Motor accidents disputes – 2017 scheme

Disputes are assigned to the most appropriate dispute resolution pathway.

Merit review dispute

Disputes are assigned to the most appropriate dispute resolution pathway.

Merit reviews are a particular type of review that have been created under the Motor Accidents Insurance Act 2017. A person who is a merit reviewer is not a Member, they are a decision-maker appointed by the President of the Commission.

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Merit review applications
Merit review applications Panel review

Merit review applications

When to lodge an application

Merit reviews involve the determination of disputes between the insurer and claimant about matters such as entitlements to statutory benefits. Merit review disputes include topics such as weekly benefits payments, funeral expenses, payment of expenses such as treatment and care, rehabilitation, vocational training, and entitlement to recover costs in relation to claims for statutory benefits, including legal costs.

Only a claimant may lodge an application for a merit review. Before lodging the application for merit review, the claimant must have applied for an internal review of the disputed decision by the insurer.

An application for merit review may be made at any time; however, if it is made more than 28 days after a claimant receives notice of the internal review decision of the insurer, the Commission does not have to accept the application.

The complete list of matters that may be the subject for an application for merit review is set out under Schedule 2 of the Motor Accidents Insurance Act 2017.

The merit review dispute pathway is as follows:

  1. Insurer internal review
  2. Lodgement by claimant following insurer internal review
  3. Reply provided by insurer.
  4. Determination made by merit reviewer
  5. Certificate and statement of reasons issued.

Insurer internal reviews

Most insurer decisions that can be referred for a merit review by the Commission will first need to be referred for an internal review by the insurer. If a claimant requests an internal review of a decision within 28 days of receiving it, the insurer must accept the application.

An application for internal review may be made more than 28 days after the claimant receives a decision from the insurer; however, the application does not have to be accepted.

A claimant may refer a matter for merit review after they have applied for an internal review:

  • within 28 days of the insurer having conducted the internal review and advised the claimant of the outcome
  • within 28 days of the insurer notifying the claimant that the application for internal review has been accepted but that the insurer declines to conduct the review
  • if the insurer fails to conduct the internal review within 28 days of receiving the request.

How to lodge a merit review application

Applications for merit review should be lodged via the Commission’s online portal.

If a self-represented claimant is unable to use the portal to lodge their application, they may contact the Commission to obtain a PDF copy of the form or have an application mailed to them. These applications may be lodged via email or post, or in person at the Commission.

The following details must be included in a merit review application:

  • the decision of the insurer that is referred for merit review
  • the alternative decision sought in the merit review
  • issues under review – the elements of the original decision that the party wishes to be reviewed
  • the reasons the decision should be changed
  • any additional documentation or materials that the party considers relevant to a review of the decision
  • any regulated costs sought.

A claimant should list all documents relevant to their application but does not need to attach copies of documents previously provided to the insurer. Only material not previously provided to the insurer must be attached by the claimant to their application.

The insurer is required to provide all of the documents or materials in its possession relevant to the proceedings, including documents and materials listed in the application by the claimant and all documents the claimant has previously provided to the insurer.

How to respond to an application

The respondent will receive a copy of the application via the Commission’s online portal and must respond within 14 days after receiving the application.

The response should be lodged through the Commission’s online lodgement portal. More information about lodgement methods is available on our lodge a dispute page.

Replies to a merit review application must include:

  • the response of the insurer to the alternative decision sought in the merit review application
  • the response of the insurer to the reasons the claimant believes the decision should be changed
  • the response of the insurer to any regulated costs sought (if applicable).

All relevant information that has not been included by the applicant should be attached by the respondent at the time the response is lodged. Respondents may not be able to submit further information at a later time.

The insurer must also provide all documents or materials in its possession relevant to the application and reply, including documents and materials listed in the reply that the claimant has previously supplied to the insurer.

How long does resolving a dispute take?

The Commission endeavours to issue merit reviews decisions as soon as practicable.

Determination

The merit review must be dealt with in a way that best supports the objects of the Motor Accidents Injuries Act 2020. This may include conducting the review on the papers or via teleconference, videoconference or face-to-face meeting. The merit reviewer will act with as little formality as circumstances permit and will make their findings according to equity, good conscience and the substantial merits of the matter without regard to technicalities.

Information and material that was not before the internal reviewer may be considered and a merit reviewer may also request further information from the parties. The merit reviewer will decide what is the correct and preferable decision in the matter, having regard to the material before them and any applicable written or unwritten law.

A decision of the insurer may be affirmed, varied or set aside. Where a decision is set aside, the merit reviewer may make a decision in substitution for the reviewable decision or remit the matter for the insurer to reconsider in accordance with directions.

The parties will be issued a certificate as to the determination, including a brief statement of reasons.

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Panel review

How to lodge a panel review application

Applications for a panel review of a merit review must be made within 28 days of the date the decision was sent by the Commission.

An application for a panel review of a merit review must include the following information:

  1. the decision of the single merit reviewer that is the subject of the application for review
  1. the reasons why the decision that is the subject of the application for review is incorrect in a material respect.

How to respond to an application

A respondent may lodge a reply within 14 days of receiving the application.

The response should be lodged through the Commission’s online lodgment portal.

If a self-represented respondent is unable to use the portal to lodge their application, they may contact the Commission to obtain a PDF copy of the form or have an application mailed to them. These applications may be lodged via email or post, or in person at the Commission at the direction of the President.

A reply to an application for a panel review must include a response to the reasons given in the application.

How is the application managed by the Commission?

The President will consider the application and determine whether there is reasonable cause to suspect that the decision of the single merit reviewer was incorrect in a material respect.

The Commission aims to provide the determination of the President as soon as practicable; however, timeframes may vary. The President will notify the parties of their determination in writing.

If the President is satisfied that the threshold test for a panel review is met, the matter will be referred for review.

How is the panel review conducted?

A panel review may be conducted on the basis of the documents and information lodged with the application and reply or via teleconference, videoconference or face-to-face meeting, as appropriate. The review panel may determine the review procedure, is not bound by the rules of evidence, and may inquire into any matter relevant to the issues in dispute in such manner as the panel thinks fit.

The panel may consider material that was not before the single merit reviewer and is required to decide what the correct and preferable decision is having regard to the material before it, including any relevant factual material.

Panel review outcomes

The panel may confirm the decision of the single merit reviewer or set it aside and make a decision in substitution. The panel will issue a certificate of determination to the parties and a brief statement of reasons for its decision.

Panel reviews are generally conducted within 28 days of the date of the President’s determination, but this timeframe may vary.

Relevant resources

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