Motor Accident Injuries Act 2019

This section applies if—

the relevant insurer for a motor accident receives a quality of life benefits application from a person injured in the accident and—

section 138 applies to the person; or

section 140 applies to the person; or

both of the following apply:

the person is receiving income replacement benefits or, because of the circumstances prescribed by regulation, would have been eligible to receive income replacement benefits;

the person’s injuries may have a significant occupational impact on the person’s ability to undertake employment; and

either—

the person has not had a WPI assessment in relation to the injuries; or

a WPI assessment has confirmed that the person’s injuries have not stabilised; and

it is 4 years and 6 months after the date of the motor accident.

The relevant insurer must refer the injured person to an authorised IME provider for a WPI assessment.

If the WPI assessment states that the injured person’s injuries have not stabilised—

the assessment must estimate the person’s WPI; and

for a person who is not a person mentioned in subsection (4)—the estimated WPI is taken to be the person’s WPI.

Note If more than 1 WPI assessment is carried out in relation to the injured person, payment of the assessments must be in accordance with the MAI guidelines (see s 147 (3)).

Subsections (5) and (6) apply if—

either of the following applies:

if separate reports from an independent medical examiner assess an injured person’s physical injuries and psychological injuries—the higher estimated WPI is at least 5%;

if only 1 WPI report from an independent medical examiner assesses an injured person’s WPI—the estimated WPI is at least 5%; and

the injured person is entitled to make a motor accident claim in relation to the motor accident.

The relevant insurer for the motor accident must, within 14 days after receiving the WPI report about the injured person, give the injured person a written notice—

including a copy of the report; and

telling the person that the person must, within 26 weeks after receiving the notice—

accept the estimated WPI as the person’s WPI; or

make a motor accident claim and apply to stay a proceeding on the claim until the person’s injuries have stabilised; and

telling the person that if the person decides to take the action mentioned in paragraph (b) (ii)—

the person must notify the relevant insurer when the person’s injuries have stabilised; and

that the relevant insurer will refer the person to an authorised IME provider for a second WPI assessment; and

that the person is liable for the costs of the second WPI assessment; and

that if the WPI report from the second WPI assessment assesses the person’s WPI as less than 10%, the person is not entitled to proceed with the motor accident claim and is liable for their own costs in relation to the claim.

The injured person must make a decision under subsection (5) within 26 weeks after the date the person is notified of the person’s estimated WPI.

Note If the injured person’s estimated WPI is taken to be the person’s WPI, div 2.6.3 and ch 3 apply to the person.

If the injured person does not notify the insurer within the 26 weeks, the injured person is taken to have accepted the estimated WPI as the person’s WPI.

The relevant insurer must take all reasonable steps to notify the injured person about the consequences of failing to notify the insurer as stated in the notice under subsection (5) within the 26 weeks.

Examples—reasonable steps

1 including information in the written notice under s (5) about the consequences of failing to notify the insurer within the 26 weeks

2 sending the injured person a reminder notice before the end of the 26 weeks

If the injured person refuses to have a WPI assessment, the person’s quality of life benefits application is taken to have been finally dealt with.