application under section 193 of the Motor Accident Injuries Act 2019
application for leave to present further material
whether treatment is reasonable and necessary
Quick Take
1An insurer's duty to investigate a treatment request before declining it is not discharged merely by obtaining independent specialist opinions where those opinions contain unresolved internal inconsistencies, lack adequate reasoning, or conflict with the treating practitioner's assessment — the insurer must take reasonable steps to clarify material gaps and contradictions.
2Where a treating practitioner recommends treatment in the context of an accepted claim and the insurer identifies that the practitioner has not expressly linked the treatment to the accident, the insurer should seek clarification from that practitioner rather than drawing an adverse inference from the omission.
3On remittal following expiry of the defined benefits period, where the applicant lodged all applications within time, any benefit that should have been approved at the date of the reviewable decision should be treated as an accrued entitlement and is not defeated by subsequent expiry of the benefits period.
