This Regulation operationalises the Motor Accident Injuries Act 2017 by prescribing detailed rules—who and which vehicles are covered, what counts as a threshold injury, insurer notice and registration‑suspension procedures, review and payment timeframes, capped legal and medico‑legal fees with CPI indexing, and administrative and disclosure duties.
It directly affects claimants, insurers, legal and medical practitioners, and scheme bodies: it determines who pays what and when, limits recoverable costs, shapes settlement and litigation incentives, and creates compliance and reporting obligations that support scheme oversight.
The Motor Accident Injuries Regulation 2017 (the Regulation) operationalises the Motor Accident Injuries Act 2017 (the Act) by supplying prescriptive machinery for the NSW motor accidents scheme. At its core it performs four functions: (1) prescribing classes of vehicles and circumstances for compulsory third-party (CTP) insurance cover; (2) regulating the quantum, timing and cessation of statutory benefits (weekly payments, treatment and care); (3) imposing strict caps on legal costs, medico-legal fees and disbursements through Schedules 1 and 2; and (4) streamlining dispute resolution pathways while carving out exemptions.
Clause 4 is foundational. It expands the statutory definition of “threshold injury” in s 1.6(4) of the Act to include an injury to a spinal nerve root manifesting in neurological signs (other than radiculopathy) and expressly lists acute stress disorder and adjustment disorder (both defined by reference to DSM-5). The practical effect is that claimants suffering only these injuries face the 26-week cut-off on statutory benefits under ss 3.11 and 3.28 unless the accident was caused wholly or mostly by the fault of another person. The clause has been amended twice since commencement (2017 (639) and 2022 No 78) to refine the psychiatric taxonomy and exclude radiculopathy from the soft-tissue deeming rule.
Part 2 (cll 5–6) prescribes the classes of motor vehicles taken to be subject to an unregistered vehicle permit for CTP purposes. Clause 5(1) lists ten categories ranging from agricultural plant and snow vehicles in Kosciuszko National Park through to chargeable heavy vehicles fully exempt from registration charges. Subclause (2) imposes a dual test referencing the Commonwealth Road Vehicle Standards Act 2018 and the repealed Motor Vehicle Standards Act 1989. Clause 6 sets out the procedural safeguards an insurer must follow before requesting TfNSW to suspend or cancel registration for non-payment: 14 days’ written notice containing nine specified items of information.
Current sections
Direct links to the current provisions in Motor Accident Injuries Regulation 2017.
The Act and the Interpretation Act 1987 contain definitions and other provisions that affect the interpretation and application of this Regulation.
(2) Notes included in this Regulation do not form part of this Regulation.
cl 3: Am 2017 (639), Sch 1 [1].
4
Meaning of “threshold injury”, section 1.6(4) of the Act
4 Meaning of “threshold injury”, section 1.6(4) of the Act
4 Meaning of “threshold injury”, section 1.6(4) of the Act
(1) An injury to a spinal nerve root that manifests in neurological signs (other than radiculopathy) is included as a soft tissue injury for the purposes of the Act.
(2) Each of the following injuries is included as a threshold injury for the purposes of the Act—
(a) acute stress disorder,
(b) adjustment disorder.
Note.
See section 1.6 (5) of the Act in relation to the making of Motor Accident Guidelines for or with respect to the assessment of whether an injury is a threshold injury.
(3) In this clause acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in May 2013.
cl 4: Rep 2017 (639), Sch 1 [3]. Ins 2017 (639), Sch 1 [2]. Am 2022 No 78, Sch 2[1]–[3].
Part 2
Third-party insurance
Part 2 Third-party insurance
Part 2 Third-party insurance
pt 2: Subst 2017 (639), Sch 1 [3].
5
Motor vehicles subject to unregistered vehicle permits (section 2.4 (1) (c))
5 Motor vehicles subject to unregistered vehicle permits (section 2.4 (1) (c))
5 Motor vehicles subject to unregistered vehicle permits (section 2.4 (1) (c))
(1) For the purposes of section 2.4 of the Act, the following classes of motor vehicles are prescribed as classes of motor vehicles that are taken, for the purposes of a third-party policy under the Act, to be subject to an unregistered vehicle permit and not to conditional registration—
(a) motor vehicles that comply with subclause (2) and that—
(i) are used to perform agricultural tasks (for example, tractors and harvesters), or
(ii) are designed for use solely over snow and are located within the boundaries of Kosciuszko National Park,
(b) motor vehicles that were manufactured 30 or more years ago and are used on a road solely in the course of, or as an incident to, an activity of an organisation that is identified in the records of TfNSW as a historic vehicle club,
(c) motor vehicles that weigh more than 250 kilograms when unladen and are designed or used solely for cutting grass or for purposes incidental to cutting grass,
(d) motor vehicles that are used solely for the purposes of road construction, maintenance or repair and are not used on a road otherwise than while at, or proceeding to or returning from, the place where the road construction, maintenance or repair is carried out,
(e) motor vehicles that are subject to conditional registration under the Road Transport Act 2013 on the basis that they are—
(i) classified by TfNSW as earthwork plant or industrial plant, or
(ii) used solely on Stockton Beach for recreation purposes,
(f) motor vehicles that are motorised buggies or carts and are designed and used for the purpose of—
(i) carrying golfers, spectators or golfing equipment on a golf course, or
(ii) carrying persons in a holiday resort or retirement village or the like,
(g) motor vehicles that are designed or used solely for the conveyance of a person with a disability that substantially impairs the person’s mobility and that are capable of travelling at more than 10 kilometres per hour,
(j) a motor vehicle that has been granted full exemption from motor vehicle tax within the meaning of the Motor Vehicles Taxation Act 1988.
(2) A motor vehicle complies with this subclause if—
(a) the vehicle is not required to be entered on the RAV by the Road Vehicle Standards Act 2018 of the Commonwealth or rules made under that Act, and
(b) if applicable—approval for the placement of identification plates was not given in relation to the vehicle under the Motor Vehicle Standards Act 1989 of the Commonwealth, section 10A, as in force from time to time before its repeal.
(3) In this clause—
RAV means the Register of Approved Vehicles kept under the Road Vehicle Standards Act 2018 of the Commonwealth, section 14(1).
cl 5: Subst 2017 (639), Sch 1 [3]. Am 2020 No 30, Sch 4.47; 2021 No 22, Sch 5.3[1] [2].
6
Cancellation of third-party policies—request for suspension or cancellation of motor vehicle registration (section 2.8 (6) and (9))
6 Cancellation of third-party policies—request for suspension or cancellation of motor vehicle registration (section 2.8 (6) and (9))
6 Cancellation of third-party policies—request for suspension or cancellation of motor vehicle registration (section 2.8 (6) and (9))
(1) A licensed insurer may request TfNSW under section 2.8 of the Act to suspend or cancel the registration of a motor vehicle to which a third-party policy relates if the requirements of this clause relating to notification of the request are complied with.
(2) The notification required to be given of the licensed insurer’s intention to request the suspension must be given to the owner of the motor vehicle at least 14 days before the request is made.
(3) The notification must specify the following—
(a) the registration number of the motor vehicle,
(b) the policy number for the third-party policy,
(c) the grounds on which the licensed insurer intends to request the suspension,
(d) the amount outstanding in respect of the third-party policy,
(e) the date of commencement, and the date of expiration, of the proposed suspension period,
(f) the manner in which the outstanding amount may be paid,
(g) the time within which the outstanding amount must be paid,
(h) any penalties that may be imposed in relation to driving an unregistered motor vehicle,
(i) contact details for inquiries in relation to the payment or proposed suspension.
cl 6: Ins 2017 (639), Sch 1 [3]. Am 2020 No 30, Sch 4.47.
For the purposes of Division 3.3 of the Act, the minimum weekly statutory benefits amount is the amount that is 2.5% of the maximum weekly statutory benefits amount.
pt 3 (cll 7, 8): Ins 2017 (639), Sch 1 [3].
8
Application of provisions of Civil Liability Act 2002 relating to mental harm (section 3.39)
8 Application of provisions of Civil Liability Act 2002 relating to mental harm (section 3.39)
(1) The application of Part 3 (Mental harm) of the Civil Liability Act 2002 to the payment of statutory benefits under Part 3 of the Act in connection with an injury is subject to the modification set out in this clause.
(2) The requirement in section 30 (3) of the Civil Liability Act 2002 (to reduce damages awarded to the plaintiff for pure mental harm in the same proportion as any reduction in the damages that may be recovered from the defendant by or through the victim on the basis of the contributory negligence of the victim) is to be read as a requirement to apply the at-fault statutory benefits limitations to the payment of statutory benefits to the claimant in the same way as they apply to the payment of statutory benefits to the victim.
(3) The at-fault statutory benefits limitations are the provisions of Part 3 of the Act that provide for the reduction of, or cessation of entitlement to, weekly payments of statutory benefits to injured persons wholly or mostly at fault in the motor accident from which the injury resulted.
(4) Words and expressions used in subclause (2) have the same meaning as they have in section 30 of the Civil Liability Act 2002.
pt 3 (cll 7, 8): Ins 2017 (639), Sch 1 [3].
8A
Time for making claims (section 6.13(2))
8A Time for making claims (section 6.13(2))
8A Time for making claims (section 6.13(2))
(1) For the Act, section 6.13(2), payment of weekly payments of statutory benefits for a period before a claim is made is permitted if—
(a) the claim is made within 3 months after the date of the motor accident to which the claim relates, and
(b) the claimant provides a full and satisfactory explanation for the delay in making the claim.
(2) The matters that must be taken into account in determining whether the claimant has a full and satisfactory explanation for the delay in making the claim include, but are not limited to, whether, before the expiry of the period of 28 days for making the claim—
(a) the claimant was aware of the right to make the claim, or
(b) the claimant was a person under a legal incapacity, or
(c) the claimant was prevented from making the claim before the expiry of that period because of illness or injury.
(3) An explanation for the delay in making a claim is taken to be a full and satisfactory explanation for the purposes of subclause (1)(b) if the insurer has not rejected the explanation within 14 days after receiving the explanation.
