Issued under Division 7.4 of the Motor Accident Injuries Act 2017

In accordance with s 7.13 of the _Motor Accident Injuries Act 2017 (_the MAI Act), my determination of the merit review matter is:

1. The insurer's decisions of 17 May 2025 are set aside.
2. In accordance with s 7.13(3)(d) of the MAI Act, I remit the dispute about the cost of care provided to the claimant by her sister Concepcion for reconsideration by the insurer.
3. The insurer's reconsideration is to be made in accordance with the attached reasons and the directions contained at paragraph 128.

A statement setting out the reasons for the determination is included with this certificate.

1. Miss Mauricia Villanueva was involved in a motor accident on 6 November 2018. She was the victim of a carjacking outside a fast-food restaurant and was injured by the assailant as he took control of her car, as he drove off in the car, and when Miss Villanueva was ejected from the car as he drove away.
2. At the time of her accident, Ms Villanueva was 65 years of age. She is now 72 years of age. Miss Villanueva sustained physical injuries to her head, lower back, hips, legs, feet and toes as well as her left shoulder and left elbow. She has also developed a psychological injury as a result of the accident.
3. Miss Villanueva made a claim for statutory benefits with Insurance Australia Limited t/as NRMA Insurance (NRMA), her own third-party insurer. NRMA admitted liability for the claim. Miss Villanueva made a claim for damages and that claim has resolved with Miss Villanueva receiving a lump sum including a lump sum for non-economic loss.
4. In the statutory benefits claim, a dispute arose between Miss Villanueva and NRMA about attendant care services provided to Miss Villanueva after the accident by her sisters, Concepcion Villanueva and Lourdes Tibig. That dispute was the subject of a medical assessment (and Review) in terms of the entitlement to, and amount of the care provided. The Review Panel (the 2024 Panel) found[1] Miss Villanueva required eight hours of care and assistance per week. A dispute about the cost of that care was referred for Merit Review. The matter was allocated to me, and I determined that the reasonable cost of the disputed past care was the sum of $35 per hour[2]. Both the Panel's decision and my decision dealt only with past care provided up to 6 November 2023, which was the fifth anniversary of Miss Villanueva's accident.
5. Five years after the accident, Miss Villanueva's statutory benefits claim was transferred to the Lifetime Care Authority of New South Wales (the Authority) for management through its program CTP Care. A dispute arose between Miss Villanueva and the Authority about the level of attendant care services now being provided to Miss Villanueva by her sister Concepcion alone and the cost of that care.
6. The dispute about whether Miss Villanueva required additional care and assistance was the subject of medical assessments by Medical Assessors Kenna and Castle-Burton and Review proceedings. The President of the Commission convened a Review Panel (the 2025 Panel) comprised of the same members as in the earlier Review proceedings. The Panel determined on 5 November 2025 that Miss Villanueva did not require additional care and assistance and that her attendant care needs would be met by eight hours of domestic services per week[3].
7. The dispute between Miss Villanueva and the Authority as to the cost of the care being provided and funded by the Authority is a declared merit review matter and that has been allocated to me for determination.
8. I have held four preliminary telephone conferences with the parties, and I have received submissions and documentation from both parties. At the last conference I set a timetable for the provision of final documents and submissions and determined I would be assessing the matter on the documentary material, supplemented by the evidence provided by the claimant during the teleconferences.

1. The current dispute began with two letters dated 17 May 2024 sent by the Authority to the claimant dated 17 May 2024 provided in the claimant's bundles. In those letters:

(a) iCare agreed to reimburse the claimant for eight hours per week of care at $35 per hour from 7 November 2023 to 21 March 2024 (the second letter);

(b) does not agree to pay the claimant $60 per hour for eight hours per week of care from 7 November 2023 to 21 March 2024 (the second letter), and

(c) iCare approved eight hours a week of domestic assistance "as per Review Panel certificate dated 07 February 2024" for the period from 22 March 2024 to 21 March 2025 (the first letter).

1. The claimant responded to these letters seeking an internal review by phone on the same day and then in writing as per the document at page 11 of her bundle of documents in support of the current application.
2. In that document, under a heading "Part 1" she sought from the Authority "the total number of hours of domestic assistance be increased from eight to 12 hours per week because her needs are increasing" and she relied on daily diaries provided by her sister Concepcion. Under a heading "Part 2" she seeks the hourly rate be increased from $35 per hour to $60 per hour due to inflation and the high cost of commodities.
3. The insurer's internal review concerning the cost of care and assistance from 7 November 2023 to 21 March 2024 was undertaken on 31 May 2024. The insurer affirmed its decision.
4. The insurer's internal review concerning the claim for an increase in the number of hours of care being provided from 8 hours to 12 hours was undertaken on 19 June 2024. The insurer affirmed its decision.
5. On 24 April 2025, the Authority approved eight hours of care per week at $35 per hour from 22 March 2025 to 22 March 2026. It is not clear whether an internal review of that decision had been undertaken of that decision and it has not been referred for Merit Review.

1. Miss Villanueva's claim is governed by the provisions of the Motor Accident Injuries Act 2017 (the MAI Act). This legislation provides a scheme for the compulsory third-party insurance of all motor vehicles registered in New South Wales and a scheme of statutory benefits (under Part 3) and compensation by way of lump sum damages (under Part 4) for persons injured in motor accidents in New South Wales.
2. Statutory benefits payable by the "relevant insurer"[4] in accordance with Part 3 of the MAI Act include:

(a) weekly loss of income benefits for "earners" under Division 3.3, and

(b) treatment and care benefits for all claimants under Division 3.4.

"(1) An injured person is entitled to statutory benefits for the following expenses ... incurred in connection with providing treatment and care for the injured person -

(2) No statutory benefits are payable for the cost of treatment and care to the extent that the treatment and care concerned was not reasonable and necessary in the circumstances or did not relate to the injury resulting from the motor accident concerned."

