Relevant insurer must decide liability for defined benefits
65 Relevant insurer must decide liability for defined benefits
If a relevant insurer for a motor accident receives an application for defined benefits, the relevant insurer must, within 28 days after the date of the receipt notice given to the applicant—
decide whether the relevant insurer accepts or rejects liability for the defined benefits; and
give the applicant a notice about the decision.
If the relevant insurer accepts liability for the defined benefits, the relevant insurer must give the applicant a written notice (a defined benefits notice)—
stating that the insurer accepts liability for the defined benefits; and
including any information required under the MAI guidelines.
If the relevant insurer does not accept liability for the defined benefits, the relevant insurer must give the applicant either—
a written notice (a transfer notice) stating—
that the insurer does not accept liability for the defined benefits because another insurer is liable; and
that the application has been given to another insurer; and
the name and contact details of the other insurer; or
Note Transfers of applications are dealt with in s 69.
a written notice (a rejection notice) stating—
that the insurer does not accept liability for the defined benefits; and
the reasons for the decision; and
how the applicant may dispute the decision.
If the relevant insurer fails to give the applicant a transfer notice or rejection notice within the 28 days, the relevant insurer—
is taken to have accepted liability for the defined benefits; and
is liable for the defined benefits; and
must give the applicant a defined benefits notice.
Note 1 A decision by a relevant insurer to accept liability does not prevent the insurer from making a later decision to reject the liability (see s 68).
Note 2 For how documents may be given, see the Legislation Act, pt 19.5.
This section is subject to section 70 (Dispute about liability for application).
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