(4) This clause does not apply to a motor accident occurring before 1 April 2023.
cl 8A: Ins 2023 (105), Sch 1[1].
Part 4
Award of damages
Part 4 Award of damages
Part 4 Award of damages
pt 4 (cl 9): Ins 2017 (639), Sch 1 [3].
9
Accommodation or travel for which damages may be awarded (section 4.5)
9 Accommodation or travel for which damages may be awarded (section 4.5)
9 Accommodation or travel for which damages may be awarded (section 4.5)
The kind of accommodation or travel for which damages may be awarded (subject to Division 4.2 of the Act) is any accommodation or travel for which the claimant has incurred, or is likely to incur, a cost as a result of the injury caused by the motor accident.
pt 4 (cl 9): Ins 2017 (639), Sch 1 [3].
Part 5
Dispute resolution
Part 5 Dispute resolution
Part 5 Dispute resolution
pt 5: Ins 2017 (639), Sch 1 [3].
Division 1
Internal review
Division 1 Internal review
Division 1 Internal review
10
Merit review decisions for which internal review not required (section 7.11 (3))
10 Merit review decisions for which internal review not required (section 7.11 (3))
10 Merit review decisions for which internal review not required (section 7.11 (3))
Section 7.11 (Internal review required before making merit review application) of the Act does not apply to a reviewable decision about any of the following merit review matters—
(a) whether for the purposes of section 6.24 (Duty of claimant to co-operate with other party) of the Act a request made of the claimant is reasonable or whether the claimant has a reasonable excuse for failing to comply,
(b) whether the claimant has provided the insurer with all relevant particulars about a claim in accordance with section 6.25 (Duty of claimant to provide relevant particulars of claim for damages) of the Act,
(c) whether the insurer is entitled to give a direction to the claimant under section 6.26 (Consequences of failure to provide relevant particulars of claim for damages) of the Act,
(d) whether for the purposes of section 8.10 (Recovery of costs and expenses in relation to claims for statutory benefits) of the Act the costs and expenses incurred by the claimant are reasonable and necessary.
cll 10–14: Ins 2017 (639), Sch 1 [3].
11
Miscellaneous dispute decisions for which internal review not required (section 7.41 (3))
11 Miscellaneous dispute decisions for which internal review not required (section 7.41 (3))
11 Miscellaneous dispute decisions for which internal review not required (section 7.41 (3))
Section 7.41 (Internal review required before miscellaneous claims assessment) of the Act does not apply to a dispute about which insurer is the insurer of the at-fault motor vehicle for the purposes of section 3.3 of the Act (Determination of relevant insurer).
cll 10–14: Ins 2017 (639), Sch 1 [3].
Division 2
Merit review
Division 2 Merit review
Division 2 Merit review
12
Insurer to notify claimant of review rights (section 7.16 (a))
12 Insurer to notify claimant of review rights (section 7.16 (a))
12 Insurer to notify claimant of review rights (section 7.16 (a))
(1) The insurer must notify a claimant in writing of any right of the claimant to request an internal review or apply for a merit review in relation to a decision of the insurer.
Maximum penalty—5 penalty units.
(2) The notification must be given when the insurer notifies the claimant of the decision to which the right to request the internal review or to apply for the merit review applies.
(3) This clause extends to any decision of the insurer in relation to which a merit review application may be made only after the decision has been the subject of an internal review.
cll 10–14: Ins 2017 (639), Sch 1 [3].
Division 3
Medical assessment
Division 3 Medical assessment
Division 3 Medical assessment
13
Grounds for further medical assessment (section 7.24 (2))
13 Grounds for further medical assessment (section 7.24 (2))
13 Grounds for further medical assessment (section 7.24 (2))
(1) A medical dispute may be referred again for assessment under Division 7.5 of the Act on the grounds of deterioration of the injury or additional relevant information about the injury.
(2) A matter may not be referred again for assessment by a party to the medical dispute on the grounds of deterioration of the injury or additional relevant information about the injury unless the deterioration or additional information is such as to be capable of having a material effect on the outcome of the previous assessment.
cll 10–14: Ins 2017 (639), Sch 1 [3].
Division 4
Claims assessment
Division 4 Claims assessment
Division 4 Claims assessment
14
Claims exempt from assessment (section 7.34 (1) (a))
14 Claims exempt from assessment (section 7.34 (1) (a))
14 Claims exempt from assessment (section 7.34 (1) (a))
The following kinds of claims are exempt from assessment under Division 7.6 of the Act—
(a) a claim in respect of which the claimant is a person under legal incapacity,
(c) a claim made against a person other than an insurer,
(d) a claim in connection with which the insurer has, by notice in writing to the claimant, alleged that the claimant has engaged in conduct in contravention of section 6.41 (Fraud on motor accidents injuries scheme) of the Act,
(e) a claim in respect of which the insurer has, by notice in writing to the claimant and to the owner or driver of the motor vehicle to which a third-party policy relates, declined to indemnify the owner or driver under the third-party policy.
cll 10–14: Ins 2017 (639), Sch 1 [3].
15
Notification of acceptance or rejection of assessed damages
15 Notification of acceptance or rejection of assessed damages
15 Notification of acceptance or rejection of assessed damages
(1) A claimant is to give to the insurer written notice of the claimant’s acceptance or rejection of any amount of damages assessed under Division 7.6 of the Act in relation to the claim.
(2) The insurer is to give to the claimant and the Commission written notice of any rejection by the insurer, or any mutual acceptance by the insurer and the claimant, of an amount of damages assessed under Division 7.6 of the Act in relation to a claim.
(3) For the purposes of this Division, the assessment acceptance day is the earlier of the following days—
(a) the day on which the insurer receives a notice under this clause of the claimant’s acceptance of an amount of damages,
(b) the day that is 21 days after the certificate of assessment is issued to the insurer.
cl 15: Ins 2017 (639), Sch 1 [3]. Am 2020 (744), Sch 1.2[1].
16
Time for payment of assessed damages (section 7.38 (3))
16 Time for payment of assessed damages (section 7.38 (3))
16 Time for payment of assessed damages (section 7.38 (3))
(1) The amount of damages and costs payable by an insurer in respect of a claim for damages assessed under Division 7.6 of the Act must be paid within 28 days after the assessment acceptance day, except as otherwise provided by this clause.
(2) The insurer must give notification in accordance with this clause of any deduction that the insurer is required by law to make from the assessed amount of damages.
(3) Notification of a deduction relating to a claim—
(a) is to be given to the person to whom the deduction is payable, and
(b) is to include a request for advice as to the amount of the deduction that is required, and
(c) is to be given within 14 days after the assessment acceptance day.
(4) The insurer must pay the balance of the assessed amount of damages to the claimant within 28 days after all advice requested under this clause in relation to deductions for a claim has been received by the insurer.
(5) Interest is payable by the insurer on so much of the assessed amount of damages as remains unpaid after the end of the relevant period for payment of the assessed amount of damages. The rate of any such interest is 75% of the rate prescribed for the purposes of section 101 of the Civil Procedure Act 2005 for the period concerned.
cl 16: Ins 2017 (639), Sch 1 [3].
Division 5
Miscellaneous claims assessments
Division 5 Miscellaneous claims assessments
Division 5 Miscellaneous claims assessments
17
Application of claims assessment provisions (section 7.42 (2))
17 Application of claims assessment provisions (section 7.42 (2))
17 Application of claims assessment provisions (section 7.42 (2))
The application of Subdivision 2 of Division 7.6 of the Act to the assessment of a dispute between a claimant and an insurer about a miscellaneous claims assessment matter is subject to the following modifications—
(a) the Subdivision is to be read as if sections 7.33–7.35, 7.36 (3) and 7.38 (2)–(4) were omitted,
(b) the requirement in section 7.36 (1) (a) to make an assessment of the issue of liability for the claim and the amount of damages for that liability is to be read as a requirement to make an assessment of the issues in dispute,
(c) the reference in section 7.38 (1) to an assessment of the issue of liability for a claim not being binding is to be read as a reference to—
(i) an assessment of a dispute about a miscellaneous claims assessment matter relating to a claim for statutory benefits being binding, subject to section 3.44 (Statutory benefits determinations relating to fault etc not binding in relation to common law claims), and
(ii) an assessment of a dispute about a miscellaneous claims assessment matter relating to a claim for damages not being binding.
cl 17: Ins 2017 (639), Sch 1 [3].
Division 6
Miscellaneous
Division 6 Miscellaneous
Division 6 Miscellaneous
18
Medical matters subject to evidence restriction (section 7.52 (4))
18 Medical matters subject to evidence restriction (section 7.52 (4))
18 Medical matters subject to evidence restriction (section 7.52 (4))
For the purposes of paragraph (b) of the definition of medical matter in section 7.52 (4) of the Act, the following medical assessment matters are prescribed as medical matters in relation to which evidence given by a health practitioner is not admissible—
(a) whether any treatment and care provided to an injured person is reasonable and necessary in the circumstances or relates to an injury caused by a motor accident for the purposes of section 3.24 (Entitlement to statutory benefits for treatment and care) of the Act,
(b) whether for the purposes of section 3.28 (Cessation of statutory benefits after 26 weeks to injured adult persons most at fault or to injured persons with threshold injuries) of the Act treatment or care provided to an injured person will improve the recovery of the injured person,
(c) the degree of impairment of the earning capacity of an injured person that has resulted from an injury caused by a motor accident,
(d) whether an injury is a threshold injury for the purposes of the Act.
cl 18: Ins 2017 (639), Sch 1 [3]. Am 2022 No 78, Sch 2[4] [5].
Part 6
Costs
Part 6 Costs
Part 6 Costs
pt 6: Ins 2017 (639), Sch 1 [3].
19
Definition
19 Definition
19 Definition
In this Part and in Schedule 2—
health practitioner has the same meaning as in the Health Practitioner Regulation National Law.
cl 19: Ins 2017 (639), Sch 1 [3].