1. The phrase "treatment and care" is defined in s 1.4 to include medical treatment, rehabilitation, respite care, attendant care services, home and transport modification and so on.
2. Attendant care services are defined as "services that aim to provide assistance to people with everyday tasks, and includes (for example) personal assistance, nursing, home maintenance and domestic services."
3. Treatment and care expenses are therefore the expenses associated with providing treatment and care, including attendant care, to a person injured in a motor accident.
4. Section 3.25 provides that no statutory benefits are payable for expenses incurred in connection with the provision of gratuitous attendant care services, that is attendant care services for which the claimant has not paid and is not liable to pay.

1. Schedule 2 of the MAI Act lists a number of dispute types that can be determined by either a merit reviewer, a medical assessor or a member of the Personal Injury Commission (the Commission).
2. Clause 1(i) of the Schedule, declares the following matter to be a merit review matter:

"whether the cost of treatment and care provided or to be provided to the claimant is reasonable for the purposes of section 3.24(1)."

1. Section 7.23(2) provides that a medical assessment certificate issued by a single Medical Assessor or a Review Panel is "conclusive evidence" in, amongst other things, merit review proceedings.

1. At the first teleconference, held on 25 July 2024, the claimant advised that she had filed an application for medical assessment. The merit review proceedings were deferred pending the conclusion of the medical assessment process.
2. On 11 December 2025 I conducted the second teleconference. By that time the following had occurred in the medical assessment matter:

(a) on 5 December 2024, Medical Assessor Kenna determined that he was unsure whether the additional care claimed (12 hours per week versus 8 hours per week) related to the accident or was reasonable and necessary in the circumstances and he recommended the claimant be assessed by an occupational therapist;

(b) on 13 March 2025, Medical Assessor Castle-Burton had assessed the claimant in her new home and determined that the claimant's request for additional care and assistance (12 hours per week versus the previous 8 hours per week) was related to the accident but the additional care was not reasonable and necessary in the circumstances, and

(c) on 5 November 2025, the 2025 Panel comprising Senior Member McTegg and Medical Assessors Gibson and Piebanga determined that the certificate of Medical Assessor Castle-Burton should be affirmed. As part of that Review, Medical Assessor Piebanga had undertaken an assessment of the claimant's care needs in her new home and in the presence of the claimant.

1. As the claimant was considering her rights to appeal or review the 2025 Panel's decision, I deferred the merit review proceedings.
2. A third preliminary teleconference was held on 20 January 2026 and the claimant advised she had lodged an application for the correction of an obvious error and had also written to the President of the Commission taking issue with the decision. I deferred the proceedings.
3. On 17 February 2026 I held a fourth teleconference, and the parties advised me that Miss Villanueva had lodged a further application for the correction of a different obvious error and had written to the President. The parties requested I determine the Merit Review proceedings now on the basis of the information before me.
4. I set a timetable for the provisions of additional documents and final submissions. In particular, I requested the Authority provide me with the hourly rate for commercially provided care and the gratuitous care rates published in respect of the Motor Accidents Compensation Act 1999 (the MAC Act).

1. Two documents were filed by the claimant with her application. The first, dated 27 June 2024,[5] is in the form of a letter to the "PIC team", and the second dated 24 June 2024[6] sets out what the dispute is about. The fundamental issue in dispute identified in both those documents is:

"The hourly rate of $35 per hour of domestic care services that Concepcion Villanueva is providing me ... be increased from $35 per hour to $60 per hour."

1. In her document lodged with the Commission on 19 March 2026, Miss Villanueva says:

"There is a still a dispute because Concepcion is dissatisfied with the amount of money she is being paid by Lifetime Care. Concepcion herself is requesting ICARE to increase the hourly rate from $35 to $60 per hour. The hourly rate ICARE is currently paying her is $35 per hour which is very very very low and NOT enough."

1. The arguments Ms Villanueva has raised in June 2024, and March 2026 are very similar, and the following points can be gleaned from them:

(a) the claimant sustained an L4 compression fracture in the accident which she says has increased from 50% to 70% and that as a result she needs more assistance. Five years has passed since her injury, and her condition has worsened and the level of care has increased justifying an increase in the hourly rate. Miss Villanueva also says that because her sister is required to do more and has "greater duties and responsibilities" she should be paid $60 per hour not $35 per hour;

(b) NRMA was reimbursing her $12.50 an hour for domestic services provided by her sisters, then they increased it to $25 per hour in 2022 and then $35 an hour up to 6 November 2023. This was because Concepcion was charging the claimant $12.50 an hour, then $25, then $35 and now Concepcion is charging her $60 an hour for the work she does;

(c) the National Disability Insurance Scheme (NDIS) hourly rate for "domestic helpers" is $80 - $110 per hour during weekends and "my sister ... is charging way below the market rate". She also suggests the hourly rate for an external domestic care service would be $80 - $110 per hour during weekdays and $100 - $150 per hour during weekends or holidays;

(d) the claimant says that inflation needs to be considered and that the buying power of $35 in 1977 is the equivalent of $60 per hour in 2023. She refers to "the Motor Compensation Act 1977" and that the rate therein was $34.77 "$35 per hour according to Member Cassidy" and that the buying power of $35 per hour in 1977 is equivalent to $60 in 2024. Miss Villanueva says that the wage rate for carers, doctors and health care providers have "increased from time to time" due to inflation and the cost of commodities are increasing;

(e) in a similar argument the claimant says that since the previous decision was delivered, wages and prices have increased, the cost of quality care has increased and the cost of living in Sydney has gone up. She says everything is more expensive. As a result, in order to afford living in Sydney, Concepcion will be required to work part time outside the home as well as providing the claimant with services;

(f) Miss Villanueva says she needs "domestic, physical, nursing, medical, psychological and emotional care assistance" and she needs it at any time which means Concepcion needs to be working for her full time or be available all of the time. The sum of $35 an hour for eight hours a week is not enough for Concepcion's subsistence, and she may need to get another job. If she works an outside job, she will not be available "any time" the claimant needs her;

(g) Concepcion helps the claimant manage her medication and reminds her to take it - which is "nursing and medical" care which has not been included by the insurer;

(h) the claimant says she cannot sleep and she feels low and depressed and Concepcion is always there to listen and provide company, encouraging her "when it is impossible to go on". The claimant says she relives and revisits in her mind the time when the car jacker sat on her and touched her breasts. She describes nightmares, panic attacks, anxiety and depression and refers to the assessment by Medical Assessor Samuell. She says Concepcion is always there to help, listen, console and reassure her. She says this is "nursing care" which has not been included in the domestic assistance allowed by the insurer. She claims her sister provides her with emotional and psychological care. When she has a panic attack, Concepcion prepares a hot water bottle and a hot drink. When she has a nightmare, she wakes up her sister who comes to her and gives her "encouraging words";

(i) Miss Villanueva says that Concepcion also helps the claimant with her exercises including walking and push up exercises as well as psychological care and this has not been included. She says her sister provides her with physical care services giving her daily exercise for her back, legs and hands;

(j) she says her sister is her domestic care giver and provides her with assistance at home including preparing food, cooking, cleaning, laundry, gardening and grocery shopping;

(k) she says her sister, who is her carer, drives her to her medical practitioner and allied health provider appointments.

