Was the impugned decision invalid?
- The claims assessor had a "full" explanation as to what happened in the two year period after the claim was made and before the explanation was provided. That was, in short, that the claimant had attended for a medical examination and, having heard nothing from his solicitors thereafter, concluded that his claim was not worth pursuing. Early in that period his first child was born.
- The claims assessor dealt in some detail with the explanation given for the period from the date of the accident until the claim form was served. He was satisfied that the claimant acted reasonably in that period. [15] Then, a heading followed, "What does from the date of the accident until the date of providing the explanation mean?" That issue was apparently addressed over the next five paragraphs, concluding with the statement that the assessor was of the opinion that a satisfactory explanation had been provided by the claimant. [16]
- In effect, the claims assessor answered the question he had posed for himself by reference to two decisions of the Court of Appeal which led him to conclude that the only relevant period of delay to be satisfactorily explained was from the expiration of the six month period (6 November 2015) to the date of filing the claim (11 February 2016). [17]
- It is best to start by referring to the language of the statute. The first sentence in s 66(2) (set out at [6] above) is clear: it requires a "full" account of the claimant's conduct and beliefs "from the date of the accident until the date of providing the explanation." The second sentence deals with whether the explanation is "satisfactory" and uses different language, namely whether "a reasonable person in the position of the claimant … would have been justified in experiencing the same delay." [18]
- As noted above, the claims assessor approached the question of statutory interpretation by reference to two decisions of the Court of Appeal. The first was Karambelas v Zaknic (No 2). [19] The judgment in that case did not address the issue relevant for present purposes for the simple reason that the claim form was accompanied by an explanation for the delay. [20] There was, arguably, only one period. Further explanations were given thereafter, and were found to be full and satisfactory by a claims assessor. The matter was referred for an assessment of damages, which were assessed but not accepted by the injured party, and the matter proceeded to hearing in the District Court. The Court of Appeal held (indeed it was conceded) that the trial judge in the District Court had been in error in requiring a full and satisfactory explanation for a period which extended up to and including the commencement of proceedings in the District Court. That approach was erroneous, and the matter was reassessed by the Court of Appeal considering the explanation up to the date of serving the claim and providing the explanation. Meagher JA stated:
"[16] An explanation is 'full and satisfactory' within s 66(2) if it satisfies two requirements. First, it must include a full account of the conduct, including the actions, knowledge and belief of the claimant, from the date of the accident until 'the date of providing the explanation'. In the case of a late claim under s 73(1) that is the date on which the explanation is first provided. Secondly, the explanation must be such that a reasonable person in the position of the claimant 'would have been justified in experiencing the same delay'. The delay is the period during which the claimant was late in making his or her claim; a period commencing six months after the date of the motor accident and continuing until the claim is first made by giving notice to the third-party insurer. This summary of the position accords with the observations of this Court in Nominal Defendant v Browne [2013] NSWCA 197; 64 MVR 214 at [15]-[16] (Basten JA, Barrett and Gleeson JJA agreeing) as to the application of the definition in s 66(2) to the circumstances of a late claim, and is not inconsistent with the decision in Mancini v Thompson [2002] NSWCA 38, which makes clear that the focus of the "full" account is on the period of delay to be explained: at [46]-[47] per Rolfe AJA, Beazley and Stein JJA agreeing." (Emphasis added.)
- It is true that in Nominal Defendant v Browne, [21] after referring to s 66(2), I said:
"[16] In the present case, the respondent's explanation was required to cover the period from the date of the accident (5 January 2009) until the date of the motor accident claim. The personal injury claim form was served on the Nominal Defendant on 16 June 2011; an amended statement of claim joining the Nominal Defendant was served on 28 November 2011." (Emphasis added.)
- The italicised passage set out above did not accurately reflect the requirements of the first sentence of s 66(2). However, as appears from the following paragraphs in the judgment, the Court, in finding that there had been no full and satisfactory explanation, focused on the period before the solicitors for the claimant took the first steps to bring a claim under the Act. No period after the date the claim was received was relevant.
- The second decision relied upon by the claims assessor in the present matter was Dijakovic v Perez. [22] That case involved a delay in commencing proceedings within the period of three years prescribed by s 109(1) of the Act. Mr Dijakovic was injured in a motor vehicle accident that occurred on 21 October 2009; he did not commence legal proceedings until 13 December 2013, that is some four years and two months after the accident. However, time does not run whilst a matter is being considered by a claims assessor. Accordingly, the period of "delay" beyond the prescribed limitation period, was not 14 months, but about 16 weeks. [23]
- Justice Gleeson, with whom Leeming JA and McCallum J agreed, addressed the period for which an explanation was required, in the following terms:
"[81] The inquiry required by s 109(3)(a) and s 66(2) has two temporal elements. One is the period of 'delay' in commencing the proceedings after the three year time limit has expired. It is 'the delay' which requires explanation under s 109(3)(a). The other is the period in respect of which a 'full' account is required of the claimant's conduct including the actions, knowledge and belief of the claimant. Authority makes plain that this period is from the date of the accident until the date of providing the explanation for the delay in commencing proceedings. [24] "
- Further, in introductory observations, Gleeson JA stated, in a passage relied upon by the claims assessor:
"[19] The concept of a satisfactory explanation in s 66(2) requires the making of an evaluative judgment or assessment as to whether, by reference to an objective standard and given the claimant's position, the delay which has occurred was reasonably justifiable. The explanation is directed to the delay which occurred to the time when the proceedings were commenced: Karambelas v Zaknic at [17]."
