The delay in lodging the claim form
27A claim form was only forwarded to the CTP insurer, AAMI Insurance (AAMI), on 18 January 2006. The insurer contended that the claim was incomplete in that it did not include a CTP Medical Certificate and the certificate was not provided until 20 June 2006. It seems that it was conceded, therefore, that notice of the plaintiff's claim was not given on 18 January 2006, but was only given when the relevant medical certificate was provided, on 20 June 2006.
28By a Certificate dated 28 September 2009, an Assessor from the Claims Assessment and Resolution Service (CARS) certified that the plaintiff could make a late claim in accordance with s 73 of the MAC Act . In his reasons the CARS Assessor concluded that he was satisfied the plaintiff had provided a full and satisfactory explanation for the delay in lodging his claim form. The assessment of the dispute by the CARS Assessor was, however, made pursuant to s 96(1)(a) of the MAC Act , and is not binding on the parties: Hayek v Trujillo [2007] NSWCA 139 at [47] - [50]. The plaintiff acknowledges that I am bound by that decision, such that the defendant's insurer is entitled to re-agitate the issue the issue before me.
29The accident in which the plaintiff's injuries were sustained occurred during a journey that entitled him to receive workers' compensation benefits. He made a workers' compensation claim, which he assumed "took care of everything". He did not seek legal advice until 18 October 2005 when he consulted his present solicitors, Brydens Law Office (Brydens).
30On that day he had a conference with a solicitor employed by Brydens, Ms Kha, when he learned, for the first time, that he was under a separate obligation to give notice of a claim to the CTP insurer of the other vehicle involved in his accident, in addition to his claim for workers compensation, and that notice was required to have been given within 6 months of the accident, namely by 30 March 2005. He would, therefore, have to make a "late" claim and provide a full and satisfactory explanation for the delay in making the claim.
31Ms Kha gave the plaintiff a claim form to complete "as best he can" and asked him to return it to Brydens.
32Subsequently, another solicitor at Brydens, Ms Mary Nguyen, took over the file. She noted that the plaintiff had not returned the claim form, and telephoned him on 6 January 2006. She explained to the plaintiff the urgency, and that the claim form needed to be lodged as soon as possible. He said he had 90% completed it and would send it back next week. She then wrote to the plaintiff on 9 January 2006, asking him to return the completed form urgently.
33On 17 January 2006 the plaintiff attended at Brydens and completed the claim form. The claim form was forwarded by Brydens to the CTP insurer, AAMI Insurance (AAMI), by letter dated 18 January 2006.
34In reply, AAMI advised Brydens, by letter dated 27 January 2006, that the claim form was incomplete, and asked for a CTP Medical Certificate. AAMI also noted that the claim form had been lodged after the 6-month period allowed by the MAC Act , and requested a full and satisfactory explanation for the delay in lodging the claim.
35The essence of the explanation proffered in respect of the period up until the end of January 2006 is that the plaintiff was unaware of his legal obligation to give notice of the claim within 6 months of the accident, and thereafter took steps to lodge the claim form. Ultimately, no submission was made on behalf of the defendant that the explanation in respect of this period was not full or satisfactory.
36It then took some 5 months to obtain and lodge the CTP Medical Certificate.
37The evidence establishes that during this period the plaintiff experienced considerable difficulty in obtaining the relevant certificate, due to the non-cooperation of his general practitioner, Dr Nicolau. It wasn't until 12 May 2006 when he telephoned Brydens and was told that he could obtain the certificate from another doctor.
38The plaintiff then changed doctors, and obtained a certificate from Dr Amjad on 17 May 2006. In the meantime, he was also chasing up an earnings certificate, and once he had received this, both certificates were forwarded by facsimile to Brydens on 19 June 2006. The original certificates were received by Brydens on 30 June 2006 and immediately forwarded to the insurer.
39The delay between the lodging of the claim form on 18 January 2006 and the supply of the CTP Medical Certificate on 30 June 2006 has, in my view, been fully explained by these events.
40It is clear that the focus during this period was in getting the CTP Medical Certificate , and I am satisfied that a reasonable person in the position of the claimant would have been justified in experiencing the same delay.
