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[2015] NSWCA 380
Court of Appeal (NSW)
2015-10-21
Beazley P, Ward JA, Simpson JA, Adams J
Original judgment source is linked above.
Solicitors: McIness Wilson Lawyers (Appellant) Stacks/Goudkamp (First Respondent) Crown Solicitor's Office (Second and Third Respondents) File Number(s): CA 2015/79665 Decision under appeal Court or tribunal: Supreme Court Citation: Aaron Mordue v QBE Insurance (Australia) Limited [2015] NSWSC 98 Date of Decision: 20 February 2015 Before: Adams J File Number(s): 2014/200844
[Note: The Uniform Civil Procedure Rules 2005 provide (Rule 36.11) that unless the Court otherwise orders, a judgment or order is taken to be entered when it is recorded in the Court's computerised court record system. Setting aside and variation of judgments or orders is dealt with by Rules 36.15, 36.16, 36.17 and 36.18. Parties should in particular note the time limit of fourteen days in Rule 36.16.]
[This headnote is not to be read as part of the judgment] The first respondent was injured on 1 December 2012, when, during a car rally, the vehicle in which he was travelling as a passenger went out of control and landed in a drain. The vehicle was subject to an unregistered vehicle permit issued under the Road Transport (Vehicle Registration) Act 1997 (NSW) and to a third party policy of insurance issued by the appellant, QBE, to the driver and owner of the car, who was the first respondent's son (the insured). The first respondent made a claim under the Motor Accidents Compensation Act 1999 (NSW) (the Act) for medical and other expenses and for damages arising from the injuries he sustained in the accident. Section 81 of the Act provided that the insurer had a duty to admit or deny liability in respect of a claim. Section 83 provided that, once liability was admitted, the insurer was required to make certain payments to the claimant. Section 92(1)(a) provided that a claim was exempt from assessment if it was of a kind that was exempt under the Motor Accidents Claims Assessment Guidelines (the Guidelines). Clause 8.11.5 of the Guidelines provided an exemption, pursuant to s 92(1)(a), for claims for which, by notice in writing, the insurer had declined to indemnify the insured. QBE initially admitted liability under s 81 of the Act on the basis that the accident was due to the fault of the insured, but subsequently purported to withdraw its admission of liability by serving an amended s 81 notice stating that, as the accident occurred in the course of a car rally, being an organised motor sports event, QBE had available to it the defence of voluntary assumption of risk pursuant to s 140 of the Act. On 7 March 2014, QBE lodged an application with the Motor Accidents Authority, as it then was, seeking mandatory exemption of the claim from the Claims Assessment and Resolution Service (CARS) process. On 20 May 2014, the Principal Claims Assessor, who considered that she was obliged to do so by the terms of the Act and the Guidelines, issued a certificate of exemption. The first respondent sought judicial review of that determination. The trial judge, Adams J, found that QBE's admission of liability necessarily implied an admission that the policy responded to the claim, and considered that it followed that the question of liability was precluded from further examination once it had been admitted. His Honour concluded that QBE was "bound for all purposes" by its notice admitting liability. He quashed the decision of the Principal Claims Assessor and declared that the Authority was prohibited from issuing a certificate of exemption. QBE appealed from his Honour's determination. It did not dispute that it was not entitled to withdraw the admission of liability that it made pursuant to s 81. It contended, however, that it was nonetheless entitled to decline to indemnify the insured in respect of any liability arising from the claim made by the first respondent. It further contended that having so notified the insured, it was entitled to a certificate of exemption under s 92(1)(a) pursuant to cl 8.11.5.
Beazley P and Ward JA, allowing the appeal: (1) The determination of whether a claim is exempt pursuant to cl 8.11 of the Guidelines, being made "as at the time of the consideration of the application", must be made by reference to all relevant factors as at that time. [41]. (2) A s 81 notice admitting liability is not binding for all purposes. The insurer continues, after giving notice admitting liability under s 81, to have an entitlement to deny indemnity to an insured and, for that reason, to have the claim determined curially. This approach is consistent with the statutory scheme which, first, draws a distinction between liability to indemnify the insured under the policy and liability to the claimant for damages; and secondly, provides in s 81 a requirement for a timely response by an insurer, which militates against that response being final for all purposes. [38], [42]-[43]. Smalley v Motor Accidents Authority of New South Wales [2013] NSWCA 318; 85 NSWLR 580 (3) As the first respondent accepted, fraudulent claims could be subject to exemption pursuant to cl 8.11.6, notwithstanding an admission of liability under s 81. Other exemptions and means of recovery relating to fraud were also available. However, contrary to the first respondent's submissions, there was no basis, as a matter of statutory construction or principle, to treat cases involving fraud differently from those coming under cl 8.11.5. [44]-[49]. The Nominal Defendant v Gabriel [2007] NSWCA 52; 71 NSWLR 150
Beazley P and Ward JA, Simpson JA agreeing: (4) The trial judge erred in prohibiting the issue of a certificate of exemption, notwithstanding the position with respect to s 92(1)(a) and cl 8.11.5, as there was nothing before the court to preclude the consideration of a further exemption on some other basis, particularly the discretionary exemption pursuant to s 92(1)(b). [55] (Beazley P and Ward JA); [99] (Simpson JA).
Simpson JA, dissenting: (5) As delegated legislation, the Guidelines must be read consistently with the Act. Since the language of s 81(1) does not admit of an interpretation whereby an insurer can admit liability for the claim but not indemnify the insured, neither can sub-cl 8.11. [87]-[93]. (6) The exclusion of the insured, by Ch 4 of the Act, from involvement in the resolution of the claim has the consequence that once an insurer has admitted liability for a claim it cannot be given exemption from the assessment process by reason of sub-cl 8.11.5 of the Guidelines. [95].
Judgment
The statutory scheme
Trial judge's reasons
Submissions of the parties
Consideration
Order 2 made by the primary judge
Additional comment
Orders
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QBE Insurance (Australia) Ltd
Mordue