Review of insurer's decision

If you were injured in a motor accident and do not agree with the insurer’s decision about your application for defined benefits, from 1 February 2020 you may be able to apply to ACAT to review the decision on a question of law or fact.

There are time limits on how long you have to make an application to ACAT.

ACAT does not have power to review every decision made by the relevant insurer.

The decisions that ACAT can review are set out in the Motor Accident Injuries Act 2019 (see Schedule 1 Part 1.2).

Before you apply

How do I know if the decision is reviewable?

After you have applied to the relevant insurer for defined benefits, the insurer will write to you explaining the decision and the reasons for the decision.

As part of that letter, the insurer should tell you if and how you can apply to have the decision reviewed.

If the document the insurer gives you is a ‘reviewable decision notice’, the notice will tell you about how you can apply to ACAT to have the insurer’s decision reviewed.

If the written information you receive from the insurer about the decision does not tell you that you can apply to ACAT, then ACAT may not have the power to review the decision by the insurer, or you may have to do other things before you can apply to ACAT.

If you are unsure, ask the insurer for information or seek advice about your review rights.

Do I need to ask for an internal review first?

The decision may be internally reviewable. That means you need to follow the insurer’s processes to request an internal review by the insurer. Information about relevant time limits for you to request a review, and for the insurer to make a review decision, should be included in the information the insurer sends to you.

When an insurer makes an internal review decision, the insurer will send you an ‘internal review notice’ that includes:

  • the reasons for the decision
  • how to apply for external review.

If the insurer does not send you an internal review decision within time, you may then be able to apply to ACAT for a review of the insurer’s original decision.

How long do I have to make an application?

You must lodge an application for review of insurer’s decision [PDF 325KB] or [DOC 175KB]:

  • within 28 days after the day the internal review notice is given to you, or
  • within 28 days after you become aware of the insurer’s decision (if no internal review notice is given to you), or
  • within 28 days after the date the decision should have been made (if the insurer does not make a decision).

If you need an extension of time to make the ACAT application, complete the application for extension of time [PDF 291KB] or [DOC 156KB].

If an application for an extension of time is made, ACAT will provide a copy to the relevant insurer and ask for their views. If there are no objections, ACAT may order the extension of time without a hearing. If the insurer objects to the extension of time (or it is not clear there are reasonable grounds to extend time), ACAT may schedule a short hearing to decide whether or not there are reasonable grounds to extend time.

Is the decision under review automatically stayed?

Lodging an application for review of an insurer’s decision has no effect on the reviewable decision. The insurer’s decision will continue to be in effect unless ACAT makes an order to ‘stay’ the decision.

To request a stay of the insurer’s decision, fill in the application for interim or other orders form – general [PDF 56KB]. You will need to set out what order you are seeking and why.

If you request a stay, ACAT will advise the insurer and ask if they agree. If there is agreement, ACAT may immediately make an order for a stay. If the insurer does not agree, ACAT will usually schedule a short hearing as early as possible to consider the application to stay the insurer’s decision.

If ACAT makes an order without holding a hearing, the parties will be provided with a copy of the order. ACAT may review any order it makes as the matter progresses.

What are reviewable decisions?

ACAT only has power to review an insurer decision on a question of law or fact. The full list of ACAT reviewable decisions is set out in Schedule 1 Part 1.2 of the Motor Accident Injuries Act 2019 or in regulations made under the Act. Download or summary of reviewable decisions [DOC 18KB].

Is there a fee to lodge an application?

There is a fee to lodge an lodge an application for review of insurer’s decision [PDF 325KB] or [DOC 175KB], unless you have an exemption, waiver or deferral.

Are there any other fees in the case?

There may also be a hearing fee if your matter is scheduled for more than one day of hearing.

If you want to subpoena documents or subpoena a person to attend a hearing to give evidence you will need to pay a fee.

Find a list of ACAT fees.

Will I have to pay costs?

ACAT may order a party to pay the other party’s costs of an application to review an insurer’s decision under the Motor Accident Injuries Act 2019. Either party can apply for a costs order. If ACAT makes a costs order, there may be limits on the amount and the kind of costs that ACAT can order a party to pay.

Do I need a lawyer?

See our information about:

ACAT registry staff can give you procedural information, but not legal advice.

You may decide to get legal advice early, before making an application or before the first directions hearing.

You can be represented by a lawyer when you come to ACAT, but it is not necessary. If ACAT does make a costs order in your favour, there may be limits on the amount and kind of costs that the other side will be ordered to pay. You can also be represented by someone other than a lawyer if that person is authorised. Any authorisation should be provided at the time the application is lodged.

How to apply to ACAT

To make an application you need to:

Remember to consider if you:

  • need to ask for an internal review from the insurer first
  • are within the timeframe for making the application
  • need to ask ACAT for a stay of the insurer’s decision
  • need to ask ACAT for an urgent order
  • want to ask for an order about costs and fees if you are successful.

Urgent applications

If there is an issue in your case that needs to be urgently decided, you can request ACAT make urgent orders. To apply for urgent orders, you need to complete an application for interim or other orders form [PDF 56KB]. You will need to set out what orders you are requesting and why.

