austlii:nsw/NSWPICMR/2025/22
General information, not legal advice.
NSWPICMR
2025-08-25
Original judgment source is linked above.
Schutz v AAI Limited t/as GIO [2025] NSWPICMR 22
MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; merit review; dispute regarding amount of weekly payments of statutory benefits under ; claimant self-employed small business owner; late claim; weekly payments limited to second entitlement period; statutory interpretation of , considered and applied; whether calculation of post-accident earnings for the purposes of should consider entire financial year; - requires post-accident earnings to be calculated by reference to earnings after the first entitlement period; there is no basis upon which to base the calculation under on the full financial year if that period is not after the first entitlement period; claimant's entitlement to be calculated accordingly; reviewable decision set aside.
Issued under s 7.13(4) of the Motor Accident Injuries Act 2017
first entitlement period, in respect of an injury resulting from a motor accident, means the period of 13 weeks that starts on the day after the day of the motor accident.
maximum weekly statutory benefits amount - see section 3.9.
minimum weekly statutory benefits amount - see section 3.10.
second entitlement period, in respect of an injury resulting from a motor accident, means the period of 65 weeks that starts on the day after the end of the first entitlement period.
(2) Words and expressions in this Division that are defined in Schedule 1 have the meanings provided by that Schedule. The regulations may amend Schedule 1.
Definitions include "earner", "loss of earnings", "pre-accident weekly earnings", "pre-accident earning capacity" and "post-accident earning capacity".
3.6 Weekly payments during first entitlement period (first 13 weeks after motor accident)
(1) An earner who is injured as a result of a motor accident and suffers a total or partial loss of earnings as a result of the injury is entitled to weekly payments of statutory benefits under this section during the first entitlement period.
Only a person who was an earner when injured is entitled to statutory benefits under this section - see Schedule 1.
(2) A weekly payment of statutory benefits under this section is to be at the rate of 95% of the difference between the person's pre-accident weekly earnings and the person's post-accident earning capacity (if any) or post-accident earnings, whichever is the greater, for the first entitlement period.
(3) A weekly payment of statutory benefits to a person under this section is not to exceed the maximum weekly statutory benefits amount less the person's post-accident earning capacity (if any) or post-accident earnings, whichever is the greater, for the first entitlement period.
(4) A weekly payment of statutory benefits to a person under this section is not to be less than the minimum weekly statutory benefits amount or the person's pre-accident weekly earnings, whichever is the lesser.
(5) If a weekly payment of statutory benefits is payable under this section, but further information is required to determine the amount of the payment, interim payments are to be made in accordance with the Motor Accident Guidelines until the correct amount of the payment can be determined and paid.
3.7 Weekly payments during second entitlement period (weeks 14-78 after motor accident)
(1) An earner who is injured as a result of a motor accident and suffers a total or partial loss of earnings as a result of the injury is entitled to weekly payments of statutory benefits under this section during the second entitlement period.
Only a person who was an earner when injured is entitled to statutory benefits under this section - see Schedule 1.
(2) A weekly payment of statutory benefits under this section is to be at the rate of -
(a) in the case of total loss of earnings - 80%, or
of the difference between the person's pre-accident weekly earnings and the person's post-accident earning capacity (if any) or post-accident earnings, whichever is the greater, after the first entitlement period.
(3) A weekly payment of statutory benefits to a person under this section is not to exceed the maximum weekly statutory benefits amount less the person's post-accident earning capacity (if any) or post-accident earnings, whichever is the greater, after the first entitlement period.
(4) A weekly payment of statutory benefits to a person under this section is not to be less than the minimum weekly statutory benefits amount or the person's pre-accident weekly earnings, whichever is the lesser."
(1) Loss of earnings means a loss incurred or likely to be incurred in a person's income from personal exertion.
(a) the amount that is the income of the person consisting of earnings, salaries, wages, commissions, fees, bonuses, pensions, retiring allowances and retiring gratuities, allowances and gratuities received in the capacity of employee or in relation to any services rendered, and
(b) the proceeds of any business carried on by the person either alone or in partnership with any other person, and
(c) any amount received as bounty or subsidy in carrying on a business.
(3) A person's income from personal exertion does not include -
(a) interest, unless the person's principal business consists of the lending of money, or unless the interest is received in respect of a debt due to the person for goods supplied or services rendered by the person in the course of the person's business, or
(d) the monetary amount of any annual, sick or other leave entitlement.
"(3) If the Commission is satisfied that sufficient information has been supplied to it in connection with proceedings, the Commission may exercise functions under this Act and enabling legislation without holding any conference or formal hearing."
How should Mr Schutz's post-accident earnings for 30 November 2023 to 31 March 2024 be calculated?
