austlii:nsw/NSWPIC/2025/513
General information, not legal advice.
NSWPIC
2025-09-26
Original judgment source is linked above.
BUP v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 513
MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; miscellaneous claims assessment; late claim for damages; whether claimant provided a "full and satisfactory explanation" under section 6.14(3) and section 6.2; claim lodged more than two years after the statutory three-year limit; claimant had received multiple written warnings from the insurer and referred them to his solicitors; claimant advised by his solicitor that the claim had been or would be lodged; subsequently told "we will take care of it" and "the claim has already been lodged"; claimant relied on that advice and persistently followed up; solicitor failed to lodge claim; explanation found to be full and supported by detailed contemporaneous correspondence; explanation also found satisfactory having regard to reliance on solicitor's assurances and the claimant's repeated efforts to obtain progress updates; Held - claimant provided a full and satisfactory explanation; Commission has jurisdiction to refer the late claim for assessment under section 6.14(5)(b).
Pursuant to the Motor Accident Injuries Act 2017 (MAI Act) and Schedule 2 to the MAI Act, the Personal Injury Commission determines:
self-represented in these proceedings. 3. On 7 September 2021 the insurer wrote to both the claimant and his then solicitors expressly advising that any claim for damages had to be lodged by 1 August 2022, being three years after the accident, failing which a full and satisfactory explanation for the delay would be required. The claimant forwarded that advice to his solicitor the same day, asking whether he needed to do anything. He was told: "We will take care of it." 4. No claim for damages was lodged within the prescribed period. The statutory deadline of
1 August 2022 passed without lodgement. It was not until 28 October 2024 that the claimant, then represented by new solicitors following a merger, signed an Application for Damages which was lodged with the insurer on 29 October 2024, more than two years after the statutory deadline had expired. 5. On 1 November 2024 the insurer issued a notice rejecting the claim as late and requesting a full and satisfactory explanation. On 12 November 2024 and again on 14 January 2025, the insurer issued liability notices rejecting the claim for want of a satisfactory explanation. On internal review dated 24 March 2025, the insurer affirmed that decision. 6. The claimant lodged the present application with the Commission on 25 March 2025. A direction was subsequently issued requiring his former solicitors to produce material concerning their knowledge of the statutory deadline and the circumstances of the delay. That direction has not been complied with. 7. On 7 August 2025 the insurer issued a further liability notice admitting liability for the claim, and on 18 August 2025 filed submissions contending that the matter should be withdrawn. However, the question of whether the claimant has provided a full and satisfactory explanation for the delay remains a jurisdictional precondition under s 6.14(5) of the Act, and must be determined by the Commission notwithstanding the insurer's recent admission of liability.
7 August 2025. 2. It submits that, in consequence, the proceedings lack substance and should be dismissed under s 54 of the Personal Injury Commission Act 2020 (PIC Act) and rule 77 of the Personal Injury Commission Rules 2021 (PIC Rules), on the basis that there is "no dispute" between the parties. 3. The insurer points to the objects of the PIC Act, including proportionality, efficiency, and early dispute resolution, and argues that it is within the Commission's discretion to decline to determine the question of delay. 4. That submission misstates the legal position. Neither the PIC Act nor the MAI Act confers on the insurer the power to determine whether a late claim may proceed. Section 6.14(5) of the MAI Act is cast in mandatory and jurisdictional terms: a late claim "cannot be referred" unless the statutory preconditions are met. The Commission is therefore required to determine whether the claimant has provided a full and satisfactory explanation for delay, unless the insurer has lost the right to reject under s 6.14(6). In this case, the insurer rejected the claim for delay within the required timeframes. It therefore did not lose its right, and the matter falls squarely within s 6.14(5)(b). 5. It follows that the insurer's subsequent admission of liability does not cure the statutory requirement under s 6.14(5). The right to pursue damages is not dependent on the insurer's consent but on satisfaction of the legislative condition imposed by Parliament. To treat the insurer's concession as dispositive would invert the statutory scheme by allowing a private party to determine the scope of the Commission's jurisdiction. Jurisdictional preconditions must be independently satisfied, and with the principle that Parliament, not the parties, sets the boundaries of statutory entitlements.
