed insurers—general\n(1) This section applies if the MAI commission believes on reasonable\ngrounds that a licensed insurer is contravening, has contravened or is\nlikely to contravene—\n\nPart 7.6B MAI insurer licences—directions to licensed insurers\n(2) The MAI commission may direct the licensed insurer to do 1 or more\nof the following things:\n(a) rectify the contravention or avoid the likely contravention\nmentioned in subsection (1);\n(b) comply with the Act, condition of the licence or insurance\nindustry deed.\n(3) A direction must be in writing and include the following:\n(a) details of the licensed insurer’s contravention or likely\ncontravention;\n(b) details of the thing required to be done or not done by the\n(c) the day by which the licensed insurer must comply with the\ndirection;\n(d) a statement that, under section 394H, the insurer may object to\nthe direction.\n(4) The licensed insurer must comply with the direction by the later of—\n(a) the day stated in the direction; and\n(b) if a later day is agreed between the MAI commission and the\ninsurer—that day.\n","sortOrder":399},{"sectionNumber":"394H","sectionType":"section","heading":"Objection to direction","content":"394H Objection to direction\n(1) A licensed insurer may make a written objection to the MAI\ncommission about a direction given to the insurer under\nsection 394G.\n(2) However, an objection may only be made on 1 or more of the\nfollowing grounds:\n(a) the stated contravention did not happen or the stated likely\ncontravention is unlikely to happen;\n\n(b) doing or not doing the stated thing would place an unreasonable\ncost burden on the insurer;\n(c) the stated time for compliance is either not reasonable or not\nproportionate to the thing that must be done or not done.\n(3) An objection does not operate to stay the direction or otherwise\nprevent action being taken based on the direction.\n(4) As soon as practicable after receiving an objection, the MAI\ncommission must review the direction and decide to—\n(a) affirm the direction; or\n(b) amend the direction; or\n(c) set aside the direction and make a different direction; or\n(d) withdraw the direction.\n(5) After making a decision under subsection (4), the MAI commission\nmust give the licensed insurer a written notice that states—\n(a) the commission’s decision; and\n(b) the reasons for the decision; and\n(c) if the decision is to amend the direction or set aside the direction\nand substitute it for a different direction—the day the amended\nor different direction takes effect.\n","sortOrder":400},{"sectionNumber":"394I","sectionType":"section","heading":"Directions to licensed insurers—remediation plans","content":"394I Directions to licensed insurers—remediation plans\n(1) The MAI commission may direct a licensed insurer to give the\ncommission a proposed remediation plan if the commission believes\non reasonable grounds that the insurer is contravening, has\ncontravened or is likely to contravene—\n\nPart 7.6B MAI insurer licences—directions to licensed insurers\n(2) A direction must be in writing and include the following:\n(a) details of the licensed insurer’s contravention or likely\ncontravention (the identified contravention);\n(b) a statement that the licensed insurer must give the MAI\ncommission a proposed remediation plan;\n(c) the day by which the licensed insurer must give the MAI\ncommission the proposed remediation plan.\n(3) The licensed insurer must give the MAI commission the proposed\nremediation plan by the later of—\n(a) 15 business days after the day the direction is given to the\n(b) if a later day is agreed between the MAI commission and the\ninsurer—that day.\n(4) A licensed insurer must include the following details in a proposed\nremediation plan:\n(a) the nature and extent of—\n(i) the identified contravention mentioned in the direction\ngiven to the insurer; and\n(ii) any other contravention or likely contravention (a further\ncontravention) that is the same as or similar to the\nidentified contravention mentioned in the direction; and\n(b) any action the insurer has taken, or proposes to take, to\nremediate the identified contravention and further\ncontravention;\n(c) the insurer’s assessment of the risk of the further contravention\nhappening;\n(d) any action the insurer has taken, or proposes to take, to remove\nor minimise the risk of the further contravention happening;\n\n(e) the timeframes for the insurer taking the actions mentioned in\nparagraph (b) and (d).\n(5) If a licensed insurer gives the MAI commission a proposed\nremediation plan (including an amended proposed remediation plan),\nthe commission must—\n(a) approve the proposed plan; or\n(b) require the insurer to amend the proposed plan.\n(6) However, the MAI commission must not approve a proposed\nremediation plan unless the proposed plan—\n(a) complies with subsection (4); and\n(b) identifies appropriate actions and timeframes for responding to\nthe risks identified in the proposed plan.\n(7) If the MAI commission approves a proposed remediation plan, the\ncommission must give the insurer a written notice stating—\n(a) that the proposed plan has been approved; and\n(b) that the insurer must comply with the approved remediation\nplan.\n(8) If the MAI commission requires the licensed insurer to amend a\nproposed remediation plan, the commission must give the insurer a\nwritten notice stating—\n(a) what amendments the commission requires the insurer to make\nto the proposed plan; and\n(b) the day by which the insurer must submit the amended proposed\nremediation plan.\n\nPart 7.7 MAI insurer licences—\ncancellation\n","sortOrder":401},{"sectionNumber":"395","sectionType":"section","heading":"Grounds for licence cancellation","content":"395 Grounds for licence cancellation\nEach of the following is a ground for cancelling a licensed insurer’s\n(a) the MAI commission considers the cancellation appropriate for\nany reason, including reasons relating to the motor accident\ninjury insurance scheme under this Act generally, whether or not\nthe reasons relate to the efficiency and conduct of the licensed\ninsurer;\n(b) the insurer surrenders the MAI insurer licence to the\nMAI commission and the MAI commission approves the\nsurrender.\nNote An MAI insurer must surrender its licence to the MAI commission if the\nMAI commission approves the transfer of the MAI insurer licence to\nsomeone else (see s 398).\n","sortOrder":402},{"sectionNumber":"396","sectionType":"section","heading":"Proposed licence cancellation","content":"396 Proposed licence cancellation\n(1) If the MAI commission proposes to cancel a licensed insurer’s\nMAI insurer licence on a ground mentioned in section 395 (a), the\nMAI commission must give the licensed insurer a written notice\n(a show cause notice) stating—\n(a) that the MAI commission proposes to cancel the licence; and\n(b) the grounds for the proposed cancellation; and\n(c) that the licensee may, not later than 14 days after the day the\nlicensee is given the notice, give a written submission to the\nMAI commission about the proposed cancellation.\n(2) In deciding whether to cancel the licence, the MAI commission must\nconsider any submission given to the MAI commission in accordance\nwith the show cause notice.\n\nMAI insurer licences—cancellation Part 7.7\n","sortOrder":403},{"sectionNumber":"397","sectionType":"section","heading":"Licence cancellation","content":"397 Licence cancellation\n(1) If the MAI commission believes on reasonable grounds that a ground\nfor cancelling a licensed insurer’s MAI insurer licence exists, the\nMAI commission may cancel the licence by giving the licensed\ninsurer written notice of the cancellation (a cancellation notice).\nNote A decision by the MAI commission to cancel an MAI insurer licence is a\nreviewable decision (see ch 10 and sch 2).\n(2) The cancellation notice must state—\n(a) that the licence is cancelled on—\n(i) the day the insurer is given the notice; or\n(ii) if the cancellation notice states a later date—the day stated\nin the notice; and\n(b) the ground for the cancellation.\nNote A decision to cancel an MAI insurer licence is a reviewable decision (see\nch 10 and sch 2).\n(3) However, the MAI commission must not cancel an MAI insurer\nlicence unless satisfied that the licensed insurer has—\n(a) discharged all of its past, present and future liabilities—\n(i) under any MAI policy for which it is the insurer; and\n(ii) to the nominal defendant fund; and\n(iii) to any other licensed insurer; or\n(b) provided security, or entered into other arrangements\nsatisfactory to the MAI commission, for the liabilities.\n\n(4) If the MAI commission is unable to cancel a licensed insurer’s\nMAI insurer licence because of subsection (3), the MAI commission\nmay instead impose a condition on the licence that prohibits the\ninsurer from issuing any further MAI policies.\nNote A decision to impose a condition on an MAI insurer licence is a\nreviewable decision (see ch 10 and sch 2).\n\nMAI insurer licences—transfer Part 7.8\n","sortOrder":404},{"sectionNumber":"398","sectionType":"section","heading":"MAI insurer licence—transfer","content":"398 MAI insurer licence—transfer\n(1) A licensed insurer (the old insurer) may, with the approval of the\nMAI commission, transfer the insurer’s MAI insurer licence to—\n(a) another licensed insurer (the new insurer); or\n(b) a corporation to whom the MAI commission proposes to issue\nan MAI insurer licence (the new insurer).\nNote A decision by the MAI commission to refuse to transfer an MAI insurer\nlicence to the new insurer is a reviewable decision (see ch 10 and sch 2).\n(2) The MAI commission must not approve the transfer of an\nMAI insurer licence unless satisfied that the new insurer is able to\nmeet the past, present and future liabilities of the old insurer—\n(a) under any MAI policy for which the old insurer is the insurer;\nand\n(b) to the nominal defendant fund; and\n(c) to any other licensed insurer.\n(3) If the MAI commission approves the transfer of the old insurer’s\nMAI insurer licence to the new insurer—\n(a) the old insurer must surrender the insurer’s MAI insurer licence\nto the MAI commission; and\n(b) all rights and liabilities subject to the transfer are transferred to,\nand become rights and liabilities of, the new insurer; and\n(c) this Act operates as if the new insurer had been selected as the\ninsurer under the MAI policies subject to the transfer.\nNote If the MAI commission approves the transfer of the old insurer’s licence\nunder this section, the MAI commission must cancel the old insurer’s\nlicence on surrender of the licence to the MAI commission (see pt 7.7).\n\n","sortOrder":405},{"sectionNumber":"399","sectionType":"section","heading":"Transfer of policies to other insurers","content":"399 Transfer of policies to other insurers\n(1) The MAI commission may transfer an insurer’s MAI policies to a\nlicensed insurer if—\n(a) the insurer’s MAI insurer licence is cancelled or otherwise\nceases to be in force; or\n(b) the MAI commission is satisfied that it is necessary to do so to\nensure compliance with a condition of the licence.\nNote A decision by the MAI commission to refuse to transfer an insurer’s MAI\npolicies is a reviewable decision (see ch 10 and sch 2).\n(2) The MAI commission must give a written notice to both insurers\nstating—\n(a) the MAI policies that are to be transferred; and\n(b) the day when the transfer happens.\nNote A decision to transfer an insurer’s MAI policies is a reviewable decision\n(see ch 10 and sch 2).\ninsurer means a licensed insurer, and includes a person whose\nMAI insurer licence has been cancelled or has otherwise ceased to be\nin force.\n","sortOrder":406},{"sectionNumber":"400","sectionType":"section","heading":"Effect of transfer of policies","content":"400 Effect of transfer of policies\n(1) If an MAI policy (the original policy) is transferred from an insurer\n(the old insurer) to a licensed insurer (the new insurer) under\nsection 399—\n(a) the original policy is cancelled; and\n(b) the new insurer is taken to have issued an MAI policy—\n(i) on the day of the transfer; and\n\nMAI insurer licences—transfer Part 7.8\n(ii) on the same terms as the original policy; and\n(iii) for the balance of the period of the original policy; and\n(c) the old insurer must pay to the new insurer—\n(i) the same proportion of the MAI premium paid, or to be\npaid, for the original policy as the balance of the indemnity\nperiod of the policy bears to the whole indemnity period of\nthe policy; and\n(ii) an additional amount decided by the MAI commission for\nthe income from investment and the management fee for\nthe MAI premium.\n(2) The new insurer may recover an amount payable under\nsubsection (1) (c) as a debt from the old insurer.\n(3) Cancellation of an MAI policy under this section ends the indemnity\nperiod of the policy but, subject to this section, does not affect any\nright, obligation or liability acquired, accrued or incurred under the\npolicy during the indemnity period.\n\nPart 7.9 MAI insurer licences—\nsupervision\n","sortOrder":407},{"sectionNumber":"401","sectionType":"section","heading":"Licensed insurer to have business plan","content":"401 Licensed insurer to have business plan\n(1) A licensed insurer must have a plan describing how the licensed\ninsurer’s MAI insurance business must be carried out (a business\nplan).\nNote MAI insurance business, for a licensed insurer, means any business\nassociated with MAI policies (see dict, def MAI insurance business).\n(2) The business plan must—\n(a) include a description of how the following things must be\ncarried out:\n(i) the handling of applications for defined benefits;\n(ii) the handling of motor accident claims;\n(iii) management;\n(iv) expenses;\n(v) systems for processing and transmitting information; and\n(b) comply with the MAI guidelines.\nNote The MAI guidelines may make provision in relation to business plans\n(see s 404).\n(3) If the MAI commission asks a licensed insurer for the business plan,\nthe licensed insurer must give the MAI commission a copy of the\nbusiness plan as soon as practicable.\n\n","sortOrder":408},{"sectionNumber":"402","sectionType":"section","heading":"Licensed insurer to comply with business plan","content":"402 Licensed insurer to comply with business plan\n(1) A licensed insurer must carry out the insurer’s MAI insurance\nbusiness in accordance with the insurer’s business plan.\n(2) If a licensed insurer carries out the insurer’s MAI insurance business\nin a way that departs significantly from the business plan, the insurer\nmust tell the MAI commission.\n","sortOrder":409},{"sectionNumber":"403","sectionType":"section","heading":"Licensed insurer to revise business plan","content":"403 Licensed insurer to revise business plan\nA licensed insurer must revise the insurer’s business plan—\n(a) at least once each year; and\n(b) if the insurer’s MAI insurance business departs significantly\nfrom the business plan; and\n(c) if the MAI commission directs the insurer to revise the business\nplan.\n","sortOrder":410},{"sectionNumber":"404","sectionType":"section","heading":"Business plans—MAI guidelines","content":"404 Business plans—MAI guidelines\n(1) The MAI guidelines may make provision for—\n(a) business plans for licensed insurers; and\n(b) the issue of MAI policies.\n(2) The MAI commission must consult each licensed insurer before\nmaking an MAI guideline in relation to the matters mentioned in\nsubsection (1).\n\n","sortOrder":411},{"sectionNumber":"405","sectionType":"section","heading":"Reinsurance arrangements of licensed insurers","content":"405 Reinsurance arrangements of licensed insurers\nA licensed insurer must tell the MAI commission—\n(a) details of arrangements made, or proposed to be made, for\nreinsurance for liabilities under MAI policies issued by the\n(b) the terms of any approval of APRA under the Insurance\nAct 1973 (Cwlth) for the reinsurance.\n","sortOrder":412},{"sectionNumber":"406","sectionType":"section","heading":"Offence—licensed insurer to keep accounts","content":"406 Offence—licensed insurer to keep accounts\n(1) A licensed insurer commits an offence if the insurer does not keep the\nfollowing accounting records and other records for the business or\nfinancial position of the insurer:\n(a) the records prescribed by regulation;\n(b) if the MAI commission directs the insurer, in writing, to keep a\nrecord—the records that the insurer is directed to keep.\naccounting records, of a licensed insurer, include the following:\n(a) invoices;\n(b) receipts;\n(c) orders for the payment of amounts;\n(d) bills of exchange;\n(e) cheques;\n\n(f) promissory notes;\n(g) vouchers and other prime entry documents;\n(h) the working papers and other documents that are necessary to\nexplain the methods and calculations by which accounts are\nmade up.\nNote A licensed insurer must also comply with the requirements under ch 9 in\nrelation to giving information to the MAI commission (see s 462 and\ns 465).\n","sortOrder":413},{"sectionNumber":"407","sectionType":"section","heading":"Audit of accounting records and compliance with","content":"407 Audit of accounting records and compliance with\n(1) The MAI commission may appoint an appropriately qualified person\n(an appointed auditor) to audit or inspect, and report to the\nMAI commission on—\n(a) the accounting records of a licensed insurer; or\n(b) other records relating to the business or financial position of a\nlicensed insurer; or\n(c) the licensed insurer’s compliance with the MAI guidelines.\n(2) An appointed auditor is, in exercising a function under this section,\nentitled to inspect the accounting records and other records of the\n(3) An appointed auditor exercising a function under this section has\nqualified privilege in a proceeding for defamation for any statement\nthat the auditor makes orally or in writing in the course of exercising\nthe function.\naccounting records, of a licensed insurer—see section 406 (2).\n\n","sortOrder":414},{"sectionNumber":"408","sectionType":"section","heading":"Offence—licensed insurer to assist appointed auditor","content":"408 Offence—licensed insurer to assist appointed auditor\nA licensed insurer commits an offence if—\n(a) an appointed auditor is exercising a function under section 407\nin relation to the insurer; and\n(b) the insurer does not provide all reasonable assistance requested\nby the auditor to allow the exercise of the function.\n","sortOrder":415},{"sectionNumber":"409","sectionType":"section","heading":"Audit of licensed insurer’s profitability","content":"409 Audit of licensed insurer’s profitability\n(1) The MAI commission may carry out an audit to work out the\nprofitability of a licensed insurer and, in carrying out the audit, may\nexercise a function of an appointed auditor.\n(2) The MAI commission must report on the audit, on a confidential\nbasis, to APRA.\n","sortOrder":416},{"sectionNumber":"410","sectionType":"section","heading":"MAI commission to analyse licensed insurer’s net","content":"410 MAI commission to analyse licensed insurer’s net\nprofitability\n(1) The MAI commission may analyse the following information about\na licensed insurer (a net profit analysis):\n(a) the insurer’s net profit;\n(b) the insurer’s expenses, other than expenses relating to the\nhandling of applications for defined benefits and motor accident\nclaims.\n(2) A net profit analysis may be based on the following information about\nthe licensed insurer:\n(a) information the MAI commission receives in relation to the\nconduct of an audit of the insurer under section 409 (Audit of\nlicensed insurer’s profitability);\n\n(b) information the MAI commission receives in relation to the\ninsurer under the following sections:\n(i) section 401 (Licensed insurer to have business plan);\n(ii) section 405 (Reinsurance arrangements of licensed\ninsurers);\n(iii) section 407 (Audit of accounting records and compliance\nwith MAI guidelines);\n(iv) section 462 (Licensed insurers must give information to\nMAI commission);\n(v) section 463 (Licensed insurer to provide investment\ndetails);\n(c) any other information available to the MAI commission under\nthis Act or another territory law in relation to the insurer’s\nexpenses or performance.\n(3) A regulation may prescribe the following:\n(a) when the MAI commission may prepare a net profit analysis;\n(b) the information that may be included in a net profit analysis.