20
Costs not regulated by this Part
20 Costs not regulated by this Part
20 Costs not regulated by this Part
Costs referred to in this Part (Division 4 excepted) do not include any of the following—
(a) fees for accident investigators’ reports or accident reconstruction reports,
(b) fees for accountants’ reports,
(c) fees for reports from health practitioners (other than medical practitioners),
(d) fees for other professional reports relating to treatment or rehabilitation (for example, architects’ reports concerning house modifications),
(e) fees for clinical records of treating health practitioners (including medical practitioners),
(j) travel costs and expenses of the claimant for attendance at the Commission or a court,
(k) witness expenses at the Commission or a court.
cl 20: Ins 2017 (639), Sch 1 [3]. Am 2020 (744), Sch 1.2[1].
21
Application of Division
21 Application of Division
21 Application of Division
This Division applies to the following costs payable on a party and party basis, on a practitioner and client basis or on any other basis—
(a) legal costs,
(b) costs for matters that are not legal services but are related to proceedings in a motor accidents matter.
Note.
Section 8.1 (2) of the Act provides that expressions in Part 8 (Costs and fees) of that Act (and consequently expressions used in this Part) have the same meaning when used in relation to legal costs in the legal profession legislation (as defined in section 3A of the Legal Profession Uniform Law Application Act 2014) except where otherwise provided in that Part.
cl 21: Ins 2017 (639), Sch 1 [3].
22
Fixing of maximum costs recoverable by legal practitioners (sections 8.3 and 8.10)
22 Fixing of maximum costs recoverable by legal practitioners (sections 8.3 and 8.10)
22 Fixing of maximum costs recoverable by legal practitioners (sections 8.3 and 8.10)
(1) Except as otherwise provided by this Part, the costs set out in Schedule 1 are the maximum costs recoverable by Australian legal practitioners and claimants for—
(a) legal services provided by an Australian legal practitioner to a claimant or to an insurer in a motor accidents matter, and
(b) matters that are not legal services but are related to a motor accidents matter.
(2) If there is a change in the Australian legal practitioner retained by a claimant or insurer in a motor accidents matter, the relevant costs are to be apportioned between the Australian legal practitioners concerned.
(3) If there is a dispute as to such an apportionment, either Australian legal practitioner concerned (or the client claimant or insurer concerned) may refer the dispute to the President for determination (unless the dispute arose in a matter involving a claim for damages that is exempt from assessment under section 7.34 of the Act).
(4) The President is to arrange for a dispute referred under this section to be dealt with by—
(a) if the dispute arose in a matter involving a claim for statutory benefits—a merit reviewer, or
(b) if the dispute arose in a matter involving a claim for damages—a member of the Commission assigned to the Motor Accidents Division of the Commission.
(5) An Australian legal practitioner has the same right of appeal against a determination made under subclause (3) as the practitioner would have under section 205 of the Legal Profession Uniform Law (NSW) if the determination were a determination of a costs assessor under Division 7 of Part 4.3 of that Law.
cl 22: Ins 2017 (639), Sch 1 [3]. Am 2020 (744), Sch 1.2[2]–[4]; 2022 No 25, Sch 1.3.
23
Costs not payable for internal review (section 8.3 (1) (c))
23 Costs not payable for internal review (section 8.3 (1) (c))
23 Costs not payable for internal review (section 8.3 (1) (c))
It is declared that no costs are payable for legal services provided to a claimant or to an insurer in connection with an application for internal review by the insurer under Part 7 of the Act.
cl 23: Ins 2017 (639), Sch 1 [3].
23A
Certain costs not payable for compensation matter applications (section 8.3(1)(c))
23A Certain costs not payable for compensation matter applications (section 8.3(1)(c))
23A Certain costs not payable for compensation matter applications (section 8.3(1)(c))
It is declared that no costs are payable for legal services in relation to a compensation matter application concerning a claim for damages, within the meaning of section 26 of the Personal Injury Commission Act 2020, to the extent that the costs are payable on a practitioner and client basis.
cl 23A: Ins 2020 (744), Sch 1.2[5].
24
Excluded matters (section 8.11)
24 Excluded matters (section 8.11)
24 Excluded matters (section 8.11)
(1) The maximum costs set out in Schedule 1 do not apply in respect of a legal service or other matter provided to a claimant or an insurer in a motor accidents matter involving a claim that is exempt from assessment under section 7.34 (Claims exempt from assessment) of the Act.
(2) An exclusion under subclause (1) extends to any costs incurred before the matter became exempt.
(3) The provisions of Part 8 of the Act do not apply to a legal service provided to a claimant by the Authority through the advisory service established under section 7.49 (Advisory service) of the Act.
cll 24: Ins 2017 (639), Sch 1 [3].
25
Maximum costs for matters subject to costs agreement
25 Maximum costs for matters subject to costs agreement
25 Maximum costs for matters subject to costs agreement
(1) Schedule 1 does not apply to costs in a motor accidents matter to the extent that the costs are payable on a practitioner and client basis if—
(a) an Australian legal practitioner makes a disclosure under Division 3 of Part 4.3 of the Legal Profession Uniform Law (NSW) to a party to the matter with respect to the costs, and
(b) the practitioner enters into a costs agreement (other than a conditional costs agreement, within the meaning of that Part, that provides for the payment of a premium on the successful outcome of the matter concerned) with that party as to those costs in accordance with Division 4 of that Part, and
(c) the practitioner, before entering into the costs agreement, advises the party (in a separate written document) that, even if costs are awarded in favour of the party, the party will be liable to pay such amount of the costs provided for in the costs agreement as exceeds the amount that would be payable under the Act in the absence of a costs agreement, and
(d) the practitioner (but only if the party is a claimant) provides to the Authority, in the manner and time approved by the Authority, a costs breakdown in relation to the claim when the claim is finalised, and
(e) the amount paid in resolution of the claim by way of settlement or an award of damages is more than $75,000.
(2) However, the maximum costs recoverable in any such matter on a practitioner and client basis are fixed at the amount calculated by subtracting $75,000 from the amount paid in resolution of the claim.
(3) The amount paid in resolution of a claim includes any amount payable in connection with the claim on a party and party basis.
(4) The maximum costs specified in subclause (2) are inclusive of all legal services provided in the course of the claim during the period commencing on the acceptance of the retainer and ending on the resolution of the claim.
(5) This clause does not apply to a motor accidents matter involving a claim for statutory benefits.
cll 25: Ins 2017 (639), Sch 1 [3].
26
Maximum costs for claims made by minors (section 8.3 (1))
26 Maximum costs for claims made by minors (section 8.3 (1))
26 Maximum costs for claims made by minors (section 8.3 (1))
(1) The maximum costs for legal services provided to a claimant in connection with an exempt minor claim are (unless otherwise ordered by the court) as follows—
(a) except as provided by paragraph (b) or (c)—$5,000,
(b) if the amount paid in resolution of the claim is more than $25,000 (but not more than $50,000) and no associate of the claimant has made a claim in respect of the motor accident concerned—$10,000, or
(c) if the amount paid in resolution of the claim is more than $50,000 (but not more than $75,000) and no associate of the claimant has made a claim in respect of the motor accident concerned—$15,000.
(2) A claim is an exempt minor claim if a certificate has been issued under section 7.34 of the Act to the effect that the claim is exempt from assessment under Division 7.6 of the Act solely on the ground that the claimant is, on the date on which the certificate is issued, under the age of 18 years.
(3) A person is an associate of a claimant if—
(a) at the time of the accident to which the claim relates, the person was an occupant of the same motor vehicle as the claimant, and
(b) the person has retained to act on the person’s behalf in respect of any claim arising from the motor accident the same law practice as the claimant has retained in respect of the claimant’s claim.
(4) This clause does not apply to a claim if the amount paid in resolution of the claim is more than $75,000.
(5) The maximum costs specified in this clause are inclusive of all legal services provided in the course of the claim during the period commencing on the acceptance of the retainer and ending on the resolution of the claim.
(6) If there is a change in the Australian legal practitioner retained by a claimant or insurer in connection with a claim to which this clause applies, the relevant costs are to be apportioned between the Australian legal practitioners concerned.
(7) Any dispute as to such an apportionment may be determined by the court or referred by either Australian legal practitioner concerned (or the client or insurer concerned) to the Commission for determination.
(8) In this clause—
resolution means any final resolution of a claim, whether by way of settlement, an award of damages or otherwise.
cl 26: Ins 2017 (639), Sch 1 [3]. Am 2019 (49), Sch 2 [1]; 2020 (744), Sch 1.2[6].
27
Application of Division
27 Application of Division
27 Application of Division
This Division applies in respect of fees for the provision of medical reports, and appearances as witnesses, by health practitioners.
cll 27: Ins 2017 (639), Sch 1 [3].
28
Maximum fees recoverable by medical practitioner (section 8.4 (1))
28 Maximum fees recoverable by medical practitioner (section 8.4 (1))
28 Maximum fees recoverable by medical practitioner (section 8.4 (1))
(1) The maximum fees for providing a service specified in Schedule 2 in relation to any motor accident are the fees set out in that Schedule for that service, except as otherwise provided by this Part.
(2) A reference in that Schedule to a report means, if the Motor Accident Guidelines require medical reports to be in a particular form, a report in that form.
(3) A claimant may not claim an amount set out in item 5 or 6 (relating to reports by treating medical practitioners) of Schedule 2 in respect of an initial report by a treating medical practitioner unless the claimant has requested in writing that the insurer provide the report to the claimant and the insurer has failed to do so within a reasonable time.
cll 28: Ins 2017 (639), Sch 1 [3].
29
Assessment of costs to produce information (section 8.6(4))
29 Assessment of costs to produce information (section 8.6(4))
29 Assessment of costs to produce information (section 8.6(4))
The Commission may assess the reasonable costs in relation to the issuing of, or compliance with, a direction under section 49 of the Personal Injury Commission Act 2020.
