Disputes are assigned to the most appropriate dispute resolution pathway.
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:
- Insurer internal review
- Lodgement by claimant following insurer internal review
- Reply provided by insurer.
- Determination made by merit reviewer
- Certificate and statement of reasons issued.