(l) she says before the accident she had no pains and no need for help and that after the accident she has been diagnosed with osteoporosis, and

(m) she says she is unable to perform any cooking, cleaning, washing, grocery shopping or watering of her plants.

1. In its submissions lodged with the reply, the Authority at [1.1] - [1.8] summarises the dispute and the previous proceedings and decisions. The Authority submits at [1.9] - [1.12] that its decision of 17 May 2024 was based on the number of hours certified by the 2024 Panel and the cost certified in the previous Merit Review matter.
2. The Authority says at [1.13] that the hourly rate of $60 is not reasonable because the claimant's sister is not required to travel or buy supplies in order to complete her services. The Authority also says the claimant is providing domestic services not personal care or nursing services.
3. The Authority sets out at [1.14] - [1.18] its understanding of the claims made by Miss Villanueva.
4. The Authority submits at [1.22] that its internal review certificate declined to approve the requested increase in the number of hours as there was no new evidence or clinical information to support that request.
5. The Authority says at [2.5] it does not dispute the claimant is entitled to attendant care services and to be reimbursed for the services she has paid for but, at [2.6] refers to my previous determination in the earlier dispute between the claimant and NRMA.
6. The Authority notes at [2.7] - [2.9] the decision of the 2024 Panel and says at [2.10] that there is no evidence to support a variation in the 2024 Panel's decision. The Authority refers at [2.11] - [2.12] to the report of Dr Dias and at [2.13] to the report of Dr Suttor (both reports relied on by the claimant dating back to 2020).
7. The Authority reiterated at [2.19] that the rate of $60 per hour is inconsistent with the previous decisions and is unsubstantiated.
8. The Authority lodged final submissions on or about 4 March 2026 attached to which were various documents I had requested.
9. At [2.1] the Authority summarises the arrangements in place between the claimant and NRMA for the provision of domestic services. The Authority noted my directions with respect to obtaining information from the claimant in order to facilitate the direct payment to Concepcion. The Authority then at [2.3] - [2.5] confirms that there are now arrangements in place between the Authority and Concepcion enabling Concepcion to be paid direct.

Additional bundles of documents lodged by the claimant

1. The claimant submitted a bundle of documents to the Commission on 19 March 2026. There are 61 pages of documents comprising the following:

(a) 19 March 2026 notes on Preliminary Conference (which I will summarise below);

(b) a letter dated 19 March 2026 addressed "Dear PIC Merit Review Assessor Cassidy" which is said to be a joint letter from the claimant and Concepcion which restates the argument summarised in paragraph 33 (a) - (k) above. The language of this letter contains multiple references to "I and Concepcion" but it is clearly a document written by the claimant because elsewhere it only refers to "I" in the context of the claimant. The document has two signatures at the end, which are said to be the claimant's and Concepcion;

(c) a letter to the PIC Team dated 27 March 2025 lodged with the application for Medical Review signed by the claimant and addressing multiple issues associated with the medical assessment matter;

(d) a letter dated 19 March 2025 said to be a statement from Concepcion, already received and summarised;

(e) a letter dated 15 December 2025 addressed to Dear PIC Director of Medical Services / and or PIC Manager of Dispute Services / and or PIC President & PIC Panel." This letter is the claimant's submissions in respect of issues about the 2025 Panel's decision and errors or issues the claimant has with Medical Assessor Castle-Burton's assessment. I have read the letter put do not propose to refer to it further;

(f) a letter dated 15 February 2026 addressed to "Dear PIC Director of Medical Services / and or PIC Manager of Dispute Services / and or PIC President & PIC PANEL" which takes issue with the 2025 Panel's correspondence of 15 January 2026. I have read this letter, but it does not add anything to my understanding of the claimant's situation or of the matters which I have to determine in the current proceedings;

(g) a letter dated 24 February 2026 addressed to "Dear PIC Director of Medical Services / and or PIC Manager of Dispute Services / and or PIC President & PIC PANEL" which also takes issue with the 2025 Panel's decisions. I have read this letter and do not consider it adds anything to my knowledge of the matters in dispute between the claimant and the Authority;

(h) a letter dated 19 March 2026 addressed to "Dear PIC Director of Medical Services / and or PIC Manager of Dispute Services / and or PIC President & PIC PANEL". This is said to be a response to the further correspondence issued by the 2025 Panel dated 2 March 2026 and is clearly a letter expressing the claimant's dissatisfaction with the outcome of the Review proceedings. I have read this letter, but it is not a matter for me to respond to it;

(i) copies of medical reports already before me (Dr Ong 18 February 2025, Dr Hartin 17 May 2025) and copies of MRI reports (dated 21 November 2019 and 17 March 2025);

(j) a handwritten letter from Concepcion "to whom it may concern" undated but from the Westmead address, and

(k) what appears to be a payslip for Concepcion as a Registered Nurse for a two-week period in April 2019 and a two week period in July 2019.

1. To avoid any confusion, I have admitted into evidence all the letters and documents and submissions that have been uploaded by the claimant in these proceedings that is the original documents from 27 June 2024, additional documents on 26 March 2025, 8 December 2025, 16 February 2026, and 19 March 2026.
2. The claimant lodged an additional bundle of 38 pages of documents dated 22 March 2026 however upon querying this document, the claimant advised an officer of the Commission that it was not a document meant for the Merit Review proceedings but it was a document meant for the 2025 Panel and medical assessment proceedings. I have therefore not considered any of the material in that bundle.

