austlii:nsw/NSWPICMR/2025/29
General information, not legal advice.
NSWPICMR
2025-09-29
Original judgment source is linked above.
Faiz v QBE Insurance (Australia) Limited [2025] NSWPICMR 29
MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; merit review; dispute about payment of weekly benefits under Division 3.3; pre-accident weekly earnings (PAWE); meaning of PAWE; Schedule 1, clause 4(1), clause 4(2)(b) and clause 4(3); significant change in earning circumstances; onus of proof; inconsistencies in evidence; incomplete evidence; outstanding documents; where evidence of earnings not reconcilable; GST; superannuation; business expenses; - the reviewable decision is affirmed.
Issued under s 7.13(4) of the Motor Accident Injuries Act 2017
The reviewable decision is about the amount of weekly payments of statutory benefits payable under Division 3.3 of the Motor Accident Injuries Act 2017 (the MAI Act) and is therefore a Merit Review matter under Schedule 2(1)(a) of the MAI Act.
(a) a complete copy of bank statement number 44 for account ending 942 (being the statement for the period 11 October 2024 to 11 April 2025);
(b) a complete copy of bank statement number 16 for account ending 964 (being for the period 26 October 2024 to 26 November 2024);
(c) a copy of the statement of income for the financial year ending 30 June 2025 from his ATO MyGov account in respect of Aeroklas earnings, and
(d) a copy of his 2024/2025 financial year Uber tax summary.
13 June 2025. 6. On 30 June 2025 the insurer issued their internal review decision in which the insurer varied PAWE to $1,730. 7. The claimant has requested a Merit Review of the insurer's internal review decision dated
(a) earnings under an Australian Business Number (ABN) from Uber driving;
(b) earnings under the same ABN as a sole trader providing automotive/mechanical services, and
(c) earnings as a mechanic employed by Aeroklas Asia Pacific Group (Aeroklas).
1 August 2025 interim directions were issued to the parties (the interim directions) which required the claimant to provide:
(a) a complete copy of their 2023, 2024 and 2025 tax returns, including the supplementary sections (note: the current version of the 2024 tax return provided is incomplete as it does not include the supplementary section where business expenses are declared);
(b) notices of assessment for 2023, 2024 and 2025;
(c) ATO pre-filing statement for the financial year ending 30 June 2025, if the tax return has not yet been lodged;
(d) the BAS for April to June 2025;
(e) payslips issued by Aeroklas for the period from commencement of employment in or about August 2024 to 30 June 2025;
(f) bank statements for the account into which Uber earnings, Aeroklas earnings and other income has been received for the period 25 February 2024 to
30 June 2025;
(g) monthly Uber tax summaries for the months of February 2024 to June 2024 inclusive and January and February 2025;
(h) Uber tax summary for FY2024/2025;
(i) a summary of expenses incurred in deriving Uber income including telephone and motor vehicle expenses (rent/hire, petrol, registration, tolls, insurance, CTP, repairs) for the period 25 February 2024 to 24 February 2025, and
(j) any further submissions and/or documents relied upon.
(a) payslips provided under interim direction 1(e) are limited to payslips to
25 February 2025 despite other documents evidencing payment of wages by Aeroklas after this date;
(b) bank statements for account ending 942 are limited to the period
8 December 2023 to 10 October 2024 such that all bank statements required by direction 1(f) have not been provided;
(c) bank statements for account ending 964 for the period 26 October 2024 to
26 November 2024 have not been provided such that all bank statements required by direction 1(f) are not provided;
(d) the claimant failed to provide the 2024/2025 financial year Uber tax summary, as required by direction 1(h), and
(e) the claimant failed to provide any documents regarding business expenses, as required by direction 1(i) (the claimant clearly would have had business expenses in connection with his Uber driving income not limited to those listed in the Uber tax summaries).
26 August 2024, which triggers cl 4(3), when the claimant commenced employment with Aeroklas. 4. The insurer submits the claimant's PAWE has been calculated pursuant to cl 4(2) based on gross earnings received from Aeroklas. 5. The insurer acknowledges the claimant received other income from Uber during this period but says there is insufficient information upon which to calculate the additional Uber earnings and accordingly, Uber earnings are not included.
"...the weekly average of the gross earnings the earner received as an earner, or could reasonably have been expected to receive, during the 12 months after the change of circumstance... occurred".
