Tag: Treatment & Care

#45 – English Language Course found to be Rehabilitation

Decision

Perez v AAI Limited t/as AAMI [2026] NSWPIC 264

Sixty-Second-Or-Less Read

An injured claimant seeks to recover the cost of an English language course as a treatment and care expense. They argue that they need to improve their English language skills in order to enhance their prospects of employment, within the restrictions caused by their injuries.

Does an English language course fall within the definition of “treatment and care” in s 1.4 of MAIA?

In Perez v AAMI, a PIC Member found that an English language course is a claim for “rehabilitation” because the course helps the injured person attain and maintain their independence in all aspects of their life, including their vocational aspirations. As such, the claimed English language course was a claim for treatment and care. Whether this particular claim for an English language course was reasonable and necessary and related to an injury sustained in the accident was a matter for a Medical Assessor.

Principles

✅ A claim for an English language course falls within the definition of “rehabilitation” and “education and vocational training” and, therefore, constitutes a claim for “treatment and care” as defined by section 1.4 of the Motor Accident Injuries Act 2017 (MAIA).

Facts

The Claimant was injured in a motor accident, at Mascot, on 24 October 2023. He sought to recover the cost of an English language course from the CTP Insurer as a treatment and care expense. The Insurer declined the request on the grounds that the language course was not a form of rehabilitation or treatment because it did not aim to rehabilitate any injury sustained in the accident. Furthermore, the course was designed to give the Claimant a skill he did not possess prior to his accident.

The dispute regarding whether the English language course fell within the definition of “rehabilitation” and, therefore, within the definition of “treatment and care” was referred to a PIC Member for resolution as a Miscellaneous Assessment matter.

It was not the PIC Member’s role to decide whether the English language course was reasonable and necessary and related to an injury sustained in the motor accident..

Relevant Definitions

Section 3.24 of the MAIA states, in general terms, that an injured person is entitled to statutory benefits for treatment and care provided to the injured person, provided the treatment and care is reasonable and necessary and related to the injuries sustained in the motor accident.


Section 1.4 of MAIA provides a definition of “treatment and care“, which includes an exhaustive list of eleven types of treatment and care. One of those items is “rehabilitation“ and another is “education and vocational training”.


Section 1.4 of MAIA defines “rehabilitation” as “the process of enabling or attempting to enable the person to attain and maintain—

(a)  the maximum level of independent living, and

(b)  full physical, mental, social and vocational ability, and

(c)  full inclusion and participation in all aspects of life”

The Member’s Decision

The Member determined that the English language course fell within the statutory definition of “rehabilitation” for the following reasons:

🟪 Pursuant to the definition in s 1.4, “rehabilitation” is a “process” which aims to allow an injured person to “attain and maintain” their independence and “full inclusion and participation in all aspects of life.

🟪 The definition of “rehabilitation” does not focus on a particular injury or injuries but, instead, focuses on the impact of the injury or injuries on the particular injured person.

🟪 Where a labourer loses their capacity for labouring work as a consequence of their injuries, a course to help them acquire the skills to work in an office would, undoubtedly, be considered rehabilitation. By analogy, an English language course is rehabilitation for an injured person who does not speak English well before the accident but will need to improve their English to compete for office jobs post-accident. In both instances, the injured person is being taught a new skill to help them retrain for vocational options which are within their capacity post-accident.

The Member noted that a claim for an English language course might also fall within “education and vocational training” which is one the eleven examples provided in the definition of “treatment and care” in s 1.4.

The Member, therefore, concluded that the claim to recover the cost of the English language course was a claim for “treatment and care”, as defined by s 1.4.

My Perspective

The decision in Perez is another decision which confirms that the concept of “rehabilitation”, as defined by s 1.4 of MAIA, extends beyond services provided by a rehabilitation provider.

It is important to note, however, that the Member’s function was limited to deciding whether the claim to recover the cost of the English Language course was a claim for “rehabilitation”.

Whether the specific claim for an English language course was reasonable and necessary, in the circumstances of this particular claim, and whether it related to an injury sustained in the motor accident was a matter for a subsequent medical assessment.

PJH

#2 – Can Treatment & Care be Found on the Uber App?

PIC Decision

Phothisenh v AAI Limited t/as AAMI [2025] NSWPIC 338

Principles

✅ A claim for the cost of transporting an injured child to school, via private transport, could be a claim for “treatment and care” because it is a claim for “transport modification” and/or a claim for “rehabilitation” and/or a claim for “attendant care services“.

✅ A claim for the cost of transporting an injured child to school, via private transport, is not a claim for “education and vocational training” because that term is limited to education and vocational training required as a consequence of an injury, not to the compulsory education of a child.

Sixty-Second-Or-Less-Summary

An infant Claimant claims she requires private transport to get to and from school.

