Schemes
8 The PSR scheme is described in a lengthy and detailed affidavit of Paul Edward Pemberton and in documents which were tendered in evidence. Mr Pemberton is employed by Insurance Manufacturers of Australia Pty Ltd ('IMA'). IMA is a joint venture company owned by NRMA Insurance and RACV Insurance Limited. Mr Pemberton is the manager of the Claims and Assessing segment of IMA.
9 Since at least early 2000, NRMA Insurance has engaged IMA to provide, among other things, claims management services with respect to claims lodged under motor vehicle policies issued by NRMA Insurance. Under the engagement, IMA provides to it a 'teleclaims' service, assesses claims, and manages the claim settlement process.
10 Most, if not all, of the features of the PSR scheme as described by Mr Pemberton were not the subject of challenge. Unless I indicate otherwise, I accept, and make findings in accordance with, Mr Pemberton's description of the PSR scheme in his affidavit and oral testimony referred to below. It is convenient to note here that it seemed to me that all witnesses attempted to give their best recollection of events, and, unless a different intention appears, I accept their evidence as summarised below.
11 Prior to 1998, NRMA Insurance maintained a list of 'Known Repairers'. These were repairers NRMA Insurance authorised to undertake for it repairs of its insureds' vehicles. The Known Repairers invoiced NRMA Insurance and were paid by NRMA Insurance. If an insured elected to have the vehicle repaired by a repairer other than a Known Repairer, NRMA Insurance would pay the insured a sum it assessed to be the reasonable cost of the repairs. In those circumstances, it was a matter for the insured to engage and pay a repairer, and any dispute over the repairs was one between the insured and that repairer.
12 In 1998 NRMA Insurance developed and trialled a new scheme known as 'Competitive Partnering', which was introduced throughout New South Wales in 1999. NRMA Insurance agreed to appoint selected Known Repairers as 'Partnered Repairers' (sometimes called 'Competitive Partners') and to refer work to them. In return, these Partnered Repairers were required by NRMA Insurance to maintain their facilities and standards of service at an agreed level and to ensure that quotes which they provided to NRMA Insurance were 'competitive'.
13 The Competitive Partnering scheme was reviewed in 2000. As a result, the PSR scheme was developed. NRMA Insurance was to appoint from the pool of Partnered Repairers a smaller group - the PSRs.
14 Following an assessment of repairers in the period October 2000 to June 2001, NRMA Insurance identified those Partnered Repairers it regarded as appropriate for PSR status by reference to various criteria, including cost, quality of repairs, relationship with NRMA Insurance, 'strategic need' and 'potential'. That status was conferred upon the making of a National Preferred Smash Repairer Agreement ('PSR Agreement') between NRMA Insurance and the PSR. The first of the PSR Agreements was made in late 2000. Accordingly, at that time (late 2000) there were PSRs, other Partnered Repairers remaining from the Competitive Partnering scheme, other Known Repairers remaining from the Known Repairers scheme, and, of course, repairers who had not been part of any scheme.
15 In November 2001 NRMA Insurance proposed to create a new category of repairer known as 'Associate Smash Repairers' ('ASRs'). The remaining Partnered Repairers and Known Repairers were invited to become ASRs. To accept the offer, a repairer was required to enter into an 'Associate Smash Repairer Service Level Agreement' ('ASR Agreement'). In late January 2002, NRMA Insurance forwarded copies of that form of agreement to the remaining Partnered Repairers and Known Repairers. The result achieved was that from 1 March 2002 there were only two categories of repairer 'recognised' by NRMA Insurance - PSRs and ASRs.
16 Smash repairers with whom NRMA Insurance has no established business relationship, that is to say, who have not entered into either a PSR Agreement or an ASR Agreement, are referred to by NRMA Insurance as 'Non-Accredited Repairers' ('NARs'). Prior to about June 2003 they were referred to as 'Unauthorised Repairers'.