- Leeming JA, in further observations, with which McCallum J agreed, stated:
"[130] As [Gleeson JA] points out at [81], it is essential to distinguish between the two time periods specified in s 66(2), regard to which is made necessary by the inquiry required by s 109(3)(a). A full account for the conduct, from the date of accident until the date it is provided, is required to be given. A satisfactory explanation for the delay is also required to be given. The "delay" is the period of time which caused the need for the grant of leave under s 109(1). That is established by authority, and is a natural reading of the language, bearing in mind that s 109(3)(a) is a precondition for the grant of leave made necessary by the expiration of the three year period in s 109."
- For the most part, the insurer accepted that the period of "delay" referred to in the second sentence of s 66(2), for which the explanation had to be "satisfactory" in the terms explained in that sentence, was the delay beyond the limitation period up until the claim was lodged. Nevertheless, the insurer contended that the claims assessor had erred in failing to take account of so much of the explanation as concerned the period after the claim was lodged and up to the point when the explanation was given. That was necessary, the insurer submitted, in order to make sense of the requirement of a full account covering the extended period. Further, it was said to be required in accordance with the reasoning of the Court of Appeal in Walker v Howard. [25]
- The passages relied upon by the insurer in Walker v Howard are to be found in the reasoning of Allsop P (with whom the other members of the Court agreed). The relevant passages were as follows:
"[48] As is made clear by the first sentence of s 66(2), the explanation to be given for the delay is from the date of the accident until the provision of the explanation.
…
[50] Section 66(2) has two sentences. They should be read together as a composite whole intended to give content to the notion of a full and satisfactory explanation."
- A five judge Court had been convened for Walker v Howard in order to resolve differences of opinion as to the operation of s 66(2), and its predecessor (in identical terms) in the Motor Accidents Act 1988 (NSW). The critical feature of the case was the application of s 66(2) to the circumstances of an incompetent (brain-damaged) accident victim. The issue requiring resolution was far removed from the present circumstances; it concerned two factors, namely (i) whether the "full account" referred to in the first sentence was limited to the conduct of the claimant, and (ii) whether, if a broader view of the relevant conduct were accepted, whether the "reasonable person in the position of the claimant", referred to in the second sentence, involved a more limited concept. The first issue was resolved in favour of the broader approach, Allsop P stating that "the explanation or full account referred to in the first sentence is not restricted to the conduct of the claimant personally." [26] With respect to the second issue, Allsop P reached two conclusions. First, he concluded that "the test of satisfactoriness in the second sentence of s 66(2) [is] the operative standard: that is, it is not merely necessary, but it is sufficient." [27] Secondly, he rejected the proposition that "the focus in the second sentence is only upon the acts or omissions of the claimant", continuing: [28]
"It is the whole explanation - the full explanation contemplated by the first sentence against which the question is to be asked whether [the delay was one] the reasonable person in the position of the claimant would or would not have been justified in experiencing."
- The combined operation of the two sentences in s 66(2) is not without its difficulties. Some of these are highlighted by the present case in which there was, unusually, a delay of some two years between the lodgement of the claim and the provision of the explanation.
- First, there is an arbitrariness about the need to explain steps taken or not taken after the lodgement of the claim. One may readily accept that post-claim conduct may be revealing in relation to earlier delays; nevertheless, where an explanation is given contemporaneously with the lodgement of the claim, that conduct will not be available for consideration. In that sense, the cut-off date for the full explanation is somewhat arbitrary; it appears to be a compromise based on practical considerations.
- Secondly, there is a degree of uncertainty as to when the period ends. As the present case illustrates, there are not infrequently exchanges between claimant and insurer which result in further information being provided over time. Where the limitation period is agitated before a court, the supply of information may continue through to the evidence given by the claimant, including in cross-examination.
- Thirdly, once it is acknowledged that the delay which is to be explained is the delay in making the claim, and once it is accepted that the account eventually given by the claimant was a full account up to the point at which it was provided, it may be difficult to know how material which explained the delay in giving the full account would be relevant to determining whether the delay in lodging the claim was satisfactorily explained. The last point is critical to the question whether there was an error of law, or indeed jurisdictional error, on the part of the claims assessor in the present case.
- In written submissions, the insurer stated: [29]
"Whilst the words used in the second sentence of s 66(2) focus upon the failure to lodge the claim form within the 6 month time period and the delay between the end of that 6 month period and the time when the claim form was lodged it was nevertheless incumbent upon the [claims assessor] to consider the totality of the explanation provided by the claimant up to the time when the explanation was provided."
Further, the submission asserted that the assessor's finding "that a satisfactory explanation has been provided failed to give any consideration to any actions, knowledge or belief of the [claimant] after 11 February 2016." [30]
- The obligation underlying these statements, namely that the claims assessor was required to have regard to the explanation given for delay over the period up until the explanation was provided was correct, if one adds the qualification, so far as it was relevant to assessing the delay in lodging the claim. The problem the insurer faced was that there was no basis for a finding that the claims assessor did not have regard to the full account, so far as relevant. No evidence was placed before this Court to demonstrate that there was relevant information about what happened after the claim was lodged which was disregarded and could not properly have been disregarded by a reasonable assessor carrying out his or her functions under the Act. Nor can any inference be drawn from the absence of reference to such later conduct in the assessor's reasons because there is no basis to infer that any later conduct would have been material to an assessment of the explanation for the delay in lodging the claim. It follows that the insurer has failed to demonstrate reviewable error on the part of the assessor.
- There was a second proposition raised in the written submissions which, if correct, might have demonstrated legal error on the part of the approach adopted by the assessor. The submission read as follows: [31]
"It is submitted that [having regard to the objects of the Act] the provisions of s 66(2) require the explanation of the delay between the end of the 6 month period and the date of making the claim but also require a satisfactory explanation for what occurred up to the time the explanation was provided."
- For the reasons explained above, the statement following the words "but also" are not correct as a matter of law.