sec.26Information to be provided by return— Act , s 88

sec.26 Information to be provided by return— Act , s 88

A licensed insurer must, within 7 days after the end of each reporting period, give the commission a return for the reporting period, in a form approved by the commission, stating— for each notice of claim received in the reporting period— the required claim details; and if the notice of claim is not disputed—the required further claim details; and for each disputed notice of claim for which the dispute was resolved in the reporting period—the required further claim details; and for each notifiable step in the processing of a claim that takes place in the reporting period— the nature of the step; and the date the step was taken; and other details of the step required by the commission in written notice given to all licensed insurers. Each of the following is a notifiable step in the processing of a claim— a dispute affecting the notice of claim is resolved; the insurer asks the claimant to complete an additional information form; the claimant returns a completed additional information form to the insurer; the insurer admits liability on the claim, with or without an allegation of contributory negligence against the claimant, or denies liability on the claim; the insurer makes a decision about the provision of rehabilitation services for the claimant or agreement is reached on the rehabilitation services to be provided for the claimant; a compulsory conference is held; the claim is settled; a proceeding based on the claim is started in a court; a court makes a decision about liability or the amount of damages; the claim is finalised. A licensed insurer must, within 15 days after the end of each reporting period, give the commission a return for the reporting period stating— the insurer’s costs on each claim for the reporting period, including details of— professional legal costs and disbursements; and investigative costs; and private hospital, medical and pharmaceutical expenses; and the cost of medical examinations and obtaining medical reports; and the cost of rehabilitation; and other costs the commission requires, by notice to the licensed insurers, to be separately itemised; and the amount recovered under part 4 , division 7 of the Act on each claim. If a claim involves 2 or more licensed insurers and a claim manager is appointed, an insurer (other than the claim manager) that has notified the required claim details for the claim and notified the appointment of the claim manager need not notify further information about the claim under subsections (1) and (3) . A return must include particulars updating information supplied in previous returns about motor vehicle accidents, claims, estimates and costs. In this section— certifying doctor means the doctor who signed the certificate mentioned in section 18 (1) (a) . compliance date , for a notice of claim, means— if the notice is not a disputed notice of claim—the date the notice was received by the insurer; or if the notice is a disputed notice of claim—the date the dispute was resolved. disputed notice of claim means a notice of claim for which the insurer states in the insurer’s response to the notice of claim that the insurer— is not satisfied the notice has been given as required under part 4 , division 3 of the Act ; and does not waive compliance with the relevant requirements. See section 39 (1) (a) of the Act . reporting period means— if the commission has given written notice to all licensed insurers that the reporting period is to be reduced to a period shorter than a month as from a stated date that is at least 3 months after the date of the notice and the stated date has passed—the shorter period; or otherwise—a month. required claim details , for a claim, means each of the following details— the date the notice of claim was received by the insurer; the date the insurer opened a file on the claim; the date, time and place of the accident; an identifying accident number assigned by the insurer; an identifying claim number; the relevant police accident report reference number; for each claimant— the claimant’s full name and residential address; and the claimant’s date of birth; and the claimant’s medicare number; and if the notice of claim was accompanied by an identity document under section 18 that has a unique identifying number—the number. required further claim details , for a claim, means each of the following details— the compliance date for the notice of claim; the make, model, type, year of manufacture, and registration number of each motor vehicle involved in the accident; the names and addresses of the owner and driver of each motor vehicle involved in the accident; whether, in relation to the vehicle the claimant or, for a derivative claim, the injured person was travelling in at the time of the accident, a property damage claim has been made under a comprehensive insurance policy or a third party property damage policy; if a claim has been made under a policy mentioned in paragraph (d) —the insurer for the policy, the policy number and the number of any property damage claim made under the policy; the name and address of each witness to the accident known to the insurer; the circumstances of the accident, including how the claimant came to be involved in the accident; the nature of the personal injury to the claimant; for a claim other than a derivative claim, the following details as shown in the notice of claim— the date the claimant was first physically examined by a doctor in relation to personal injury resulting from the accident; the date the claimant was first physically examined by the certifying doctor in relation to personal injury resulting from the accident; the unique identifier given to the certifying doctor under the Health Practitioner Regulation National Law , section 233 ; for a claim other than a derivative claim, whether the claimant was, at the date of the accident, an existing patient of the doctor or of a medical practice in which the doctor practises or was practising, as shown in the certificate accompanying the notice of claim; if the claimant consulted a lawyer about the possibility of making a claim—the date, as shown in the notice of claim, the claimant first consulted the lawyer; if the claimant has retained a law practice to act for the claimant in relation to the claim, the following details as shown in the notice of claim— the name of the law practice; the date the claimant retained the law practice. resolved , in relation to a disputed notice of claim, means— the insurer is satisfied the claimant has complied with the relevant requirements of part 4 , division 3 of the Act , or is satisfied with the action taken by the claimant to remedy the noncompliance or waives compliance in any event; or the court declares the claimant has remedied the noncompliance; or See section 39 (5) (c) (i) of the Act . the court authorises further proceedings based on the claim despite the noncompliance. See section 39 (5) (c) (ii) of the Act . s 26 amd 2019 