17 NRMA Insurance provides its insureds with a standard form of written 'Lifetime Guarantee' in respect of 'the quality of workmanship and repairs' of PSRs and ASRs. Upon completion of the repairs, the PSR or ASR signs the form of Lifetime Guarantee on behalf of NRMA Insurance and gives the signed form to the insured. Where NRMA Insurance has occasion to honour the Lifetime Guarantee, it usually seeks to recover the cost of doing so from the PSR or ASR, but sometimes fails in the attempt, as where, for example, the PSR or ASR has ceased to carry on business.
18 NRMA Insurance does not normally engage NARs to effect repairs. If an insured decides to have an NAR effect the repairs, NRMA Insurance does not engage the NAR to do so, but pays the insured (not the NAR) a 'cash settlement amount', being an amount which is the amount NRMA Insurance assesses as 'the fair and reasonable cost of repairing the vehicle'.
19 Paragraphs 66 to 70 of Mr Pemberton's affidavit are as follows:
'66 To determine the fair and reasonable cost of repairing the vehicle, NRMA Insurance needs to inspect the vehicle prior to the commencement of any repair work. This is effected in any of the following ways.
(a) An NRMA Insurance assessor inspecting the vehicle at the premises of the Non-Accredited Repairer. In some rare cases, NRMA Insurance may refuse to inspect the vehicle at the Non-Accredited Repairer's premises. This may occur, for example, where NRMA Insurance is of the view that its assessor may experience threatening, intimidating or otherwise unacceptable behaviour if the assessor visits the premises of a particular Non-Accredited Repairer, or if the state of the repairer's premises is such that NRMA Insurance concludes there is an unacceptable occupational health and safety risk for its assessor associated with conducting an inspection at the repairer's premises.
(b) An NRMA Insurance assessor inspecting the vehicle at a location other than the premises of the Non-Accredited Repairer, such as the home or work premises of the insured.
(c) NRMA Insurance directing the insured to take the vehicle to the premises of a PSR or ASR so that the PSR or ASR can prepare, for NRMA Insurance, a quote for the repair of the vehicle. If the vehicle requires towing, NRMA Insurance arranges for the vehicle to be towed from and to the Non-Accredited Repairer's premises. The cost of the towing is borne by NRMA Insurance.
67. It is not unusual for the insured or the Non-Accredited Repairer to organise a second quote on the vehicle from a second repairer or a third party vehicle assessor, and forward that quote to NRMA Insurance.
68. After inspecting the vehicle, or obtaining a quote on the vehicle from a PSR or ASR, or considering the second quote provided by the insured, or a combination of the foregoing, the NRMA Insurance assessor determines the Cash Settlement Amount. The assessor then discusses with the insured the amount that NRMA Insurance will pay as the fair and reasonable cost of repair, and usually reiterates NRMA Insurance's recommendation that the vehicle be repaired by a PSR.
69. If, following the discussion with the assessor referred to in the previous paragraph, the insured still elects to have the vehicle repaired by a Non-Accredited Repairer, then NRMA Insurance pays the Cash Settlement Amount to the insured. The insured is not obliged to apply these monies to the repair of the vehicle, but usually does as a failure to return the vehicle to a state of good repair entitles NRMA Insurance to cancel the insurance policy. NRMA Insurance does not authorise the quote of the Non-Accredited Repairer or otherwise engage the Non-Accredited Repairer to undertake the repair work for or on behalf of NRMA Insurance. NRMA Insurance does not pay any amount to the Non-Accredited Repairer.