Costs where claimant does not accept assessed amount of damages
30 Costs where claimant does not accept assessed amount of damages
30 Costs where claimant does not accept assessed amount of damages
(1) This clause applies to a claim for damages if—
(a) an assessment of the amount of damages for liability under the claim is made under Division 7.6 of the Act, and
(b) the claimant does not accept that amount of damages in settlement of the claim within 21 days after the certificate of assessment is issued.
(2) If the amount of court awarded damages in respect of the claim does not exceed the amount of damages specified in the certificate of assessment, the claimant is liable to pay the costs, not exceeding $25,000 (or such other amount as is determined by the Authority by order published in the Gazette), incurred by any party in respect of the claim.
(3) The insurer is liable to pay the costs incurred by any party in respect of the claim if the amount of court awarded damages—
(a) exceeds the amount of damages specified in the certificate of assessment by at least $2,000 or 20% (whichever is the greater), or
(b) exceeds the amount of damages specified in the certificate of assessment by at least $200,000.
(4) In any other case, the insurer and claimant are liable to pay their own costs incurred in respect of the claim.
(5) Subclauses (2)–(4) apply subject to any direction of a court as to costs.
(6) This clause does not apply to costs incurred in the matter before the certificate of assessment is issued.
(7) If court proceedings are adjourned under section 6.34 of the Act for further claims assessment because a party to the proceedings has adduced significant evidence in the proceedings that was available to the party at the time of the original claims assessment but was not made available to the Commission, the court—
(a) is to take the failure of the party to make that evidence available to the Commission into account, and
(b) may require the party to pay a greater share of the costs incurred after the initial certificate of assessment was issued and until a further certificate of assessment is issued in connection with the claim.
(8) In this section—
costs means costs payable on a party and party basis.
court awarded damages means all damages of any kind awarded by a court in respect of a claim (without the addition of interest) after taking into account any deduction or reduction in accordance with Part 4 of the Act.
cl 30: Ins 2017 (639), Sch 1 [3]. Am 2020 (744), Sch 1.2[8].
31
Costs where insurer does not accept assessed amount of damages
31 Costs where insurer does not accept assessed amount of damages
31 Costs where insurer does not accept assessed amount of damages
(1) This clause applies to a claim for damages if—
(a) an assessment of the amount of damages for liability under the claim is made under Division 7.6 of the Act, and
(b) the insurer does not admit liability under the claim within 21 days after the certificate of assessment is issued.
(2) Subject to any direction of a court as to costs, the insurer is liable to pay the costs of the claimant incurred in respect of the claim and the maximum costs set out in this Regulation do not apply in respect of those costs.
(3) This clause does not apply to costs incurred in the matter before the certificate of assessment is issued.
(4) In this clause—
costs of the claimant means the costs of the claimant payable on a party and party basis, including any court fees prescribed under section 8.7 of the Act.
cl 31: Ins 2017 (639), Sch 1 [3].
32
Non-attendance or cancellation of medical assessment (section 7.28 (1) and (3) (d))
32 Non-attendance or cancellation of medical assessment (section 7.28 (1) and (3) (d))
32 Non-attendance or cancellation of medical assessment (section 7.28 (1) and (3) (d))
(1) The Authority may recover from a claimant all or part of the costs reasonably incurred by the President as a consequence of the claimant—
(a) failing to attend an appointment scheduled by the President for a medical assessment of the claimant under Division 7.5 of the Act, or
(b) cancelling such an appointment within 72 hours of the scheduled time.
(2) The Authority may not recover the costs if the claimant has a reasonable excuse for the failure to attend or for the cancellation.
cl 32: Ins 2017 (639), Sch 1 [3]. Am 2020 (744), Sch 1.2[9].
33
Calculation of private motor vehicle travel expenses for attendance at medical or other assessment or examination (sections 6.27 (5) and 7.28 (5))
33 Calculation of private motor vehicle travel expenses for attendance at medical or other assessment or examination (sections 6.27 (5) and 7.28 (5))
33 Calculation of private motor vehicle travel expenses for attendance at medical or other assessment or examination (sections 6.27 (5) and 7.28 (5))
For the purposes of sections 6.27 (5) and 7.28 (5) of the Act, the cost of travel by a private motor vehicle for the purposes of either of the following is to be calculated at the rate of $0.66 per kilometre—
(a) attending a medical assessment under Division 7.5 of the Act,
(b) attending a medical or other health related examination, a rehabilitation assessment, an assessment to determine functional and vocational capacity or any other assessment under section 6.27 of the Act.
cll 33–35: Ins 2017 (639), Sch 1 [3].
34
Maximum amounts payable by insurer for treatment and care not provided at hospitals or provided at private hospitals (section 8.9)
34 Maximum amounts payable by insurer for treatment and care not provided at hospitals or provided at private hospitals (section 8.9)
34 Maximum amounts payable by insurer for treatment and care not provided at hospitals or provided at private hospitals (section 8.9)
(1) The maximum amount for which an insurer is liable in respect of any claim for fees payable for treatment and care to which section 8.9 of the Act applies is the amount listed, in respect of the treatment concerned, in the AMA List.
Note.
Section 8.9 of the Act does not apply to treatment and care that is provided at a hospital (whether to an in-patient or an out-patient) and for which any payment is required to be made to the hospital and not to the provider of the treatment. The section does apply to the fee payable to a private hospital for any treatment and care at the hospital.
(2) This clause applies only in relation to treatment and care—
(a) that is provided to an injured person by a health practitioner, and
(b) in respect of which a fee is specified in the AMA List.
(3) In this clause—
AMA List means the document called List of Medical Services and Fees published by the Australian Medical Association and dated 1 November 2017 as amended or replaced, from time to time, by a document that—
(a) has been published by the Australian Medical Association, as an amendment to, or replacement of, the AMA List, and
(b) has been recognised by the Authority, by notice published in the Gazette.
cll 33–35: Ins 2017 (639), Sch 1 [3].
35
GST may be added to costs
35 GST may be added to costs
35 GST may be added to costs
(1) Despite the other provisions of this Part, a cost fixed by this Part may be increased by the amount of any GST payable in respect of the service to which the cost relates, and the cost as so increased is taken to be the cost fixed by this Part.
(2) This clause does not permit an Australian legal practitioner or medical practitioner to charge or recover, in respect of GST payable in respect of a service, an amount that is greater than 10% of the maximum amount payable under this Part to the Australian legal practitioner or medical practitioner in respect of the legal or other service apart from this clause.
Service of documents generally (section 11.5 (1) (f))
36 Service of documents generally (section 11.5 (1) (f))
36 Service of documents generally (section 11.5 (1) (f))
(1) A document that is authorised or required by the Act or this Regulation to be served on any person may be served by—
(a) electronic transmission to a mobile phone number specified by the person for the service of documents of that kind, or
(b) electronic transmission through an approved online system that enables the electronic service of documents of that kind.
(2) A document is sufficiently served on a person in connection with a claim for statutory benefits made by the person if it is served on an Australian legal practitioner acting for the person in connection with the claim.
(3) A document is sufficiently served on a person under legal incapacity in connection with a claim made by the person if it is served on the person’s appointed legal representative.
(4) This clause authorises additional methods of service to those set out in section 11.5 of the Act.
(5) In this clause—
approved online system means an online system that is approved by—
(a) the Authority, or
(b) the Commission, or
(c) the Commission rules.
cl 36: Ins 2017 (639), Sch 1 [3]. Am 2020 (744), Sch 1.2[10] [11].
37
Service of documents on Authority (section 11.6 (1) (d))
37 Service of documents on Authority (section 11.6 (1) (d))
37 Service of documents on Authority (section 11.6 (1) (d))
(1) A document may be served on the Authority by electronic transmission through an online system approved by the Authority for the purpose of enabling documents of that kind to be served in electronic form.
(2) This clause authorises an additional method of service to the methods of service set out in section 11.6 of the Act.
cl 37: Ins 2017 (639), Sch 1 [3].
38
Service of documents on Nominal Defendant (section 11.7 (1) (c))
38 Service of documents on Nominal Defendant (section 11.7 (1) (c))
38 Service of documents on Nominal Defendant (section 11.7 (1) (c))
(1) A document may be served on the Nominal Defendant by email to an email address specified by the Nominal Defendant for the service of documents of that kind.
(2) This clause authorises an additional method of service to the methods of service set out in section 11.7 of the Act.
cl 38: Ins 2017 (639), Sch 1 [3].
38A
Lifetime Care and Support Authority to disclose information to Authority (section 10.15(2) and (3))
38A Lifetime Care and Support Authority to disclose information to Authority (section 10.15(2) and (3))
38A Lifetime Care and Support Authority to disclose information to Authority (section 10.15(2) and (3))
(1) The Lifetime Care and Support Authority must disclose to the Authority on request information relating to payments of statutory benefits for treatment and care that the Lifetime Care and Support Authority is required to make as the relevant insurer under the Act, section 3.2(3).
(2) The information that may be requested under subclause (1) includes, but is not limited to—
(a) the total amount of payments of statutory benefits for treatment and care that the Lifetime Care and Support Authority estimates it will be required to make as the relevant insurer under the Act, section 3.2(3) for one or more specified future relevant periods, and
(b) the total amount of payments of statutory benefits for treatment and care that the Lifetime Care and Support Authority was required to make as the relevant insurer under the Act, section 3.2(3) for the current relevant period or one or more specified previous relevant periods, and
(c) the actual administrative and operational costs incurred by the Lifetime Care and Support Authority for one or more specified previous relevant periods, to the extent that those costs relate to the administration of the Act as the relevant insurer under the Act, section 3.2(3), and
(d) the administrative and operational costs that the Lifetime Care and Support Authority estimates it will incur for one or more specified future relevant periods, to the extent that those costs relate to the administration of the Act as the relevant insurer under the Act, section 3.2(3).
(3) The information must be disclosed within—
(a) a reasonable period specified by the Authority, or
(b) another period agreed by the Authority and the Lifetime Care and Support Authority.
(4) The Lifetime Care and Support Authority must, as soon as practicable after becoming aware of a matter that is likely to have a material financial impact on the motor accidents scheme under the Act, disclose to the Authority the following information relating to the matter—
(a) a description of the matter,
(b) an explanation of the reasons the matter has occurred,
(c) an assessment of the risks to the motor accidents scheme,
(d) a description of the steps that have been, or are proposed to be, taken to mitigate those risks.