"[21] The interpretation of [the section of the act] must 'begin with a consideration of the text itself', that is, the text of the statute as a whole. That said, ascertaining the meaning of the text requires a consideration of its context, which includes the general purpose and policy of a provision and, in particular, the mischief it is seeking to remedy (citing Alcan (NT) Alumina Pty Ltd v Commissioner of Territory Revenue (2009) 239 CLR 27 260 ALR 1; [2009] HCA 41 at [47] per Hayne, Heydon, Crennan and Kiefel JJ. See also SAS Trustee Corporation v Miles (2018) 265 CLR 137 361 ALR 206; [2018] HCA 55 at [20] per Kiefel CJ, Bell and Nettle JJ, at [41] per Gageler J, at [64] per Edelman J), Cooper Brookes (Wollongong) Pty Ltd v Federal Commissioner of Taxation [1981] HCA 26; (1981) 147 CLR 297 at 304; [1981] HCA 26; 35 ALR 151 at 156 per Gibbs CJ, at CLR 320; ALR 169 per Mason and Wilson JJ, CIC Insurance Ltd v Bankstown Football Club Ltd (1997) 187 CLR 384 at 408; 141 ALR 618 at 634-5 per Brennan CJ, Dawson, Toohey and Gummow JJ)"
(4) An Australian legal practitioner is not entitled to be paid or recover legal costs for any legal services provided to a party to a claim for statutory benefits (whether the claimant or the insurer) in connection with the claim unless payment of those legal costs is permitted by the regulations or the Commission."
"(1) A claimant for statutory benefits is (subject to this section) entitled to recover from the insurer against whom the claim is made the reasonable and necessary legal costs, and other costs and expenses, incurred by the claimant in connection with the claim. Other costs and expenses include the cost of medical and other tests and reports."
"(2) The regulations may make provision for or with respect to fixing the maximum costs and expenses recoverable by a claimant under this section (including any matters for which no costs and expenses are recoverable from the insurer).
(3) A claimant for statutory benefits is only entitled to recover from the insurer against whom the claim is made reasonable and necessary legal costs incurred by the claimant if payment of those costs is permitted by the regulations or the Commission:
(4) The Commission can permit payment of legal costs incurred by a claimant but only if satisfied that -
(b) exceptional circumstances exist that justify payment of legal costs incurred by the claimant."
[1] Supplementary Report of Furzer Crestani Forensic Accountants dated 7 July 2025 at [8.2.5] and [8.2.6].
[2] Supplementary Report of Furzer Crestani Forensic Accountants dated 7 July 2025 at [8.2.7] and onwards.
[3] It is noted that there seems to be a minor typographical error in the claimant's calculations, and the Commission calculates $1,872.68 x 38.86 to be $72,772.34. Accordingly, the amount said to be owed is calculated to be $72,772.34 - $15,939.96 = $56,832.38.
[4] The insurer's initial submissions dated 24 February 2025 referred to the period 7 December 2023 to 24 August 2024. However, at the preliminary conference on 10 March 2025, the parties confirmed that the relevant period was 30 November 2023 to 24 August 2024.
[5] It is noted that the profit in this period is reported to be positive. It is assumed Mr Katehos is referring to the subsequent period of 26 August 2023 to 6 December 2023.
[6] It is noted that Mr Kahler does not provide an opinion as to the claimant's actual post-accident earnings for the period 30 November 2023 to 6 December 2023 (inclusive).
[7] Per s 6.13 of the MAI Act and regulation 8A of the Regulations.
[8] It is noted that some of the insurer's documents reference the commencement date as 7 December 2023. At the preliminary conference on 10 March 2025, the parties confirmed the relevant period to be 30 November 2023 to 24 August 2024. This was also confirmed by the parties in their subsequent submissions.
[15] See ss 8, 31 to 34 of Personal Injury Commission Act 2020.
[16] See the commentary in Allianz Australia Insurance Ltd v Rymer [2022] NSWPICMRP 6.
[17] San v Rumble (No 2) [2007] NSWCA 259 at [67].
[18] San v Rumble (No 2) [2007] NSWCA 259 at [67].
[19] Ho v Professional Services Review Committee No 295 [2007] FCA 388 at [26].
[20] AAI Ltd trading as GIO v Moon [2020] NSWSC 714 (Moon).
[21] I refer to the discussion in Moon as to the meaning of incurred.
Schutz
AAI Limited t/as GIO [2025] NSWPICMR 22;
(2024) 278 CLR 300
(2009) 239 CLR 27
(2018) 265 CLR 137
(1981) 147 CLR 297
(1997) 187 CLR 384