70. In unusual circumstances, NRMA Insurance may authorise repair work by a Non-Accredited Repairer and thereby become responsible to the insured for repair of the vehicle. An example of circumstances in which NRMA Insurance may be prepared to authorise the work of a Non-Accredited Repairer is when an event (such as a violent hailstorm) causes widespread damage and results in so many claims under NRMA Insurance policies that all the work cannot be expeditiously handled through the PSR and ASR networks. Rather than deny a customer the benefit of having NRMA Insurance engage the repairer and so take responsibility for the repair work, if there is no PSR or ASR able to undertake the work within a reasonable timeframe, NRMA Insurance may authorise a Non-Accredited Repairer to perform the work. In such a case, NRMA Insurance engages the repairer and pays the repairer directly, rather than cash settling [paying] the insured.'
20 There are four methods which NRMA Insurance uses to assess quotes for repairs:
· Field assessment;
· 'Line by line' assessing;
· 'Fast-track' assessing;
· Self assessing.
Field assessment involves a physical examination of the vehicle by the assessor. It is the method which allows the most detailed and informed review of a quote. It was the main method of assessment used prior to the introduction by NRMA Insurance of its 'Online Repair Management' ('ORM') system in 2000.
21 The ORM system involves the submission of quotes, digital images of damaged vehicles and other information to NRMA Insurance via the internet. The ORM system eliminates the delay associated with field assessment. All PSRs and about 70% of ASRs participate in the ORM system. Accordingly, in the cases of all PSRs and about 70% of ASRs, there is no delay in assessment of the claim and authorisation to proceed with repairs that is attributable to any necessity of field assessment.
22 Both line by line assessing and fast-track assessing involve the ORM system and take place at the assessor's desk at the NRMA Insurance assessing centre. The latter does not entail a detailed review of every item on the quote, whereas the former does. Although line by line assessing itself takes, on average, only about 15 minutes, the quote may be in a queue - it is not 'fast-tracked'. When it will be reached depends on the length of the queue. Mr Pemberton said that on average it should, and probably does, take about a day for an individual quote to be reached. He said that he did not 'have the statistic in [his] head', but agreed with the cross-examiner that it would not take one or two weeks to be reached.
23 In relation to 'self assessing' Mr Pemberton states:
'PSRs with whom NRMA Insurance has a very strong business relationship and who have a proven record of providing competitive quotes may be appointed to "self-assessing" status. NRMA Insurance has policies regarding which repairers are eligible to be considered for self-assessing status, with the final decision whether to appoint a repairer to self-assessing status at the discretion of the local NRMA Insurance assessing centre management. The appointment to self-assessing status reflects a decision by NRMA Insurance, through its local managers, that it can rely upon the repairer to submit a competitive quote.
Under the self-assessing process, a repairer is still required to prepare and submit a quote to NRMA Insurance. The repairer, however, is authorised by NRMA Insurance to commence repairing the vehicle prior to receiving an authorisation of the quote from NRMA Insurance. The quote must, however, be authorised by NRMA Insurance before NRMA Insurance will accept an invoice from the repairer for the work. Which assessment method (fast-track or line-by-line) is used to review a quote from a self assessing repairer is at the discretion of the relevant NRMA Insurance assessing centre. In the ordinary course, a quote from a self-assessing repairer is assessed under the fast-track method.'
24 Repairers whose quotes are dealt with by fast-track assessing are predominantly PSRs, but some of them are ASRs. The criterion for 'fast-track' assessment is 'performance' (see [26] to [28] below). Ordinarily, under the fast-track method, a quote is approved within a matter of hours from its receipt by NRMA Insurance.
25 It is clear from the above account, that the timeliness of assessment and of authorisation depends on many considerations. As a broad generalisation only, a quote is likely to be assessed and commencement of repairs authorised earlier in the case of PSRs than in the case of ASRs, but this is definitely not always true. A major consideration is whether the particular ASR is, as all PSRs are, on the ORM system. But most ASRs are also on the ORM system. Another is whether the PSR or ASR enjoys the benefit of fast-track assessing.