(a) 2025 tax return: an additional $9,612.45 in wages from Aeroklas is included which cannot be accounted for by accrued leave entitlements (according to the payslip year to date gross earnings as of 25 February 2025 were $45,851.54 yet by 30 June 2025 the claimant had earned $55,464 from Aeroklas indicating ongoing wages received after the accident), and
(b) bank records: the claimant has not provided bank statements for account 942 (the account into which Aeroklas wages were paid) for any period after
10 October 2024 (despite the following, unprovided, statement number 44 being relevant to PAWE). However, a comparison of the available statements for both accounts shows the claimant routinely transferred these wages from account 942 to account 964 with account 964 showing this continued post-accident that is, a net wages amount of $1,353 continued to be transferred from account 942 to 964 on a weekly basis for a period of time after the accident.
post-accident for the purpose of payment of weekly benefits (a matter for the insurer to determine) the observations are also relevant to this Merit Review, as follows:
(a) clause 4(2)(b) requires consideration of earnings/expected earnings over the
12-month period from when the change occurred. In this case, the change occurred 26 August 2024 and accordingly, the 12-month period is 26 August 2024 to 25 August 2025, with the outstanding documents required by the directions falling within this period, and
(b) the conflict between the claimant's statement in the schedule of earnings and the financial documents puts the veracity of the claimant's evidence into question such that his contention his PAWE is $3,563 should be carefully scrutinised.
24 February 2025 there should be an additional allowance included in PAWE based on the weekly average of Uber earnings over this 26-week period. 3. One issue is the absence of sufficient evidence of business expenses. It is clear the claimant incurred business expenses in addition to those summarised in the Uber summaries. However, the claimant has not provided the documents requested in the interim directions about this. 4. In my view, the following might be a reasonable work around for calculation of business expenses:
(a) determining gross Uber payments exclusive of GST noting payments to the claimant are inclusive of GST;
(b) taking the average expenses percentage of income based on the potential tax deductions (tolls, service fees etc) listed in the Uber tax summaries, which is an average of 42% (for example, gross earnings of $5,103 inclusive of GST are stated in the March 2024 Uber tax summary, which is $4,639 net of GST. This includes taxable expenses totalling $1936 which represents 41.7% of gross earnings net of GST);
(c) taking the expenses percentage from the claimant's 2024 tax return (being the nearest complete year for Uber driving), which is 65% indicating additional expenses not listed in the Uber tax summaries such as petrol, vehicle maintenance and repairs and other motor vehicle expenses equating to an additional 23% of business income, and
(d) therefore allowing 65% of gross Uber earnings, excluding GST, for total business expenses based on (b) and (c) above.
(a) $11,285.90 gross earnings received inclusive of GST equates to $10,259 exclusive of GST;
(b) 65% allowance for business expenses is $6,668.35, and
(c) $10,259 gross earnings net of GST less $6,668.35 for business expenses results in net business earnings (before tax) in the sum of $3,590.65 which equates to a weekly average of $138.10 over the 26-week period from 26 August 2024 to
24 February 2025.
28 February 2025 in the sum of $40,810.07 shown in the monthly Uber tax summaries. The tax return amount also differs from total payments received into the claimant's bank accounts from 1 July 2024 to 24 February 2025 in the sum of $21,924.10 (noting the claimant contends no Uber earnings were received after the accident). The claimant failed to provide the required 2024/2025 financial year Uber tax summary, which may assist to clarify some of the inconsistencies. 6. I have given careful consideration as to whether the claimant's PAWE should be determined on the available bank statements and adopting 65% of business income for business expenses, which would equate to PAWE in the sum of $1,868.10 based on the calculation set out above. However:
(a) the bank statements are incomplete (the evidence establishes the claimant received Uber payments from time to time into both accounts 942 and 964 (and possibly a third account) and accordingly, he ought to provide complete statements for the whole of the period requested in the interim directions for both accounts and if there is a third account this should also be provided);
(b) there are inconsistencies in the documents about what earnings the claimant did in fact receive from Uber in the period 26 August 2024 to 24 February 2025;
(c) the claimant has not fully complied with the interim directions;
(d) there is a question about the veracity of some of the claimant's contentions such that careful consideration should be given to the evidence;
(e) the request for additional documents made by the insurer and in the interim directions ought not be onerous to the claimant and there is no reasonable explanation as to why they have not been provided. The documents requested ought to be readily available to the claimant (for example, the claimant ought to have to hand missing statement number 16 for account ending 964, missing statement number 44 for account ending 942 and his 2024/2025 financial year Uber tax summary, noting the claimant has prepared his 2025 tax return), and
(f) the claimant bears the onus of establishing his PAWE amount based on evidence that appears to the decision maker to be truthful, reliable and cogent.
(a) a complete copy of bank statement number 44 for account ending 942 (being the statement for the period 11 October 2024 to 11 April 2025);
(b) a complete copy of bank statement number 16 for account ending 964 (being for the period 26 October 2024 to 26 November 2024);
(c) a copy of the statement of income for the financial year ending 30 June 2025 from his ATO MyGov account in respect of Aeroklas earnings, and
(d) a copy of his 2024/2025 financial year Uber tax summary.
Faiz
QBE Insurance