1. The claimant has filed many documents in this matter and several submissions which are repetitive both within each document and across all the documents. The documents provide a mix of both evidence and submissions.
2. Much of the documentation before me concerns the medical dispute about the amount of care provided by Concepcion to her sister.

1. The medical evidence has been summarised by the Review Panel in the 2025 decision at paragraphs [25] to [72]. I have read that summary and considered it and adopt the summary for the purpose of these reasons.
2. I note in particular the up-to-date evidence from Dr Ong who certified on 18 February 2025 that the claimant complained of:

(a) chronic excruciating back pain;

(b) an inability to get up from bed due to intense/or severe back pain, and

(c) worsening or deteriorating back pain.

1. Dr Ong stated the claimant required 12 hours per week of domestic and nursing care assistance. Dr Ong has provided no reasoning, justification or explanation for what she was written in her certificate.
2. I also note the two reports from Dr Hartin from March 2025. Dr Hartin reported:

(a) Ms Villanueva's low back pain had deteriorated, and she complained of paraesthesia extending down the lower extremities in a non-dermatomal distribution;

(b) there was generalised deconditioning in the claimant's lower extremities and that knee reflexes were symmetric and ankle reflexes absent;

(c) Miss Villanueva's dominant symptoms are those of axial back pain;

(d) lumbar fusion surgery was contra-indicated given the claimant's severe osteoporosis, and

(e) low back pain relating to the claimant's kyphotic deformity and spinal imbalance was not easily remediable.

1. In the short second report, he says it would be reasonable for the claimant to have 12 hours of domestic and personal care assistance.
2. The Review Panel's decision of 5 November 2025 included a review of the imaging studies by Medical Assessor Gibson and an assessment of the claimant's attendant care needs by Medical Assessor Piebenga which was performed on 22 September 2025.
3. The claimant presented in chronic pain but was co-operative. The new home was considered "significantly more suitable" as her bedroom (with ensuite) was on the main level which meant she no longer needed to climb stairs to access the bathroom.
4. The claimant was said to have significant postural abnormalities, she ambulated with two walking sticks, and she complained of sever constant pain with limited tolerance to standing and an inability to undertake many movements.
5. The claimant was said to be independent with personal care tasks but had help with washing from her sister. Medical Assessor Piebenga considered some additional aids to further the claimant's independence.
6. The claimant's functional limitations were said to "have remained remarkably consistent across assessments". While her back condition may have deteriorated this "has not translated into functional regression" and she has the same limitations and lack of capacity as she had before.
7. Concepcion says she cooks for both herself and Miss Villanueva but it does not take her longer to cook for two people. Concepcion says she is a "clean freak" who can take an hour to wash a small number of dishes. Concepcion says she does the shopping as frequently as she did before the accident and it takes little extra time to shop for two people as opposed to one. Concepcion said she does most of the cleaning meticulously including two bathrooms upstairs that are not used by any of the residents of the homes. The claimant could not longer do the laundry. Medical Assessor Piebenga notes that the claimant had surrendered her driver license and relied on others for transport.
8. Medical Assessor Piebenga states:

[121] A key observation is the remarkable consistency in Ms Villanueva's reported functional abilities across occupational therapy assessments over nearly three years. Despite the passage of time and change to a more accessible home, her functional limitations have remained essentially stable. While she has demonstrated improvement in personal care (particularly showering frequency) due to environmental modifications, her capacity to engage in domestic tasks requiring standing, walking, bending, lifting, and carrying has not meaningfully changed.

[122] Medical imaging demonstrates progression of L4 vertebral compression from 50% (November 2019) to 70% (June 2023) - documented structural deterioration of approximately 20 percentage points over 3.5 years. However, this structural change has not been accompanied by corresponding functional deterioration. Ms Villanueva presents with the same mobility limitations, standing/walking tolerance, and inability to perform domestic tasks as consistently documented since her accident."

1. The Panel noted the claimant's medication had been modified (Pregalbin had been added) but that her pain levels were consistent with previous assessments. The Panel also noted that Concepcion's diary documented 23 hours of domestic care which the claimant relied on as evidence that eight hours of care was not enough.
2. The Panel said at [129]:

"Concepcion has ceased working as a registered nurse and is available at home full-time. She may naturally provide companionship, prepare elaborate meals, maintain the home to exceptionally high standards, and anticipate needs before assistance must be requested. While these caring behaviours are admirable, they exceed the threshold of reasonable and necessary care for compensation purposes."

1. The Panel affirmed the decision of Medical Assessor Castle-Burton and considered the allowance of eight hours of attendant care services reasonable and necessary in the circumstances.

Concepcion's statement 19 March 2025 and updated document

1. Concepcion has provided a detailed statement about the things she does for her sister both physically and by way of emotional support. She states in very similar language to that of the claimant, dissatisfaction with the assessment of Medical Assessor Castle-Burton and says the claimant requires more than eight hours of care per week and it should be increased to 12 although she then says she performs 23 hours of care per week for her sister.
2. She says she is only charging the Authority for 12 hours instead of the 23 hours she works.
3. Concepcion provides a daily and weekly log of what she does for her sister including the ingredients for the meals she cooks.
4. The claimant provided a handwritten letter from Concepcion "to whom it may concern." It is undated but is from the Westmead address. It says:

I stopped working as a Registered Nurse so I can look after and take care of my sister, Mauricia Villanueva, following her horrifying car jacking accident."

1. The claimant provided a document described by the Review Panel as a statement which was filed by way of a reply to the assessment of Medical Assessor Castle Burton. This document takes issue with the various assessments of time taken including the number of hours Concepcion provides for cooking hot Filipino meals three times a day, washing dishes, cleaning, laundry, bed changing and making, rubbish management, shopping and transport assistance.
2. The claimant recounts her injuries, her symptoms and says that her sister takes her blood pressure, provides hot drinks, listens to her when she has nightmares and helps her dressing and washing. The claimant says her sister provides 23 hours of care per week.
3. She relies on a certificate from Dr Ong which "certifies that I require 12 hours of domestic and nursing care assistance." She also relies on a report from Dr Hartin that says her back is worsening and deteriorating.
4. This statement is clearly written in support of the medical issues in the dispute and does not address the cost of the care that is being provided.