26 Clause 11 of the PSR Agreement requires NRMA Insurance and the PSR to negotiate and enter into a 'Repairer Performance Plan', specifying the PSR's goals, how its performance by reference to those goals is to be measured, and the steps to be taken by the PSR to achieve the goals. Clause 11 of the ASR Agreement provides that if requested by NRMA Insurance, the ASR must do likewise. As at December 2003, approximately 30% of ASRs had entered into performance plans.
27 NRMA Insurance monitors the 'performance' of PSRs and ASRs. As well as reviewing quotes as they are submitted, it monitors a PSR's or ASR's 'average repair costs'. According to Mr Pemberton, it also undertakes, from time to time, 'Performance Investigations' of individual PSRs or ASRs, in which it reviews any or all of: 'the cost of repair or the amount quoted'; 'the quality of repair work'; and 'the standard of service provided to NRMA Insurance customers'. NRMA Insurance ranks PSRs as 'gold', 'silver', 'bronze' and 'red'. Repairers ranked gold or silver are considered the better performers and those ranked bronze and red are considered not to be performing to the expected standard. Unless a bronze or red rated PSR improves its performance, NRMA Insurance will consider terminating the PSR Agreement with that repairer. ASRs who have entered into a performance plan with NRMA Insurance are similarly ranked. It follows that about 70% of ASRs are not in a position to attract the benefits of a gold or silver performance rating. NRMA Insurance informs repairers of their rankings. An ASR may be 'promoted' to the status of PSR.
28 A practical consequence of the rankings is that NRMA Insurance gives priority to gold and silver PSRs over bronze and red PSRs in the allocation of work. In addition, gold and silver ranked repairers receive the benefit of expeditious payment of their invoices. According to Mr Pemberton, approved invoices of gold and silver PSRs and ASRs are paid within one day; bronze PSRs and ASRs are paid within 7 days; and red PSRs and ASRs are paid within 14 days. ASRs who have not entered into a performance plan, and who therefore are not ranked, but who participate in the ORM system, are paid within 14 days. In other cases, invoices are paid within 21 days.
29 In relation to towing, Mr Pemberton stated in his affidavit:
'When an insured vehicle is damaged and requires towing, and the policyholder is entitled to and does make a claim under the insurance policy, the usual practice of NRMA Insurance is to pay for the cost of towing the vehicle from the place of the accident to the repairer (except to the extent that the cost of the tow is unreasonable in the circumstances) whether that repairer be a PSR, an ASR or a Non-Accredited Repairer. NRMA Insurance's general policy and practice does not require the insured to agree to have the vehicle repaired by a PSR or ASR before it, NRMA Insurance, will pay for or indemnify the insured for the cost of towing.'
30 Obviously, the focus of AARA's attack is, as it must be, the scheme currently operating, which I have called the PSR scheme, and which might as well have been called the PSR/ASR scheme. Shortcomings in the antecedent Competitive Partnering scheme, or the even earlier Known Repairer scheme, are not to the point unless they have been carried forward into the PSR scheme.
31 NRMA Insurance led evidence from Peter Van Der Weide, a director of JPV Creative Custom Auto Repairs Pty Ltd ('JPV') which was previously a Competitive Partner, and is now a PSR, and a 'Self-Assessing Repairer'. Mr Van Der Weide testified as to the procedure followed by JPV in connection with its repair of vehicles insured by NRMA Insurance. His testimony was generally in line with that of Mr Pemberton. He states that JPV receives a notification from NRMA Insurance when NRMA Insurance allocates a vehicle to it for repair. Since JPV participates in the ORM system, communication between JPV and NRMA Insurance is via the internet. Since JPV is a Self-Assessing Repairer, once it receives the notification of allocation, it is authorised by NRMA Insurance to commence repairing the vehicle immediately, even before sending its quote to the insurer. Indeed, Mr Van Der Weide states that by stretching and stripping the vehicle first, JPV is able to provide a better informed quote to NRMA Insurance. In any event, JPV receives NRMA Insurance's response to its quote within 24 hours.