7 September 2021 the insurer wrote to the claimant (copied to his solicitor) advising, relevantly, that while a damages claim could be lodged from 20 months after the accident, it must be lodged within three years of the accident (by 1 August 2022) and that a claim made after three years would require "a full and satisfactory explanation for the delay" with the possibility that the entitlement to claim would be lost. The email records the insurer had received an approach from Elmassian Lawyers on 31 August 2021. 4. Later that evening, the claimant forwarded the insurer's warning to Mr George Elmassian and others, asking whether he needed to do anything or whether his solicitor would act on his behalf. On 8 September 2021, Mr Elmassian replied: "We will take care of it. If your injuries are greater than 10% whole person impairment (WPI) we can claim a lump sum." 5. On 16 September 2021 the insurer wrote again to the claimant (copied to his solicitor) closing the statutory benefits file on the basis that he had returned to work and was not receiving ongoing treatment. That letter repeated the damages-claim timing advice in terms materially identical to the advice given on 7 September 2021. The claimant forwarded that letter to his solicitors the same day. 6. On 15 October 2021 the insurer wrote to the claimant estimating WPI would not exceed 10% and again recorded that any damages claim must be lodged by 1 August 2022, failing which a full and satisfactory explanation would be required. 7. Elmassian Lawyers arranged a psychiatric assessment with Dr Bertucen for 2 March 2022; the claimant attended as directed. He then wrote on 29 March 2022 asking for the result and "what is required next", pasting beneath his request the insurer's three-year deadline extract emphasising the 1 August 2022 date and the need for a "full and satisfactory explanation" if late. The firm responded on 30 March 2022: "The claim has already been lodged. Once we have Dr Bertucen's report we will propose an informal settlement conference ... If [that] cannot be resolved ... we will file an application with PICs to formally proceed with the matter." 8. Through April-September 2022 the claimant sent a series of follow-ups to the firm: on 20 and 28 April 2022 (funding/report queries and "what stage is my claim at"); on 6 July 2022 ("Has there been a date for settlement as it is almost 4 years since the accident"); on
11 August 2022("has this [informal settlement conference] been successful?"); and on
31 August 2022 and 19 September 2022 ("please provide an update regarding settlement"). The firm's 11 July 2022 reply said only that an invitation to an informal settlement conference had been sent to the insurer and "we are continuing to follow this up". 9. On 3 April 2023 Elmassian Lawyers recommended lodging a Medical Assessment Service WPI application because the insurer had closed its file on 13 March 2023; that same day the claimant instructed the firm to proceed. In October 2023 the firm wrote that no reply had been received to its November 2022 email about psychological treatment; the claimant responded that he had replied and that no one had contacted him, and he again queried progress. 10. In September 2024, with no apparent movement, counsel Ms Denise Kaiti emailed
Mr Elmassian asking "as a matter of urgency" for the file to provide advice to "reopen it as it is now over a year since [BUP] has had any correspondence. We need to settle it."
Mr Elmassian responded that he would get the file ready and asked whether to call "the other side and set up an ISC". Ms Kaiti directed that he telephone the insurer to reopen the case and ask for mediation. The claimant asked that the file be sent to counsel to "finalise it off ... It has been over five years." 11. On 28 October 2024 the claimant signed an Application for Damages under common law; the insurer received it on 29 October 2024. On 1 November 2024 the insurer acknowledged receipt, rejected the claim as late, and asked for a full and satisfactory explanation. On
12 November 2024 the insurer issued a liability notice rejecting the claim for delay. 12. On 16 December 2024 the claimant's then solicitors provided:
(a) the claimant's signed statement dated 13 December 2024, saying he was not aware that a damages claim had to be lodged by 1 August 2022, that he had left matters in the hands of Elmassian Lawyers and only in October 2024 learnt no claim had been lodged, and
(b) a statement from Mr Elmassian dated 16 December 2024 acknowledging he was aware the damages claim had to be lodged by 1 August 2022 but saying he was unaware until October 2024 that the claim had not in fact been lodged, and referring to a May 2022 merger/transition.