\n","sortOrder":417},{"sectionNumber":"411","sectionType":"section","heading":"Action if licensed insurer’s actual net profit differs from","content":"411 Action if licensed insurer’s actual net profit differs from\nreasonable industry net profit\n(1) A regulation may prescribe—\n(a) the way the MAI commission must work out the reasonable net\nprofit for a licensed insurer for a year (the reasonable industry\nnet profit); and\n(b) if a licensed insurer’s actual net profit for a year differs from the\nreasonable industry net profit for the year—action the MAI\ncommission may take in relation to the insurer’s actual net\nprofit.\n\n(2) If the MAI commission proposes to take action prescribed under\nsubsection (1) (b), the MAI commission must give notice, in writing,\nto the licensed insurer setting out—\n(a) the MAI commission’s reasons for taking the action; and\n(b) the action the MAI commission proposes to take; and\n(c) that the insurer may, not later than 28 days after the day the\ninsurer is given the notice, give a written submission to the MAI\ncommission about the proposed action.\n(3) In deciding whether to take the proposed action, the MAI commission\nmust consider any submission given to the MAI commission in\naccordance with the notice.\n(4) If the MAI commission decides to take action, the MAI commission\nmust give the licensed insurer written notice of—\n(a) the decision; and\n(b) what the insurer must do to comply with the decision.\n","sortOrder":418},{"sectionNumber":"412","sectionType":"section","heading":"Reports about insurers","content":"412 Reports about insurers\n(1) The MAI commission may give the Minister reports about—\n(a) the level of compliance by insurers with—\n(i) the requirements of this Act; and\n(ii) any conditions of MAI insurer licences under this Act\n(including the MAI guidelines); and\n(b) complaints made about insurers that relate to any matter to\nwhich this Act relates; and\n(c) anything else about insurers that relates to any matter to which\nthis Act relates.\n\n(2) A report may relate to—\n(a) insurers generally; or\n(b) a class of insurers; or\n(c) a particular insurer.\n(3) A report may identify a particular insurer.\n(4) A report may include the observations and recommendations the\nMAI commission considers appropriate.\nNote The Minister may publish a summary of a report prepared under this\nsection. The summary must not identify a licensed insurer, or allow the\nlicensed insurer’s identity to be worked out (see s 475).\n","sortOrder":419},{"sectionNumber":"412A","sectionType":"section","heading":"Notice of reportable conduct","content":"412A Notice of reportable conduct\n(1) If a licensed insurer becomes aware of reportable conduct in relation\nto the insurer, the insurer must give the MAI commission a written\nnotice about the reportable conduct that includes—\n(a) the known details about the reportable conduct; and\n(b) details about any action the licensed insurer has taken, or\nproposes to take to—\n(i) investigate the nature and extent of the reportable conduct\nand any other conduct that is the same as or similar to the\nreportable conduct; and\n(ii) remediate the reportable conduct and any other conduct\nidentified as a result of an investigation mentioned in\nsubparagraph (i); and\n(iii) remove or mitigate the risk of the same or similar\nreportable conduct happening; and\n(c) any other information required by the MAI guidelines.\n\n(2) The MAI guidelines may make provision in relation to the following:\n(a) what constitutes a significant contravention;\n(b) information a licensed insurer must include in a notice given\nunder subsection (1).\nreportable conduct means conduct by a licensed insurer that causes,\nor is likely to cause, a significant contravention of—\n","sortOrder":420},{"sectionNumber":"413","sectionType":"section","heading":"MAI commission may apply for policy holder protection","content":"413 MAI commission may apply for policy holder protection\norder\n(1) The MAI commission may apply to the Supreme Court for an order\n(a policy holder protection order) to protect the interests of the\nholders of MAI policies issued by a licensed insurer or a former\n(2) If the MAI commission intends to apply for a policy holder protection\norder, the MAI commission must give the following entities notice of\nits intention:\n(a) APRA;\n(b) ASIC.\n(3) Each of the following entities has a right to appear, and be heard, in a\nproceeding for a policy holder protection order:\n(a) APRA;\n(b) ASIC.\n\n(4) Before considering an application for a policy holder protection\norder, the Supreme Court may, if in its opinion it is desirable to do\nso, make an interim policy holder protection order that is expressed\nto have effect until the application is decided.\n(5) If the Supreme Court makes an interim policy holder protection order,\nthe court may not require the MAI commission to give an undertaking\nas to damages as a condition of making the order.\n","sortOrder":421},{"sectionNumber":"414","sectionType":"section","heading":"Court orders to protect policy holders","content":"414 Court orders to protect policy holders\n(1) The Supreme Court may, on the application of the MAI commission,\nmake any order the court considers necessary or desirable to protect\nthe interests of the holders of MAI policies issued by a licensed\nNote Licensed insurer includes a former licensed insurer (see s (6)).\n(2) However, the court may make an order for a licensed insurer only if—\n(a) satisfied that the insurer—\n(i) is not, or may not be, able to meet the insurer’s liabilities\nunder the MAI policies; or\n(ii) has acted, or may act, in a way that is prejudicial to the\ninterests of the holders of the MAI policies; and\n(b) the insurer is not a corporation that is in the course of being\nwound up.\n(3) Without limiting subsection (1), the court may make the following\norders:\n(a) an order regulating the administration and payment of defined\nbenefits and motor accident claims under the MAI policies;\n(b) an order prohibiting or regulating the transfer or disposal of, or\nother dealing in, the assets of the licensed insurer;\n\n(c) an order requiring the licensed insurer to discharge its liabilities\nunder the MAI policies out of its assets and the assets of any\nrelated body corporate;\n(d) an order appointing a receiver or receiver and manager, having\nthe powers that the court orders, of the property or part of the\nproperty of the licensed insurer or of any related body corporate.\n(4) If the Supreme Court makes an order under this section, the court\nmay, on application by the MAI commission or anyone else affected\nby the order, make another order revoking or amending the order.\n(5) To remove any doubt, the powers of the Supreme Court under this\nsection are in addition to any other powers of the Supreme Court.\n","sortOrder":422},{"sectionNumber":"415","sectionType":"section","heading":"Offence—contravene court order","content":"415 Offence—contravene court order\n(a) a court order under section 414 is in force for the person; and\n(b) the person contravenes the order.\n\n","sortOrder":423},{"sectionNumber":"416","sectionType":"section","heading":"Offence—insurer to tell MAI commission about grounds","content":"416 Offence—insurer to tell MAI commission about grounds\nfor suspension\n(a) the person is a licensed insurer or a former licensed insurer; and\n(b) an event or thing mentioned in section 384 (Grounds for licence\nsuspension—other grounds) happens, other than an event or\nthing mentioned in section 384 (e), (m) or (p); and\n(c) the person does not tell the MAI commission about the event or\nthing, in writing, within 21 days after the event or thing happens.\n","sortOrder":424},{"sectionNumber":"417","sectionType":"section","heading":"Offence—insurer to tell MAI commission of decrease in","content":"417 Offence—insurer to tell MAI commission of decrease in\nissued capital\n(a) the person is a licensed insurer; and\n(b) there is, or is to be, a decrease in the issued capital of the insurer;\nand\n(c) the person does not tell the MAI commission about the decrease\nor proposed decrease, in writing, within 21 days after the\ndecrease or proposal.\n\n","sortOrder":425},{"sectionNumber":"418","sectionType":"section","heading":"Offence—insurer to tell MAI commission of bidder’s","content":"418 Offence—insurer to tell MAI commission of bidder’s\nstatement or target’s statement\n(a) is a licensed insurer; and\n(b) receives a bidder’s statement or target’s statement; and\n(c) does not tell the MAI commission about the statement, in\nwriting, within 21 days after the licensed insurer receives the\nstatement.\nbidder’s statement—see the Corporations Act, section 9.\ntarget’s statement—see the Corporations Act, section 9.\n","sortOrder":426},{"sectionNumber":"419","sectionType":"section","heading":"Only MAI commission may issue proceeding against","content":"419 Only MAI commission may issue proceeding against\nA proceeding against a licensed insurer for failure to comply with the\nterms of the insurer’s MAI insurer licence, or this Act, may only be\nissued by the MAI commission.\n\nPart 7.10 MAI insurer licences—insolvent\n","sortOrder":427},{"sectionNumber":"420","sectionType":"section","heading":"Definitions—pt 7.10","content":"420 Definitions—pt 7.10\ninsolvent insurer means a licensed insurer, or former licensed\ninsurer, for which an insolvent insurer declaration is in force.\ninsolvent insurer declaration—see section 422.\nliquidator includes a provisional liquidator.\nMAI policy issued by an insolvent insurer means—\n(a) an MAI policy issued by an insolvent insurer, whether before or\nafter the insurer became an insolvent insurer; or\n(b) an MAI policy, issued by a person other than an insolvent\ninsurer, for which an insolvent insurer has (whether before or\nafter becoming an insolvent insurer) entered into a contract or\nan arrangement under which the insolvent insurer is (or would\nbe but for its dissolution) liable to indemnify the person against\nthe person’s liability under the policy.\n","sortOrder":428},{"sectionNumber":"421","sectionType":"section","heading":"Liquidators","content":"421 Liquidators\n(1) In this part, a reference to a liquidator includes a reference to a\nliquidator appointed outside the ACT.\n(2) The liquidator of an insolvent insurer may exercise its functions\ninside and outside the ACT.\n\n","sortOrder":429},{"sectionNumber":"422","sectionType":"section","heading":"Insolvent insurer declarations","content":"422 Insolvent insurer declarations\n(1) The Minister may declare a licensed insurer, or former licensed\ninsurer, to be an insolvent insurer (an insolvent insurer declaration)\nif—\n(a) the Minister is satisfied that—\n(i) a liquidator has been appointed for the licensed insurer or\nformer licensed insurer; or\n(ii) the licensed insurer, or former licensed insurer, has been\ndissolved; and\n(b) the Minister has consulted—\n(i) APRA; and\n(ii) ASIC; and\n(c) the Treasurer approves the making of the declaration.\n(2) An insolvent insurer declaration is a notifiable instrument.\n","sortOrder":430},{"sectionNumber":"423","sectionType":"section","heading":"Nominal defendant is insurer if MAI insurer insolvent","content":"423 Nominal defendant is insurer if MAI insurer insolvent\n(1) If an MAI insurer for an MAI policy becomes an insolvent insurer,\nthe nominal defendant becomes the insurer for the policy.\n(2) However, subsection (1) does not apply to an MAI policy that is\ntransferred to a licensed insurer (other than an insolvent insurer).\nNote Transfer of MAI policies is dealt with in pt 7.8.\n\n","sortOrder":431},{"sectionNumber":"424","sectionType":"section","heading":"Nominal defendant may recover from insolvent insurer","content":"424 Nominal defendant may recover from insolvent insurer\n(1) If the nominal defendant becomes the insurer for an MAI policy in\nplace of an insolvent insurer under section 423, any costs reasonably\nincurred by the nominal defendant for the following become debts of\nthe insolvent insurer to the nominal defendant and provable in the\ninsolvency:\n(a) applications for defined benefits in relation to motor accidents\nfor which the insolvent insurer was the relevant insurer;\n(b) motor accident claims under an MAI policy for which the\ninsolvent insurer was the insurer.\n(2) The costs that become the debts of the insolvent insurer under\nsubsection (1) have the same order of priority in the winding-up of\nthe insolvent insurer as they would if the nominal defendant were an\nMAI insured person under the MAI policy.\n(3) If an application for defined benefits or a motor accident claim for\nwhich costs are incurred by the nominal defendant is covered by a\ncontract of reinsurance, the nominal defendant succeeds to the rights\nof the insolvent insurer under the contract of reinsurance.\n","sortOrder":432},{"sectionNumber":"425","sectionType":"section","heading":"Offence—liquidator to give applications for defined","content":"425 Offence—liquidator to give applications for defined\nbenefits and motor accident claims to nominal defendant\n(1) The liquidator of an insolvent insurer commits an offence if the\nliquidator—\n(a) receives an application for defined benefits in relation to a motor\naccident for which the insolvent insurer is the relevant insurer;\nand\n(b) does not give the application to the nominal defendant.\n\n(2) The liquidator of an insolvent insurer commits an offence if the\nliquidator—\n(a) receives a motor accident claim in relation to an MAI policy\nissued by the insolvent insurer; and\n(b) does not give the motor accident claim to the nominal defendant.\n","sortOrder":433},{"sectionNumber":"426","sectionType":"section","heading":"Offence—liquidator to give information etc to nominal","content":"426 Offence—liquidator to give information etc to nominal\ndefendant\n(1) The liquidator of an insolvent insurer commits an offence if—\n(a) the nominal defendant asks the liquidator, in writing, to give the\nnominal defendant all documents, or information, in the\nliquidator’s possession relating to the following:\n(i) MAI policies issued by the insolvent insurer;\n(ii) applications for defined benefits in relation to motor\naccidents for which the insolvent insurer is the relevant\ninsurer;\n(iii) motor accident claims, or judgments, made in relation to\nthe MAI policies; and\n(b) the liquidator does not give the documents or information to the\nnominal defendant within 45 days after the day the nominal\ndefendant asks for them.\n\n(2) Subsection (1) does not apply to a liquidator if—\n(a) before the end of the 45-day period, the liquidator—\n(i) tells the nominal defendant, in writing, that it is not\nreasonably practicable to give the nominal defendant the\ndocuments or information within the period; and\n(ii) explains why it is not reasonably practicable; and\n(b) the nominal defendant extends the time for providing the\ndocuments or information; and\n(c) the liquidator provides the documents or information to the\nnominal defendant within the extended time.\n","sortOrder":434},{"sectionNumber":"427","sectionType":"section","heading":"Offence—liquidator to allow inspection of documents","content":"427 Offence—liquidator to allow inspection of documents\n(1) The liquidator of an insolvent insurer commits an offence if—\n(a) a person authorised by the Minister asks the liquidator to make\navailable for inspection by the person all documents in the\nliquidator’s possession relating to—\n(i) MAI policies issued by the insolvent insurer; or\n(ii) applications for defined benefits in relation to motor\naccidents for which the insolvent insurer is the relevant\n(iii) motor accident claims or judgments made in relation to the\nMAI policies; and\n(b) the liquidator does not make the documents available to the\nperson within 45 days after the day the person asks for them.\n\n(2) Subsection (1) does not apply to a liquidator if—\n(a) before the end of the 45-day period, the liquidator—\n(i) in writing, tells the person authorised that it is not\nreasonably practicable to give the person the documents\nwithin the period; and\n(ii) explains why it is not reasonably practicable; and\n(b) the person extends the time for providing the documents; and\n(c) the liquidator makes the documents available to the person\nwithin the extended time.\n","sortOrder":435},{"sectionNumber":"428","sectionType":"section","heading":"Borrowing for nominal defendant fund","content":"428 Borrowing for nominal defendant fund\nThe nominal defendant may borrow the amounts that the nominal\ndefendant considers necessary to satisfy applications for defined\nbenefits in relation to motor accidents for which an insolvent insurer\nis the relevant insurer, motor accident claims and judgments for\nMAI policies issued by an insolvent insurer if the nominal defendant\nwould not otherwise be able to satisfy the applications, claims and\njudgments from the nominal defendant fund.\n","sortOrder":436},{"sectionNumber":"429","sectionType":"section","heading":"Nominal defendant may intervene in legal proceeding","content":"429 Nominal defendant may intervene in legal proceeding\n(a) the liquidator of an insolvent insurer applies to a court for\ndirections for a matter arising under the winding-up; or\n(b) the exercise, by the liquidator of an insolvent insurer, of any of\nthe liquidator’s functions, whether under this part or not, is\nchallenged, reviewed or called into question in a proceeding\nbefore a court; or\n(c) another matter that may affect the operation of this part is raised\nin a proceeding before a court.\n(2) The nominal defendant may intervene at any stage of the proceeding.\n\n(3) If the nominal defendant intervenes, the nominal defendant becomes\na party to the proceeding and has all the rights of a party to the\nproceeding including the right to appeal against any order, judgment\nor direction of the court.\n(4) The nominal defendant is entitled to be paid, out of the nominal\ndefendant fund, all the costs and expenses incurred by the nominal\ndefendant in exercising a function under this section.\n","sortOrder":437},{"sectionNumber":"430","sectionType":"section","heading":"Nominal defendant may take legal proceeding","content":"430 Nominal defendant may take legal proceeding\n(1) This section applies to a proceeding if—\n(a) the nominal defendant may take the proceeding for a person who\nis entitled (or who would be entitled but for the dissolution of\nthe insolvent insurer), under an MAI policy issued by an\ninsolvent insurer, to be indemnified against a motor accident\nclaim or judgment arising from or relating to the MAI policy;\nand\n(b) the proceeding is for, or for enforcing or securing compliance\nwith, any provision under this part or another Act.\n(2) The nominal defendant is taken to represent sufficiently the interests\nof the public and may take the proceeding in its own name.\n(3) The nominal defendant is entitled to be paid, out of the nominal\ndefendant fund, all the costs and expenses incurred by the nominal\ndefendant in exercising a function under this section.\n\nPart 7.11 MAI insurer licences—miscellaneous\nPart 7.11 MAI insurer licences—\n431 Insurer to deter fraudulent applications or claims\nAn insurer must take all reasonable steps to deter and prevent the\nmaking of fraudulent applications for defined benefits or motor\naccident claims.\n","sortOrder":438},{"sectionNumber":"432","sectionType":"section","heading":"Communicating with people in relation to motor accident","content":"432 Communicating with people in relation to motor accident\n(1) The relevant insurer for a motor accident may contact the following\npeople directly (whether or not the person has legal representation) in\nthe circumstances stated in the MAI guidelines:\n(a) a person injured in the motor accident;\n(b) an applicant for defined benefits;\n(c) a claimant for a motor accident claim.\n(2) The MAI guidelines may make provision in relation to the following:\n(a) the circumstances in which an insurer may communicate with\nan applicant for defined benefits or a claimant for a motor\n(b) the matters about which an insurer may communicate with an\napplicant for defined benefits or a claimant for a motor accident\n\nEnforcement—general Part 8.1\n","sortOrder":439},{"sectionNumber":"Part 8","sectionType":"part","heading":"1 Enforcement—general","content":"Part 8.1 Enforcement—general\n","sortOrder":440},{"sectionNumber":"433","sectionType":"section","heading":"Definitions—ch 8","content":"433 Definitions—ch 8\nat premises includes in or on the premises.\nauthorised person means a person appointed as an authorised person\nunder section 434.\nconnected—a thing is connected with an offence if—\n(a) the offence has been committed in relation to it; or\n(b) it will provide evidence of the commission of the offence; or\n(c) it was used, is being used, or is intended to be used, to commit\nthe offence.