41Unfortunately, it then took Brydens a further 15 months to provide the insurer with any sort of explanation for the delay in lodging the claim form. It is necessary, therefore, to examine what happened in that period, and the period after that leading up to the CARS determination of the special assessment in respect of the late claim made on 28 September 2009.
42Some time after the provision of the CTP Medical Certificate conduct of the file was assumed by a principal of Brydens, Mr Robert Bryden. By letter dated 4 July 2006 Mr Bryden wrote to the plaintiff confirming lodgement of the claim form and reminding the plaintiff of the need to provide the insurer with a full and satisfactory explanation on why his claim form was lodged outside the required six-month period. He told the plaintiff Brydens would need to prepare an explanation for his signature. In order to prepare the explanation, Brydens required details relating to his treatment since the accident, and enclosed various medical authorities for signature and return by the plaintiff. The letter went on to stress that it was "essential that we proceed without any further delays."
430n 28 July 2006 Mr Bryden wrote to the plaintiff requesting him to sign and return medical authorities, urgently, by 4 August 2006.
44The plaintiff returned the signed medical authorities on or around 10 August 2006. Brydens then wrote to Medicare requesting a Claims History Statement. On 31 August Brydens wrote to the workers compensation insurer and to AAMI, advising that they would be in a position to forward the explanation for the delay once the Medicare statement was obtained.
45It was not until December, however, that Brydens made any effort to follow up Medicare, and on 18 December 2006 a further, up to date Claims History Statement was requested. On 8 January 2008 a follow up phone call was made to Medicare, when Medicare advised the statement would be forwarded next week.
46But nothing further happened until 14 April 2007 when AAMI wrote again requesting the explanation for the delay. Soon after that letter, another solicitor at Brydens, Ms Frances Smith, reviewed the file and on 27 March 2007 wrote to AAMI advising that some difficulty had been experienced in obtaining the HIC documentation "necessary to provide a full chronology of treatment". The explanation would be provided as soon as possible. Ms Smith gave instructions to a paralegal to take steps to obtain various pieces of information she considered were required for the completion of the explanation.
47According to the unchallenged evidence of Ms Smith:
"It [was] my task to prepare the explanations for delay in lodgement of claim forms in matters conducted by Mr Bryden. It [was] the usual practice of the firm to require an HIC list of payments and if applicable a schedule of workers compensation payments in order that a full chronology of treatment can be provided in such explanations for delay."
48What followed then was a period of relative confusion concerning the information required for the explanation. There were two factors at play that contributed to the confusion, and further delay. First, correspondence from Brydens and Medicare was being sent to the plaintiff's old address. This situation did not become apparent until the plaintiff contacted Brydens on 7 August 2007. On 8 August Brydens wrote again to Medicare requesting that the Claims History Statement be sent to the plaintiff. Second, some of the documentation requested went to the workers compensation section of Brydens and there was a delay in the information being passed on to Mr Bryden's section, where the motor accident claim was being handled.
49Finally, however, on 28 August 2007, Ms Smith drafted a statutory declaration for the plaintiff to execute, with a view to explaining the late lodgement of his claim form. This was subscribed and declared on 13 September 2007 and forwarded to AAMI on 17 September 2007.
50The plaintiff's first statutory declaration of 13 September 2007 describes the post-accident history and sets out treatment dates and payments, including HIC payments. It goes on to recount that the plaintiff first obtained legal advice in October 2005, following which steps were taken to lodge the claim form. He stated:
"...I did not know that a motor accident claim form needed to be lodged. It was my understanding that the workers compensation insurer took care of everything..."
51Brydens then prepared an Application to CARS for General Assessment, which was lodged on 28 September 2007.
52On 3 October 2007, AAMI wrote to Brydens rejecting the plaintiff's explanation because no details were provided as to why the plaintiff did not seek legal advice earlier, or as to the delay between the initial conference with Brydens and the lodging of the claim form.
53Accordingly, Ms Smith set about preparing a further statutory declaration for the plaintiff to execute. She also prepared a statutory declaration for her own execution, setting out the history of the conduct of the matter by Brydens.