Evidence from Ms Villanueva given on 17 February 2026

1. Ms Villanueva has three siblings, Concepcion Villanueva, Lourdes Tibig and Fely Salenga. I understand there are other sisters living elsewhere. Ms Villanueva identified her sister Concepcion as her care giver.
2. Ms Villanueva told me:

(a) she used to own (until 2023) a house at Woodcroft. While she said it was the "family home" or a "family property" she conceded reluctantly that she was the registered owner of the property, and it has now been sold;

(b) she now owns a home in Westmead which she says she built. Again, she reluctantly conceded that she is the registered owner of the property but described it as the "family home" or a "family property" and that she and her sisters made decisions about the house and how it would be designed and built "as a family";

(c) she lives in this five-bedroom house with Concepcion, Lourdes (who is currently out of the country) and Fely Salenga (who lives in the home, but who spends every day of the year at her daughter's home looking after her grandchildren);

(d) Miss Villanueva bought the land and paid for the house to be built, and she pays the rates, the electricity, the water and all the bills for the maintenance of the house;

(e) Lourdes and Fely Salenga do not pay rent or financially contribute to the running of the house, but they live in the house. Lourdes and Fely Salenga do not provide any care and assistance to Miss Villanueva;

(f) Concepcion, who also lives in the house, pays rent to the claimant in the sum of $75 a week and she is the only sister who provides care to Miss Villanueva;

(g) after the accident, Concepcion gave up her job as a nurse to look after Miss Villanueva. If the accident had not occurred, Concepcion would still be working as a nurse in a hospital. Concepcion was born in 1947 and will be 79 years of age this year. Miss Villanueva says her sister is in a better state of health than she is;

(h) Concepcion pays rent because she did not contribute as much as the other sisters to the purchase of the property - this appears to conflict with the claimant's earlier evidence that she purchased the land and built the house without any contribution from her sisters;

(i) Concepcion does not get any money from Centrelink. She is not receiving the aged pension and she is not receiving the carer payment;

(j) Miss Villanueva does not get any money from Centrelink. She is not receiving the aged pension or a disability payment. She was awarded a lump sum of money in her damages claim but there is nothing left, it has all been spent. She pays for things for the house and for herself with her savings;

(k) if Concepcion does the groceries, Miss Villanueva gives her money for groceries which are for her, but Concepcion pays for her own groceries;

(l) Fely Salenga visits her daughter's house every single day of the year to look after her grandchildren and eats food there. Sometimes she brings food from that house to the claimant's house, sometimes she eats with Miss Villanueva and Concepcion, sometimes Fely Salenga cooks food in the family house and they share the food; sometimes she buys cooked food and they all eat it;

(m) Fely Salenga does not always like the food that Concepcion cooks, in which case she will buy cooked food and bring it to the house, or she will cook her own food if she does not like what Concepcion has cooked. Sometimes Fely Salenga will eat what Concepcion has cooked, and they will all eat together;

(n) she does not do the paperwork for this case, she said she has a "secretary". When I asked her who her secretary was, she said Fely Salenga and Concepcion. Ms Villanueva said she cannot type things herself as she is in excruciating pain, and

(o) she lives a simple life. There is always food on the table but there are no luxuries.

1. Ms Villanueva confirmed that she is no longer borrowing money from Fely Salenga in order to pay Concepcion, as Lifetime Care is now paying Concepcion direct. I asked Miss Villanueva to confirm that she had not incurred any expenses at all since November 2023 in relation to the care her sister was providing and she said that was correct, that the Authority is paying her sister direct at the rate of $35 per hour not the $60 that the claimant and Concepcion have been asking for. The claimant said she is not paying the difference (between $35 and $60 per hour) to Concepcion because she cannot afford it. The claimant said that inflation and the cost of living means that $35 is not enough for her sister and that her sister needs to be earning $60 per hour.

Claimant's additional evidence provided 19 March 2026

1. Miss Villanueva has provided "notes on Preliminary Conference Report". This included further arguments and submissions already made. In relation to the evidence she provided at the preliminary conference, she says:

(a) she has no siblings living in the Philippines although she does have three siblings living overseas. She has five sisters living in Sydney. Lourdes Tibig is in the Philippines temporarily as, at the age of 83 she is still working as a meteorological consultant;

(b) the Woodcroft house was sold to pay for the construction of the Westmead house. The claimant bought the house in Westmead 37 years ago and lived in it with her mother, the claimant then went to live in Woodcroft and tenants lived in the Westmead house for about 20 years but after that, the property was empty for about two decades. The family decided to build the new house on the Westmead block. The family decided to build a house with a bedroom on the ground floor for the claimant. The family paid for the construction of the house;

(c) the claimant pays for the rates, electricity, water and all bills for the house from savings she had from when she was working;

(d) Concepcion gave up her nursing job to look after the claimant and if the accident had not happened, she would be working earnings what is stated she earns in her payslips;

(e) the claimant confirms she was awarded a lump sum of money in her damages claim but it was "very, very minimal". She says one third of it went to her solicitor and the remainder has "all been spent and gone" and she is paying for things with her savings;

(f) Lourdes thinks her cooking is superior to others, so she always cooks her own food separately, and

(g) the claimant's secretary is Fely Salenga and not Concepcion, Concepcion is only the sole carer.

1. Ms Costello for the Authority confirmed at the preliminary conference in February 2026 that the Authority was now paying the claimant's sister direct and had entered into an agreement with her with respect to the payments.
2. The Authority has provided copies of five invoices issued by the claimant's sister Concepcion Villanueva to the Authority for services provided from 22 March 2024 to 1 November 2025. Each of the invoices claims eight hours a week of care at $35 per hour.
3. Each of them notes several times that the annual income of Concepcion Villanueva is not more than $75,000 and therefore no Goods and Services Tax has been included.
4. Each of them notes that the hourly rate for the work claimed in the invoice is $60 and the number of hours per week worked in the period is 12 hours. The invoice notes that the greater sum and greater number of hours has been included "to ensure it could be paid retroactive" if the Commission allowed it.
5. The Authority has provided remittance advices corresponding to each of the invoices.

