An insurer that relied on an inference of driver fault to deny a car crash wound claim has lost a case before the NSW Personal Injury Commission.

NRMA Insurance rejected James Sheeran’s claim under the state’s Motor Injuries Act for statutory benefits after 52 weeks, saying it could be inferred he caused the accident by failing to take reasonable care, not maintaining a proper lookout, and not driving in accordance with prevailing road conditions.

There was no evidence of another reason for the accident, it said.

However, the commission found the accident could not be deemed wholly or mostly Mr Sheeran’s fault, because there was a chance he had a medical episode or a “micro-nap”.

Mr Sheeren, aged in his 80s, suffered serious injuries when his car veered to the wrong side of the road and hit a truck and another car at Budgewoi in December 2023.

The accident happened during the day, the weather was fine, visibility was good and the road was dry.

Mr Sheeran was familiar with the area and speed was not a factor, nor were alcohol or illegal drugs. He had no memory of the accident and told police he may have had a “nanny nap”.

A witness said they saw Mr Sheeran’s head slumped as the car crossed the lanes, and police believed the accident could have been caused by a medical episode.

NRMA Insurance argued investigations failed to identify a medical cause for the accident and it should be inferred it was Mr Sheeran’s fault.

Commission senior member Brett Williams said the burden of proof lay with the insurer but it was entitled to rely upon a reasoning process that led to the inference.

He said the accident was so unusual it may have been caused by failure of care on Mr Sheehan’s part, but while this was possible “I am not satisfied it is more probable than not”.

Read the determination here.