\noccupier, of premises, includes—\n(a) a person believed on reasonable grounds to be an occupier of the\n(b) a person apparently in charge of the premises.\noffence includes an offence that there are reasonable grounds for\nbelieving has been, is being, or will be, committed.\npremises includes land, a vehicle, a vessel and an aircraft.\nwarrant means a warrant issued under part 8.3 (Enforcement—search\nwarrants).\n\n","sortOrder":441},{"sectionNumber":"434","sectionType":"section","heading":"MAI commission may appoint authorised people","content":"434 MAI commission may appoint authorised people\nThe MAI commission may appoint a public servant as an authorised\nperson for this Act.\nNote 1 For the making of appointments (including acting appointments), see the\nLegislation Act, pt 19.3.\nNote 2 In particular, a person may be appointed for a particular provision of a\nlaw (see Legislation Act, s 7 (3)) and an appointment may be made by\nnaming a person or nominating the occupant of a position (see Legislation\nAct, s 207).\n","sortOrder":442},{"sectionNumber":"435","sectionType":"section","heading":"MAI commission must give identity cards","content":"435 MAI commission must give identity cards\n(1) The MAI commission must give each authorised person an identity\ncard that states the person’s name and that the person is an authorised\nperson.\n(2) The identity card must show—\n(a) a recent photograph of the authorised person; and\n(b) the date of issue of the card; and\n(c) the date of expiry of the card; and\n(d) anything else prescribed by regulation.\n(3) A person commits an offence if the person—\n(a) stops being an authorised person; and\n\n(b) does not return the person’s identity card to the\nMAI commission as soon as practicable (but not later than\n7 days) after the day the person stops being an authorised\nperson.\nMaximum penalty: 1 penalty unit.\n(4) Subsection (3) does not apply to a person if the person’s identity card\nhas been—\n(a) lost or stolen; or\n(b) destroyed by someone else.\nNote The defendant has an evidential burden in relation to the matters\nmentioned in s (4) (see Criminal Code, s 58).\n(5) An offence against this section is a strict liability offence.\n","sortOrder":443},{"sectionNumber":"436","sectionType":"section","heading":"Authorised person must show identity card on exercising","content":"436 Authorised person must show identity card on exercising\npower\n(1) If an authorised person exercises a power under this Act that affects\nan individual, the authorised person must first show the authorised\nperson’s identity card to the individual.\n(2) If an authorised person exercises a power under this Act that affects\na person, other than an individual, the authorised person must first\nshow the authorised person’s identity card to an individual the\nauthorised person believes on reasonable grounds is an employee,\nofficer or agent of the person.\nExamples—person other than an individual\n• corporation\n• partnership\n\n","sortOrder":444},{"sectionNumber":"437","sectionType":"section","heading":"Power to enter premises","content":"437 Power to enter premises\n(1) For this Act, an authorised person may—\n(a) at any reasonable time, enter premises that the public is entitled\nto use or that are open to the public (whether or not on payment\nof money); or\n(b) at any time, enter premises with the occupier’s consent; or\n(c) enter premises in accordance with a warrant.\n(2) However, subsection (1) (a) does not authorise entry into a part of\npremises that is being used only for residential purposes.\n(3) An authorised person may, without the consent of the occupier of\npremises, enter land around the premises to ask for consent to enter\nthe premises.\n(4) To remove any doubt, an authorised person may enter premises under\nsubsection (1) without payment of an entry fee or other charge.\nat any reasonable time includes at any time when the public is\nentitled to use the premises, or when the premises are open to or used\nby the public (whether or not on payment).\n","sortOrder":445},{"sectionNumber":"438","sectionType":"section","heading":"Production of identity card","content":"438 Production of identity card\nAn authorised person and any other person other than a uniformed\npolice officer who is accompanying the authorised person must not\nremain at premises entered under this chapter if the authorised person\ndoes not produce the authorised person’s identity card when asked by\nthe occupier.\n\n","sortOrder":446},{"sectionNumber":"439","sectionType":"section","heading":"Consent to entry","content":"439 Consent to entry\n(1) When seeking the consent of an occupier of premises to enter\npremises under section 437 (1) (b), an authorised person must—\n(a) produce their identity card; and\n(b) tell the occupier—\n(i) the purpose of the entry; and\n(ii) the reason for, and identity of, any other person\naccompanying the authorised person; and\n(iii) that anything found and seized under this chapter may be\nused in evidence in court; and\n(iv) that consent may be refused.\n(2) If the occupier consents, the authorised person must ask the occupier\nto sign a written acknowledgment (an acknowledgment of\nconsent)—\n(a) that the occupier was told—\n(i) the purpose of the entry; and\n(ii) the reason for, and identity of, any other person\naccompanying the authorised person; and\n(iii) that anything seized under this chapter may be used in\nevidence in court; and\n(iv) that consent may be refused; and\n(b) that the occupier consented to the entry; and\n(c) stating the time and date consent was given.\n(3) If the occupier signs an acknowledgment of consent, the authorised\nperson must immediately give a copy to the occupier.\n\n(4) A court must find that the occupier did not consent to entry to the\npremises by the authorised person under this chapter if—\n(a) the question arises in a proceeding in the court whether the\noccupier consented to the entry; and\n(b) an acknowledgment of consent is not produced in evidence; and\n(c) it is not proved that the occupier consented to the entry.\n","sortOrder":447},{"sectionNumber":"440","sectionType":"section","heading":"General powers on entry to premises","content":"440 General powers on entry to premises\n(1) An authorised person who enters premises under this chapter may, for\nthis Act, do 1 or more of the following in relation to the premises or\nanything at the premises:\n(a) examine anything;\n(b) examine and copy, or take extracts from, documents relating to\na contravention, or possible contravention, of this Act;\n(c) take photographs, films, or audio, video or other recordings;\n(d) require the occupier, or anyone at the premises, to give\ninformation, answer questions, or produce documents or\nanything else (whether the information, document or other thing\nis at the premises or elsewhere) that the occupier or person at the\npremises has, or has access to, that are reasonably needed to\nexercise a function under this chapter;\n(e) require the occupier, or anyone at the premises, to give the\nauthorised person copies of documents produced under\nparagraph (d) that are reasonably necessary to exercise a\nfunction under this chapter;\n(f) require the occupier, or anyone at the premises, to give the\nauthorised person reasonable help to exercise a power under this\nchapter.\nNote The Legislation Act, s 170 and s 171 deal with the application of the\nprivilege against self-incrimination and client legal privilege.\n\n(2) Also, an authorised person who enters premises under a warrant may\nsearch the premises or anything at the premises.\n(3) A person must take reasonable steps to comply with a requirement\nmade of the person under subsection (1) (d), (e) or (f).\n","sortOrder":448},{"sectionNumber":"441","sectionType":"section","heading":"Power to seize things","content":"441 Power to seize things\n(1) An authorised person who enters premises under this part with the\noccupier’s consent may seize anything at the premises if seizure of\nthe thing is consistent with the purpose of the entry told to the\noccupier when seeking the occupier’s consent.\n(2) An authorised person who enters premises under a warrant under this\nchapter may seize anything at the premises that the authorised person\nis authorised to seize under the warrant.\n(3) An authorised person who enters premises under this chapter\n(whether with the occupier’s consent, under a warrant or otherwise)\nmay seize anything at the premises if the authorised person believes\non reasonable grounds that—\n(a) the thing is connected with an offence against this Act; and\n(b) the seizure is necessary to prevent the thing from being—\n(i) concealed, lost or destroyed; or\n(ii) used to commit, continue or repeat the offence.\n(4) Having seized a thing, an authorised person may—\n(a) remove the thing from the premises where it was seized\n(the place of seizure) to another place; or\n(b) leave the thing at the place of seizure but restrict access to it.\n\n(5) A person commits an offence if the person—\n(a) interferes with a seized thing, or anything containing a seized\nthing, to which access has been restricted under subsection (4);\nand\n(b) does not have an authorised person’s approval to interfere with\nthe thing.\n(6) An offence against subsection (5) is a strict liability offence.\n","sortOrder":449},{"sectionNumber":"442","sectionType":"section","heading":"Power to require name and address","content":"442 Power to require name and address\n(1) An authorised person may require a person to state the person’s name\nand home address if the authorised person suspects on reasonable\ngrounds that the person is committing or has just committed an\noffence against this Act.\n(2) The authorised person must tell the person the reason for the\nrequirement and, as soon as practicable, record the reason.\n(3) The person may ask the authorised person to produce the authorised\nperson’s identity card for inspection by the person.\n(4) A person must comply with a requirement made of the person under\nsubsection (1) if the authorised person—\n(a) tells the person the reason for the requirement; and\n\n(b) complies with any request made by the person under\nsubsection (3).\nMaximum penalty: 10 penalty units.\n(5) Subsection (3) and subsection (4) (b) do not apply to an authorised\nperson who is a police officer in uniform.\n(6) An offence against this section is a strict liability offence.\n\n","sortOrder":450},{"sectionNumber":"443","sectionType":"section","heading":"Warrants generally","content":"443 Warrants generally\n(1) An authorised person may apply to a magistrate for a warrant to enter\nand search premises.\n(2) The application must be sworn and state the grounds on which the\nwarrant is sought.\nNote Swear an oath includes make an affirmation (see Legislation Act, dict,\npt 1, def swear).\n(3) The magistrate may refuse to consider the application until the\nauthorised person gives the magistrate all the information the\nmagistrate requires about the application in the way the magistrate\nrequires.\n(4) The magistrate may issue a warrant only if satisfied there are\nreasonable grounds for suspecting—\n(a) there is a particular thing or activity connected with an offence\nagainst this Act; and\n(b) the thing or activity—\n(i) is, or is being engaged in, at the premises; or\n(ii) may be, or may be engaged in, at the premises within the\nnext 7 days.\n(5) The warrant must state—\n(a) that an authorised person may, with any reasonable and\nnecessary force and assistance, enter the premises and exercise\nthe authorised person’s powers under this chapter; and\nNote An authorised person’s powers include the power to search the\npremises (see s 440 (2)).\n\n(b) the offence for which the warrant is issued; and\n(c) the things that may be seized under the warrant; and\n(d) the hours when the premises may be entered; and\n(e) the date (within 7 days after the day the warrant is issued) that\nthe warrant ends.\nconnected—an activity is connected with an offence if—\n(a) the offence has been committed by engaging or not engaging in\nit; or\n(b) it will provide evidence of the commission of the offence.\n","sortOrder":451},{"sectionNumber":"444","sectionType":"section","heading":"Warrants—application made other than in person","content":"444 Warrants—application made other than in person\n(1) An authorised person may apply for a warrant by phone, fax, email,\nradio or other form of communication if the authorised person\nconsiders it necessary because of—\n(a) urgent circumstances; or\n(b) other special circumstances.\n(2) Before applying for the warrant, the authorised person must prepare\nan application stating the grounds on which the warrant is sought.\n(3) The authorised person may apply for the warrant before the\napplication is sworn.\n","sortOrder":452},{"sectionNumber":"445","sectionType":"section","heading":"Warrants—issue on application made other than in","content":"445 Warrants—issue on application made other than in\n(1) If the magistrate issues the warrant, the magistrate must immediately\ndo either of the following if it is practicable to do so:\n(a) fax a copy to the authorised person;\n(b) email a scanned copy to the authorised person.\n\n(2) If it is not practicable to fax or email a copy to the authorised person—\n(a) the magistrate must tell the authorised person—\n(i) the date and time the warrant was issued; and\n(ii) the warrant’s terms; and\n(b) the authorised person must complete a form of warrant\n(the warrant form) and write on it—\n(i) the magistrate’s name; and\n(ii) the date and time the magistrate issued the warrant; and\n(iii) the warrant’s terms.\n(3) The faxed or emailed copy of the warrant, or the warrant form\nproperly completed by the authorised person, authorises the entry and\nthe exercise of the authorised person’s powers under the warrant.\nNote Authorised people have additional powers under this part (see s 440\nand s 441).\n(4) The authorised person must, at the first reasonable opportunity, send\nto the magistrate—\n(a) the sworn application; and\n(b) if the officer completed a warrant form—the completed warrant\nform.\n(5) On receiving the documents, the magistrate must attach them to the\nwarrant.\n(6) A court must find that a power exercised by an authorised person was\nnot authorised by a warrant under this section if—\n(a) the question arises in a proceeding in the court whether the\nexercise of power was authorised by a warrant; and\n\n(b) the warrant is not produced in evidence; and\n(c) it is not proved that the exercise of power was authorised by a\nwarrant under this section.\n","sortOrder":453},{"sectionNumber":"446","sectionType":"section","heading":"Warrants—announcement before entry","content":"446 Warrants—announcement before entry\n(1) An authorised person must, before anyone enters premises under a\nwarrant—\n(a) announce that the authorised person is authorised to enter the\n(b) give anyone at the premises an opportunity to allow entry to the\n(c) if the occupier of the premises, or someone else who apparently\nrepresents the occupier, is present at the premises—identify\nthemself to the person.\n(2) The authorised person is not required to comply with subsection (1)\nif the authorised person believes on reasonable grounds that\nimmediate entry to the premises is required to ensure—\n(a) the safety of anyone in relation to the subject matter of the\nwarrant; or\n(b) the safety of the authorised person or anyone assisting the\nauthorised person; or\n(c) that the effective execution of the warrant is not frustrated.\n","sortOrder":454},{"sectionNumber":"447","sectionType":"section","heading":"Details of warrant to be given to occupier etc","content":"447 Details of warrant to be given to occupier etc\n(1) If an occupier of premises, or someone else who apparently represents\nthe occupier, is present at the premises while a warrant is being\nexecuted, the authorised person or anyone assisting must make\navailable to the person—\n(a) a copy of the warrant or warrant form; and\n\n(b) a document setting out the rights and obligations of the person.\nwarrant form—see section 445 (2) (b).\n","sortOrder":455},{"sectionNumber":"448","sectionType":"section","heading":"Occupier entitled to observe search etc","content":"448 Occupier entitled to observe search etc\n(1) If an occupier of premises, or someone else who apparently represents\nthe occupier, is present at the premises while a warrant is being\nexecuted, the person is entitled to observe the search being conducted.\n(2) However, the person is not entitled to observe the search if—\n(a) to do so would impede the search; or\n(b) the person is under arrest, and allowing the person to observe\nthe search being conducted would interfere with the objectives\nof the search.\n(3) This section does not prevent 2 or more areas of the premises being\nsearched at the same time.\n","sortOrder":456},{"sectionNumber":"449","sectionType":"section","heading":"Moving things to another place for examination or","content":"449 Moving things to another place for examination or\nprocessing under warrant\n(1) A thing found at premises entered under a warrant may be moved to\nanother place for examination or processing to decide whether it may\nbe seized under the warrant if—\n(a) both of the following apply:\n(i) there are reasonable grounds for believing that the thing is\nor contains something to which the warrant relates;\n(ii) it is significantly more practicable to do so having regard\nto the timeliness and cost of examining or processing the\nthing at another place and the availability of expert\nassistance; or\n(b) the occupier of the premises agrees in writing.\n\n(2) The thing may be moved to another place for examination or\nprocessing for not longer than 72 hours.\n(3) An authorised person may apply to a magistrate for an extension of\ntime if the authorised person believes on reasonable grounds that the\nthing cannot be examined or processed within 72 hours.\n(4) The authorised person must give notice of the application to the\noccupier of the premises, and the occupier is entitled to be heard on\nthe application.\nNote For how documents may be given, see the Legislation Act, pt 19.5.\n(5) If a thing is moved to another place under this section, the authorised\nperson must, if practicable—\n(a) tell the occupier of the premises the address of the place where,\nand time when, the examination or processing will be carried\nout; and\n(b) allow the occupier or the occupier’s representative to be present\nduring the examination or processing.\n(6) The provisions of this chapter relating to the issue of warrants apply,\nwith any necessary changes, to the giving of an extension under this\nsection.\n\nPart 8.4 Enforcement—return and\nforfeiture of things seized\n","sortOrder":457},{"sectionNumber":"450","sectionType":"section","heading":"Receipt for seized thing","content":"450 Receipt for seized thing\n(1) As soon as practicable after an authorised person seizes a thing under\nthis chapter, the authorised person must give a receipt for it to the\nperson from whom it was seized.\n(2) If, for any reason, it is not practicable to comply with subsection (1),\nthe authorised person must leave the receipt, secured conspicuously,\nat the premises where the thing was seized.\n(3) The receipt must include the following:\n(a) a description of the thing seized;\n(b) why the thing was seized;\n(c) the authorised person’s name, and information about how to\ncontact the officer;\n(d) if the thing is moved from the premises—the address where the\nthing is to be taken;\n(e) if an authorised person has restricted access to the thing under\nsection 441 (4) (b) (Power to seize things)—that it is an offence\nunder section 441 (5) to interfere with the thing without an\nauthorised person’s approval.\n","sortOrder":458},{"sectionNumber":"451","sectionType":"section","heading":"Access to seized thing","content":"451 Access to seized thing\nA person who would, apart from the seizure, be entitled to inspect a\nthing seized under this chapter may, at any reasonable time—\n(a) inspect it; and\n(b) if it is a document—take extracts from it or make copies of it.\n\n","sortOrder":459},{"sectionNumber":"452","sectionType":"section","heading":"Return of seized thing","content":"452 Return of seized thing\n(1) If a thing was seized under this chapter and 1 of the circumstances set\nout in section 453 applies—\n(a) the thing must be returned to its owner; or\n(b) if the thing cannot be returned to its owner because it is lost,\ndestroyed or damaged—reasonable compensation must be paid\nby the Territory to the owner.\nNote The thing must be returned, or compensation paid, as soon as possible\n(see Legislation Act, s 151B).