1. The claimant has provided what appear to be two payslips issued to Concepcion when she worked as a Registered Nurse from 1 April 2019 to 14 April 2019 and from 9 July to 22 July 2019. These include the following information:

(a) Concepcion's "normal" rate of pay was $43.0555 per hour for 68 hours of work in the fortnight (approximately $2,930 per fortnight);

(b) in addition to the base rate of pay she was paid a hosiery allowance, laundry allowance and shoe allowance;

(c) she was paid an additional allowance when she was the "nurse in charge";

(d) she was paid penalty rates at 15%, 50% and 75% of the "normal rate" for work outside the usual hours;

(e) she accrued annual leave, sick leave and long service leave, and

(f) she was paid $3,093.30 for the April fortnight and $3,367.64 for the July fortnight

1. I note the undated "to whom it may concern" letter from Concepcion advising that she retired from paid work in order to look after her sister. There is no evidence from the claimant's employer such as Concepcion's resignation letter or a letter of termination.
2. There is no evidence as to the hourly rate Concepcion could earn should she return to full time work.

1. The insurer provided an extract from the Furzer Crestani's[7] published rate for gratuitous domestic assistance provided under the Motor Accidents Act 1988, the MAC 1999 and the Civil Liability Act 2002.
2. The rate from time to time is calculated in accordance with same formula provided in those pieces of legislation and is:

(a) from 20 May 2023 to 18 November 2023 - $36.24 per hour

(b) from 19 November 2023 to 17 May 2024 - $37.62 per hour

(c) from 18 May 2024 to 15 November 2024 - $38.65 per hour, and

(d) from 16 November 2024 to 16 May 2025 - $39.82 per hour.

1. The formula for the hourly rate is based on one fortieth of the average weekly total earnings of all NSW employees estimated from time to time by the Australian Statistician[8].

1. Section 7.23(2) of the MAI Act provides that a Review Panel's certificate is conclusive evidence in merit review proceedings. Section 7.14(3) provides that a merit review decision is binding on the parties to the merit review. The legislation is clear that the decisions made in the dispute between Miss Villanueva and NRMA can only bind the parties to that dispute. In my view, without clear legislative authority, the 2024 decisions issued by the earlier Review Panel and by me cannot bind Miss Villanueva and the Authority.
2. Section 7.23(2) is clear in respect of the 2025 decisions. I am bound by the certificate of the Review Panel dated 5 November 2025 that eight hours of attendant care per week is reasonable and necessary and related to the injuries caused by, and as a result of, Miss Villanueva's accident. The Panel considered the request made for 12 hours per week and rejected that claim.
3. Section 3.24(2) of the MAI Act provides that the Authority does not have to pay statutory benefits for treatment and care that is not reasonable and necessary or not related to the accident caused injuries. The Authority is therefore not liable to pay Concepcion for any attendant care services provided to Miss Villanueva that exceed eight hours per week from 6 November 2023 to date and continuing.
4. Section 3.24(1)(a) states that the insurer is only liable to pay the "reasonable" cost of treatment and care. The question for me to determine then is whether the rate being paid by the Authority to Concepcion is reasonable or whether the hourly rate claimed by Concepcion, or some other rate is reasonable.

Has there been a variation in the type of care being provided?

1. The claimant submits that her sister is providing her with more care and, because her injuries are worsening, Concepcion has greater responsibilities. This appears to be a submission that the care currently being provided is different, more onerous or more complicated that the care being provided before.
2. The Review Panel's decision which is binding on me is not supportive of this submission. The 2025 Panel has stated that while the claimant's condition has worsened, it has not resulted in any worsening of function.
3. I note that in the previous proceedings the claimant provided schedules and timetables and diary entries that suggested Concepcion was providing 22 - 23 hours of care per week which is similar to the number of hours now being claimed.
4. I am not satisfied that Concepcion is providing any different type of care or care with any greater level of difficulty or responsibility since November 2023.

1. In order to consider whether the cost claimed is reasonable, understanding the nature of the work being done is essential. If the work being done, for example, requires particular skills and qualifications then a higher hourly rate would be reasonable in comparison to the rate paid for work being done that does not require any skills and qualifications.
2. The Panel's examination findings, the documents from the claimant's sister and the claimant's own evidence suggest that most, if not all, of the care being provided by Concepcion relates to transport, cooking, cleaning, laundry, shopping and bed-making. The claimant was said to be essentially independent with personal care tasks with the assistance of adaptive equipment and was independently managing toileting and grooming. The domestic tasks being done for her includes meal preparation, cooking and washing dishes, laundry, bed making, shopping and transport to medical appointments.
3. This type of care in my view is services of a domestic nature which does not require any skills or qualifications.
4. The claimant says that her sister has to remind her to take her medication and this is a nursing or medical task. The claimant's sister is not prescribing or dispensing the medications. If the claimant is taking multiple medications on a regular basis, it is likely her pharmacy is providing these medications in a Webster pack or similar. If she is not provided with a Webster pack, then this is another aid that could be deployed to improve the claimant's independence. Reminding someone to take their medication is not in my view a nursing task and does not require any particular skills or qualifications to undertake. This is in my view particularly so in the case of Miss Villanueva who has not demonstrated any cognitive defects and has been able to pursue her claim and prosecute her disputes with NRMA and now the Authority.
5. The claimant says her sister provides her with psychological nursing care such as in the middle of the night when she is having nightmares about the carjacking. While Concepcion was a registered nurse, there is no evidence about whether Concepcion has counselling or similar qualifications, but the evidence is that she provides care involving for example comforting words and a hot drink. In my view this is not a nursing task that requires particular skill or qualifications.
6. The claimant says her sister provides her with physical therapies and helps her exercise every day. There is no detail of what these therapies and exercises are, and whether they have been prescribed by a physiotherapist as "home exercises" or whether they are exercises developed and set by Concepcion. If so, what are Concepcion's qualifications to prescribe these exercises.
7. I am satisfied that Concepcion is providing domestic services and possibly some personal assistance with bathing and dressing. I am not satisfied that Concepcion is providing nursing, medical or physical therapy services that require specialised skills or qualifications.
8. In 2019, Concepcion was being paid by her employer at the rate of about $43 per hour as a full-time registered nurse. The current award rate for a full-time registered nurse with eight years or more experience is $51 per hour[9]. As the work Concepcion is doing for her sister is not nursing work, I do not consider it appropriate for the Authority to pay Concepcion an hourly rate based on what a nurse is paid or could be paid. While the type of care being provided may be more aligned to that of an assistant in nursing, there is no evidence as to what that rate may be provided by the insurer.