It is important that you give as many details as possible when making a request for urgent orders (including your availability to attend a hearing). You can attach an extra page to the application if you need more space.

ACAT will give a copy of your application to the relevant insurer and seek their views. ACAT may then make immediate orders in chambers or schedule the case for a short hearing as soon as possible.

What to expect after an application is made

After the application is received, ACAT will send the application and a notice to all the parties, including you. The notice will explain the next steps. ACAT will direct the relevant insurer to provide:

  • a copy of the written reasons for the insurer’s decision
  • the information available to the insurer when the decision was made.

Application to present additional information

ACAT may only consider the information provided to it by the insurer unless a party makes an application to ACAT to present additional information or evidence [PDF 249KB] or [DOC 120KB]. A party can only present additional information or evidence if ACAT makes an order allowing that party to do so.

To apply to present additional information use the application to present additional information or evidence. You will need to give the reason/s why you say the information or evidence was not reasonably available to the decision-maker when the decision was made.

ACAT will provide, or will require you to provide, a copy of this application form and any information lodged with it to all other parties. The other parties will be asked about their views. ACAT will consider all views, and may hold a hearing, before it makes an order about the additional information or evidence.

Other parties

ACAT may require a party to notify other people/entities with an interest in the reviewable decision about the ACAT application. These people/entities may then make an application for order to be joined as a party [PDF 116KB] to the case.

ACAT will provide a copy of this application to all the parties and ask for their views. If there are no objections and it is clear that the person/entity is entitled to be joined, ACAT may make orders to join the person/entity to the proceedings. If there are objections or it is not clear that the person/entity is entitled to be joined, ACAT will usually consider the application to be joined at the first directions hearing.

Resolving your case

Even after an application is lodged, it is a good idea to continue to see if an agreement can be reached.

At the first directions hearing, directions will usually be made. These will tell the parties what they need to do before a hearing. All parties are required to prepare for a hearing by complying with any ACAT directions that are made.

The first directions hearing

The purpose of the first directions hearing is to decide how the matter should proceed. ACAT may ask the parties:

  • Is the name and spelling of each party’s name correct?
  • Are the details for any representative correct?
  • Is there is an email address to send documents to?
  • Have all parties received all relevant documents?
  • Should a person or entity be joined to the case?
  • Are there any specific factual or legal issues to be raised early on?
  • Should a mediation or a preliminary conference be scheduled? If so, when?
  • How many witnesses will need to give evidence? Are there any expert witnesses?
  • Do any subpoenas need to be issued?
  • When should the case be scheduled for a hearing? How long is the hearing expected to take? Are the parties and their witnesses available?
  • Is anyone requesting a private hearing? Are non-disclosure or non-publication orders sought?
  • Does anyone have special or accessibility needs to be addressed so they can participate in the hearing?

In some cases, a decision may be made without holding a hearing. A case may be scheduled for mediation or preliminary conference. A case may be resolved before a hearing. If the case does not resolve before a scheduled hearing, the parties will need to prepare for the hearing.

The case will be heard by an ACAT Member or Members. At the end of the hearing, the ACAT Member or Members will tell the parties if they can deliver a decision immediately, or if they need to reserve the decision and give it later.

Orders ACAT can make

The ACAT Member/s will review the relevant insurer’s decision and may make orders that:

  • affirm the decision or
  • amend the decision or
  • set aside the decision.

If the decision is set aside, ACAT may:

  • make a substitute decision or
  • send the matter back to the relevant insurer for reconsideration, and may include directions.

ACAT decisions are binding. An order that sets aside or amends an insurer’s decision usually takes effect on the day the insurer’s decision was made, unless ACAT orders otherwise.

Appeals

If you think ACAT made an error when it decided the application, you may apply to appeal the decision within 28 days of the decision.

Getting help

CARE Inc provides a free defined benefits information service. They can:

  • assist you to identify the types of decisions that can be reviewed
  • explain how to apply for internal or external review.

Contact CARE Inc on 1300 209 642.

More information

Find out about:

Glossary and terms

Glossary and terms

ACT Civil and Administrative TribunalA tribunal established under the ACT Civil and Administrative Tribunal Act 2008. It may also be referred to as ACAT or Tribunal.

Adjourn (or adjournment)To suspend or postpone a preliminary conference, mediation or hearing and reschedule it for a future date.

Administrative reviewACAT has jurisdiction to review some administrative decisions made by the ACT Government. Find out about Review of ACT Government decisions.

Alternative dispute resolution (ADR)Also known as dispute resolution. This is a way of resolving disputes without a formal hearing. It may involve a preliminary conference or mediation. ADR is used to help parties resolve cases by agreement.

AnorMeans ‘and another’. This term is generally used to name parties to proceedings when there is more than one applicant or respondent.

Appeal TribunalA tribunal constituted under section 81 of the ACT Civil and Administrative Tribunal 2008 to review a decision of the tribunal (not all ACAT decisions are appealable at ACAT – you may need to go to the Supreme Court).

AppellantThe individual or company that appeals an ACAT decision.

ApplicantThe individual or company that brings a case to ACAT, usually by making an application.