\n(2) However, a thing is not required to be returned, or reasonable\ncompensation is not required to be paid, if—\n(a) the thing is the subject of an application to a court, or a court\norder, in relation to the seizure or forfeiture of the thing; and\n(b) the application or order is made in relation to the thing under\nanother law in force in the ACT.\nAn application for the forfeiture of the seized thing is made to a court under the\nConfiscation of Criminal Assets Act 2003.\n","sortOrder":460},{"sectionNumber":"453","sectionType":"section","heading":"Circumstances—s 452","content":"453 Circumstances—s 452\nThe circumstances for section 452 are as follows:\n(a) an infringement notice for an offence relating to the thing is not\nseized, and a prosecution for an offence relating to the thing—\n(i) is not started within the 1-year period; or\n\n(ii) is started within the 1-year period but the offence is finally\nExamples—offence finally dealt with in owner’s favour\n1 a court finds the owner not guilty of the offence\n2 a court finds the owner guilty of the offence, the owner appeals\nagainst the conviction and the appeal court sets the conviction\naside\n3 a court permanently stays the criminal proceeding against the\nowner\n(b) an infringement notice for an offence relating to the thing is\nseized, the infringement notice is withdrawn and a prosecution\nfor an offence relating to the thing—\n(i) is not started within the 1-year period; or\n(ii) is started within the 1-year period but the offence is finally\n(c) an infringement notice for an offence relating to the thing is\nserved on the owner and not withdrawn within 1 year after the\nday the thing was seized, liability for the offence is disputed in\naccordance with the Road Transport (General) Act 1999,\nsection 51 (Disputing liability for infringement notice offence)\nand an information—\n(i) is not laid in the Magistrates Court against the person for\nthe offence within 60 days after the day notice is given\nunder that Act, section 51 that liability is disputed; or\n(ii) is laid in the Magistrates Court against the person for the\noffence within the 60-day period, but the offence is finally\n(d) an infringement notice for an offence relating to the thing is\nseized, and the infringement notice penalty for the offence is\npaid;\n\n(e) the MAI commission becomes satisfied that there is no offence\nagainst this Act with which the thing was connected;\n(f) the MAI commission decides not to have an infringement notice\nserved for the offence;\n(g) the MAI commission or DPP decides not to prosecute.\nNote Infringement notice—see the Road Transport (General) Act 1999,\ns 24 (6).\nInfringement notice penalty, for a person for an infringement notice\noffence—see the Road Transport (General) Act 1999, dictionary.\n","sortOrder":461},{"sectionNumber":"454","sectionType":"section","heading":"Return of seized thing—extension of time","content":"454 Return of seized thing—extension of time\n(1) A magistrate may, on application by the DPP, extend the relevant\nperiod in relation to a seized thing by not longer than 30 days if the\nmagistrate is satisfied there are special reasons for doing so.\n(2) A magistrate to whom an application is made may extend the relevant\nperiod only if—\n(a) the person from whom the thing was seized is told about the\napplication by the DPP; and\n(b) the person is given an opportunity to be heard about the\nextension.\n(3) An extension in relation to a seized thing may be given more than\nonce.\nrelevant period, in relation to a seized thing, means—\n(a) the 1-year period under section 453 (a) or (b); or\n(b) the 60-day period under section 453 (c).\n\n","sortOrder":462},{"sectionNumber":"455","sectionType":"section","heading":"Application for order disallowing seizure","content":"455 Application for order disallowing seizure\n(1) A person claiming to be entitled to anything seized under this chapter\nmay apply to the Magistrates Court for an order disallowing the\nseizure within 10 days after the day the thing was seized.\n(2) The application may be heard only if the applicant has served a copy\nof the application on the MAI commission.\nNote For how documents may be served, see the Legislation Act, pt 19.5.\n(3) The MAI commission is entitled to appear as a respondent at the\nhearing of the application.\n","sortOrder":463},{"sectionNumber":"456","sectionType":"section","heading":"Order disallowing seizure","content":"456 Order disallowing seizure\n(1) This section applies if a person claiming to be entitled to anything\nseized under this chapter applies to the Magistrates Court under\nsection 455 for an order disallowing the seizure.\n(2) The Magistrates Court must make an order disallowing the seizure if\nsatisfied that—\n(a) the applicant would, apart from the seizure, be entitled to the\nreturn of the seized thing; and\n(b) the thing is not connected with an offence against this Act; and\n(c) possession of the thing by the person would not be an offence.\n(3) The Magistrates Court may also make an order disallowing the\nseizure if satisfied there are exceptional circumstances justifying the\nmaking of the order.\n(4) If the Magistrates Court makes an order disallowing the seizure, the\ncourt may also make 1 or more of the following orders:\n(a) an order directing the MAI commission to return the thing to the\napplicant or to someone else who appears to be entitled to it;\n\n(b) if the thing cannot be returned or has depreciated in value\nbecause of the seizure—an order directing the Territory to pay\nreasonable compensation;\n(c) an order about the payment of costs in relation to the application.\n","sortOrder":464},{"sectionNumber":"457","sectionType":"section","heading":"Forfeiture of seized thing","content":"457 Forfeiture of seized thing\n(a) anything seized under this chapter is not required to, or cannot,\nbe returned under section 452; and\n(b) an application for disallowance of the seizure under\nsection 455—\n(i) is not made within 10 days after the day the thing was\nseized; or\n(ii) is made within the 10-day period, but the application is\nrefused or withdrawn before a decision in relation to the\napplication is made.\n(2) If this section applies to the seized thing, the thing—\n(a) is forfeited to the Territory; and\n(b) may be sold, destroyed or otherwise disposed of as the\nMAI commission directs.\n\n","sortOrder":465},{"sectionNumber":"458","sectionType":"section","heading":"People assisting authorised people","content":"458 People assisting authorised people\nA person may assist an authorised person under this chapter if—\n(a) the assistance is necessary and reasonable; and\n(b) the person follows any direction given to the person by the\nauthorised person.\n","sortOrder":466},{"sectionNumber":"459","sectionType":"section","heading":"Damage etc to be minimised","content":"459 Damage etc to be minimised\n(1) In the exercise, or purported exercise, of a function under this chapter,\nan authorised person must take reasonable steps to ensure that the\nperson, and anyone assisting the person, causes as little\ninconvenience, detriment and damage as practicable.\n(2) If an authorised person, or anyone assisting an authorised person,\ndamages anything in the exercise or purported exercise of a function\nunder this chapter, the authorised person must give written notice of\nthe particulars of the damage to the person the authorised person\nbelieves on reasonable grounds is the owner of the thing.\n(3) If the damage happens at premises entered under this chapter in the\nabsence of the occupier, the notice may be given by leaving it, secured\nconspicuously, at the premises.\n","sortOrder":467},{"sectionNumber":"460","sectionType":"section","heading":"Compensation for exercise of enforcement powers","content":"460 Compensation for exercise of enforcement powers\n(1) A person may claim compensation from the Territory if the person\nsuffers loss or expense because of the exercise, or purported exercise,\nof a function under this chapter by an authorised person or anyone\nassisting an authorised person.\n\nEnforcement—miscellaneous Part 8.5\n(2) Compensation may be claimed and ordered in a proceeding for—\n(a) compensation brought in a court of competent jurisdiction; or\n(b) an offence against this Act brought against the person making\nthe claim for compensation.\n(3) A court may order the payment of reasonable compensation for the\nloss or expense only if satisfied that it is just to make the order in the\ncircumstances of the particular case.\n(4) A regulation may prescribe matters that may, must or must not be\ntaken into account by the court in considering whether it is just to\nmake the order.\n\n","sortOrder":468},{"sectionNumber":"Part 9","sectionType":"part","heading":"Information collection and","content":"Chapter 9 Information collection and\nsecrecy\n","sortOrder":469},{"sectionNumber":"461","sectionType":"section","heading":"Meaning of publish—ch 9","content":"461 Meaning of publish—ch 9\npublish includes disseminate by oral, visual, written, electronic or\nother way.\n","sortOrder":470},{"sectionNumber":"462","sectionType":"section","heading":"Licensed insurers must give information to","content":"462 Licensed insurers must give information to\nMAI commission\n(1) A licensed insurer must, on request by the MAI commission, give the\nMAI commission stated information about the business and financial\nposition of—\n(a) the licensed insurer; or\n(b) a corporation that is a related body corporate of the licensed\nNote Licensed insurer includes a former licensed insurer (see s (6)).\n(2) A licensed insurer must give the MAI commission—\n(a) periodic returns prescribed by regulation, containing the\ninformation and documents prescribed by regulation; and\n(b) information about claims against the insurer—\n\nAn insurer may be required to provide—\n(a) details of motor accident claims against the insurer, and the dates when\nnotice of the claims were received by the insurer; and\n(b) information about the claimants; and\n(c) information about whether liability was admitted by the insurer, when\nliability was admitted or denied and, if liability was admitted, the extent\nto which liability was admitted; and\n(d) information about the costs of the insurer on claims, and how the costs\nare made up.\n(c) information about applications for defined benefits made to the\ninsurer—\n(d) other information that is relevant to the administration of this\nAct that is—\n(3) The MAI commission may request a licensed insurer to make\navailable for inspection by the commission a stated document kept\nby—\n(a) the licensed insurer; or\n(b) a corporation that is a related body corporate of the licensed\nNote A request under s (3) must be in writing and given to the licensed insurer,\nand state when and how the request is to be complied with (see s 464).\n\n(4) A regulation may—\n(a) prescribe the time within which information, or a periodic return\nor document, must be given to the MAI commission; and\n(b) make provision in relation to other information the MAI\ncommission may ask a licensed insurer to give, or make\navailable to, the MAI commission.\n(5) This section does not limit—\n(a) any other provision of this Act about the MAI commission\nobtaining information; or\n(b) how the MAI commission may obtain information.\ndocument includes—\n(a) a return or account given under the following Acts:\n(i) the Corporations Act;\n(ii) the Financial Sector (Collection of Data) Act 2001\n(Cwlth);\n(iii) the Insurance Act 1973 (Cwlth); and\n(b) a copy of, or extract from, a document.\ninformation, about the business and financial position of a licensed\ninsurer, includes—\n(a) financial information that is, or may be, relevant to the\nconsideration by the MAI commission of MAI premiums\ncharged by the licensed insurer under this Act; and\n(b) information about—\n(i) the cost of motor accident claims handling incurred by the\n\n(ii) the settlement of motor accident claims by the licensed\n(iii) the cost incurred by the licensed insurer in relation to the\nhandling of applications for defined benefits; and\n(c) information about any other matter in relation to the licensed\n","sortOrder":471},{"sectionNumber":"463","sectionType":"section","heading":"Licensed insurer to provide investment details","content":"463 Licensed insurer to provide investment details\n(1) The MAI commission may request a licensed insurer to give the\nMAI commission details of how the insurer’s third-party funds, and\nother funds, are invested.\nNote A request under s (1) must be in writing and given to the licensed insurer,\nand state when and how the request is to be complied with (see s 464).\n(2) A licensed insurer commits an offence if—\n(a) the MAI commission requests the licensed insurer to give the\nMAI commission the details mentioned in subsection (1); and\n(b) the insurer does not comply with the request within the time\nstated in the request.\nthird-party funds, of a licensed insurer, means the funds of the insurer\nderived from—\n(a) the payment of MAI premiums for MAI policies; and\n(b) the investment of the funds derived under paragraph (a).\n\n","sortOrder":472},{"sectionNumber":"464","sectionType":"section","heading":"How MAI commission is to make request","content":"464 How MAI commission is to make request\n(1) A request by the MAI commission under section 462 (Licensed\ninsurers must give information to MAI commission) or section 463\nmust—\n(a) be in writing and given to the licensed insurer or former licensed\n(b) state how and when the request must be complied with.\n(2) A statement of how a request must be complied with may include a\nrequirement that the licensed insurer, or former licensed insurer, give\nthe MAI commission a certificate of correctness for stated\ninformation or a stated document (or a copy of or extract from a stated\ndocument).\ncertificate of correctness, for stated information or a stated document\n(or a copy of, or extract from, a stated document), means a certificate\ncertifying the correctness of the information, document, copy or\nextract by any of the following:\n(a) a registered tax agent;\n(b) a registered company auditor;\n(c) an actuary approved by the MAI commission;\n(d) an executive officer of the licensed insurer.\nregistered company auditor—see the Corporations Act, section 9.\n\n","sortOrder":473},{"sectionNumber":"465","sectionType":"section","heading":"Offences—insurer to give periodic returns, documents","content":"465 Offences—insurer to give periodic returns, documents\nand information\n(1) A licensed insurer commits an offence if the insurer—\n(a) must give the MAI commission information, or a periodic return\nor document, under section 462 (Licensed insurers must give\ninformation to MAI commission); and\n(b) does not give the MAI commission the information, or the\nperiodic return or document.\n(2) A licensed insurer commits an offence if the insurer—\n(a) must give the MAI commission information, or a periodic return\nor document, under section 462; and\n(b) does not give the MAI commission the information, or the\nperiodic return or document—\n(i) in the way or time stated by regulation under section 462;\nor\n(ii) in the way or time stated by the MAI commission in a\nnotice under section 464.\n(3) It is a defence to a prosecution for an offence against this section if\nthe defendant proves that it was not in the defendant’s power to\ncomply with a request or requirement under section 462.\n\n","sortOrder":474},{"sectionNumber":"466","sectionType":"section","heading":"MAI commission may disclose information to licensed","content":"466 MAI commission may disclose information to licensed\ninsurers etc\n(1) The MAI commission may disclose any information that has been\ndisclosed to, or obtained by, the MAI commission in the exercise of\nits functions under this Act to an information sharing entity if the\nMAI commission considers that—\n(a) the information is relevant to the exercise of the functions of the\ninformation sharing entity; and\n(b) the disclosure of the information to the information sharing\nentity is appropriate.\n(2) In particular, the MAI commission may disclose information under\nsubsection (1) to an information sharing entity for the purpose of\ndetecting or investigating fraud in relation to an application for\ndefined benefits or a motor accident claim.\ninformation sharing entity means any of the following:\n(a) a licensed insurer;\n(b) the nominal defendant;\n(c) the road transport authority;\n(d) the ACAT;\n(e) a person approved in writing by the MAI commission.\n","sortOrder":475},{"sectionNumber":"467","sectionType":"section","heading":"MAI commission—disclosure of information relating to","content":"467 MAI commission—disclosure of information relating to\ncomplaints\n(1) This section applies if the MAI commission receives a complaint\nfrom a person injured in a motor accident, or the injured person’s\npersonal representative or guardian (the complainant), about the\nhandling of the injured person’s application for defined benefits or\nmotor accident claim by the relevant insurer for the motor accident.\n\n(2) The MAI commission may give the relevant insurer for the motor\naccident some or all of the information included with the complaint.\n(3) However, the MAI commission must not disclose any other\ninformation in relation to the complaint until the MAI commission\nhas completed its inquiries into the complaint.\n(4) The MAI commission must, as soon as practicable after completing\nits inquiries into the complaint, give the relevant insurer and the\ncomplainant written notice of its findings.\n(5) A notice under subsection (4) may include—\n(a) some or all of the information included with the complaint; and\n(b) any response by the relevant insurer to the complaint.\n(6) However, the notice must not include information mentioned in\nsubsection (5) if—\n(a) the MAI commission believes on reasonable grounds that\nincluding the information—\n(i) may disclose confidential information about the relevant\ninsurer’s business operations; or\n(ii) may prejudice an investigation by the police or relevant\ninsurer of the motor accident, or the application for defined\nbenefits or motor accident claim; or\n(b) a regulation prescribes the inclusion of the information as a\nprohibited disclosure of information.\n(7) The MAI guidelines may make provision in relation to the handling\nof complaints.\ninformation includes a document.\n\n","sortOrder":476},{"sectionNumber":"468","sectionType":"section","heading":"Licensed insurer may disclose information to another","content":"468 Licensed insurer may disclose information to another\n(1) A licensed insurer may disclose information about an application for\ndefined benefits or a motor accident claim to another licensed insurer\nif—\n(a) the other insurer is liable, or potentially liable, in relation to the\napplication or claim; and\n(b) the injured person has given the insurer an authority to transfer\npersonal health information to the other insurer.\nNote 1 The other insurer may then require the applicant or claimant to provide\nan authority to disclose personal health information.\nNote 2 Authority to disclose personal health information—see s 54.\n(2) A regulation may prescribe conditions in relation to the disclosure of\ninformation under this section.\nauthority to transfer personal health information, for a person\ninjured in a motor accident, means an authority—\n(a) signed by or on behalf of the injured person; and\n(b) stating that the injured person consents to the disclosure of\n(i) by the insurer; and\n(ii) to another stated insurer; and\n(iii) for transferring the injured person’s application for defined\nbenefits or motor accident claim.\n\n","sortOrder":477},{"sectionNumber":"469","sectionType":"section","heading":"Lawyers etc must give information to MAI commission","content":"469 Lawyers etc must give information to MAI commission\n(1) A regulation may require lawyers and other stated service providers\nto give information to the MAI commission in relation to applications\nfor defined benefits and motor accident claims.\n(2) A regulation may prescribe—\n(a) the information that must be given; and\n(b) the form in which the information must be given; and\n(c) when the information must be given; and\n(d) any other relevant matter.\n(3) For subsection (2) (a), the information may include—\n(a) amounts paid to applicants and claimants; and\n(b) costs and disbursements paid by applicants and claimants; and\n(c) when payments were received by or made to applicants and\nclaimants.\n(4) The MAI commission may—\n(a) give the Minister information the MAI commission receives\nunder this section; and\n(b) publish statistical data based on the information the\nMAI commission receives under this section.