Insurer has right to earnings info despite privacy concern
A claimant has been told to co-operate with an insurer seeking earnings information, to show his bid for crash injury benefits is valid.
The NSW Personal Injury Commission says is reasonable for AAMI to request the information to calculate pre-accident weekly earnings.
The insurer applied for a merit review after the insured said its request was unreasonable.
Nicholas Elias was involved in an accident in November last year and lodged a claim for benefits under the NSW Motor Accident Injuries Act.
He said he worked as a full-time manager earning $1500 a week. He sent AAMI payslips, but when the insurer detected discrepancies, it sought more information.
The commission says it is reasonable for AAMI to ask for unredacted bank statements from November 2023, a tax return for 2023-24 and a superannuation statement for November 26 2023.
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Merit reviewer Katherine Ruschen says Mr Elias worked for a family business and did not normally receive payslips, so they were created by his accountant after the accident to support the lost wages claimed.
AAMI noted Mr Elias said he was fearful of driving and unable to work, but its surveillance showed him doing both. There were significant inconsistencies and concerns around his employment and driving capacity that raised issues of reliability, and its request for more information was reasonable.
Mr Elias said he had provided adequate information and should not have to provide unredacted bank statements, to protect his privacy.
Ms Ruschen says an insurer must be satisfied with the validity of a claim and a claimant has a mandatory obligation to “co-operate fully”.
The evidence supplied was “clearly insufficient” to show pre-accident weekly earnings and there were questions that put the validity of the claim in issue.
“Where a claimant fails to provide sufficient documents and/or fails to provide relevant documents requested by the insurer, they potentially do so at their own peril given they bear the onus of establishing a valid claim for statutory benefits,” she said.
Read the judgment here.