54The plaintiff collected his second statutory declaration in January 2008. He returned it 2 days later, but Ms Smith did not receive it. She blamed the paralegal, Ms Singh, for not making a diary entry to follow up the plaintiff, when in fact, the document had already been returned. It was not until further correspondence was received from AAMI that the missing statutory declaration was followed up. Ms Smith declared in her statutory declaration:
"On 7 April 2008 three letters dated 22 November 2007, 23 January 2008 and 1 April 2008 from the Motor Accident Authority were brought to my attention. The first two letters requested among other things that an Application for Special Assessment be lodged with CARS in respect of the dispute between the parties as to whether the Claimant could make a late claim. The third letter advised that the CARS Application for General Assessment had been dismissed because neither a MAS Application for Assessment of Permanent Impairment nor a CARS Application for Special Assessment had been lodged. I did not see these letters prior to 7 April 2008."
55Following this, the plaintiff attended at Brydens to execute his second statutory declaration on 21 April 2008, following his return from a holiday, and Ms Smith executed her statutory declaration on 24 April 2008. The plaintiff's second statutory declaration dated 21 April 2008 was short:
"Shortly before consulting Brydens Law Office I had a conversation with Mr Charlie Pitcock who was my supervisor at work. I was expressing my dissatisfaction to him in relation to matters which had arisen with the workers compensation insurer. This included difficulty in obtaining approval for payment of an MRI scan. He said to me words to the effect, "you should take legal action." Within days I contacted Brydens Law Office and made an appointment for consultation with Brydens Law Office".
56The plaintiff's second statutory declaration of 21 April 2008 was not sent to the insurer. Nor was Ms Smith's statutory declaration of 24 April 2008.
57Conduct of the plaintiff's motor accident claim was then removed from Ms Smith. In May 2008 there was an internal restructure at Brydens involving Mr Bryden's common law division. Day to day carriage of the plaintiff's claim was assumed by another solicitor, Mr Wes Ranson. He undertook a review of the file on 15 May 2008.
58An appointment was made with Ms Welsh of counsel to review the material for the Special Assessment Application. A conference with Ms Welsh took place on 26 May 2008, following which the plaintiff attended at Brydens on 4 June 2008 when he swore his third statutory declaration.
59The plaintiff's third statutory declaration of 4 June 2008 set out more detail concerning the late lodgement of his claim form, including the problems he had had obtaining a medical certificate from Dr Nicolau. It also set out some detail concerning his second statutory declaration:
"I didn't know that my solicitors didn't receive that document until they contacted me in April. As soon as I knew that the document had gone astray I attended their office in order to declare a further copy."
60The plaintiff's third affidavit was then forwarded to Lee & Lyons Lawyers, which firm was by this time retained by AAMI to act for the defendant. Lee & Lyons wrote to Brydens telling them they had not received the plaintiff's second statutory declaration of 21 April 2008. Brydens sent this statutory declaration on 20 June 2008.
61By letter dated 1 August 2008, Lee & Lyons wrote to Brydens advising that AAMI had rejected the plaintiff's further explanation for the delay in lodging the claim form. Arrangements were made for a further conference with counsel on 8 September 2008, but this had to be cancelled.
62Eventually, a further conference was scheduled with Ms Welsh of counsel on 24 October 2008, which was attended by Ms Smith, for the purposes of preparing a second statutory declaration to be executed by Ms Smith in connection with a proposed Special Assessment Application.
63On 29 October 2008 Brydens wrote to Ms Welsh requesting advice concerning the draft second statutory declaration and asking if further evidence would be required in support of the Special Assessment Application.
64Ms Welsh did not respond until 12 December 2008 when she rang Mr Ranson advising him to serve Ms Smith's second statutory declaration. Ms Smith then executed her second statutory declaration on 17 December 2008 and Mr Ranson took steps to serve it on Lee & Lyons.
65In her second statutory declaration Ms Smith referred to her earlier affidavit of 21 April 2008, a mistaken reference to 24 April 2008. Lee & Lyons then wrote to Brydens on 13 January 2009 asking for Ms Smith's first statutory declaration. This was forwarded by Brydens on 9 February 2009.