\n(5) The Minister may require the MAI commission to publish statistical\ndata based on the information the MAI commission receives under\nthis section.\n(6) However, the MAI commission must not publish information relating\nto a lawyer or stated service provider if publication of the information\nwould disclose information that relates to the practices of the lawyer\nor service provider (confidential information).\n\n(7) Confidential information about the practices of a lawyer or stated\nservice provider, including the practices of a partnership that includes\na lawyer or stated service provider, is taken to be protected\ninformation for section 476 (Offences—use or divulge protected\ninformation).\n","sortOrder":478},{"sectionNumber":"470","sectionType":"section","heading":"Information about certain offences","content":"470 Information about certain offences\n(1) A court may, on request by the MAI commission, give the MAI\ncommission the following information in relation to a person injured\nin a motor accident:\n(a) information about whether, as a result of the motor accident, a\nproceeding has started in the court against the person in relation\nto any of the following offences and, if so, the outcome of the\nproceeding:\n(i) a driving offence;\n(ii) a serious offence, within the meaning of section 48 (No\nentitlement—serious offences);\n(b) if a proceeding has started in the court against the person in\nrelation to an offence mentioned in paragraph (a) that is an\noffence under the Road Transport (Alcohol and Drugs)\nAct 1977—a copy of a certificate or statement under any of the\nfollowing provisions of that Act that is admitted in evidence in\nthe proceeding:\n(i) section 41 (1) (a), (c) or (g) (Evidentiary certificate—\nalcohol-related tests);\n(ii) section 41AB (Evidentiary certificate—analysis of oral\nfluid sample);\n(iii) section 41AD (Evidentiary certificate—analysis of sample\nfor prescribed drug etc).\n\n(2) The MAI commission may give the relevant insurer for the motor\naccident the information the MAI commission receives under\nsubsection (1) in relation to the injured person.\n","sortOrder":479},{"sectionNumber":"471","sectionType":"section","heading":"MAI commission may disclose information to","content":"471 MAI commission may disclose information to\nLTCS commissioner\n(1) The MAI commission may disclose information to the\nLTCS commissioner about the following:\n(a) motor accident claims under this Act;\n(b) applications for defined benefits under this Act;\n(c) payments made to or on behalf of a person who is a participant\nin the LTCS scheme under the LTCS Act;\n(d) the treatment and care needs of a person who is a participant in\nthe LTCS scheme in relation to the motor accident injury as a\nconsequence of which the person became a participant in the\nscheme.\nTreatment and care needs—see the dictionary.\ninformation, about the treatment and care needs of a participant in\nthe LTCS scheme, includes the expenses paid or payable by the\nLTCS commissioner under the scheme in relation to those needs.\n\n","sortOrder":480},{"sectionNumber":"472","sectionType":"section","heading":"MAI injury register","content":"472 MAI injury register\n(1) The MAI commission must keep a register of applications for defined\nbenefits and motor accident claims (the MAI injury register).\n(2) The MAI injury register must contain information provided under this\nAct by insurers that the MAI commission considers appropriate to\ninclude in the MAI injury register.\n(3) The MAI injury register must also include information provided by\nthe LTCS commissioner under the LTCS Act, section 94 (Exchange\nof information) that the MAI commission considers appropriate for\ninclusion in the MAI injury register.\n(4) The following people may access information contained in the\nMAI injury register:\n(a) licensed insurers;\n(b) a person approved, in writing, by the MAI commission.\n(5) The MAI commission must not approve a person to access the\nMAI injury register unless the MAI commission is satisfied in\nrelation to the following:\n(a) the purpose for which the person needs to access the register;\n(b) that the person has appropriate procedures or systems in place\nto safeguard the handling of information accessed on the\nregister.\n(6) However, information that would, if it became generally known,\naffect an insurer’s competitive position must not be disclosed in a\nform that would allow the insurer to be identified.\nNote It is an offence to use or divulge protected information about a person\n(see s 476).\n\n","sortOrder":481},{"sectionNumber":"473","sectionType":"section","heading":"Publication of information—licensed insurers","content":"473 Publication of information—licensed insurers\n(1) The MAI commission may publish the following information in\nrelation to licensed insurers:\n(a) information about a licensed insurer’s level of compliance with\n(i) this Act;\n(ii) the insurance industry deed;\n(iii) the conditions of the licensed insurer’s MAI insurer\nlicence;\nNote A reference to an Act includes a reference to the statutory\ninstruments made or in force under the Act, including any\nregulation (see Legislation Act, s 104).\n(b) information about a licensed insurer’s pricing of premiums for\nMAI policies;\n(c) information about the profitability of a licensed insurer’s\ninsurance operations (including any proposed profit margins) in\nrelation to the motor accident injuries insurance scheme under\nthis Act;\n(d) information that compares the performance of licensed insurers\nin relation to applications for defined benefits and motor\nExamples—performance\n1 timeliness with dealing with applications for defined benefits and motor\naccident claims\n2 outcomes of applications for defined benefits and motor accident claims\n3 customer service or complaints\n(e) a copy of any return, and any document accompanying a return,\ngiven to the MAI commission under section 462 (Licensed\ninsurers must give information to MAI commission);\n\n(f) information about a licensed insurer’s market share in relation\nto the motor accident injuries insurance scheme under this Act;\n(g) information (other than personal information) about internal and\nexternal review of decisions by a licensed insurer under\npart 2.10 (Defined benefits—dispute resolution), and the\noutcomes of those reviews;\n(h) financial information relating to applications for defined\nbenefits and motor accident claims handled by a licensed\ninsurer, including any amounts ordered by the ACAT or a court,\nor paid for legal representation, in relation to disputes about\napplications for defined benefits or motor accident claims;\n(i) any other information about licensed insurers prescribed by\n(2) For subsection (1) (i), a regulation may prescribe the manner and form\nin which the information prescribed may be published.\n(3) Information published under this section may identify a particular\ninsurer (an identified insurer).\n(4) However, the MAI commission must not publish confidential\ninformation relating to an identified insurer if—\n(a) the identified insurer tells the MAI commission that publication\nof the information would disclose a trade secret not known by\nother insurers; and\n(b) the MAI commission is satisfied that, having regard to its\nknowledge of the business practices of insurers, the publication\nof the information would disclose a trade secret.\n(5) Also, the MAI commission must not publish information about a\nlicensed insurer under subsection (1) (c) that would identify the\nlicensed insurer or allow the licensed insurer’s identity to be worked\nout.\n\npersonal information—\n(a) means information about a person to whom an internal or\nexternal review of a decision under part 2.10 relates that—\n(i) discloses the name, address or suburb of the person, or of\na family member of the person; or\n(ii) would allow the person’s identity to be worked out; and\n","sortOrder":482},{"sectionNumber":"474","sectionType":"section","heading":"Publication of net profit analysis of licensed insurer","content":"474 Publication of net profit analysis of licensed insurer\n(1) The Minister may publish a net profit analysis, or part of a net profit\nanalysis, of a licensed insurer.\n(2) However, the net profit analysis, or the part of the net profit analysis,\nmust be published in a form that does not identify the licensed insurer\nor allow the licensed insurer’s identity to be worked out.\nnet profit analysis, of a licensed insurer, means a net profit analysis\nof the licensed insurer prepared by the MAI commission under\nsection 410.\n","sortOrder":483},{"sectionNumber":"475","sectionType":"section","heading":"Summary of report about insurers may be made public","content":"475 Summary of report about insurers may be made public\n(1) The Minister may publish a summary of a report prepared under\nsection 412 (Reports about insurers).\n(2) However, the summary must be published in a form that does not\nidentify a licensed insurer or allow a licensed insurer’s identity to be\nworked out.\n\n","sortOrder":484},{"sectionNumber":"476","sectionType":"section","heading":"Offences—use or divulge protected information","content":"476 Offences—use or divulge protected information\n(1) A person to whom this section applies commits an offence if—\n(a) the person uses information; and\n(b) the information is protected information about someone else;\nand\n(c) the person is reckless about whether the information is protected\ninformation about someone else.\n(2) A person to whom this section applies commits an offence if—\n(a) the person does something that divulges information; and\n(b) the information is protected information about someone else;\nand\n(c) the person is reckless about whether—\n(i) the information is protected information about someone\nelse; and\n(ii) doing the thing would result in the information being\ndivulged to someone else.\n(3) Subsections (1) and (2) do not apply—\n(a) if the information is used or divulged—\n(i) under this Act or another territory law; or\n\n(ii) in relation to the exercise of a function by a person to whom\nthis section applies under this Act or another territory law;\nor\n(iii) under the insurance industry deed; or\n(iv) in a court proceeding; or\n(b) to the using or divulging of protected information about a person\nwith the person’s consent; or\n(c) to the divulging of protected information by an insurer only to\nanother insurer that is in accordance with the insurance industry\ndeed.\nNote The defendant has an evidential burden in relation to the matters\nmentioned in s (3) (see Criminal Code, s 58).\n(4) A person to whom this section applies need not divulge protected\ninformation to a court, or produce a document containing protected\ninformation to a court, unless it is necessary to do so for this Act or\nanother law in force in the Territory.\ncourt includes a tribunal, authority or person having power to require\nthe production of documents or the answering of questions.\ndivulge includes—\n(a) communicate; or\n(b) publish.\nperson to whom this section applies means—\n(a) a person who is or has been—\n(i) the MAI commissioner; or\n(ii) a member of staff of the MAI commission; or\n(iii) a licensed insurer; or\n\n(iv) an actuary engaged by the MAI commission for this Act;\nor\n(b) anyone else who exercises, or has exercised, a function under\nthis Act.\nproduce includes allow access to.\nprotected information—\n(a) means information about a person that is disclosed to, or\nobtained by, a person to whom this section applies because of\nthe exercise of a function under this Act by the person or\nsomeone else; and\nuse, in relation to information, includes make a record of the\ninformation.\n\nNotification and review of MAI commission reviewable decisions Chapter 10\n","sortOrder":485},{"sectionNumber":"Part 10","sectionType":"part","heading":"Notification and review of MAI","content":"Chapter 10 Notification and review of MAI\ncommission reviewable\n","sortOrder":486},{"sectionNumber":"477","sectionType":"section","heading":"Definitions—ch 10","content":"477 Definitions—ch 10\nexternally reviewable decision means a decision by an MAI\ncommission reviewer under section 482.\ninternal review notice—see the ACT Civil and Administrative\nTribunal Act 2008, section 67B (1).\nMAI commission reviewable decision means a decision mentioned\nin schedule 2, column 3 under a provision of this Act mentioned in\ncolumn 2 in relation to the decision.\nMAI commission reviewer—see section 481.\n","sortOrder":487},{"sectionNumber":"478","sectionType":"section","heading":"Internal review notices","content":"478 Internal review notices\nIf the MAI commission makes an MAI commission reviewable\ndecision, the MAI commission must give an internal review notice to\nan entity mentioned in schedule 2, column 4 in relation to the\ndecision.\nNote The MAI commission must also take reasonable steps to give an internal\nreview notice to any other person whose interests are affected by the\ndecision (see ACT Civil and Administrative Tribunal Act 2008, s 67B).\n","sortOrder":488},{"sectionNumber":"479","sectionType":"section","heading":"Applications for internal review","content":"479 Applications for internal review\n(1) The following people may apply to the MAI commission for review\nof an MAI commission reviewable decision:\n(a) an entity mentioned in schedule 2, column 4 in relation to the\ndecision;\n(b) any other person whose interests are affected by the decision.\n\nChapter 10 Notification and review of MAI commission reviewable decisions\n(2) The application must—\n(a) be in writing; and\n(b) state the applicant’s name and address; and\n(c) set out the applicant’s reasons for making the application.\n(3) The application must be given to the MAI commission within—\n(a) 28 days after the day the applicant is given the internal review\nnotice for the decision; or\n(b) any longer period allowed by the MAI commission before or\nafter the end of the 28-day period.\nNote Section 484 provides for ACAT review of reviewable decisions that are\nMAI commission reviewable decisions.\n","sortOrder":489},{"sectionNumber":"480","sectionType":"section","heading":"Applications not stay MAI commission reviewable","content":"480 Applications not stay MAI commission reviewable\nThe making of an application for review of an MAI commission\nreviewable decision does not affect the operation of the decision.\n","sortOrder":490},{"sectionNumber":"481","sectionType":"section","heading":"MAI commission reviewer","content":"481 MAI commission reviewer\nThe MAI commission must arrange for a person (the MAI\ncommission reviewer) who did not make the MAI commission\nreviewable decision to review the decision.\n","sortOrder":491},{"sectionNumber":"482","sectionType":"section","heading":"Review by MAI commission reviewer","content":"482 Review by MAI commission reviewer\n(1) The MAI commission reviewer must, within 28 days (the 28-day\nperiod) after the day the MAI commission receives the application\nfor review of the MAI commission reviewable decision—\n(a) confirm the decision; or\n(b) amend the decision; or\n(c) set aside the decision and substitute the reviewer’s own decision.\n\nNotification and review of MAI commission reviewable decisions Chapter 10\n(2) If the decision is not amended or set aside within the 28-day period,\nthe decision is taken to have been confirmed by the MAI commission\nreviewer.\n","sortOrder":492},{"sectionNumber":"483","sectionType":"section","heading":"Reviewable decision notices","content":"483 Reviewable decision notices\nIf an MAI commission reviewer makes an externally reviewable\ndecision, the MAI commission reviewer must give a reviewable\ndecision notice to each person affected by the decision.\nNote The MAI commission reviewer must also take reasonable steps to give a\nreviewable decision notice to any other person whose interests are\naffected by the decision (see ACT Civil and Administrative Tribunal\nAct 2008, s 67A).\n","sortOrder":493},{"sectionNumber":"484","sectionType":"section","heading":"Applications for external review","content":"484 Applications for external review\nThe following people may apply to the ACAT for review of an\nexternally reviewable decision:\n(a) a person to whom a reviewable decision notice is required to be\ngiven in relation to the decision;\n(b) any other person whose interests are affected by the decision.\n\n","sortOrder":494},{"sectionNumber":"485","sectionType":"section","heading":"Offences—referral fees","content":"485 Offences—referral fees\n(1) A lawyer commits an offence if—\n(a) the lawyer, or an entity related to the lawyer, intentionally gives\nconsideration to someone else; and\n(b) in return for the consideration, another person refers a person to\nthe lawyer for the purpose of that person being represented by\nthe lawyer in relation to an application for defined benefits or a\nmotor accident claim; and\n(c) the lawyer is reckless about the matters mentioned in\nparagraph (b).\n(2) A lawyer commits an offence if—\n(a) the lawyer, or an entity related to the lawyer, intentionally\nreceives consideration from someone else; and\n(b) the lawyer, or entity, receives the consideration in return for the\nlawyer referring a person represented by the lawyer in relation\nto a motor accident claim to a service provider; and\n(c) the service provider provides a service to the client in relation to\nthe motor accident; and\n(d) the lawyer is reckless about the matters mentioned in\nparagraphs (b) and (c).\n\nclose associate, of a lawyer, means—\n(a) an employer of the lawyer (including, if the employer is a\ncorporation, a director of the corporation); or\n(b) a partner, or a close relative of the partner, in a partnership in\nwhich the lawyer is also a partner; or\n(c) an employee or agent of the lawyer or of a person mentioned in\nparagraph (a) or (b).\nclose relative, of a lawyer, means—\n(a) a domestic partner of the lawyer; or\n(b) a parent, grandparent, child or step-child of the lawyer; or\n(c) a sibling, half-sibling or step-sibling of the lawyer; or\n(d) an aunt, uncle, cousin, niece or nephew of the lawyer.\nconsideration includes a fee or other financial benefit but does not\ninclude hospitality that is reasonable in the circumstances.\nrelated—an entity is related to a lawyer if the entity is—\n(a) a close relative of the lawyer; or\n(b) a close associate of the lawyer; or\n(c) owned or controlled by the lawyer or a close relative or close\nassociate of the lawyer.\n\n","sortOrder":495},{"sectionNumber":"486","sectionType":"section","heading":"Extraterritorial operation","content":"486 Extraterritorial operation\n(1) It is the intention of the Legislative Assembly that any provision of a\nterritory law that provides for limits on liability for personal injury\nincluding damages, resulting from motor accidents that happen in the\nACT—\n(a) is to apply to the full extent of the Legislative Assembly’s\ncapacity to legislate extraterritorially, even if damages are\nassessed outside the ACT; and\n(b) is to be regarded by courts as a substantive rather than a\nprocedural provision.\n(2) Subsection (3) applies if, in a proceeding on a claim for damages\nbrought in another jurisdiction, a person recovers damages in excess\nof the total of the following (the ACT total):\n(a) the defined benefits that would have been payable under this\nAct;\n(b) the maximum amount that could have been recovered if the\nproceeding had been brought in the ACT.\n(3) The respondent may recover as a debt from the person the amount by\nwhich the damages exceed the ACT total.\nNote An amount owing under a law may be recovered as a debt in a court of\ncompetent jurisdiction or the ACAT (see Legislation Act, s 177).\nanother jurisdiction means a jurisdiction other than the ACT and\nincludes a jurisdiction outside Australia.\n\n","sortOrder":496},{"sectionNumber":"487","sectionType":"section","heading":"MAI guidelines","content":"487 MAI guidelines\n(1) The MAI commission may make guidelines (the MAI guidelines)\nabout any matter required or permitted by this Act to be included in\nthe guidelines.\n(2) The MAI guidelines may make provision in relation to any matter\nrequired or permitted by this Act.\n(3) The MAI guidelines may apply, adopt or incorporate an instrument,\nas in force from time to time.\nNote A reference to an instrument includes a reference to a provision of an\ninstrument (see Legislation Act, s 14 (2)).\n(4) The Legislation Act, section 47 (6) does not apply to an instrument\nmentioned in subsection (3).