Motor Accident Injuries Act 2019

This section applies if the relevant insurer for a motor accident receives—

an application for defined benefits from a person injured in the motor accident; or

a request for reimbursement of expenses for treatment and care for an applicant that are incurred before the application is made or while the application is being considered; or

a request from a provider of treatment and care for payment of treatment and care provided to an applicant.

If the relevant insurer reasonably suspects that information in the application or request is false or misleading, the relevant insurer may refuse to—

accept liability for the application; or

reimburse the applicant; or

pay the provider.

Note 1 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).

Note 2 The insurer may recover from the applicant any costs reasonably incurred because of the applicant’s fraudulent conduct (see s 349).

However, if the relevant insurer later establishes that the information in the application or request is not false or misleading, the relevant insurer must—

reimburse the applicant for the expenses incurred; or

pay the provider for the treatment and care.

Despite subsection (2), if the relevant insurer has not made a decision to accept or reject liability for the application, the relevant insurer must pay the applicant’s allowable expenses.