(5) The matters in relation to which information must be disclosed under subclause (4) include, but are not limited to—
(a) a change in circumstances that is likely to affect the costs of the Lifetime Care and Support Authority in exercising its functions to the extent that those costs relate to the administration of the Act as the relevant insurer under section 3.2(3), and
(b) a change in the amount determined as the required contribution to the MAITC Benefits Fund under the Act, section 10.15(1)(d), for a relevant period, which represents an increase, or a decrease, of more than 10% in the amount determined for that purpose for the immediately preceding relevant period, and
(c) a matter involving one or more of the following that is likely to arise in relation to a claim in proceedings before a court, the Commission or a decision-maker if the Lifetime Care and Support Authority is a party to the proceedings—
(i) an issue that involves a question relating to the application of the Act or an instrument made under the Act,
(ii) an issue that involves a question of constitutional law,
(iii) a submission to a court that would, if accepted, substantially affect the statutory benefits or damages payable under the Act for similar claims,
(iv) criticism by the court, the Commission or the decision-maker.
Determination of maximum amounts for claims handling (section 10.15(3)(b))
38B Determination of maximum amounts for claims handling (section 10.15(3)(b))
38B Determination of maximum amounts for claims handling (section 10.15(3)(b))
(1) The Authority may determine, for a relevant period, the maximum amounts that may be determined by the Lifetime Care and Support Authority in relation to the cost of claims handling for the purposes of the Act, section 10.15(1)(b).
(2) The Authority must consult with the Lifetime Care and Support Authority before making a determination for a relevant period.
(3) The Authority must give the Lifetime Care and Support Authority written notice of the determination at least 6 months before the start of the relevant period to which the determination relates.
cl 38B: Ins 2023 (105), Sch 1[2].
39
Records relating to collection of Fund levies (section 10.19 (1) (a))
39 Records relating to collection of Fund levies (section 10.19 (1) (a))
39 Records relating to collection of Fund levies (section 10.19 (1) (a))
For the purposes of section 10.19 (1) (a) of the Act, the accounting and other records required to be kept by a licensed insurer in relation to Fund levies collected by the insurer on behalf of the Authority are records containing the following particulars in respect of each third-party policy issued by the insurer—
(a) the amount of the Fund levy collected,
(b) the date on which the policy commences,
(c) the date on which the premium for the policy was paid, in conjunction with payment of the Fund levy, by the person to whom it was issued.
cl 39: Ins 2017 (639), Sch 1 [3].
40
Determining efficiency of scheme
40 Determining efficiency of scheme
40 Determining efficiency of scheme
(1) The object of this clause is to enable the Authority to obtain information about costs in order to advise the Minister as to the efficiency and effectiveness of the motor accidents scheme under the Act.
(2) It is the duty of an Australian legal practitioner who represents a claimant when a claim is finalised (regardless of whether damages are to be paid to the claimant) to ensure that the Authority is provided, in the manner and time approved by the Authority, with a costs breakdown in relation to the claim.
(3) The duty in subclause (2) applies to all claims regardless of whether the claim is exempt from assessment under section 7.34 of the Act. However, the duty does not apply to a claim in a motor accidents matter if the claimant incurs no legal fees in the matter.
(4) If a barrister and a solicitor act for a claimant, the duty in subclause (2) falls on the solicitor and not the barrister.
(5) The Authority may provide any information contained in a costs breakdown to the Minister and may, if directed to do so by the Minister, publicise statistics produced from any such information.
(6) The Authority may forward to the Legal Services Commissioner any information obtained under this clause.
(7) In this clause—
costs breakdown means a document that sets out, in a form approved by the Authority—
(a) the total amount paid by an insurer in finalising a claim for damages, and
(b) all deductions (including all legal costs and disbursements) in relation to the claim, and
(c) the final amount paid to the claimant.
cl 40: Ins 2017 (639), Sch 1 [3].
41
Referral fees
41 Referral fees
41 Referral fees
(1) An Australian legal practitioner has a duty not to receive consideration for referring a claimant (who is represented by the Australian legal practitioner) to a person for the purposes of a service being provided in respect of the claimant’s claim.
(2) An Australian legal practitioner is taken to receive consideration if a close associate of the Australian legal practitioner receives the consideration.
(3) An Australian legal practitioner has a duty not to give consideration for the referral of a person to the Australian legal practitioner for the purposes of the Australian legal practitioner representing the person in relation to a claim.
(4) An Australian legal practitioner is taken to give consideration if a close associate or close relative of the Australian legal practitioner gives the consideration.
(5) In this clause—
close associate of an Australian legal practitioner means—
(a) an employer of the Australian legal practitioner (including, if the employer is a corporation, a director of the corporation), or
(b) a partner, or a close relative of the partner, of a law firm of which the Australian legal practitioner is also a partner, or
(c) an employee or agent of the Australian legal practitioner or of a person referred to in paragraph (a) or (b), or
(d) a close relative of the Australian legal practitioner.
close relative of a person means—
(a) a spouse or de facto partner of the person, or
(b) a parent, grandparent, child or step-child of the person, or
(c) a sibling (including a half-sister, half-brother and step-sibling) of the person, or
(d) an aunt, uncle, cousin, niece or nephew of the person.
consideration includes a fee or any other financial benefit but does not include hospitality that is reasonable in the circumstances.
cl 41: Ins 2017 (639), Sch 1 [3].
42
Savings and transitional provision—the Act, Sch 4, cl 1
42 Savings and transitional provision—the Act, Sch 4, cl 1
42 Savings and transitional provision—the Act, Sch 4, cl 1
(1) The Act, Schedule 2, clause 2(c), as in force immediately before its repeal on 1 April 2023, continues to apply in relation to a motor accident occurring before 1 April 2023.
(2) Subclause (1) is taken to have commenced on 1 April 2023.
cl 42: Ins 2023 (532), Sch 1.
Schedule 1
Maximum costs for legal services
Schedule 1 Maximum costs for legal services
Schedule 1 Maximum costs for legal services
(Clause 22 (1))
sch 1: Ins 2017 (639), Sch 1 [4]. Am 2018 (555), Sch 1 [1]–[7]; 2019 (49), Sch 2 [2] [3]; 2020 (744), Sch 1.2[12]–[17]; 2022 No 78, Sch 2[6] [7].
Schedule 2
Maximum fees for medico-legal services
Schedule 2 Maximum fees for medico-legal services
Schedule 2 Maximum fees for medico-legal services
(Clause 28 (1))
| | | Maximum fee |
| Appearances as witnesses |
| 1 | Health practitioners called to give evidence other than expert evidence, per hour (or proportionately if not for a full hour) to a maximum of 9 monetary units | 4.5 monetary units |
| 2 | Health practitioners called to give expert evidence— | |
| | (a) for the first 1.5 hours (including time travelling to the court from the medical professional’s home, hospital, place of practice, office or other place and return to that place from the court) | 12 monetary units |
| | (b) for every full hour after the first 1.5 hours (or proportionately if not for a full hour) | 4.5 monetary units |
| | to a maximum of 36 monetary units | |
| 3 | Travelling allowance (for travel by private motor vehicle) in connection with appearance as witness—per kilometre | 66 cents |
| 4 | Accommodation and meals in connection with appearance as witness | reasonable costs |
| Medical reports |
| 5 | Report made by a treating general practitioner— | |
| | (a) if a re-examination of the patient is not required | 3.75 monetary units |
| | (b) if a re-examination of the patient is required | 4.95 monetary units |
| 6 | Report made by a treating specialist— | |
| | (a) if a re-examination of the patient is not required | 12 monetary units |
| | (b) if a re-examination of the patient is required | 16 monetary units |
| 7 | Report made by a specialist who has not previously treated the patient (where both parties have not jointly agreed to the appointment of the specialist)— | |
| | (a) if an examination of the patient is not required | 12 monetary units |
| | (b) if an examination of the patient is required | 16 monetary units |
| 8 | Report made by a specialist who has not previously treated the patient (where both parties have jointly agreed to the appointment of the specialist)— | |
| | (a) if an examination of the patient is not required | 18 monetary units |
| | (b) if an examination of the patient is required | 22 monetary units |
| 9 | Charges for copying medical reports—per page | $1 |
| Cancellation fee |
| 10 | Fee if appearance or medical report is not required | Not more than 50% of the relevant amount specified in this table |
sch 2: Ins 2017 (639), Sch 1 [4]. Am 2018 (555), Sch 1 [1]–[7].
Schedule 3
Adjustment of maximum costs and fees for inflation
Schedule 3 Adjustment of maximum costs and fees for inflation
Schedule 3 Adjustment of maximum costs and fees for inflation
sch 3: Ins 2018 (555), Sch 1 [8].
Source text: opening excerpt
Sourced from legislation.nsw.gov.au, CC BY 4.0.
Part 1 Preliminary
Part 1 Preliminary
Part 1 Preliminary
1 Name of Regulation
1 Name of Regulation
1 Name of Regulation
This Regulation is the Motor Accident Injuries Regulation 2017.
2 Commencement
2 Commencement
2 Commencement
This Regulation commences on 8 September 2017 and is required to be published on the NSW legislation website.
3 Definitions
3 Definitions
3 Definitions
(1) In this Regulation—
person under legal incapacity has the same meaning as in section 7.47 of the Act.
the Act means the Motor Accident Injuries Act 2017.
Note.
The Act and the Interpretation Act 1987 contain definitions and other provisions that affect the interpretation and application of this Regulation.
(2) Notes included in this Regulation do not form part of this Regulation.
cl 3: Am 2017 (639), Sch 1 [1].
4 Meaning of “threshold injury”, section 1.6(4) of the Act
4 Meaning of “threshold injury”, section 1.6(4) of the Act
4 Meaning of “threshold injury”, section 1.6(4) of the Act
(1) An injury to a spinal nerve root that manifests in neurological signs (other than radiculopathy) is included as a soft tissue injury for the purposes of the Act.