No. 36 s 31 ; 2020 SL No. 38 s 6 (sec.26-ssec.1) A licensed insurer must, within 7 days after the end of each reporting period, give the commission a return for the reporting period, in a form approved by the commission, stating— for each notice of claim received in the reporting period— the required claim details; and if the notice of claim is not disputed—the required further claim details; and for each disputed notice of claim for which the dispute was resolved in the reporting period—the required further claim details; and for each notifiable step in the processing of a claim that takes place in the reporting period— the nature of the step; and the date the step was taken; and other details of the step required by the commission in written notice given to all licensed insurers. (sec.26-ssec.2) Each of the following is a notifiable step in the processing of a claim— a dispute affecting the notice of claim is resolved; the insurer asks the claimant to complete an additional information form; the claimant returns a completed additional information form to the insurer; the insurer admits liability on the claim, with or without an allegation of contributory negligence against the claimant, or denies liability on the claim; the insurer makes a decision about the provision of rehabilitation services for the claimant or agreement is reached on the rehabilitation services to be provided for the claimant; a compulsory conference is held; the claim is settled; a proceeding based on the claim is started in a court; a court makes a decision about liability or the amount of damages; the claim is finalised. (sec.26-ssec.3) A licensed insurer must, within 15 days after the end of each reporting period, give the commission a return for the reporting period stating— the insurer’s costs on each claim for the reporting period, including details of— professional legal costs and disbursements; and investigative costs; and private hospital, medical and pharmaceutical expenses; and the cost of medical examinations and obtaining medical reports; and the cost of rehabilitation; and other costs the commission requires, by notice to the licensed insurers, to be separately itemised; and the amount recovered under part 4 , division 7 of the Act on each claim. (sec.26-ssec.4) If a claim involves 2 or more licensed insurers and a claim manager is appointed, an insurer (other than the claim manager) that has notified the required claim details for the claim and notified the appointment of the claim manager need not notify further information about the claim under subsections (1) and (3) . (sec.26-ssec.5) A return must include particulars updating information supplied in previous returns about motor vehicle accidents, claims, estimates and costs. (sec.26-ssec.6) In this section— certifying doctor means the doctor who signed the certificate mentioned in section 18 (1) (a) . compliance date , for a notice of claim, means— if the notice is not a disputed notice of claim—the date the notice was received by the insurer; or if the notice is a disputed notice of claim—the date the dispute was resolved. disputed notice of claim means a notice of claim for which the insurer states in the insurer’s response to the notice of claim that the insurer— is not satisfied the notice has been given as required under part 4 , division 3 of the Act ; and does not waive compliance with the relevant requirements. See section 39 (1) (a) of the Act . reporting period means— if the commission has given written notice to all licensed insurers that the reporting period is to be reduced to a period shorter than a month as from a stated date that is at least 3 months after the date of the notice and the stated date has passed—the shorter period; or otherwise—a month. required claim details , for a claim, means each of the following details— the date the notice of claim was received by the insurer; the date the insurer opened a file on the claim; the date, time and place of the accident; an identifying accident number assigned by the insurer; an identifying claim number; the relevant police accident report reference number; for each claimant— the claimant’s full name and residential address; and the claimant’s date of birth; and the claimant’s medicare number; and if the notice of claim was accompanied by an identity document under section 18 that has a unique identifying number—the number. required further claim details , for a claim, means each of the following details— the compliance date for the notice of claim; the make, model, type, year of manufacture, and registration number of each motor vehicle involved in the accident; the names and addresses of the owner and driver of each motor vehicle involved in the accident; whether, in relation to the vehicle the claimant or, for a derivative claim, the injured person was travelling in at the time of the accident, a property damage claim has been made under a comprehensive insurance policy or a third party property damage policy; if a claim has been made under a policy mentioned in paragraph (d) —the insurer for the policy, the policy number and the number of any property damage claim made under the policy; the name and address of each witness to the accident known to the insurer; the circumstances of the accident, including how the claimant came to be involved in the accident; the nature of the personal injury to the claimant; for a claim other than a derivative claim, the following details as shown in the notice of claim— the date the claimant was first physically examined by a doctor in relation to personal injury resulting from the accident; the date the claimant was first physically examined by the certifying doctor in relation to personal injury resulting from the accident; the unique identifier given to the certifying doctor under the Health Practitioner Regulation National Law , section 233 ; for a claim other than a derivative claim, whether the claimant was, at the date of the accident, an existing patient of the doctor or of a medical practice in which the doctor practises or was practising, as shown in the certificate accompanying the notice of claim; if the claimant consulted a lawyer about the possibility of making a claim—the date, as shown in the notice of claim, the claimant first consulted the lawyer; if the claimant has retained a law practice to act for the claimant in relation to the claim, the following details as shown in the notice of claim— the name of the law practice; the date the claimant retained the law practice. resolved , in relation to a disputed notice of claim, means— the insurer is satisfied the claimant has complied with the relevant requirements of part 4 , division 3 of the Act , or is satisfied with the action taken by the claimant to remedy the noncompliance or waives compliance in any event; or the court declares the claimant has remedied the noncompliance; or See section 39 (5) (c) (i) of the Act . the court authorises further proceedings based on the claim despite the noncompliance. See section 39 (5) (c) (ii) of the Act .