1. The Authority has provided no evidence about the current rate paid by it to commercial carers in other claims. There is no evidence about the current rate paid pursuant to any relevant award for domestic help.
2. The claimant has referred to the National Disability Insurance Scheme (NDIS) rates of pay. She has provided no evidence by way of a letter or document from NDIS to prove or support that submission. Miss Villanueva has denied she receives any financial support from the government so that suggests she is not a participant in NDIS and is not in receipt of independent commercial care provided under that scheme.
3. The claimant says the rate of pay for "domestic helpers" paid by NDIS is $80 - 110 per hour on weekday and, $100 - 150 on weekends. In the absence of a source document from the claimant, I have made by own enquiries. According to the NDIS website,[10] the National Disability Insurance Authority (NDIA) is responsible for setting price limits and has developed an "NDIS Pricing Arrangements and Price Limits" document which for 2025 - 2026 comprises 104 pages.
4. There are a number of categories of payment for assistance with "Self-care activities" based on the type of care provided (standard or complex), the day of the week (and day or at night) and the location of the care being provided (metropolitan, remote or very remote). The current rates vary from $70.23 per hour to $127.91 per hour.
5. There is only one hourly rate set for "Assistance with Personal Domestic Activities" in the metropolitan area of $50.06 per hour[11]. There is a separate section[12] in the document for "Assistance with household tasks" and an hourly rate set for house cleaning and other activities of $58.03.
6. I do not accept the claimant's submission as to the NDIS rate of pay. A rate of between $50 - $58 appears to be the more appropriate NDIS market rate for the work being done by Concepcion.
7. I note that neither the claimant nor the insurer have referred to the Centrelink "rate" of payments made to carers. The claimant says that neither she, nor her sister Concepcion are in receipt of Centrelink payments which suggests Concepcion is not being paid the Australian Carer Payment. My understanding from years of assessing personal injury claims is that the Carer Payment is paid to a person providing constant daily care to another person and is, essentially, the equivalent of a full-time job. According to the Services Australia website, as of March 2026, this payment is paid at the rate of $1,115.30 for single persons per fortnight or $557.65 per week. This is the equivalent of about $14 - $16 per hour (based on a 35 - 40 hour working week). While Concepcion's role as the claimant's carer may be more aligned with the Centrelink concept of a carer, neither party has provided submissions on this point so I do not propose to consider this rate of pay further.

Should Concepcion be paid at the market rate for domestic services?

1. If the market rate for domestic services is, in the absence of any other evidence, that paid by NDIS ($50 - $58), should that be that the basis for the rate to be paid by the Authority to Concepcion?
2. Concepcion has, since about a year after the accident, contracted with her sister to provide Miss Villanueva with care which she has been providing at the rate of $12.50 per hour, then $25 per hour and now $35 per hour. This rate of payment was at all times an amount well below the hourly rate Concepcion was earning as a registered nurse in 2019. Concepcion has been, according to her evidence and the claimant's evidence, providing 22 - 23 hours of care per week and has been doing so since 2019. While she has asked for an increase in the hourly rate, she has continued to work for a lesser sum. I do not accept the claimant's submission that if Concepcion is not paid a higher rate she will, particularly at the age of 79, return to nursing in a hospital or other place of employment. The evidence supports a finding that Concepcion has at all times accepted what NRMA, and now the Authority, is prepared to pay her to fill the role as the claimant's full-time care provider.
3. The previous arrangements in place for the payment of care involved the claimant borrowing money from one sister to pay for the care provided by another sister and then the repayment of the first sister's "loan" when NRMA paid the claimant. The current arrangement involves the Authority paying Concepcion direct. However, the financial arrangements between the sisters are no less unorthodox.
4. The family of up to four sisters is living in a new house which the claimant says was built on land the claimant has owned for many years. While the claimant told me at the last preliminary conference that she paid for the house to be built, she has corrected that evidence and now says that the "family" paid for the house to be built. The claimant has not corrected the evidence that she is the registered owner of the house and land upon which it is built. The claimant says she pays for all rates, utilities (electricity, water and gas) and maintenance of the house. Two of the claimant's sisters live rent free in this house and do not contribute to its running costs but provide no care and assistance to Miss Villanueva. The one sister who is providing all the care and assistance is the only sister paying rent to live there. When explaining why Concepcion pays rent, the claimant said this was because she did not contribute as much to the cost of the house.
5. While there is no evidence before me about the cost to rent a room in a five-bedroom brand new home in Westmead, the sum of $75 per week the claimant says Concepcion pays her to rent a room in the house, seems as a matter of common sense to be well under a realistic market rental rate. I note also that the claimant pays all the outgoings including electricity, gas, water and rates and pays for maintenance of the house. Concepcion obviously pays for her own personal expenses and pays for her own share of the food that she buys and cooks for herself and the claimant but presumably has access to the appliances and so on in the kitchen to cook her own food and presumably other appliances in the home (washing machine, dryer, vacuum cleaner and so on).
6. Concepcion is a carer providing contracted services to her sister. She is living under the same roof as her 'client' and is not required to travel in order to provide services to her 'client'. This absence of travel is clearly a benefit to her. She has some benefits associated in living in the same accommodation as her 'client' including the provision of all utilities (electricity, gas and water), the use of appliances and so on and she has the company of her family. According to the claimant's evidence, she may also have the benefit, on occasions of her other sisters providing her with meals.
7. In my view this arrangement alone supports a finding that Concepcion should not be paid at the market or commercial rate to provide care for her sister. In the absence of further evidence as to the financial contribution made by the claimant and her sisters to the building of the house, Concepcion appears to be provided with subsidised accommodation at below a market or commercial rent in order for her to be available to provide care to her sister.

What is a reasonable rate for Concepcion to be paid?