Authorising lawsA law that says an application (including referrals) may be made to ACAT. An authorising law may also set out the powers ACAT has in a case. Also see ‘jurisdiction’.

Calling a witnessA party or their representative will ‘call a witness’ at an ACAT hearing when they ask a witness to give evidence.

CaseAlso known as a matter, dispute, application or referral. Cases come to ACAT when ACAT has jurisdiction (power) to make a decision.

Cross-examinationThe process of asking a witness questions to test or check the evidence that the witness has given to ACAT.

Defined benefitsare the following benefits (see section 33 of the MAI Act):

  1. income replacement benefits;
  2. treatment and care benefits;
  3. quality of life benefits;
  4. death benefits;
  5. funeral benefits.

Deliver a decisionAlso ‘handing down a decision’. This is giving a decision about an ACAT case. It may be done verbally or in writing (or both).

DirectionsInstructions that set out what each party must do (and when), often to prepare a case for hearing.

Directions hearingA short hearing where an ACAT Member or Registrar decides how to manage a case and what needs to be done before a hearing. Find out about directions hearings.

Ex parte orderAn order made by ACAT where one or more parties were not present.

Expert reportA written report from an expert that may be used as evidence.

Expert witnessA person with specialised knowledge based on their training, study or experience. An expert can give evidence at a hearing. Find out more about witness statements.

Final directions hearingSometimes ACAT will hold a final directions hearing prior to the final hearing of an application. The purpose is to make sure the case is ready to go to a hearing and give the parties a chance to ask questions about the hearing process.

Handed upGiving documents to an ACAT Member or Registrar in a hearing.

In chambersWhen ACAT considers something without holding a hearing.

Joined party (joined/joinder)A party who was not originally a party to the dispute but has later been added to the case.

JurisdictionACAT’s authority (power) to deal with, hear and decide applications (cases).

LeaveIf someone asks for leave, they are usually asking for permission to do something.

List (or listing)A schedule (or list) of cases to be heard at ACAT each day.

Listing noticeA letter or written document from ACAT that sets out when a conference, mediation or hearing is scheduled at ACAT.

MAI ActMotor Accident Injuries Act 2019 (ACT).

MediationA private meeting where parties discuss ways to resolve their dispute, with the help of an impartial mediator (who is also an ACAT Member or Registrar). It is held under section 35 of the ACT Civil and Administrative Tribunal Act 2008.

Non-publication and/or non-disclosure orderAlso called a ‘suppression order’. It is an order that requires certain information not to be published or disclosed. It is made under section 39 of the ACT Civil and Administrative Tribunal Act 2008. Find out about public hearings and confidentiality.

Notice to partiesA letter sent to the parties in a case that sets out the time, date and location for an ACAT conference, mediation or hearing.

Opening statementUsually means a statement made at the beginning of a hearing to outline the key points in the case. Sometimes parties are asked to give an opening statement at a mediation or preliminary conference.

Originating applicationAn application that starts an ACAT case.

Party or partiesAn individual or company directly involved in an ACAT case, for example an applicant or respondent. Find out how to identify and name parties.

Preliminary conferenceA private meeting where parties discuss ways to resolve their dispute with the help of an ACAT Member or Registrar. See section 33 of the ACT Civil and Administrative Tribunal Act 2008. ACAT has different types of preliminary conferences.

RegistryThe administrative section of ACAT that accepts documents lodged by parties, handles enquiries and provides support for case management.

Relevant insurerfor a motor accident, means the insurer under the Motor Accident Injuries Act 2019 (see section 34) of the motor vehicle considered to be at fault for the motor accident in the ACT.

RepresentativeA person who represents or advocates for an individual or company at a conference, mediation or hearing at ACAT. For example, a legal practitioner or an attorney appointed under a general power of attorney.

Reserved decisionWhen an ACAT Member or Registrar reserves a decision (at the end of a hearing), this means they will give their decision later, either verbally or in writing (sometimes both).

RespondentThe party (or parties) against whom orders or relief is sought.

Serve/serviceA person who can give evidence at a hearing. Find out about witness statements.

Short service orderAn order that authorises a shorter time for service (than the time otherwise required).

Significant occupational impact (SOI)Significant impact on an injured person’s ability to undertake employment.

Statement of reasonsA document that explains why ACAT made an order in a case. It sets out the law relied on by an ACAT Member or Registrar and explains how the law was applied to the facts of the case. You can request a written statement of reasons within 14 days after an order is made. Find out about statement of reasons.

StayAn order for a particular action (or decision) to be put on hold or suspended for a period of time.

SubmissionA document that sets out your side of a case or dispute and the relevant law. It is presented to ACAT either in writing, verbally or both. Find out about submissions.

SubpoenaRequires a person to appear at ACAT to give evidence or provide documents (or both). Find out about subpoenas.

Substituted service orderAn order that says how a party is to be served with an application or other documents related to the proceedings. In a civil dispute or a rental dispute, an applicant will need to consider asking for a substituted service order if they do not have a physical address for the respondent. Find out about lodging and serving documents.

WitnessA person who can give evidence at a hearing. Find out about witness statements.