\nNote An instrument applied, adopted or incorporated by the MAI guidelines\ndoes not need to be notified under the Legislation Act because s 47 (6)\ndoes not apply (see Legislation Act, s 47 (7)).\n(5) An MAI guideline is a disallowable instrument.\n","sortOrder":497},{"sectionNumber":"488","sectionType":"section","heading":"Forms—MAI guidelines","content":"488 Forms—MAI guidelines\nThe MAI guidelines may make provision in relation to forms for this\nAct, including the following:\n(a) the information that must be included in a form;\n(b) where forms for this Act may be accessed.\n","sortOrder":498},{"sectionNumber":"489","sectionType":"section","heading":"Determination of fees","content":"489 Determination of fees\n(1) The MAI commission may determine fees for this Act.\n(2) A determination is a disallowable instrument.\n\n","sortOrder":499},{"sectionNumber":"490","sectionType":"section","heading":"Determination of motor accident levy","content":"490 Determination of motor accident levy\n(1) The Minister must determine a levy (a motor accident levy) that the\nMinister believes on reasonable grounds will fund the\nMAI commission’s functions, including the MAI commission’s staff.\n(2) The Minister may determine a motor accident levy as any of the\n(a) a fixed amount;\n(b) a percentage of the MAI premium payable for an MAI policy;\n(c) a combination of a fixed amount and percentage of the\nMAI premium payable for an MAI policy.\n(3) The Minister may determine a period for which the levy is payable.\n(4) A motor accident levy may be determined to differ according to any\nclassification or other criteria for the determination of premiums for\nMAI policies as provided for by the MAI guidelines.\n(5) A determination is a disallowable instrument.\nNote Power to make a statutory instrument includes power to make different\nprovision in relation to different matters or different classes of matters,\nand to make determination that applies differently by reference to stated\nexceptions or factors (see Legislation Act, s 48).\n","sortOrder":500},{"sectionNumber":"491","sectionType":"section","heading":"Refund of motor accident levy","content":"491 Refund of motor accident levy\n(1) This section applies if an MAI policy issued to a person is cancelled\non the cancellation of the registration for the motor vehicle to which\nthe policy relates.\n(2) The MAI commission must refund to the person, on a proportionate\nbasis, the motor accident levy paid in relation to the MAI policy.\nmotor accident levy—see section 490.\n\n","sortOrder":501},{"sectionNumber":"492","sectionType":"section","heading":"Regulation-making power","content":"492 Regulation-making power\n(1) The Executive may make regulations for this Act.\n(2) A regulation may create offences and fix maximum penalties of not\nmore than 20 penalty units for the offences.\n","sortOrder":502},{"sectionNumber":"493","sectionType":"section","heading":"Review of operation of Act","content":"493 Review of operation of Act\n(1) The Minister must review the operation of this Act as soon as\npracticable after the end of every 3rd year of its operation.\n(2) The review must include the following:\n(a) the percentage of MAI premiums used to pay defined benefits,\nincluding for treatment and care, for people injured in motor\naccidents during the review period;\n(b) the number of applications under part 2.10 (Defined benefits—\ndispute resolution) for review of decisions by insurers relating\nto applications for defined benefits that have happened during\nthe review period and the outcomes of those applications;\n(c) the average time taken to resolve a motor accident claim during\nthe review period;\n(d) the average outcome for motor accident claims made during the\nreview period, including, for example—\n(i) the degree of severity of personal injuries sustained as a\nresult of motor accidents; and\n(ii) the costs incurred for rehabilitation of people injured in\nmotor accidents who have made a motor accident claim.\n\n(3) Subsection (2) does not limit what may be included in the review.\n(4) The Minister must present a report of the review to the Legislative\nAssembly at a time decided in consultation with the Speaker.\nNote Speaker—see the Legislation Act, dictionary, pt 1.\nreview period means the 3-year period to which a review under this\nsection relates.\n\nInternally reviewable decisions Part 1.1\n","sortOrder":503},{"sectionNumber":"Sch 1","sectionType":"schedule","heading":"Defined benefits—dispute","content":"Schedule 1 Defined benefits—dispute\nresolution\n(see s 186 and s 192)\nitem\n1 59 (2) refuse late application because applicant does not have full\nand satisfactory explanation\n2 62 refuse to pay applicant’s expenses because not allowable\nexpenses under MAI guidelines\n3 65 (1) reject liability for defined benefits\n4 65 (1) reject liability for defined benefits because applicant not a\nperson mentioned in s 55 (1)\n5 65 (1) reject liability for defined benefits because application made\non behalf of applicant by someone other than a person\nmentioned in s 55 (2)\n6 66 (1) not pay income replacement benefits because applicant not\nentitled to those benefits under s 89\n7 66 (1) not pay treatment and care benefits for expenses incurred for\nstated treatment and care because of 1 or more of the\n(a) treatment and care not reasonable and necessary;\n(b) treatment and care did not relate to personal injury\nsustained in motor accident;\n(c) injured person has not paid for the treatment and\ncare and is not liable to pay for the treatment and\ncare\n\nitem\n8 66 (1) not pay treatment and care benefits for domestic services\nexpenses incurred by injured person in employing someone\nto provide domestic services to injured person’s dependants\nbecause of 1 or more of the following reasons:\n(a) expenses not reasonable and necessary;\n(b) injured person did not provide those services to\ndependants before the motor accident;\n(c) dependants are able to undertake those services\n9 66 (1) not pay treatment and care benefits for travel expenses\nincurred by injured person and a parent or other carer\naccompanying injured person because of 1 or both of the\n(a) expenses for travel and accommodation not\nreasonable and necessary;\n(b) travel not undertaken to undergo treatment and care\n10 66 (1) not pay funeral benefits because applicant not entitled to\nfuneral expenses under s 178\n11 96 decision about amount of income replacement benefits\ninjured person entitled to for first payment period\n12 97 decision about amount of income replacement benefits\ninjured person entitled to for second payment period\n13 100 (1) decision about injured person’s post-injury earning capacity\n14 101 (3) (b) (ii),\n(4) (b) (ii) or\n(5) (b) (ii)\nrefuse to make earlier payment of income replacement\nbenefits to injured person who makes late application for\ndefined benefits because not satisfied there are exceptional\ncircumstances justifying earlier payment\n15 103 (2) refuse to pay injured person interim weekly payment\n16 103 (4) refuse to pay injured person lower interim weekly payment\n17 105 (2) suspend injured person’s benefit payments\n18 107 (1) (b) reduce or stop paying income replacement benefit payments\n\nInternally reviewable decisions Part 1.1\nitem\n19 121 (1) make reasonable request to injured person to attend health\npractitioner for assessment of treatment and care needs\n20 121 (3) suspend payment of treatment and care benefits and income\nwith reasonable request to attend health practitioner\n21 124A (1) suspend payment of treatment and care benefits and income\nwith a recovery plan for the person\n22 126 (2) refuse to approve treatment and care not mentioned in\ninjured person’s recovery plan because treatment and care\nnot reasonable and necessary in the circumstances and will\nnot assist with injured person’s recovery or management of\nperson’s injury\n23 128 (2) (a) (i) (B) refuse to make earlier payment of treatment and care\nexpenses, domestic services expenses and travel expenses in\nrelation to late application for period starting on date that is\n13 weeks before date of application because insurer not\nsatisfied that there are exceptional circumstances justifying\nearlier payment\n24 129 (1) not pay treatment and care expenses, domestic services\nexpenses and travel expenses because of 1 or more of the\n(a) the expenses cannot be verified;\n(b) the expenses have not been incurred;\n(c) the insurer has previously paid the expenses;\n(d) for treatment and care expenses—the expenses\nwere—\n(i) not approved by the insurer; or\n(ii) not set out in the injured person’s recovery\nplan\n25 139 (2) tell applicant for quality of life benefits that insurer believes\nperson’s injuries have stabilised but the person is not likely\nto have a permanent impairment as a result of the injuries\n\nitem\n26 183 (2) refuse to make periodic payments of treatment and care\nbenefits and income replacement benefits because insurer\nnot satisfied injured person intends to live outside Australia\npermanently or for an extended time\n27 183 (2) refuse to make periodic payments of treatment and care\nbenefits and income replacement benefits because injured\nperson has not lived outside Australia for at least eligibility\n28 184 (4) (a) calculate amount of lump sum to be less than $10 000\n\nACAT reviewable decisions Part 1.2\nitem\n1 59 (2) refuse late application because applicant does not have full\nand satisfactory explanation\n2 65 (1) reject liability for defined benefits\n3 65 (1) reject liability for defined benefits because applicant not a\nperson mentioned in s 55 (1)\n4 65 (1) reject liability for defined benefits because application made\non behalf of applicant by someone other than a person\nmentioned in s 55 (2)\n5 65 (1) reject liability for death benefits or funeral benefits because\nperson’s death was not result of motor accident\n6 66 (1) not pay income replacement benefits because—\n(a) applicant is person mentioned in s 43 (1); and\n(b) none of the circumstances mentioned in s 43 (2)\napplies to the applicant\n7 66 (1) not pay quality of life benefits because—\n(a) applicant is person mentioned in s 43 (1); and\n(b) the circumstances mentioned in s 43 (3) do not\napply to the applicant\n8 66 (1) not pay income replacement benefits because applicant is\nperson mentioned in s 46 (1)\n9 66 (1) not pay quality of life benefits because applicant is person\nmentioned in s 46 (1)\n10 66 (1) not pay quality of life benefits and death benefits because\nperson who died as a result of motor accident is person\nmentioned in s 46 (2)\n11 66 (1) not pay defined benefits because s 49 applies to the injured\nperson or dead person but MAI commission has not notified\ninsurer that motor accident caused by, or attributable to, act\nof terrorism\n\nitem\n12 66 (1) not pay income replacement benefits because applicant not\nentitled to those benefits under s 89\n13 66 (1) not pay treatment and care benefits for expenses incurred for\nstated treatment and care because of 1 or more of the\n(a) treatment and care not reasonable and necessary;\n(b) treatment and care did not relate to personal injury\nsustained in motor accident;\n(c) injured person has not paid for the treatment and\ncare and is not liable to pay for the treatment and\ncare\n14 66 (1) not pay treatment and care benefits for domestic services\nexpenses incurred by injured person in employing someone\nto provide domestic services to injured person’s dependants\nbecause of 1 or more of the following reasons:\n(a) expenses not reasonable and necessary;\n(b) injured person did not provide those services to\ndependants before the motor accident;\n(c) dependants are able to undertake those services\n15 66 (1) not pay treatment and care benefits for travel expenses\nincurred by injured person and a parent or other carer\naccompanying injured person because of 1 or both of the\n(a) expenses for travel and accommodation not\nreasonable and necessary;\n(b) travel not undertaken to undergo treatment and care\n16 66 (1) not pay death benefits because coroner finds dead person’s\nconduct in relation to motor accident made up physical\nelements of conduct of serious offence or 2 or more driving\noffences\n17 66 (1) not pay funeral benefits because applicant not entitled to\nfuneral expenses under s 178\n\nACAT reviewable decisions Part 1.2\nitem\n18 96 decision about the amount of income replacement benefits\nan injured person is entitled to for first payment period\n19 97 decision about the amount of income replacement benefits\nan injured person is entitled to for second payment period\n20 100 (1) decision about injured person’s post-injury earning capacity\n21 101 (3) (b) (ii),\n(4) (b) (ii) or (5)\n(b) (ii)\nrefuse to make earlier payment of income replacement\nbenefits to injured person who makes late application for\ndefined benefits because not satisfied there are exceptional\ncircumstances justifying earlier payment\n22 105 (2) suspend injured person’s benefit payments\n23 107 (1) (b) reduce or stop paying income replacement benefit payments\n24 121 (1) make reasonable request to injured person to attend health\npractitioner for assessment of treatment and care needs\n25 121 (3) suspend payment of treatment and care benefits and income\nwith reasonable request to attend health practitioner\n26 124A (1) suspend payment of treatment and care benefits and income\nwith a recovery plan for the person\n27 126 (2) refuse to approve treatment and care not mentioned in\ninjured person’s recovery plan because treatment and care\nnot reasonable and necessary in the circumstances and will\nnot assist with injured person’s recovery or management of\nperson’s injury\n28 128 (2) (a) (i) (B) refuse to make earlier payment of treatment and care\nexpenses, domestic services expenses and travel expenses in\nrelation to late application for period starting on date that is\n13 weeks before date of application because insurer not\nsatisfied that there are exceptional circumstances justifying\nearlier payment\n29 160 (2) amount of injured person’s final offer WPI\n\nitem\n30 183 (2) refuse to make periodic payments of treatment and care\nbenefits and income replacement benefits because insurer\nnot satisfied injured person intends to live outside Australia\npermanently or for an extended time\n31 183 (2) refuse to make periodic payments of treatment and care\nbenefits and income replacement benefits because injured\nperson has not lived outside Australia for at least eligibility\n32 184 (4) (a) calculate amount of lump sum to be less than $10 000\n\nMAI Commission reviewable decisions Schedule 2\n","sortOrder":504},{"sectionNumber":"Sch 2","sectionType":"schedule","heading":"MAI Commission reviewable","content":"Schedule 2 MAI Commission reviewable\n(see ch 10)\nitem\ncolumn 4\n1 44 (4) MAI commission—declare\nincome replacement benefits or\nquality of life benefits\n2 45 (4) MAI commission—declare\ndefined benefits mentioned in\ns 45 (3)\n3 48 (4) MAI commission—declare\ndefined benefits mentioned in\ns 48 (3)\n4 363 (1) MAI commission—refuse to\nissue MAI insurer licence\napplicant for licence\n5 377 (2) (a) MAI commission—include MAI\ncommission condition on issue\nof MAI insurer licence\napplicant for licence\n6 377 (2) (b) MAI commission—amend MAI\ninsurer licence to include MAI\ncommission condition\n7 377 (3) MAI commission—amend MAI\ncommission condition included\non MAI insurer licence\n8 385 (1) MAI commission—suspend\nMAI insurer licence\n9 397 (1) MAI commission—cancel MAI\ninsurer licence\n\nSchedule 2 MAI Commission reviewable decisions\nitem\ncolumn 4\n10 397 (4) MAI commission—impose\ncondition on licence prohibiting\ninsurer from issuing further MAI\npolicies\n11 398 (1) MAI commission—refuse to\napprove transfer of MAI insurer\nlicence to new insurer\n12 399 (1) MAI commission—refuse to\ntransfer licensed insurer’s MAI\npolicies to another licensed\n\n(see s 3)\nNote 1 The Legislation Act contains definitions and other provisions relevant to\nthis Act.\nNote 2 For example, the Legislation Act, dict, pt 1, defines the following terms:\n• ACAT\n• ACT\n• appoint\n• Australian citizen\n• business day\n• calendar year\n• Commonwealth\n• contravene\n• coroner\n• corporation\n• Corporations Act\n• Criminal Code\n• disallowable instrument (see s 9)\n• doctor\n• domestic partner (see s 169 (1))\n• entity\n• Executive\n• fail\n• financial year\n• head of service\n• health practitioner\n• Legislative Assembly\n• may (see s 146)\n• Minister (see s 162)\n• must (see s 146)\n\n• notifiable instrument (see s 10)\n• occupational discipline order\n• parent\n• penalty unit (see s 133)\n• person (see s 160)\n• power\n• public employee\n• Speaker\n• State\n• statutory instrument (see s 13)\n• territory authority\n• territory law\n• the Territory\n• under.\nNote 3 The Road Transport (General) Act 1999 contains definitions relevant to\nthis Act. For example, the following terms are defined in the Road\nTransport (General) Act 1999, dictionary:\n• driver\n• infringement notice (see s 24 (6))\n• infringement notice management plan\n• infringement notice penalty\n• jurisdiction\n• light rail vehicle\n• motor vehicle\n• registered operator\n• responsible person\n• ride\n• road transport authority (or authority) (see s 16)\n• road transport legislation (see s 6)\n• trader’s plate\n\n• trailer\n• vehicle.\nNote 4 If a word or expression is defined in an Act (but not a regulation or\nanother publication) included in the road transport legislation, the\ndefinition applies to each use of the word or expression in other road\ntransport legislation unless the contrary intention appears (see Road\nTransport (General) Act 1999, s 8).\nACAT reviewable decision, for division 2.10.3 (ACAT review of\ninsurer’s decisions)—see section 192.\nACTIA means the Australian Capital Territory Insurance Authority\nestablished under the Insurance Authority Act 2005.\nallowable expenses, for chapter 2 (Motor accident injuries—defined\nbenefits)—see section 61.\napplication period, for an application for defined benefits, for\nchapter 2 (Motor accident injuries—defined benefits)—see\nsection 58.\nappointed auditor––see section 407.\nAPRA means the Australian Prudential Regulation Authority\nestablished under the Australian Prudential Regulation Authority\nAct 1998 (Cwlth), section 7.\nASIC means the Australian Securities and Investments Commission\nunder the Australian Securities and Investments Commission\nAct 2001 (Cwlth).\nat premises, for chapter 8 (Enforcement)––see section 433.\nauthorised IME providers—see section 15.\nauthorised person, for chapter 8 (Enforcement)—see section 433.\nauthority to disclose personal health information, for a person\ninjured in a motor accident—see section 54.\naverage weekly earnings (or AWE)—see section 17.\nAWE—see section 17.\n\nAWE adjusted, for an injured person’s pre-injury income, for\ndivision 2.4.3 (Income replacement benefits—payments)—see\nsection 94.\nAWE indexed, for an amount—see section 18.\nbusiness plan—see section 401.\ncapable, of being in paid work, for part 2.4 (Defined benefits—\nincome replacement benefits)—see section 79.\nclaimant, for a motor accident claim—see section 229.\nclaims manager—see section 337.\nCommonwealth authority means a body, whether or not\nincorporated, established under a Commonwealth Act.\ncompliance notice, for division 5.7.5 (Judgment for noncompliance\nwith time limits)—see section 278.\ncomplying notice of claim, for part 5.7 (Court proceedings on motor\naccident claims)—see section 257.\ncompulsory conference—see section 258.\nconnected, with an offence, for chapter 8 (Enforcement)—see\nsection 433.\ncontributor, to a motor accident claim, for part 5.7 (Court\nproceedings on motor accident claims)—see section 257.\ncosts—\n(a) when used in reference to the costs of an insurer for a motor\naccident claim, for part 6.10 (MAI insurer and nominal\ndefendant may recover costs incurred)—see section 341; and\n(b) when used in reference to the costs of an insurer for an\napplication for defined benefits by a person injured in a motor\naccident, for part 6.10—see section 341.\ndead person means a person who died as a result of a motor accident.\n\ndefined benefits—see section 33.\ndependant, of a person who died as a result of a motor accident, for\npart 2.7 (Defined benefits—death benefits)—see section 168.\ndomestic services expenses, for a person injured in a motor accident,\nfor part 2.5 (Defined benefits—treatment and care benefits)—see\nsection 114.\ndrive, a vehicle, includes—\n(a) be in control of the steering, movement or propulsion of the\nvehicle; and\n(b) if the vehicle is a trailer—draw or tow the vehicle; and\n(c) if the vehicle can be ridden—ride the vehicle.\ndriving offence—see section 41.