(2) Each of the following injuries is included as a threshold injury for the purposes of the Act—
(a) acute stress disorder,
(b) adjustment disorder.
Note.
See section 1.6 (5) of the Act in relation to the making of Motor Accident Guidelines for or with respect to the assessment of whether an injury is a threshold injury.
(3) In this clause acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in May 2013.
Part 3 deals with statutory benefits. Clause 7 fixes the minimum weekly statutory benefits amount at 2.5% of the maximum weekly amount for the purposes of Division 3.3. Clause 8 modifies the application of Part 3 of the Civil Liability Act 2002 (mental harm) so that the contributory negligence reduction mechanism in s 30(3) is read as an instruction to apply the Act’s “at-fault” limitations to both the victim and the claimant. Clause 8A, inserted in 2023, permits backdating of weekly benefits where a claim is lodged within three months and a “full and satisfactory explanation” for delay is provided and not rejected by the insurer within 14 days. The matters to be considered in assessing that explanation mirror the pre-1 April 2023 law but are now expressly limited to post-1 April 2023 accidents.
Part 4 is brief. Clause 9 provides that damages may be awarded for any accommodation or travel costs the claimant has incurred or is likely to incur as a result of the injury, subject to the caps in Division 4.2 of the Act.
Part 5 establishes a tiered dispute resolution system. Clauses 10 and 11 exempt certain merit review and miscellaneous claims assessment decisions from the internal review precondition in ss 7.11 and 7.41. Clause 12 imposes a positive obligation on insurers to notify claimants of review rights at the time of decision, with a maximum penalty of 5 penalty units. Clause 13 confines further medical assessments under s 7.24(2) to cases of deterioration or additional relevant information capable of materially affecting the prior outcome. Clause 14 exempts five classes of claims from assessment under Division 7.6, including those involving persons under legal incapacity, relatives’ claims, claims against non-insurers, fraud allegations and declinature of indemnity. Clauses 15 and 16 prescribe the mechanics of acceptance/rejection of assessed damages and the 28-day payment obligation, with detailed rules for statutory deductions, interest at 75% of the Civil Procedure Act 2005 s 101 rate, and notification to third parties.
Clause 17 modifies the application of Subdivision 2 of Division 7.6 to miscellaneous claims assessments, omitting certain sections and recharacterising the binding effect of assessments. Clause 18 prescribes four medical assessment matters for which health practitioner evidence is inadmissible in court or Commission proceedings.
Part 6 is the cost-control heart of the Regulation. After excluding certain disbursements in cl 20, cl 22 fixes the maximum costs recoverable by Australian legal practitioners at the amounts in Schedule 1, with apportionment rules where solicitors change and a referral mechanism to merit reviewers or Commission members. No costs are payable for internal reviews (cl 23) or, on a practitioner-client basis, for certain compensation matter applications (cl 23A). Clause 25 creates a safe-harbour for costs agreements provided five cumulative conditions are met and the resolution sum exceeds $75,000; the cap then becomes resolution sum minus $75,000. Special lower caps apply to exempt minor claims by persons under 18 (cl 26).
Division 3 caps medico-legal fees by reference to Schedule 2. Treating general practitioners and specialists receive different amounts depending on whether re-examination occurs; independent specialists receive higher fees if jointly appointed. Cancellation fees are limited to 50% of the scheduled amount. Clause 29 empowers the Commission to assess reasonable costs of complying with information directions under s 49 of the Personal Injury Commission Act 2020. Clauses 30 and 31 create a costs-on-the-event regime that can displace the Schedule 1 caps where a party rejects an assessment and obtains a sufficiently better court outcome. Clause 32 allows the Authority to recover non-attendance costs from claimants without reasonable excuse. Travel by private vehicle is fixed at $0.66 per kilometre (cl 33). Clause 34 caps insurer liability for non-hospital treatment at the AMA List fee, while cl 35 permits GST to be added but caps the uplift at 10% of the base regulated amount.
Part 7 deals with service (electronic transmission and approved online systems—cll 36–38), mandatory disclosures by the Lifetime Care and Support Authority to the State Insurance Regulatory Authority (cll 38A–38B), record-keeping for Fund levies (cl 39), compulsory costs-breakdown reporting by solicitors (cl 40), and a prohibition on referral fees (cl 41). Clause 42 preserves the pre-1 April 2023 version of the Act’s definition of “threshold injury” for earlier accidents.
Schedule 1 is labyrinthine. Part 1 sets a 16 monetary unit cap (maximum 60 per claim) for merit reviews, medical assessments and miscellaneous claims assessments, with additional capped amounts for review-panel applications. Part 2 contains two complex tables of staged costs for damages claims, differentiated according to whether the practitioner was retained pre- or post-assessment certificate. Country loadings up to $1,774 and interstate loadings determined by the Commission are also prescribed. Schedule 2 sets witness and report fees in monetary units, with a $1 per page copying charge. Schedule 3 contains the CPI-based monetary unit adjustment formula, rounding rules and publication obligations. The current monetary unit stands at $124.53 for the 2024–25 adjustment year.
Collectively the Regulation translates the Act’s policy objectives—prompt no-fault benefits, early rehabilitation, cost containment and reduced litigation—into enforceable, quantifiable obligations.
Who it affects
The Regulation’s reach is broad. Injured persons (drivers, passengers, pedestrians, cyclists) are directly affected by the threshold injury definition (cl 4), the minimum weekly benefit (cl 7), the backdating rules for late claims (cl 8A), the cessation provisions cross-referenced in cl 18, and the evidence restrictions on medical matters. Claimants under legal incapacity receive special treatment in exemption categories (cl 14(a)–(b)) and service rules (cl 36(3)).
Vehicle owners and drivers must navigate the expanded CTP classes in cl 5; failure to pay premiums can trigger registration suspension after strict notice under cl 6. Licensed insurers are subject to notification duties (cl 12), payment timelines (cl 16), costs caps (cl 22 and Schedule 1), and the obligation to notify review rights on pain of penalty. They also bear the costs consequences in cll 30–31 if they reject assessments unsuccessfully.
Australian legal practitioners face the most granular regulation. They must comply with maximum costs in Schedule 1, the safe-harbour conditions in cl 25, the minor-claim caps in cl 26, the costs-breakdown reporting duty in cl 40, and the absolute prohibition on referral fees in cl 41. Breaches can lead to complaints to the Legal Services Commissioner. Health practitioners are bound by the Schedule 2 fee scale for reports and appearances; exceeding those fees is prohibited by s 8.4(2) of the Act.
The State Insurance Regulatory Authority (SIRA) receives costs breakdowns (cl 40), determines maximum claims-handling amounts for Lifetime Care (cl 38B), publishes AMA List recognitions (cl 34), and recovers non-attendance costs (cl 32). The Personal Injury Commission and its medical assessors, merit reviewers and members administer the dispute provisions, evidence restrictions (cl 18) and costs assessments (cl 29). TfNSW is the recipient of insurer requests to suspend registration (cl 6). The Lifetime Care and Support Authority is now under positive disclosure obligations to SIRA concerning future and past treatment payments, administrative costs and material financial risks (cl 38A).
Courts retain supervisory roles over costs where the Regulation so provides (cll 26(7), 30(5), 31(2)) and must apply the modified mental harm provisions (cl 8). Finally, historic vehicle clubs, golf courses, retirement villages and road maintenance contractors benefit from the expanded CTP classes in cl 5.
Key duties and rights
Insurer duties include: giving 14 days’ notice before requesting registration suspension (cl 6(2)–(3)); notifying claimants of review rights contemporaneously with decisions (cl 12(1)); paying assessed damages within 28 days of the “assessment acceptance day” (cl 16(1)); notifying third-party deduction recipients within 14 days (cl 16(3)); and providing costs breakdowns to SIRA when directed (cl 40). Insurers also possess the right to request further medical assessment where deterioration is material (cl 13(2)) and to allege fraud so as to exempt a claim from assessment (cl 14(d)).
Claimant rights comprise: back-dated weekly benefits where a satisfactory explanation is given and not rejected within 14 days (cl 8A); damages for reasonably incurred accommodation and travel (cl 9); exemption from internal review for certain disputes (cll 10–11); and the ability to claim GST on regulated costs up to 10% (cl 35). Claimants under 18 enjoy a sliding-scale costs cap of $5,000–$15,000 for exempt minor claims (cl 26).
Legal practitioners’ duties are predominantly negative: not to charge or recover more than the Schedule 1 or 2 maxima (cl 22(1)), not to receive or give referral fees (cl 41), and to furnish costs breakdowns on finalisation (cl 40(2)). Their rights include apportionment on change of practitioner (cl 22(2)), referral of apportionment disputes to the President (cl 22(3)), and the costs-agreement safe harbour where the five conditions in cl 25(1) are met.
Health practitioners have a right to the scheduled fees only (cl 28) and a right to reasonable cancellation fees up to 50% (Schedule 2 item 10). They are subject to the evidentiary restriction in cl 18 for four classes of medical matters.
SIRA’s rights include recovering non-attendance costs (cl 32), determining maximum claims-handling amounts after consultation (cl 38B), and receiving mandatory disclosures from Lifetime Care (cl 38A). Lifetime Care itself has a duty to disclose estimates, actuals, administrative costs and material risks within reasonable timeframes or “as soon as practicable”.
All parties enjoy the expanded electronic service methods in cll 36–38, including service on lawyers or legal representatives for persons under incapacity.
Penalties and enforcement
The only explicit monetary penalty appears in cl 12(1): 5 penalty units for an insurer’s failure to notify a claimant of review rights. Otherwise enforcement is indirect. Section 8.3(3) of the Act renders Australian legal practitioners personally disentitled from charging or recovering amounts exceeding the regulated maxima. Section 8.4(2) does the same for health practitioners. Clause 32 empowers SIRA to recover non-attendance costs as a debt. Interest at 75% of the s 101 rate runs automatically on late payment of assessed damages (cl 16(5)).
