The insurer suspended the claimant’s benefits after refusing a psychometric meeting
The Personal Injury Commission (PIC) has ordered Insurance Australia Limited which trades as NRMA Insurance to reinstate claimant Humze Kammoun’s weekly statutory benefits claim due to sustained physical and psychological injuries following a motor vehicle accident. Law firm McCabes examined the decision and how the commission reached it.
In article published on its website, McCabes noted that the insurer had suspended Kammoun’s benefits after he did not push through with the appointment arranged by NRMA with another expert, Dr. Fernando Roldan, that can administer a psychometric evaluation.
The insurer had arranged the appointment after it had received an expert report from a psychiatrist that recommended Kammoun to undergo a psychometric evaluation as NRMA had accepted the liability for the statutory benefits claim following the claimant’s injuries from the accident.
However, according to PIC member Elizabeth Medland, Kammoun was not required to undergo the psychometric evaluation because the recommendation by the insurer’s expert was not reliable since they relied on a report prepared on the papers for NRMA within two months of the accident, who is not qualified in psychiatry. The expert was also found to have not interviewed Kammoun and did not include real life facts when it came to his injury and recovery.
With no credible basis for the insurer’s request for Kammoun to undergo a psychometric testing, it was found to be unreasonable under section 6.27 of the Motor Accident Injuries Act 2017. Medland then ordered NRMA to reinstate Kammoun’s weekly benefits and reimburse any weekly benefits that had not been provided to the claimant since the insurer’s decision to withhold them.
McCabes pointed out that the decision by the member served as a reminder that the insurer can only reduce or stop a claimant’s weekly benefits if its request for them to attend a medical appointment is reasonable.