\nenforcing party, for division 5.7.5 (Judgment for noncompliance with\ntime limits)—see section 278.\nexternally reviewable decision, for chapter 10 (Notification and\nreview of MAI commission reviewable decisions)—see section 477.\nfinal offer WPI—see section 160.\nfinancial penalty notice, for part 7.6A (Financial penalties)—see\nsection 394D (3).\nfirst payment period, for division 2.4.3 (Income replacement\nbenefits—payments)—see section 93.\nfirst WPI report—see section 158.\nfitness for work certificate, for part 2.4 (Defined benefits—income\nreplacement benefits)—see section 104.\nforeign national means a person who is not an Australian citizen or\npermanent resident.\nformer licensed insurer, for chapter 7 (MAI insurer licences)—see\nsection 355.\n\nfull and satisfactory explanation by an applicant for a delay in\napplying for defined benefits, for chapter 2 (Motor accident\ninjuries—defined benefits)—see section 35.\nfuture treatment payment, for chapter 4 (Payment of future medical\ntreatment expenses)—see section 222 (2).\ngross income, of an injured person who is an employee, for part 2.4\n(Defined benefits—income replacement benefits)—see section 76.\nground for financial penalty, for part 7.6A (Financial penalties)—\nsee section 394B.\nground for occupational discipline—see section 392.\nIME—see section 14.\nincome replacement benefit payment, for an injured person, for\npart 2.4 (Defined benefits—income replacement benefits)—see\nsection 75.\nindependent assessor—see section 206.\nindependent medical examiner (or IME)—see section 14.\ninformation, for part 2.3 (Application for defined benefits)—see\nsection 53.\ninjured person means a person injured in a motor accident.\ninsolvent insurer, for part 7.10 (MAI insurer licences—insolvent\ninsurers)—see section 420.\ninsolvent insurer declaration, for part 7.10 (MAI insurer licences—\ninsolvent insurers)—see section 422.\ninsurance industry deed—see section 359.\ninsured motor vehicle—see section 286.\ninsured person, for a motor accident claim—see section 231.\n\ninsurer—\n(a) in relation to an application for defined benefits, for part 2.10\n(Defined benefits—dispute resolution)—see section 185; and\n(b) of a motor vehicle, for a motor accident claim—see section 232;\nand\n(c) of a person, for a motor accident claim—see section 232.\ninternally reviewable decision, for division 2.10.2 (Internal review of\ninsurer’s decisions)—see section 186.\ninternal review, of an insurer’s internally reviewable decision, for\ndivision 2.10.2 (Internal review of insurer’s decisions)—see\nsection 186.\ninternal review notice—\n(a) for part 2.10 (Defined benefits—dispute resolution)—see\nsection 191 (1) (b); and\n(b) for chapter 10 (Notification and review of MAI commission\nreviewable decisions)—see section 477.\ninterstate insurer means an entity (including the Commonwealth, a\nCommonwealth authority and a State authority) that, under a law of\nthe Commonwealth or a State, indemnifies the responsible person for,\nand the driver of, the motor vehicle against liability for the death or\ninjury of a person.\nNote State includes the Northern Territory (see Legislation Act, dict, pt 1).\nissue, of an MAI policy, includes the issue of a renewal of the policy.\nlate application, for defined benefits—see section 59.\nlate party, for division 5.7.5 (Judgment for noncompliance with time\nlimits)—see section 278.\nlate receipt notice—see section 60.\n\nlevel, for a concentration of alcohol in blood or breath, for\ndivision 2.2.2 (Limitations and exceptions to entitlement)—see the\nRoad Transport (Alcohol and Drugs) Act 1977, dictionary.\nlicensed insurer—\n(a) see section 354; or\n(b) for part 7.6 (MAI insurer licences—occupational discipline)—\nsee section 390.\nliquidator, for part 7.10 (MAI insurer licences—insolvent\ninsurers)—see section 420.\nLTCS Act means the Lifetime Care and Support (Catastrophic\nInjuries) Act 2014.\nLTCS commissioner—see the LTCS Act, dictionary.\nLTCS scheme—see the LTCS Act, dictionary.\nMAI commission means the Motor Accident Injuries Commission\nestablished under section 22.\nMAI commission condition—see section 377.\nMAI commissioner means the person appointed as the\nMAI commissioner under section 24.\nMAI commission reviewable decision, for chapter 10 (Notification\nand review of MAI commission reviewable decisions)—see\nsection 477.\nMAI commission reviewer, for chapter 10 (Notification and review\nof MAI commission reviewable decisions)—see section 481.\nMAI guidelines means the guidelines made by the MAI commission\nunder section 487.\nMAI injury register—see section 472.\nMAI insurance business, for a licensed insurer, means any business\nof the insurer associated with MAI policies.\n\nMAI insured person, for an MAI policy—see section 286.\nMAI insurer—see section 287.\nMAI insurer licence—see section 354.\nMAI policy—see section 286.\nMAI policy issued by an insolvent insurer, for part 7.10 (MAI\ninsurer licences—insolvent insurers)—see section 420.\nMAI premium, for an MAI policy—see section 314.\nmandatory final offer—see section 263.\nmedical treatment, for chapter 4 (Payment of future medical\ntreatment expenses)—see section 221.\nminor contravention, for part 7.6A (Financial penalties)—see\nsection 394A.\nmotor accident—see section 10.\nmotor accident claim—see section 228.\nmotor accident injuries policy (or MAI policy)—see section 286.\nmultiple vehicle accident means a motor accident that involves more\nthan 1 motor vehicle.\nnet income, of an injured person who is self-employed, for part 2.4\n(Defined benefits—income replacement benefits)—see section 77.\nno-fault motor accident—see section 254.\nnominal defendant—see section 16.\nnominal defendant fund—see section 330.\nnotice of affirmation or increase—see section 159.\noccupier, of premises, for chapter 8 (Enforcement)––see section 433.\noffence, for chapter 8 (Enforcement)––see section 433.\n\noutstanding, for a charge, for division 2.2.2 (Limitations and\nexceptions to entitlement)—see section 42.\npaid work, for part 2.4 (Defined benefits—income replacement\nbenefits)—see section 78.\nparticipant, in the LTCS scheme—see the LTCS Act, dictionary.\nparty, to a motor accident claim, for part 5.7 (Court proceedings on\nmotor accident claims)—see section 257.\npension age—see the Social Security Act 1991 (Cwlth), section 23.\npermanent impairment—see section 12.\npermanent resident—see the Australian Citizenship Act 2007\n(Cwlth), section 5.\npersonal health information—see the Health Records (Privacy and\nAccess) Act 1997, dictionary.\npersonal injury—see section 9.\npersonal representative, of a person who died as a result of a motor\naccident—\n(a) means the person to whom any grant of probate of the will or\nadministration of the estate of the dead person has been made in\nthe ACT, a State or another Territory; and\n(b) includes an executor by representation or the public trustee and\nguardian.\nperson injured in a motor accident—see section 8.\nperson who died as a result of a motor accident—see section 36.\nperson with a legal disability means—\n(a) a child; or\n(b) a person with a mental disability.\n\nperson with a mental disability—\n(a) means a person who is not legally competent to apply for defined\n(b) includes a person mentioned in paragraph (a) even if a guardian\nor manager has not been appointed for the person under the\nGuardianship and Management of Property Act 1991.\npost-injury earning capacity, of an injured person, for division 2.4.3\n(Income replacement benefits—payments)—see section 93.\npre-injury earning capacity—\n(a) for a person on unpaid leave—see section 85; or\n(b) for a person with a new work arrangement—see section 86; or\n(c) for a full-time student—see section 87.\npre-injury income, for an injured person—see section 80.\npre-injury weekly income—\n(a) for an ongoing employee or fixed term contractor—see\nsection 81; or\n(b) for a self-employed person—see section 82; or\n(c) for a casual worker—see section 83; or\n(d) for a person receiving workers compensation—see section 84.\npremises, for chapter 8 (Enforcement)––see section 433.\nprivate medical examiner, for an injured person, for division 2.6.3\n(Quality of life benefits—WPI assessment)—see section 145.\npublish, for chapter 9 (Information collection and secrecy)—see\nsection 461.\nquality of life benefits application—see section 137.\nquality of life damages—see section 242.\n\nrail transport operator—see the Rail Safety National Law (ACT),\nsection 4.\nreceipt notice—see section 60.\nrecovery plan, for an injured person, for part 2.5 (Defined benefits—\ntreatment and care benefits)—see section 122.\nregistered motor vehicle means a motor vehicle registered under—\n(a) the Road Transport (Vehicle Registration) Act 1999; or\n(b) the Interstate Road Transport Act 1985 (Cwlth).\nrehabilitation, of a person injured in a motor accident—see\nsection 111.\nrelated body corporate, in relation to a body corporate—see the\nCorporations Act, section 9.\nrelevant insurer, for a motor accident—see section 34.\nrelevant notice claim, for division 5.7.5 (Judgment for\nnoncompliance with time limits)—see section 279.\nrequired thing, under a compliance notice, for division 5.7.5\n(Judgment for noncompliance with time limits)—see section 277.\nrespondent, for a motor accident claim, for chapter 5 (Motor accident\ninjuries—common law damages)—see section 230.\nroad—\n(a) means an area that is—\n(i) open to or used by the public; and\n(ii) developed for, or has as 1 of its main uses, the driving or\nriding of motor vehicles; but\n(b) does not include an area that would otherwise be a road but for\na declaration under the Road Transport (General) Act 1999,\nsection 12 (Power to include or exclude areas in road transport\nlegislation) that this Act does not apply to the area.\n\nroad related area—\n(a) means—\n(i) an area that divides a road; or\n(ii) a footpath or nature strip adjacent to a road; or\n(iii) an area that is open to the public and is designated for use\nby cyclists or animals; or\n(iv) an area that is not a road and that is open to or used by the\npublic for driving, riding or parking vehicles; or\n(v) a shoulder of a road; or\n(vi) any other area that is open to or used by the public so far\nas a declaration under the Road Transport (General)\nAct 1999, section 12 (Power to include or exclude areas in\nroad transport legislation) declares that this Act applies to\nthe area; but\n(b) does not include an area that would otherwise be a road related\narea so far as a declaration under that section declares that this\nAct does not apply to the area.\nsecond payment period, for division 2.4.3 (Income replacement\nbenefits—payments)—see section 93.\nsecond WPI report—see section 158.\nself-employed, for part 2.4 (Defined benefits—income replacement\nbenefits)—see section 74.\nserious contravention, for part 7.6A (Financial penalties)—see\nsection 394A.\nsignificant occupational impact (or SOI), of an injured person’s\ninjury on the injured person’s ability to undertake employment—see\nsection 205.\nsingle vehicle accident means a motor accident that involves only\n1 motor vehicle.\n\nSOI—see section 205.\nSOI assessment, of a person injured in a motor accident—see\nsection 207.\nSOI assessment guidelines—see section 208.\nSOI report—see section 207.\nstaff of the MAI commission—see section 27.\nsuspended insurer, for part 7.5 (MAI insurer licences—\nsuspension)—see section 382.\ntravel expenses, for a person injured in a motor accident, for part 2.5\n(Defined benefits—treatment and care benefits)—see section 115.\ntreatment and care, of a person injured in a motor accident—see\nsection 110.\ntreatment and care expenses, for a person injured in a motor\naccident, for chapter 2 (Motor accident injuries—defined benefits)—\nsee section 113.\ntreatment and care needs, of a participant in the LTCS scheme—see\nthe LTCS Act, section 9.\nunidentified motor vehicle—see section 327.\nuninsured motor vehicle—see section 325.\nunpaid leave, from paid work, for part 2.4 (Defined benefits—\nincome replacement benefits)—see section 74.\nunregistered vehicle permit—see the Road Transport (Vehicle\nRegistration) Act 1999, dictionary.\nuse, a motor vehicle—see section 11.\nUVP liability contribution—see section 332.\n\nvalid trader’s plate means a trader’s plate that—\n(a) is issued by the road transport authority to a person; and\n(b) the road transport authority has not required the person to return\nto the authority under the Road Transport (Vehicle Registration)\nRegulation 2000—\n(i) section 89 (Recall of trader’s plates); or\n(ii) section 101 (Return of trader’s plate); and\n(c) has not been surrendered to the road transport authority under\nthe Road Transport (Vehicle Registration) Regulation 2000,\nsection 102 (Surrender of trader’s plates).\nwarrant, for chapter 8 (Enforcement)––see section 433.\nwhole person impairment (or WPI), of a person—see section 13.\nworkers compensation scheme means a workers compensation\nscheme under the Workers Compensation Act 1951, the Safety,\nRehabilitation and Compensation Act 1988 (Cwlth), or a statutory\nworkers compensation scheme of a place outside the ACT.\nWPI, of a person—see section 13.\nWPI assessment, of a person injured in a motor accident—see\nsection 143.\nWPI assessment guidelines—see section 146.\nWPI report—see section 144.\n\n1 About the endnotes\n1 About the endnotes\nAmending and modifying laws are annotated in the legislation history and the\namendment history. Current modifications are not included in the republished law\nbut are set out in the endnotes.\nNot all editorial amendments made under the Legislation Act 2001, part 11.3 are\nannotated in the amendment history. Full details of any amendments can be\nobtained from the Parliamentary Counsel’s Office.\nUncommenced amending laws are not included in the republished law. The details\nof these laws are underlined in the legislation history. Uncommenced expiries are\nunderlined in the legislation history and amendment history.\nIf all the provisions of the law have been renumbered, a table of renumbered\nprovisions gives details of previous and current numbering.\nThe endnotes also include a table of earlier republications.\n2 Abbreviation key\nA = Act NI = Notifiable instrument\nAF = Approved form o = order\nam = amended om = omitted/repealed\namdt = amendment ord = ordinance\nAR = Assembly resolution orig = original\nch = chapter par = paragraph/subparagraph\nCN = Commencement notice pres = present\ndef = definition prev = previous\nDI = Disallowable instrument (prev...) = previously\ndict = dictionary pt = part\ndisallowed = disallowed by the Legislative r = rule/subrule\nAssembly reloc = relocated\ndiv = division renum = renumbered\nexp = expires/expired R[X] = Republication No\nGaz = gazette RI = reissue\nhdg = heading s = section/subsection\nIA = Interpretation Act 1967 sch = schedule\nins = inserted/added sdiv = subdivision\nLA = Legislation Act 2001 SL = Subordinate law\nLR = legislation register sub = substituted\nLRA = Legislation (Republication) Act 1996 underlining = whole or part not commenced\nmod = modified/modification or to be expired\n\nLegislation history 3\n3 Legislation history\nMotor Accident Injuries Act 2019 A2019-12\nnotified LR 31 May 2019\ns 1, s 2 commenced 31 May 2019 (LA s 75 (1))\nremainder commenced 1 February 2020 (s 2 (1) and CN2019-13)\nas amended by\nRoad Transport Legislation Amendment Act 2019 A2019-21 pt 3\nnotified LR 8 August 2019\ns 1, s 2 commenced 8 August 2019 (LA s 75 (1))\npt 3 commenced 1 February 2020 (s 2 (2) and see Motor Accident\nInjuries Act 2019 A2019-12, s 2 (1) and CN2019-13)\nStatute Law Amendment Act 2019 A2019-42 sch 1 pt 1.4, sch 3 pt 3.19\nnotified LR 31 October 2019\ns 1, s 2 commenced 31 October 2019 (LA s 75 (1))\nsch 1 pt 1.4, sch 3 pt 3.19 commenced 1 February 2020 (s 2 (2) and see\nMotor Accident Injuries Act 2019 A2019-12, s 2 (1) and CN2019-13)\nMotor Accident Injuries Amendment Act 2020 A2020-2\nnotified LR 17 February 2020\ns 1, s 2 taken to have commenced 1 February 2020 (LA s 75 (2))\nremainder taken to have commenced 1 February 2020 (s 2)\nJustice Legislation Amendment Act 2020 A2020-42 pt 24\nnotified LR 27 August 2020\ns 1, s 2 commenced 27 August 2020 (LA s 75 (1))\npt 24 commenced 28 August 2020 (s 2 (9))\nRoad Transport Legislation Amendment Act 2022 A2022-3 sch 1\npt 1.1\nnotified LR 30 March 2022\ns 1, s 2 commenced 30 March 2022 (LA s 75 (1))\nsch 1 pt 1.1 commenced 13 April 2022 (s 2)\nRoad Transport Legislation Amendment Act 2022 (No 2) A2022-5\nsch 1 pt 1.1\nnotified LR 13 April 2022\ns 1, s 2 commenced 13 April 2022 (LA s 75 (1))\nsch 1 pt 1.1 commenced 11 May 2022 (s 2 (2))\n\n3 Legislation history\nMotor Accident Injuries Amendment Act 2023 A2023-30\nnotified LR 7 July 2023\ns 1, s 2 commenced 7 July 2023 (LA s 75 (1))\ns 12 commenced 14 July 2023 (s 2 (2) (a))\nremainder commenced 14 July 2023 (s 2 (1))\nRoad Safety Legislation Amendment Act 2024 A2024-20 sch 1 pt 1.2\nnotified LR 24 May 2024\ns 1, s 2 commenced 24 May 2024 (LA s 75 (1))\nsch 1 pt 1.2 commenced 25 May 2024 (s 2 (1))\nStatute Law Amendment Act 2025 A2025-29 sch 4 pt 4.128\nnotified LR 6 November 2025\ns 1, s 2 commenced 6 November 2025 (LA s 75 (1))\nsch 4 pt 4.128 commenced 26 December 2025 (s 2 (7))\n\nCommencement\ns 2 om LA s 89 (4)\nMeaning of AWE indexed for amount\ns 18 am A2023-30 s 4\nIndexation of defined benefits and quality of life damages\ns 19 am A2025-29 amdt 4.129\nDuty to act in good faith—applicants, claimants and insurers\ns 20 am A2023-30 s 5\nDelegation by MAI commission\ns 30 am A2023-30 s 6; pars renum R5 LA\nMeaning of private medical examiner—ch 2\ns 37 om A2019-42 amdt 3.77\nMeaning of driving offence\ns 41 am A2020-42 s 130; A2022-3 amdt 1.1; A2022-5 amdt 1.1,\namdt 1.2; A2024-20 amdt 1.2; pars renum R6 LA\nDefinitions—div 2.2.2\ns 42 def found guilty ins A2023-30 s 7\ndef non-conviction order om A2023-30 s 8\nEntitlement limited—single driving offence\ns 44 am A2023-30 s 9; ss renum R5 LA\nNo entitlement—multiple driving offences\ns 45 am A2023-30 s 10\nNo entitlement—serious offences\ns 48 am A2020-42 s 131, s 132; A2022-5 amdt 1.3, amdt 1.4;\nA2023-30 s 11, s 12; ss, pars renum R5 LA; A2024-20\namdt 1.3; pars renum R6 LA\nEntitlement limited—workers compensation claimant\ns 50 sub A2023-30 s 13\nWhen entitlement to certain benefits ends\ns 51 am A2023-30 s 14\nMeaning of authority to disclose personal health information\ns 54 am A2023-30 s 15\nApplication for defined benefits—authority to disclose personal health\ns 57 am A2023-30 s 16\nMeaning of allowable expenses—ch 2\ns 61 sub A2019-42 amdt 3.78\n\nDispute about liability for application\ns 70 am A2023-30 s 17\nApplication for defined benefits—notification of claim under workers\ns 73 sub A2023-30 s 18\nMeaning of gross income—pt 2.4\ns 76 am A2019-42 amdts 1.32-1.34\nMeaning of capable of being in paid work—pt 2.4\ns 79 am A2019-42 amdt 3.79\nMeaning of pre-injury weekly income—ongoing employee or fixed term\ncontractor\ns 81 am A2019-42 amdt 3.80, amdt 3.81\nMeaning of pre-injury weekly income—self-employed person\ns 82 am A2019-42 amdt 3.82\nMeaning of pre-injury weekly income—person receiving workers\ncompensation\ns 84 am A2019-42 amdt 3.83\nMeaning of AWE adjusted—div 2.4.3\ns 94 am A2023-30 s 19\nAmount of income replacement benefits—first payment period\ns 96 am A2019-42 amdts 1.35-1.37\nAdjustment of pre-injury income\ns 95 am A2025-29 amdt 4.129\nAmount of income replacement benefits—second payment period\ns 97 am A2019-42 amdt 1.38, amdt 1.39\nNotice required to reduce or stop income replacement benefit payments\ns 107 am A2023-30 s 20\nWho is entitled to treatment and care benefits?\ns 112 am A2023-30 s 21\nAssessment of injured person’s injuries\ns 121 am A2023-30 s 22, s 23\nRecovery plan—suspension of benefits\ns 124A ins A2023-30 s 24\nWho is entitled to quality of life benefits?