66By letter dated 12 March 2009 Lee & Lyons advised Brydens that AAMI still considered that a full and satisfactory explanation had not been provided for the delay in lodging a claim form:
"In particular your Client's explanation is not satisfactory in that a reasonable person in the position of your Client would not have been justified in experiencing the same delay."
67Mr Ranson then arranged a further conference with Ms Welsh of counsel, which did not take place till 2 April 2009. A week later Ms Welsh provided an advice with Submissions in support of the proposed Special Assessment Application.
68The Special Assessment Application was lodged and served on 28 April 2009.
69The Special Assessment Application took its course. The insurer's reply was lodged on 29 May 2009 and a preliminary conference took place on 30 June 2009.
70In support of the application a fourth statutory declaration was executed by the plaintiff on 20 August 2009 and served on Lee & Lyons, with more detail of some of the events.
71In due course, the CARS Assessor determined the application and issued his Certificate of 28 September, to which I have already referred. The Assessor determined the application in favour of the plaintiff, and gave reasons.
72The insurer does not accept the determination and I am required to consider the issue of a full and satisfactory explanation afresh.
73I have examined the events between 30 June 2006 and 28 September 2009 in some considerable detail, in order that it might be understood why things happened as they did, or more correctly, why things did not happen until they did; to put them in context: Russo v Aiello [2003] HCA 53 at [4].
74In my view, these events, viewed in their sequence, amounted to a full account of the conduct, including the actions of the plaintiff and his solicitors, and of their knowledge and belief. I am satisfied that details of all the acts and omissions relevant to the delay were provided to the CARS Assessor, so as to enable an evaluation of the reasons for the delay.
75Much could be said about the ineptitude of the lawyers involved in prosecuting the plaintiff's motor accident claim. There is an almost surreal aura of casualness surrounding the matter. Words such as neglect, incompetence, ineptitude and inefficiency spring to mind. The attention paid to this matter by those concerned was dilatory and desultory. Criticism, if it were relevant, is to be levelled at the participants I have mentioned, and also at the firm and its principals for the seemingly total absence of any systems and supervision.
76But the focus of the legislation is not about apportioning blame. It is about justifying the delay rather than excusing it: Russo v Aiello [2003] HCA 53 at [7].
77I find, therefore, that the explanation for the delay was full. The next question is whether it was satisfactory, that is, would a reasonable person in the position of the plaintiff have been justified in experiencing the same delay?
78What constitutes justifiable delay on the part of a reasonable person in making a claim is to be considered in the light of the legislative purpose explained in the Act: Russo v Aiello [2003] HCA 53 at [5]. What the Act requires is justification for the delay; not demonstration that the delay did not cause harm: Russo v Aiello [2003] HCA 53 at [7]. In this case the insurer has known about the plaintiff's intention to claim since at least 18 January 2006.
79The essence of the plaintiff's explanation is that he relied upon his lawyers to do all the things necessary to prosecute his claim. In my view, there was nothing particular in the sequence of events that I have set out that indicates the plaintiff was aware there was a particular problem with the provision of the explanation. There are some instances of his being slow to attend to matters, but none of these were extreme, and the evidence establishes that once given a specific deadline in which to do something, he invariably complied.
80It was submitted on behalf of the defendant that the plaintiff is an educated man, employed in a senior management role. The need for urgency was pressed upon him on numerous occasions. He was not entitled to "sit in silence" but has to take some responsibility for periods of considerable inaction on the part of his lawyers. He never made an enquiry as to progress of his claim, or the outcome of any of the events, or why things were required, such as four separate affidavits. This is not the conduct of a reasonable person.
81This is the hindsight, legal counsel of perfection. The fact is that everyday, lay clients trust their lawyers. That's why they engage them. They assume that their lawyers are competent, and are diligently attending to the client's matter.
82Sadly, it is not always the case. But in the present matter, there was, as I have said, nothing in particular to alert the plaintiff to any problem and in my view, a reasonable person in his position would not have acted differently.
83I am satisfied, therefore, that a reasonable person in the position of the plaintiff would have been justified in experiencing the same delay. I find therefore that a full and satisfactory explanation was provided to the CARS Assessor for the delay in giving notice to the insurer of the plaintiff's claim.