On 22 April 2025, following a preliminary teleconference, the Commission issued directions. A Dispute Officer's email to the claimant on 11 June 2025 recited that the directions (items 3-4) required information from the claimant by 10 June 2025 and noted the claimant's understanding that his material would follow responses sought from Mr Elmassian and Thornton & King. On 17 and 21 July 2025 the claimant uploaded to the portal his further correspondence bundle in response to the directions. 3. A direction for production was made to Mr Elmassian to produce a signed statement addressing his awareness of the statutory limitation, systems for managing deadlines and the circumstances of non-lodgement. No production was made in response. 4. On 7 August 2025 the insurer issued a "Further Liability Notice - Claim for Damages", expressly admitting liability while indicating quantum remained to be determined and listing the claimant's email communications as part of the information relied upon. 5. On 23 September 2025 the insurer filed reply submissions asserting that, because liability had now been admitted, the dispute had been resolved and should be dismissed under s 54 of the PIC Act and rule 77 of the PIC Rules for lack of substance or want of a "real dispute". Those submissions emphasise the objects of the PIC Act (efficiency, proportionality, early resolution), refer to s 54(b) and (c), and submit that the Member (or the President's delegate) has power to dismiss proceedings at any stage.
Oral Hearing - Evidence of the claimant (22 September 2025)
(a) the insurer has lost the right to reject the claim on the ground of delay, or
(b) the Commission has determined that the claimant has a full and satisfactory explanation for the delay in making the claim..."
13 December 2024, and that it covers also the relevant conduct of his solicitors so far as it was within his knowledge. 8. He says that his explanation is "satisfactory" because a reasonable person in his position, having engaged solicitors and been reassured that the claim had already been lodged, would have relied on those assurances. He points to his lack of legal experience, his unfamiliarity with motor accident procedure, and his repeated attempts to obtain information from his solicitors as factors which support the objective reasonableness of his conduct. 9. He emphasises that he is now self-represented and has done his best to place before the Commission the record of his attempts to progress the claim, including his emails to Elmassian Lawyers over 2022-2024.
14 January 2025 and again on internal review on 24 March 2025. In those notices it was said that the claimant's explanation was neither full nor satisfactory for the following reasons. 2. The claimant had been expressly informed of the three-year deadline in the insurer's letters of 7 and 16 September 2021 and again on 15 October 2021. He was therefore on clear notice of the need to act. 3. His statement of 13 December 2024, to the effect that he was "not aware" of the deadline, was inconsistent with the contemporaneous documentary record. 4. He had not explained the period between September 2021 and October 2024 when no damages claim was lodged, notwithstanding repeated reminders from the insurer. 5. The statement of Mr Elmassian did not provide detail of the systems in place or the reasons why the claim was not lodged despite his knowledge of the deadline. 6. The insurer subsequently changed its position. By Further Liability Notice dated
7 August 2025 it admitted liability for the damages claim. 7. In submissions dated 18 August 2025 and in reply submissions dated 23 September 2025 the insurer contended that, because liability had been admitted, the dispute has been resolved and should be dismissed. It submitted that:
(a) there is no longer a "real issue" between the parties as to liability for the damages claim;
(b) pursuant to s 54 of the PIC Act and r 77 of the PIC Rules, the Commission has the power to dismiss proceedings which are lacking in substance;
(c) the guiding principles in s 42 of the PIC Act require disputes to be resolved justly, quickly, and cost-effectively, and dismissal in the present case would be consistent with those principles, and
(d) the Commission should not devote further resources to determining an issue which, in its submission, has been overtaken by its acceptance of liability.
(a) the claimant has provided a full and satisfactory explanation within the meaning of ss 6.14(3) and 6.2 of the MAI Act, and
(b) by operation of s 6.14(5)(b), the Commission has jurisdiction to refer the claimant's late claim for damages to assessment.
BUP
Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 513;
(2003) 215 CLR 643