\ns 132 am A2023-30 s 25\nQuality of life benefits application\ns 137 am A2023-30 ss 26-28\n\nWPI assessment 4 years 6 months after motor accident\ns 141 am A2023-30 s 29, s 30\nMeaning of private medical examiner—div 2.6.3\ns 145 am A2019-42 amdt 1.40\nWPI assessment guidelines\ns 146 am A2025-29 amdt 4.129\nWPI assessment—multiple body systems affected\ns 151 am A2019-42 amdt 3.84; A2023-30 s 31, s 32\nWPI less than 5%—insurer may make offer\ns 154 hdg sub A2023-30 s 33\ns 154 am A2023-30 ss 34-36\nWPI 5% to 9%—insurer must make offer\ns 155 hdg sub A2023-30 s 37\ns 155 am A2019-42 amdt 3.85; ss renum R1 LA\nWPI 10% or more—injured person not entitled to make motor accident claim\ns 156 am A2019-42 amdt 3.86; ss renum R1 LA\nWPI 10% or more—injured person entitled to make motor accident claim\ns 157 am A2019-42 amdt 3.87; ss renum R1 LA; A2023-30 s 38,\ns 39\nSecond WPI report—original WPI may be affirmed or increased\ns 159 am A2023-30 s 40\nFinal offer WPI less than 5%\ns 161 am A2023-30 ss 41-43\nFinal offer WPI 5% to 9%\ns 162 am A2023-30 s 44, s 45\nFinal offer WPI 10% or more—injured person not entitled to make motor\naccident claim\ns 163 am A2023-30 s 46, s 47\nFinal offer WPI 10% or more—injured person entitled to make motor accident\nclaim\ns 164 am A2023-30 s 48, s 49\nWPI assessment—relevant insurer to pay\ns 165 am A2023-30 s 50\nEffect of certain WPI assessments on motor accident claim\ns 166 am A2019-42 amdt 3.88; A2023-30 s 51\nMeaning of ACAT reviewable decision—div 2.10.3\ns 192 hdg sub A2019-42 amdt 3.89\ns 192 am A2019-42 amdt 3.90\n\nLegal costs and fees payable by applicants and insurers\ns 203 am A2020-2 s 4\nMeaning of independent assessor\ns 206 sub A2023-30 s 52\nMeaning of SOI assessment and SOI report\ns 207 am A2023-30 ss 53-55\nSOI assessment guidelines\ns 208 am A2023-30 s 56; A2025-29 amdt 4.129\nSOI assessment 4 years 6 months after motor accident\ns 209 am A2019-42 amdt 3.91; A2023-30 s 57\nArrangement of SOI assessment\ns 210 am A2023-30 s 58\nSOI assessment—provision of information\ns 211 am A2023-30 s 59\nSOI report to be prepared\ns 212 am A2023-30 s 59\nSOI report—injury has significant occupational impact\ns 213 am A2023-30 s 60, s 61\nSOI report—no significant occupational impact—ACAT review\ns 215 am A2023-30 s 62\nACAT review—decision\ns 218 am A2023-30 s 63, s 64; ss renum R5 LA\nFuture treatment payment—assessment and calculation\ns 223 am A2023-30 s 65, s 66\nMotor accident claim—notification of claim made under workers\ns 238 sub A2023-30 s 67\nAward of damages—requirements\ns 239 am A2023-30 ss 68-71\nApplication—pt 5.3\ns 240 am A2023-30 s 72, s 73\nWPI assessment—application and assessment\ns 241 am A2019-42 amdt 3.92; pars renum R1 LA; A2023-30\nss 74-78; pars renum R5 LA\nCourt orders in favour of claimant\ns 282 am A2019-42 amdt 3.93\nLegal costs and fees payable by claimants and insurers\ns 284 am A2020-2 s 5\n\nOffence—use uninsured motor vehicle on road or road related area\ns 289 am A2019-21 s 6\nEstablishment of nominal defendant fund\ns 330 am A2023-30 s 79\nMAI insurer licence—application\ns 362 am A2025-29 amdt 4.129\nCompliance with certain provisions\ns 365 am A2023-30 s 80\nCompliance with directions and remediation plans\ns 366A ins A2023-30 s 81\nSuspended insurer selected after suspension\ns 389 am A2023-30 s 82, s 83\nMAI commission may choose occupational discipline instead of prosecution\ns 391 am A2023-30 s 84\nOccupational discipline orders\ns 394 am A2023-30 s 85\nFinancial penalties\npt 7.6A hdg ins A2023-30 s 86\nDefinitions—pt 7.6A\ns 394A ins A2023-30 s 86\ndef financial penalty notice ins A2023-30 s 86\ndef ground for financial penalty ins A2023-30 s 86\ndef minor contravention ins A2023-30 s 86\ndef serious contravention ins A2023-30 s 86\nMeaning of ground for financial penalty—pt 7.6A\ns 394B ins A2023-30 s 86\nNotice of proposed financial penalty\ns 394C ins A2023-30 s 86\nImposing financial penalties\ns 394D ins A2023-30 s 86\nMediation for serious contravention financial penalty notice\ns 394E ins A2023-30 s 86\nPayment of financial penalty\ns 394F ins A2023-30 s 86\nMAI insurer licences—directions to licensed insurers\npt 7.6B hdg ins A2023-30 s 86\nDirections to licensed insurers—general\ns 394G ins A2023-30 s 86\n\nObjection to direction\ns 394H ins A2023-30 s 86\nDirections to licensed insurers—remediation plans\ns 394I ins A2023-30 s 86\nNotice of reportable conduct\ns 412A ins A2023-30 s 87\nInsolvent insurer declarations\ns 422 am A2025-29 amdt 4.129\nHow MAI commission is to make request\ns 464 am A2023-30 s 88\nInternal review notices\ns 478 am A2025-29 amdt 4.129\nReviewable decision notices\ns 483 am A2025-29 amdt 4.129\nExtraterritorial operation\ns 486 am A2019-42 amdt 3.94; ss renum R1 LA\ns 487 am A2025-29 amdt 4.129\nDetermination of fees\ns 489 am A2025-29 amdt 4.129\nDetermination of motor accident levy\ns 490 am A2025-29 amdt 4.129\nRegulation-making power\ns 492 am A2025-29 amdt 4.129\nTransitional\nch 15 hdg exp 1 February 2025 (s 613)\nDefinitions—ch 15\ns 600 exp 1 February 2025 (s 613)\nCTP premiums paid before commencement day\ns 601 exp 1 February 2025 (s 613)\nMotor accidents happening before commencement day\ns 602 exp 1 February 2025 (s 613)\nExisting claims under repealed Act\ns 603 exp 1 February 2025 (s 613)\nCTP policies under repealed Act\ns 604 exp 1 February 2025 (s 613)\n\nLicensed insurers\ns 605 exp 1 February 2025 (s 613)\nFormer insurers\ns 606 exp 1 February 2025 (s 613)\nPowers of CTP regulator may be exercised by MAI commission\ns 607 exp 1 February 2025 (s 613)\nInformation to be provided by licensed insurers under repealed Act\ns 608 exp 1 February 2025 (s 613)\nPowers of nominal defendant under repealed Act\ns 609 exp 1 February 2025 (s 613)\nNominal defendant fund\ns 610 exp 1 February 2025 (s 613)\nAnnual report\ns 611 exp 1 February 2025 (s 613)\nTransitional regulations\ns 612 exp 1 February 2025 (s 613)\nExpiry—ch 15\ns 613 exp 1 February 2025 (s 613)\nRepeals and consequential amendments\nch 16 hdg om LA s 89 (3)\nLegislation amended—sch 3\ns 614 om LA s 89 (3)\nLegislation repealed\ns 615 om LA s 89 (3)\nInternally reviewable decisions\nsch 1 pt 1.1 am A2023-30 s 89; items renum R5 LA\nACAT reviewable decisions\nsch 1 pt 1.2 am A2023-30 s 90; items renum R5 LA\nConsequential amendments\nsch 3 om LA s 89 (3)\ndict def financial penalty notice ins A2023-30 s 91\ndef ground for financial penalty ins A2023-30 s 91\ndef independent assessor ins A2023-30 s 92\ndef independent health assessor om A2023-30 s 93\ndef initial period om A2019-42 amdt 3.95\ndef minor contravention ins A2023-30 s 94\ndef non-conviction order om A2023-30 s 95\ndef private medical examiner sub A2019-42 amdt 3.96\n\ndef road sub A2019-42 amdt 3.97\ndef serious contravention ins A2023-30 s 96\n\nEarlier republications 5\n5 Earlier republications\nSome earlier republications were not numbered. The number in column 1 refers to\nthe publication order.\nSince 12 September 2001 every authorised republication has been published in\nelectronic pdf format on the ACT legislation register. A selection of authorised\nrepublications have also been published in printed format. These republications are\nmarked with an asterisk (*) in column 1. Electronic and printed versions of an\nauthorised republication are identical.\nRepublication\nNo and date\nEffective Last\namendment\nmade by\nRepublication\nfor\n1 Feb 2020\n1 Feb 2020–\n27 Aug 2020\nA2019-42 amendments by\nA2019-21 and\nA2019-42\nR1 (RI)\n17 Feb 2020\n1 Feb 2020–\n27 Aug 2020\nA2019-42 reissued for\nretrospective\namendments by\nA2020-2\n28 Aug 2020\n28 Aug 2020–\n12 Apr 2022\nA2020-42 amendments by\nA2020-42\n13 Apr 2022\n13 Apr 2022–\nA2022-3 amendments by\nA2022-3\n11 May 2022–\nA2022-5 amendments by\nA2022-5\nR5 (RI)\n12 Aug 2024\n14 July 2023–\nA2023-30 amendments by\nA2023-30\nreissued for textual\ncorrection in\ns 394D, s 394E\nR6 (RI)\n25 May 2024–\n1 Feb 2025\nA2024-20 amendments by\nA2024-20\nreissued for textual\ncorrection in\ns 394D, s 394E\n2 Feb 2025\n2 Feb 2025–\n25 Dec 2025\nA2024-20 expiry of\ntransitional\nprovisions (ch 15)\n\n6 Expired transitional or validating provisions\n6 Expired transitional or validating provisions\nThis Act may be affected by transitional or validating provisions that have expired.\nThe expiry does not affect any continuing operation of the provisions (see\nLegislation Act 2001, s 88 (1)).\nExpired provisions are removed from the republished law when the expiry takes\neffect and are listed in the amendment history using the abbreviation ‘exp’ followed\nby the date of the expiry.\nTo find the expired provisions see the version of this Act before the expiry took\neffect. The ACT legislation register has point-in-time versions of this Act.","sortOrder":505}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":9,"scope_assessment":{"changed":true,"description":"The Act started as a statutory no‑fault motor accident benefits scheme with a nominal defendant and basic insurer licensing (objects in s 6 and defined benefits in ch 2). Subsequent amendments expanded the MAI commission’s market‑regulatory role and intrusive supervisory tools: premium approval and arbitration (ss 317–323), routine profitability and net‑profit analysis (ss 409–411), mandatory business plans and audits (ss 401–407), broad data‑collection and disclosure powers (ss 462–466), remediation directions and remediation plans (ss 394G–394I) and a statutory financial‑penalty regime for insurers (pt 7.6A, ss 394A–394F). The insolvency framework for insurers and a strengthened nominal‑defendant fund are also added (pt 7.10; ss 329–336). Collectively these later additions move the Act beyond an accident‑compensation code into an active market‑regulation statute with detailed supervisory, investigatory and penalty tools; the effect is a clear growth of regulatory scope and discretionary authority (see s 6, s 25 and pt 7)."},"complexity_factors":["Very long Act (about 493 numbered sections and multiple Schedules) with extensive procedural detail","Large interpretation layer: dictionary plus many cross‑references throughout (definitions appear across chs and in Legislation Act)","Multiple decision‑makers and review tiers (insurers, MAI commission, MAI commissioner, MAI reviewers, ACAT) creating nested review paths (parts 2.10 and ch 10)","Complex medical‑assessment logic with conditional branching and timing rules (WPI and SOI processes across ss 137–166 and 205–219)","Complicated insurer licensing and supervision regime with conditions, suspension, cancellation, transfers and insolvency special rules (pt 7, pts 7.5–7.11 and pt 7.10)","Detailed premium approval, mediation and arbitration procedures with actuarial criteria (ss 316–323, 318–322)","Extensive obligations to provide returns, periodic reporting and audits with criminal penalties for non‑compliance (ch 9, ss 462–465, 407)","Significant conditional exceptions and exclusions (driving offences, serious offences, terrorism, LTCS participants, foreign nationals) that modify entitlement rules across ch 2","New regulatory enforcement tools added by later amendments (financial penalties, remediation directions and obligations in pt 7.6A and pt 7.6B)"],"plain_english_summary":"**What this law does, in plain language**\n\n- Establishes a no‑fault motor accident insurance system for the ACT and the mechanics of how it operates (main objects, s 6). Benefits are provided to people injured in motor accidents without the need to prove fault, subject to stated exclusions and limits (chapter 2).  \n\n- Creates the Motor Accident Injuries Commission (the MAI commission) and a single executive (the MAI commissioner) to run and regulate the scheme, supervise insurers, approve premiums and guidelines, collect data and combat fraud (ss 22–26; s 316; s 316–323).  \n\n- Defines the package of “defined benefits” available on a statutory (no‑fault) basis: income replacement, treatment & care, quality‑of‑life payments (WPI‑based) and death/funeral benefits, with eligibility, timing and calculation rules (ch 2, esp. ss 33; 74–103; 110–131; 132–167; 168–177).  \n\n- Sets a structured WPI (whole person impairment) assessment and offer process. WPI assessments are done by independent medical examiners arranged by authorised IME providers; results trigger specific entitlements and limits on common‑law claims (ss 143–166; s 15; ss 137–142).  \n\n- Keeps common‑law (fault) claims possible but imposes a threshold and offsets: claimants generally need a WPI ≥ 10% (or other statutory triggers) to sue for common‑law damages; statutory payments are deducted from later damages in set ways (pt 5, esp. s 239 and ss 242–249).  \n\n- Requires compulsory MAI cover for most motor vehicles used on roads or road‑related areas and prescribes the mechanism for choosing an MAI insurer at registration or trader’s‑plate issue; creates the nominal defendant to step in for uninsured/unidentified vehicles (pt 6, ss 289–306; ss 324–328).  \n\n- Creates the nominal defendant fund and funding mechanisms (UVP contributions, collections) to pay claims that fall on the nominal defendant (ss 329–335; ss 331–334).  \n\n- Establishes a licence, supervision and enforcement regime for MAI insurers: licence criteria and conditions, reporting, audits, business plans, power to suspend/cancel licences, transfer policies, and a new toolkit for regulatory action including remediation directions and financial penalties (pt 7, ss 361–413; pt 7.6A ss 394A–394F; pt 7.6B ss 394G–394I).  \n\n- Provides dispute‑resolution paths: internal insurer review, MAI commission review and external review in ACAT with no monetary cap for ACAT’s jurisdiction in this context (pt 2.10 and ch 10, ss 185–204; ss 192–199).  \n\n- Sets broad information‑collection and secrecy rules: insurers must give extensive returns and documents to the MAI commission; the MAI commission can share and publish aggregated or anonymised material; and strict limits apply to use/divulgence of protected information (ch 9, ss 462–476).  \n\n**Why the law matters (official rationale and how it works mechanically)**\n\n- Officially the Act aims to ensure prompt, no‑fault support to injured people while keeping premiums affordable and allowing competition in premium setting (s 6). Mechanically, affordability + competition are implemented by: licensed insurer applications for MAI premiums which the MAI commission approves/rejects (ss 314–323); an audit and net‑profit surveillance regime (ss 409–411); and an ability to arbitrate unresolved premium disputes (ss 321–322).  \n\n- The MAI commission is given wide regulatory tools (guidelines, approvals, information powers and enforcement) to both stabilise the insurance market and supervise insurer conduct (ss 25–26; ss 316; ss 462–466). The Act makes the MAI commission the central decision‑maker on many technical and market questions (premium sufficiency, UVP levels, IME authorisations).  \n\n**How the key mechanisms change incentives and what to watch in practice**\n\n- Who pays: insurers fund statutory benefits through MAI premiums (s 314). The nominal defendant fund—supported by UVP levies on unregistered permits and other collections—backs liabilities for uninsured or unidentified vehicles (ss 329–334). The MAI commission is funded by a motor‑accident levy (s 490).  \n\n- Who decides: insurers decide day‑to‑day liability and benefit payments (s 65), the MAI commission sets rules, approves premiums and supervises insurers (ss 25–26, ss 319–323), and ACAT provides external review of many disputed decisions (pt 2.10; ch 10).  \n\n- Behaviour the law nudges: the no‑fault benefits plus treatment‑plan regime (recovery plans and suspension powers, ss 122–127; s 124A) push early treatment and return‑to‑work; the WPI processes (ss 143–166) constrain when claimants can litigate for common‑law damages; and the licence/penalty toolkit (pt 7 and pt 7.6A–7.6B) strengthens insurer compliance incentives.  \n\n- Costs and trade‑offs: the Act shifts substantial costs onto licensed insurers (through benefit payments, reporting and compliance duties s 462, audits s 407 and capital/reinsurance expectations s 405). Those costs can influence premiums and reinsurance arrangements (s 405). The MAI commission’s discretion to approve premiums, impose licence conditions and analyse net profits (ss 318–323; ss 409–411) creates a powerful regulatory lever that can stabilise the market but adds regulatory timing and compliance costs to insurers and creates potential for regulatory intervention.  \n\n- Compliance and administration risks: the scheme requires complex medical‑assessment processes (WPI and SOI), authorised IME providers (s 15), extensive data flows (s 462) and multi‑step dispute and court‑preparation procedures (pt 5.7). Practical risks include delays in IME/assessment processes, costs of repeated assessments, data quality and privacy handling (ch 9), and insurer operational capacity to meet MAI guidelines (s 366).  \n\n- Concentrated benefits, diffuse costs, capture risks: beneficiaries (injured persons) are a concentrated and visible group; the costs fall largely on licensed insurers and ultimately on policyholders via premiums (s 314). The Act gives the MAI commission broad monitoring and intervention powers (ss 25–26; ss 394G–394I; ss 409–411). That centralised regulatory capacity reduces market volatility risk but creates a risk that regulators’ choices (premium approvals, required remediation) will have material market effects—an effect that should be tested against clear evidence and proportionality (see ss 318–319; s 320).  \n\n- Substitution effects and edge cases: the law changes incentives for foreign nationals and people leaving Australia (s 184) by allowing lump‑sum exits in limited cases. Participants in the LTCS scheme are excluded from certain statutory and common‑law recovery paths, which shifts costs and benefits between the LTCS scheme and MAI system (s 118; s 250).  \n\n**Key implementation points for users (who should note what, and where)**\n\n- Injured people: apply early (13‑week application period, s 58–59), sign medical‑information authorities (ss 54, 57), and comply with recovery plans (ss 122–127) or risk suspension (s 124A). WPI timing rules affect your right to sue (ss 137–157; s 239).  \n\n- Insurers and intermediaries: keep detailed returns and be ready for audits (ss 462–465; s 407), comply with licence conditions and MAI guidelines (ss 365–366; s 487), and expect MAI commission intervention powers (ss 394G–394I; ss 394A–394F).  \n\n- Lawyers and service‑providers: referral fees and certain referral arrangements are criminalised (s 485); information sharing obligations may apply to legal representatives under regulation (s 469).  \n\n**Selected section references for mechanics**: objects (s 6); defined benefits (s 33 and ch 2); WPI process (ss 143–166); insurer licensing & supervision (pt 7); MAI commission powers (ss 25–26, s 319); nominal defendant & fund (ss 324–335); information powers (ss 462–466); enforcement/search (ch 8)."},"issue_detection":{"absurdities":[],"contradictions":[]},"kimi_summary":{"_metrics":{"completionTokens":823},"content_quality":"ok","complexity_score":8,"scope_assessment":{"changed":false,"description":"The legislation appears consistent with its original 2019 intent as a comprehensive no-fault motor accident insurance scheme. The 2025 republication (No. 8) reflects ongoing amendments but no fundamental expansion beyond the original scope of providing defined benefits and common law damages for motor accident injuries."},"complexity_factors":["493 sections across 11 chapters with extensive cross-referencing to other ACT legislation (Civil Law (Wrongs) Act, Workers Compensation Act, LTCS Act, etc.)","Multiple parallel pathways: defined benefits scheme vs common law damages with election requirements","Extensive defined terms (WPI, SOI, AWE indexed, MAI policy, etc.) with mathematical formulas for benefit calculations","Nested conditional logic: eligibility varies by employment status (ongoing employee, casual, self-employed, student, etc.) with different calculation methods","Strict procedural timeframes (13 weeks, 26 weeks, 4 years 6 months, 5 years) with exceptions and late application provisions","Dual assessment systems: WPI (Whole Person Impairment) assessments and SOI (Significant Occupational Impact) assessments with different thresholds","Complex insurer liability rules including interstate insurers, nominal defendant provisions, and transfer mechanisms between insurers","Mandatory pre-court procedures (compulsory conferences, mandatory final offers) with cost consequences for non-compliance"],"plain_english_summary":"This ACT law creates a no-fault motor accident insurance scheme: anyone injured in an ACT motor crash (drivers, passengers, pedestrians, cyclists) or their dependants can claim compulsory-insurer benefits for income support, treatment/care, lump-sum impairment, funeral and death payments without proving fault. It speeds access to care but has time limits, exclusions for serious criminality and uninsured vehicles, and preserves the option to sue for serious (≥10% impairment) injuries."}},"importantCases":[],"_links":{"self":"/api/acts/motor-accident-injuries-act-2019","history":"/api/acts/motor-accident-injuries-act-2019/history","analysis":"/api/acts/motor-accident-injuries-act-2019/analysis","conflicts":"/api/acts/motor-accident-injuries-act-2019/conflicts","importantCases":"/api/acts/motor-accident-injuries-act-2019/important-cases","documents":"/api/acts/motor-accident-injuries-act-2019/documents"}}