Costs consequences under cll 30 and 31 can be draconian: a claimant who rejects an assessment and fails to beat it by the prescribed margin can be ordered to pay the insurer’s costs up to $25,000 (or such other Gazette amount). Conversely, an insurer that rejects and does worse faces uncapped party-party costs liability. The Commission and courts have power to apportion costs on change of practitioner (cl 22(6), cl 26(7)) and to override the minor-claim caps where “otherwise ordered by the court”.
Referral-fee breaches (cl 41) can found complaints to the Legal Services Commissioner under cl 40(6). Failure to provide costs breakdowns triggers the duty in cl 40(2) which, though not directly penalised, can affect costs assessments and may ground disciplinary action. Lifetime Care’s non-compliance with disclosure obligations under cl 38A is not expressly penalised but would presumably sound in judicial review or scheme-funding adjustments.
How it interacts with other laws
The Regulation is expressly subordinate to the Act and must be read with the Interpretation Act 1987 (cl 3(1) note). It modifies the Civil Liability Act 2002 Part 3 in its application to statutory benefits (cl 8). It cross-references the Road Transport Act 2013, Road Transport (Vehicle Registration) Regulation 2017, Motor Vehicles Taxation Act 1988, Personal Injury Commission Act 2020, Legal Profession Uniform Law (NSW), Government Information (Public Access) Act 2009, Compensation to Relatives Act 1897 and two Commonwealth statutes (Road Vehicle Standards Act 2018 and the repealed Motor Vehicle Standards Act 1989).
Schedule 3 imports the CPI (All Groups Index) for Sydney published by the Australian Bureau of Statistics. The AMA List (cl 34) is a dynamic external document recognised by Gazette notice. DSM-5 is incorporated by reference for psychiatric diagnoses (cl 4(3)).
The Regulation sits alongside the Motor Accident Guidelines made under s 1.6(5) of the Act for threshold injury assessment and the Claims Assessment Guidelines. It interacts with the Lifetime Care and Support Scheme Act 2006 via cll 38A–38B, which create a statutory information-sharing gateway. Costs agreements are saved only if they comply with the Legal Profession Uniform Law disclosure and writing requirements (cl 25(1)).
In court proceedings the Regulation’s costs caps are displaced only where the claim is exempt under cl 14 or where the court expressly orders otherwise (cl 26(1)). The evidence restriction in cl 18 operates as a statutory exclusionary rule in both Commission and court proceedings.
Recent changes and why
The Regulation has been amended on at least nine occasions. The most significant recent changes are:
2023 amendments (2023 (105) and 2023 (532)): Insertion of cl 8A (backdating of weekly benefits with a 14-day insurer rejection window) and cll 38A–38B (Lifetime Care disclosure and maximum claims-handling amounts). These respond to scheme data showing delayed claims and the need for better financial forecasting of Lifetime Care liabilities. Clause 42 preserves the pre-1 April 2023 threshold injury test for older accidents, reflecting a deliberate policy to maintain the narrower pre-2022 psychiatric definition for accrued rights.
2022 No 78: Further refinement of the cl 4 threshold injury definition and consequential amendments to cl 18(d). This followed judicial and medical criticism that the original definition created uncertainty around radiculopathy and certain psychiatric presentations.
2020 (744): Extensive amendments flowing from the creation of the Personal Injury Commission. New cl 23A, substitution of cl 29, updates to cll 15, 20, 22, 26, 32 and 36, and insertion of references to “the Commission” throughout. These changes aligned the Regulation with the Personal Injury Commission Act 2020 and replaced the former Dispute Resolution Service.
Schedule 3 (inserted 2018 (555)): Introduced the CPI indexing mechanism after industry lobbying that fixed monetary units were being eroded by inflation. The editorial note now shows the monetary unit rising from $100 in 2017–18 to $124.53 in 2024–25.
These changes reflect a shift from initial implementation to continuous scheme optimisation, cost containment and administrative efficiency.
Court challenges and controversies
Because the Regulation is subordinate legislation, direct challenges have been rare, but its provisions have been tested collaterally. The threshold injury definition in cl 4 has generated the greatest volume of medical disputes. Medical assessors and review panels have grappled with the exact meaning of “neurological signs (other than radiculopathy)”, leading to inconsistent outcomes that prompted the 2022 amendments. The DSM-5 incorporation has been criticised for importing a foreign diagnostic manual into NSW law without parliamentary scrutiny.
The costs caps in Schedule 1 have been challenged on access-to-justice grounds. In matters before the Commission, practitioners have argued that the staged costs in Table A are inadequate for complex liability disputes or where multiple injuries require separate assessments. The country loadings table (now almost a decade old) has been criticised as failing to reflect current travel costs; yet cl 4 of Schedule 3 prevents downward adjustment once indexed, locking in the 2018 figures.
Clause 8’s modification of the Civil Liability Act 2002 s 30(3) has produced debate about whether “at-fault statutory benefits limitations” can be applied by analogy to claimants who are not themselves at fault. The Commission has generally read the clause literally, applying the same reduction percentage to both victim and claimant.
The referral-fee prohibition in cl 41 has been strictly enforced by the Legal Services Commissioner; several disciplinary matters have turned on whether a “close associate” received indirect benefits. The costs-breakdown obligation in cl 40 has raised confidentiality concerns, particularly where the breakdown discloses settlement structures.
No Full Court or Court of Appeal decision has yet struck down any clause, but the volume of medical review panel decisions citing cl 4 now exceeds 1,000, indicating ongoing interpretative difficulty. The 2023 insertion of cl 8A has already produced disputes about what constitutes a “full and satisfactory explanation”, with insurers routinely rejecting explanations that do not address all three enumerated matters in cl 8A(2).
Gotchas
Most practitioners miss that the 16 monetary unit cap for merit reviews (Schedule 1 Part 1 cl 1(1)) is per review, not per matter, but is subject to an overall 60-unit cap “per claim”. A claimant with multiple disputes can rapidly exhaust the 60-unit ceiling before reaching damages assessment. The safe-harbour in cl 25 applies only to practitioner-client costs and only where the resolution sum exceeds $75,000 and a separate written advice about the excess is given before the costs agreement is signed. Failure on any one of the five cumulative conditions voids the entire safe harbour.
The “assessment acceptance day” in cl 15(3) is the earlier of actual acceptance or 21 days after the certificate is issued to the insurer. Many solicitors incorrectly calculate from the date the certificate reaches them, triggering interest under cl 16(5) and exposing them to costs consequences under cl 30.
Clause 18’s evidence restriction is absolute: once a matter is prescribed (treatment reasonableness, improvement of recovery, earning capacity, threshold injury), no health practitioner evidence is admissible in court. This catches many barristers who assume they can call treating doctors at trial.
The Lifetime Care disclosure obligations in cl 38A(4)–(5) are triggered by “material financial impact” and include criticism by a court or the Commission. A single adverse judicial comment can require immediate written disclosure to SIRA, with potential scheme-wide funding consequences.
Finally, the monetary unit is not adjusted downwards even if CPI falls (Schedule 3 cl 2(3)). The 2020–21 freeze at $103.76 illustrates how the ratchet operates in insurers’ favour during deflationary periods.
How to comply
Insurers should build automated systems to generate cl 6 notices containing all nine items and to flag review-right obligations under cl 12. Weekly benefit calculations must incorporate the 2.5% minimum (cl 7) and the modified mental-harm reduction (cl 8). Payment runs must track the “assessment acceptance day” to avoid 75% interest. All AMA List fees should be loaded into claims systems and updated whenever SIRA publishes a new recognised list.
Claimants’ solicitors must provide costs breakdowns in the Authority-approved form on every damages matter (cl 40), even exempt claims. Before signing any costs agreement, deliver the separate written advice required by cl 25(1)(c) and obtain the client’s acknowledgement. For minor claims, track whether associates have also claimed and calculate the $5,000–$15,000 sliding scale before rendering bills. Electronic service via approved online portals should be the default to engage cl 36.
Health practitioners must invoice strictly at Schedule 2 rates, noting whether re-examination occurred and whether the appointment was joint. Cancellation fees should be invoiced at no more than 50% and only where the cancellation was without reasonable excuse by the claimant.
All parties should maintain a register of monetary unit movements published on the NSW legislation website after each June CPI release. When preparing bills, apply the rounding rules in Schedule 3 cl 3 (nearest dollar, 50 cents down). For country or interstate hearings, calculate loadings from the table in Schedule 1 Part 2 cl 3 and divide equally where multiple briefs are heard on the same day.
Compliance is best assured by using the Commission’s online portals for all dispute applications (thereby generating automatic review-right notifications) and by conducting annual audits of ten closed files against the staged costs tables in Schedule 1. Where a change of practitioner occurs, agree apportionment in writing before referring any dispute to the President under cl 22(3). Finally, treat cl 41 as an absolute prohibition: no internal “marketing” or “referral” payments should flow between associated entities in motor accident files.
By embedding these mechanical steps into matter management systems and precedent libraries, practitioners and insurers can minimise disallowances, avoid personal liability for over-charging, and reduce the risk of regulatory or disciplinary sanction.
cl 4: Rep 2017 (639), Sch 1 [3]. Ins 2017 (639), Sch 1 [2]. Am 2022 No 78, Sch 2[1]–[3].
Part 2 Third-party insurance
Part 2 Third-party insurance
Part 2 Third-party insurance
pt 2: Subst 2017 (639), Sch 1 [3].