Is the cost of the private transport recoverable as a statutory benefit for treatment and care?

In Phothisenh v AAMI, a PIC Member found that the cost of private transport could constitute “transport modification“, “rehabilitation” or an “attendant care service“, all of which are included in the exhaustive list of items which constitute “treatment and care” found in s 1.4 of MAIA.

As such, the claim for private transport was a claim for treatment and care. Whether the transport was reasonable and necessary and related to the injuries sustained in the accident, however, was a Medical Assessment Matter to be determined by a Medical Assessor.

Facts

The Claimant was only five and a half years old when she was involved in a motor accident on 18 July 2023. On that day, she was crossing the road with her mother. She was riding a scooter and she was crossing under the protection of a pedestrian crossing. One motorist stopped to allow the Claimant and her mother to cross the road. The Insured, however, failed to stop and collided with the Claimant.

The Claimant sustained facial injuries together with fractures of both her left and right femurs. She was restricted to a wheelchair for some period post-MVA.

A dispute subsequently arose between the Claimant and the Insurer regarding the Claimant’s need for private transport to and from school.

The dispute was initially allocated to a Member, as a Miscellaneous Assessment Matter, to determine whether the claim for private transport constituted a claim for treatment and care within the meaning of section 1.4 of the Motor Accident Injuries Act 2017 (MAIA).

Relevant Definitions

The definition of “treatment and care” in section 1.4 of MAIA includes, amongst other items, “education and vocational training“, “rehabilitation“, “home and transport modification” and “attendant care services“.

The term “rehabilitation” is separately defined in s 1.4 as follows:

“…the process of enabling or attempting to enable the person to attain and maintain—

(a)  the maximum level of independent living, and

(b)  full physical, mental, social and vocational ability, and

(c)  full inclusion and participation in all aspects of life.“

The term “attendant care services” also has its own definition s 1.4 as follows:

“..services that aim to provide assistance to people with everyday tasks, and includes (for example) personal assistance, nursing, home maintenance and domestic services.”

The Member’s Decision

The Member addressed the multiple arguments advanced by the parties as follows:

Is Education Treatment?

The term “education and vocational training” in the definition of “treatment” in s 1.4 of MAIA does not include the compulsory education of children. The term is directed to additional education and vocational training required as a consequence of an injury. For example, a hypothetical Claimant with a head injury might require specialised education and training as a consequence of that injury. It follows that transport to and from school is not transport for the purpose of obtaining “treatment“.

Is Travel to School Rehabilitation?

If a hypothetical Claimant needed assistance to access the school grounds and enter the classroom, that assistance would be part of the Claimant’s rehabilitation because it would be part of a process which helps the Claimant attain and maintain full inclusion in their school life. The same applies, in this claim, to getting the Claimant to school in the morning and home again in the afternoon. Whether the process of the Claimant’s rehabilitation has ended is a Medical Assessment Matter to be determined by a Medical Assessor.

Is Uber Travel a Form of Transport Modification?

Travelling to school via Uber rather than public transport is a form of “transport modification” as that term is used in the definition of “treatment and care” in section 1.4 of MAIA. “Transport modification” refers to a change or an alteration in the way the Claimant was transported before the accident. In this case, the Claimant used public transport before her accident. Following the accident, she claims she needed to modify that arrangement and use private vehicles.

Is Taking a Child to School an Attendant Care Service?

Taking a child to school is an “everyday task” in the sense that it is routine or commonplace. Furthermore, given that the Claimant could not go to and from school by herself, given her age, accompanying her to school is a form of “personal assistance“. Whilst the Claimant’s mother would have assisted her to get to and from school, irrespective of her injury, the change in transport from public transport to a private vehicle is a form of treatment and care provided to the Claimant because of her injury.

As such, the Member found that the claim for private travel was a claim for treatment and care within the meaning of sections 1.4 and 3.24 of MAIA because it was a claim for transport modification and/or a claim for attendant care services and/or a claim for rehabilitation.

Whether the private transport was reasonable and necessary and related to the injuries the Claimant sustained in her accident was a Medical Assessment Matter. Any subsequent dispute about the cost would be a Merit Review Matter.

Pete’s Perspective

The decision in Phothisenh is instructive because it demonstrates the overlap that exists between the twelve items listed in the definition of “treatment and care” in s 1.4 of MAIA. In this claim, the Member found that the private transport sought by the Claimant fell within three separate items in the definition.

It is important to understand, however, that the Member’s role was limited to deciding whether the claim for private transport was a claim for “treatment and care” within the definition. It was not the Member’s role to decide whether the claim for private transport was reasonable and necessary, in the circumstances, and whether the claim related to the injuries the Claimant sustained in the accident. Those issues were to be decided in a subsequent medical assessment conducted by a Medical Assessor.

PJH