Duty to act in good faith—applicants, claimants and insurers
20 Duty to act in good faith—applicants, claimants and insurers
This section applies to the following people:
a licensed insurer;
an applicant for defined benefits in relation to a motor accident;
a claimant for a motor accident claim.
Each person to whom this section applies—
has a duty to act in good faith in relation to an application for defined benefits or a motor accident claim; and
must endeavour to finalise the application, or resolve the claim, as justly and promptly as possible.
The duty of an applicant or claimant to act in good faith in relation to an application for defined benefits or a motor accident claim includes the following:
a duty to act honestly and with integrity at all times, and not to mislead, in all dealings and communications in relation to the application or claim;
a duty to disclose, in a timely manner—
all relevant information in relation to the application or claim, including reports by health practitioners; and
Note Health practitioner—see the Legislation Act, dictionary, pt 1.
any other information reasonably requested by an insurer in relation to the application or claim;
a duty to do all things reasonably necessary to facilitate the resolution of a dispute in relation to the application or claim;
a duty to take all reasonable steps to minimise the loss caused by the applicant’s or claimant’s personal injury, including—
undertaking reasonable and necessary treatment and care, rehabilitation and vocational training; and
applying for treatment and care benefits as soon as practicable after the motor accident or after the applicant or claimant becomes aware of the personal injury; and
starting or returning to work as soon as practicable after a health practitioner certifies that the applicant or claimant is fit for starting or returning to work.
The duty of a licensed insurer to act in good faith in relation to an application for defined benefits or a motor accident claim includes the following:
a duty to disclose, as soon as practicable, all information that an applicant or claimant may reasonably need to understand the process for applying for defined benefits or making a motor accident claim;
a duty to give an applicant information about the applicant’s entitlements to defined benefits;
a duty to keep an applicant or claimant informed at all times about the status or progress of their application or claim;
a duty to give the applicant or claimant written reasons for all decisions having a material effect on an entitlement to defined benefits or damages;
a duty to tell an applicant or claimant about the applicant’s or claimant’s right to review of a decision of the insurer;
a duty to promptly pay any defined benefits to which a person is entitled or damages agreed to in settlement of the motor accident claim or ordered by a court.
If a court or the ACAT is hearing a dispute involving a licensed insurer and an applicant or claimant in relation to an application for defined benefits or a motor accident claim, the court or the ACAT may—
take into account a duty the insurer, applicant or claimant has under this section; and
make an order in relation to the exercise of the duty.
Note It is an offence to make a false or misleading statement, give false or misleading information or produce a false or misleading document (see Criminal Code, pt 3.4).
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