1. The Authority concedes the claimant's need for care and that she is entitled to have that care paid for. The claimant does not want a stranger providing that care but wants her sister to provide that care and the Authority has been paying Concepcion on that basis. There is a degree of give and take required by both parties when considering the cost of this care. The Authority is likely to be paying less than the market rate when paying the claimant's sister, and the claimant is obtaining care from someone she knows and trusts.
2. If Miss Villanueva had been injured in a car accident before 1 December 2017, she would have been entitled to damages under the MAC Act which would include compensation for care provided commercially or gratuitously:

(a) in accordance with the common law, if she had been paying for commercial care, she would have been entitled in a MAC Act damages claim to a lump sum to compensate her for past and future commercial care provided and to be provided based on the evidence as to what commercial care would have cost. She would have then been able to engage her own carer and negotiate a pay rate she could afford based on the investment of the lump sum she was awarded for the commercial care, and

(b) in accordance with s 141B of the MAC Act if she had not been paying for commercial care, she would have been entitled to a lump sum in damages for any gratuitous domestic assistance being provided to her or to be provided[13]. Because care on this basis is provided gratuitously, the legislation prescribes the rate of the cost of that care and a mechanism to adjust the cost of care over time. An injured person is not obliged to repay the gratuitous care giver any amount from the damages awarded.

1. Had Miss Villanueva been injured in an accident resulting in a successful claim under the Civil Liability Act 2002 she would also have been entitled to a lump sum for commercial and, or gratuitous care provided or to be provided to her.
2. However Miss Villanueva was injured in a motor accident and as her accident occurred on or after 1 December 2017, the MAI Act applies and no damages can be awarded for any form of care and assistance provided to injured persons because care and assistance is part of the statutory benefits claim[14]. Care provided gratuitously by family and friends[15] is not payable as part of the statutory benefits claim.
3. The rate for gratuitous domestic assistance payable in some types of damages claims in this state provided guidance to me in the previous decision when determining how much Concepcion should be paid. The rate for gratuitous domestic assistance continues to provide guidance to me in these proceedings.
4. Miss Villanueva says the hourly rate set for gratuitous domestic assistance was $35.00 in 1977 and makes various submissions about the change in rates since then, the effect of inflation and the buying power of $35 back in 1977. The legislation the claimant quotes in her submissions was not in effect in 1977. The MAC Act was passed by the New South Wales government in July 1999 and applies to accidents occurring on or after 1 October 1999.
5. The hourly rate for gratuitous care under the MAC Act was not set at $35 in 1977 or 1999. The hourly rate for gratuitous care was set at one fortieth of the average weekly earnings of all persons in New South Wales and is revised every quarter based on the estimate of the Australian Statistician. The hourly rate paid by insurers back in 1999 was based on the average weekly earnings of employees in 1999.
6. At the time of my previous decision in 2024, the hourly rate set by the Australian Statistician was close to $35, it has now increased to almost $40 per hour.
7. The claimant has submitted that there has been a reduction in the buying power of $35 which justifies an increase in the hourly rate. While I accept there has been an increase in the cost of living since the time of Miss Villanueva's accident and more recently and a reduction in the buying power of $35 in the last two years, this is ameliorated by the increase in the average weekly earnings set by the Australian Statistician and the adjustment over time of the hourly rate.

1. The Review Panel has determined that eight hours of attendant care services to Miss Villanueva is related to the injuries sustained in the accident and is reasonable and necessary in the circumstances.
2. In my view the rate for gratuitous care payable under common law compensation schemes in this state is a reasonable rate for the Authority to pay for the cost of attendant care services currently being provided by Concepcion Villanueva to her sister Mauricia Villanueva.
3. I note that this rate is recalculated every six months and the hourly rate has increased from $36.24 in November 2023 to $39.82 in May 2025. The payments to Concepcion should reflect this adjustment and should be recalculated.
4. I therefore remit the insurer's decision about the cost of care to the Authority to be remade in accordance with the following directions:

(a) for the care provided from 7 to 18 November 2023 that care should be paid at the rate of $36.24 per hour;

(b) for care provided from 19 November 2023 to 17 May 2024 that care should be paid at the rate of $37.62 per hour;

(c) for care provided from 18 May 2024 to 15 November 2024 that care should be provided at the rate of $38.65 per hour, and

(d) for care provided from 16 November 2024 to 21 March 2025 that care should be paid at $39.82 per hour.

1. It is likely there is a different rate for care provided from March 2025 to November 2025 and a current rate applicable for care provided from November 2025 to May 2026. I note that the dispute between the parties referred for Merit Review concerned care provided up to 21 March 2025 only (see paragraph 9 above). In order to avoid any future disputes about the cost of care, I would recommend the Authority align the rate paid to Concepcion to the rate applicable under the MAC Act or Civil Liability Act as varied from time to time and adjust what Concepcion is to be paid accordingly in the future.

[1] The Medical Review Panel's decision was published as Villanueva v Insurance Australia Limited t/as NRMA Insurance [2024] NSWPICMP 59.

[2] The merit review matter was decided by me and is published as Villanueva v Insurance Australia limited t/as NRMA Insurance [2024] NSWPICMR 7.

[3] The Medical Review Panel's decision was published as Villanueva v Lifetime Care and Support Authority of New South Wales [2025] NSWPICMP 855.

[4] The "relevant insurer" is determined in accordance with s 3.2 of the MAI Act.

[5] At page 71 of the claimant's initial 80 page bundle

[6] Page 74 of 80 in the claimant's bundle.

[7] Furzer Crestani are a firm of accountants who provide expert opinion in personal injury cases and publish resources which assist legal practitioners and members of the public in the calculation of losses.

[8] See for example s 141B(5) of the MAC Act 1999.

[9] Public Health System Nurses' and Midwives' State Award 2023.

[10] https://www.ndis.gov.au/participants/working-providers/providers-and-pricing

[11] Page 44 of the 2025-2026 pricing document.

[12] Page 47 of the 2025-2026 pricing document.

[13] Subject to the six hours per week for six months threshold.

[14] Section 4.5 of the MAI Act limits the types of economic loss that can be compensated to loss of earnings or earning capacity, cost of accommodation and transport, funds management and income tax on weekly earnings.