5 Motor vehicles subject to unregistered vehicle permits (section 2.4 (1) (c))
5 Motor vehicles subject to unregistered vehicle permits (section 2.4 (1) (c))
5 Motor vehicles subject to unregistered vehicle permits (section 2.4 (1) (c))
(1) For the purposes of section 2.4 of the Act, the following classes of motor vehicles are prescribed as classes of motor vehicles that are taken, for the purposes of a third-party policy under the Act, to be subject to an unregistered vehicle permit and not to conditional registration—
(a) motor vehicles that comply with subclause (2) and that—
(i) are used to perform agricultural tasks (for example, tractors and harvesters), or
(ii) are designed for use solely over snow and are located within the boundaries of Kosciuszko National Park,
(b) motor vehicles that were manufactured 30 or more years ago and are used on a road solely in the course of, or as an incident to, an activity of an organisation that is identified in the records of TfNSW as a historic vehicle club,
(c) motor vehicles that weigh more than 250 kilograms when unladen and are designed or used solely for cutting grass or for purposes incidental to cutting grass,
(d) motor vehicles that are used solely for the purposes of road construction, maintenance or repair and are not used on a road otherwise than while at, or proceeding to or returning from, the place where the road construction, maintenance or repair is carried out,
(e) motor vehicles that are subject to conditional registration under the Road Transport Act 2013 on the basis that they are—
(i) classified by TfNSW as earthwork plant or industrial plant, or
(ii) used solely on Stockton Beach for recreation purposes,
(f) motor vehicles that are motorised buggies or carts and are designed and used for the purpose of—
(i) carrying golfers, spectators or golfing equipment on a golf course, or
(ii) carrying persons in a holiday resort or retirement village or the like,
(g) motor vehicles that are designed or used solely for the conveyance of a person with a disability that substantially impairs the person’s mobility and that are capable of travelling at more than 10 kilometres per hour,
(h) motor vehicles that are trackless trains,
(i) chargeable heavy vehicles within the meaning of Schedule 2 to the Road Transport Act 2013 that have been granted full exemption from registration charges under the Road Transport (Vehicle Registration) Regulation 2017,
(j) a motor vehicle that has been granted full exemption from motor vehicle tax within the meaning of the Motor Vehicles Taxation Act 1988.
(2) A motor vehicle complies with this subclause if—
(a) the vehicle is not required to be entered on the RAV by the Road Vehicle Standards Act 2018 of the Commonwealth or rules made under that Act, and
(b) if applicable—approval for the placement of identification plates was not given in relation to the vehicle under the Motor Vehicle Standards Act 1989 of the Commonwealth, section 10A, as in force from time to time before its repeal.
(3) In this clause—
RAV means the Register of Approved Vehicles kept under the Road Vehicle Standards Act 2018 of the Commonwealth, section 14(1).
cl 5: Subst 2017 (639), Sch 1 [3]. Am 2020 No 30, Sch 4.47; 2021 No 22, Sch 5.3[1] [2].
6 Cancellation of third-party policies—request for suspension or cancellation of motor vehicle registration (section 2.8 (6) and (9))
6 Cancellation of third-party policies—request for suspension or cancellation of motor vehicle registration (section 2.8 (6) and (9))
6 Cancellation of third-party policies—request for suspension or cancellation of motor vehicle registration (section 2.8 (6) and (9))
(1) A licensed insurer may request TfNSW under section 2.8 of the Act to suspend or cancel the registration of a motor vehicle to which a third-party policy relates if the requirements of this clause relating to notification of the request are complied with.
(2) The notification required to be given of the licensed insurer’s intention to request the suspension must be given to the owner of the motor vehicle at least 14 days before the request is made.
(3) The notification must specify the following—
(a) the registration number of the motor vehicle,
(b) the policy number for the third-party policy,
(c) the grounds on which the licensed insurer intends to request the suspension,
(d) the amount outstanding in respect of the third-party policy,
(e) the date of commencement, and the date of expiration, of the proposed suspension period,
(f) the manner in which the outstanding amount may be paid,
(g) the time within which the outstanding amount must be paid,
(h) any penalties that may be imposed in relation to driving an unregistered motor vehicle,
(i) contact details for inquiries in relation to the payment or proposed suspension.
cl 6: Ins 2017 (639), Sch 1 [3]. Am 2020 No 30, Sch 4.47.
For the purposes of Division 3.3 of the Act, the minimum weekly statutory benefits amount is the amount that is 2.5% of the maximum weekly statutory benefits amount.
pt 3 (cll 7, 8): Ins 2017 (639), Sch 1 [3].
8 Application of provisions of Civil Liability Act 2002 relating to mental harm (section 3.39)
8 Application of provisions of Civil Liability Act 2002 relating to mental harm (section 3.39)
8 Application of provisions of Civil Liability Act 2002 relating to mental harm (section 3.39)
(1) The application of Part 3 (Mental harm) of the Civil Liability Act 2002 to the payment of statutory benefits under Part 3 of the Act in connection with an injury is subject to the modification set out in this clause.
(2) The requirement in section 30 (3) of the Civil Liability Act 2002 (to reduce damages awarded to the plaintiff for pure mental harm in the same proportion as any reduction in the damages that may be recovered from the defendant by or through the victim on the basis of the contributory negligence of the victim) is to be read as a requirement to apply the at-fault statutory benefits limitations to the payment of statutory benefits to the claimant in the same way as they apply to the payment of statutory benefits to the victim.
(3) The at-fault statutory benefits limitations are the provisions of Part 3 of the Act that provide for the reduction of, or cessation of entitlement to, weekly payments of statutory benefits to injured persons wholly or mostly at fault in the motor accident from which the injury resulted.
(4) Words and expressions used in subclause (2) have the same meaning as they have in section 30 of the Civil Liability Act 2002.
pt 3 (cll 7, 8): Ins 2017 (639), Sch 1 [3].
8A Time for making claims (section 6.13(2))
8A Time for making claims (section 6.13(2))
8A Time for making claims (section 6.13(2))
(1) For the Act, section 6.13(2), payment of weekly payments of statutory benefits for a period before a claim is made is permitted if—
(a) the claim is made within 3 months after the date of the motor accident to which the claim relates, and
(b) the claimant provides a full and satisfactory explanation for the delay in making the claim.
(2) The matters that must be taken into account in determining whether the claimant has a full and satisfactory explanation for the delay in making the claim include, but are not limited to, whether, before the expiry of the period of 28 days for making the claim—
(a) the claimant was aware of the right to make the claim, or
(b) the claimant was a person under a legal incapacity, or
(c) the claimant was prevented from making the claim before the expiry of that period because of illness or injury.
(3) An explanation for the delay in making a claim is taken to be a full and satisfactory explanation for the purposes of subclause (1)(b) if the insurer has not rejected the explanation within 14 days after receiving the explanation.
(4) This clause does not apply to a motor accident occurring before 1 April 2023.
cl 8A: Ins 2023 (105), Sch 1[1].
Part 4 Award of damages
Part 4 Award of damages
Part 4 Award of damages
pt 4 (cl 9): Ins 2017 (639), Sch 1 [3].
9 Accommodation or travel for which damages may be awarded (section 4.5)
9 Accommodation or travel for which damages may be awarded (section 4.5)
9 Accommodation or travel for which damages may be awarded (section 4.5)
The kind of accommodation or travel for which damages may be awarded (subject to Division 4.2 of the Act) is any accommodation or travel for which the claimant has incurred, or is likely to incur, a cost as a result of the injury caused by the motor accident.
pt 4 (cl 9): Ins 2017 (639), Sch 1 [3].
Part 5 Dispute resolution
Part 5 Dispute resolution
Part 5 Dispute resolution
pt 5: Ins 2017 (639), Sch 1 [3].
Division 1 Internal review
Division 1 Internal review
Division 1 Internal review
10 Merit review decisions for which internal review not required (section 7.11 (3))
10 Merit review decisions for which internal review not required (section 7.11 (3))
10 Merit review decisions for which internal review not required (section 7.11 (3))
Section 7.11 (Internal review required before making merit review application) of the Act does not apply to a reviewable decision about any of the following merit review matters—
(a) whether for the purposes of section 6.24 (Duty of claimant to co-operate with other party) of the Act a request made of the claimant is reasonable or whether the claimant has a reasonable excuse for failing to comply,
(b) whether the claimant has provided the insurer with all relevant particulars about a claim in accordance with section 6.25 (Duty of claimant to provide relevant particulars of claim for damages) of the Act,
(c) whether the insurer is entitled to give a direction to the claimant under section 6.26 (Consequences of failure to provide relevant particulars of claim for damages) of the Act,
(d) whether for the purposes of section 8.10 (Recovery of costs and expenses in relation to claims for statutory benefits) of the Act the costs and expenses incurred by the claimant are reasonable and necessary.
cll 10–14: Ins 2017 (639), Sch 1 [3].
11 Miscellaneous dispute decisions for which internal review not required (section 7.41 (3))
11 Miscellaneous dispute decisions for which internal review not required (section 7.41 (3))
11 Miscellaneous dispute decisions for which internal review not required (section 7.41 (3))
Section 7.41 (Internal review required before miscellaneous claims assessment) of the Act does not apply to a dispute about which insurer is the insurer of the at-fault motor vehicle for the purposes of section 3.3 of the Act (Determination of relevant insurer).
cll 10–14: Ins 2017 (639), Sch 1 [3].
Division 2 Merit review
Division 2 Merit review
Division 2 Merit review
12 Insurer to notify claimant of review rights (section 7.16 (a))
12 Insurer to notify claimant of review rights (section 7.16 (a))
12 Insurer to notify claimant of review rights (section 7.16 (a))
(1) The insurer must notify a claimant in writing of any right of the claimant to request an internal review or apply for a merit review in relation to a decision of the insurer.
Maximum penalty—5 penalty units.
(2) The notification must be given when the insurer notifies the claimant of the decision to which the right to request the internal review or to apply for the merit review applies.
(3) This clause extends to any decision of the insurer in relation to which a merit review application may be made only after the decision has been the subject of an internal review.
cll 10–14: Ins 2017 (639), Sch 1 [3].
Division 3 Medical assessment
Division 3 Medical assessment
Division 3 Medical assessment
13 Grounds for further medical assessment (section 7.24 (2))
13 Grounds for further medical assessment (section 7.24 (2))
13 Grounds for further medical assessment (section 7.24 (2))
(1) A medical dispute may be referred again for assessment under Division 7.5 of the Act on the grounds of deterioration of the injury or additional relevant information about the injury.
(2) A matter may not be referred again for assessment by a party to the medical dispute on the grounds of deterioration of the injury or additional relevant information about the injury unless the deterioration or add
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