Tag: Weekly Payments

#51 – Claimant Not Entitled to Both WC Payments and CTP Payments for Same Period

Decision

Jaggi v AAI Limited t/as AAMI [2026] NSWPICMR 30

Sixty-Second-Or-Less Summary

A Claimant is injured in a motor accident. He was already on workers compensation benefits as a consequence of a prior work injury.

Is the Claimant entitled to weekly payments from both the CTP Insurer and the Workers Compensation Insurer for the same period?

In Jaggi v AAMI, a Merit Reviewer determined that the Claimant had not suffered any loss of earnings, as a consequence of the injury he sustained in the motor accident given the ongoing weekly payments he continued to receive from the Workers Compensation Insurer.

The Merit Reviewer also determined that the Claimant’s bid to recover weekly payments from both Insurers offended the rule against double compensation.

Principles

✅ In addition to being “an earner” and suffering an injury, a claimant is not entitled to weekly payments unless they establish that the injury caused a loss of earnings.

✅ A claimant has not suffered any loss of earnings if they are already totally incapacitated for work as a consequence of a prior work injury.

✅ A claimant is not entitled to weekly payments from a CTP Insurer and a Workers Compensation Insurer, for the same period, because that would be contrary to the rule against double compensation.

Facts

The Claimant was injured in a motor accident on 26 April 2024.

The Claimant subsequently made a request for the back payment of weekly benefits for the period from 13 January 2025 to 25 March 2025.

Prior to his motor accident, however, the Claimant lodged a workers compensation claim for a psychiatric injury. The Claimant was certified unfit to work, as a consequence of his work injury, from 13 June 2024 to 21 March 2025.

The Insurer refused the Claimant’s request on the grounds that the Claimant received workers compensation benefits for the same period and, therefore, had not suffered a total or partial loss of earnings for that period.

The Insurer’s determination was affirmed on Internal Review and the Claimant sought Merit Review.

The Merit Reviewer’s Decision

The Merit Reviewer agreed that the Claimant was not entitled to weekly payments, from the CTP Insurer, for the relevant period, for the following reasons:

🟪 To satisfy the requirements of section 3.7 of MAIA, and to become entitled to weekly payments, a claimant must demonstrate they were “an earner”, they were injured as a result of a motor accident and they suffered a total or partial loss of earnings as a result of that injury.

🟪 In this dispute, the Claimant was “an earner” and the motor accident caused him an injury.

🟪 The Claimant, however, did not lose any earnings as a consequence of the injuries he sustained in the motor accident because he was already certified totally unfit for work by reason of his prior work injury.

🟪 Even if the Claimant satisfied the requirements of s 3.7(1) – which he does not – he would not be entitled to weekly payments from the CTP Insurer because he had already received weekly payments, for the same period, from the Workers Compensation Insurer. Compensating the Claimant for the same period would offend the rule against double compensation.

My Perspective

The decision in Jaggi confirms what should, perhaps, be obvious; namely, that a Claimant cannot receive weekly payments from both the CTP Insurer and a Workers Compensation Insurer for the same period, even if the payments relate to injuries sustained in different accidents.

(Indeed, the Merit Reviewer expressed concern that the Claimant also appeared to have received NewStart benefits for the same period.)

As the Merit Reviewer observed, the rule against double compensation was neatly defined by Chen J in McMillan Investment Holdings Pty Limited v Mangos & Ors (No 3) [2023] NSWSC 1327, at [53] as follows:

“The rule has been explained as a principle (`the principle of full satisfaction prevents double recovery’), and it reflects the fundamental idea that a party `cannot recover in the aggregate from one or more defendants an amount in excess of [their] loss.”

PJH

#42 – Weekly Benefits Not Allowed Where Post-Accident Earnings Exceed PAWE

Decision

Cameron v Allianz Australia Insurance Limited [2026] NSWPICMR 15

Sixty-Second-or-Less Read

An injured Claimant runs a short-term accommodation business prior to being injured in a motor accident. They earn more per week, on average, than their calculated pre-accident weekly earnings. They argue, however, that they would have earned even more post-accident, if it were not for their injuries.

Can the Claimant recover weekly benefits based on their potential increased earnings post-accident?

In Cameron v Allianz, a Merit Reviewer found that the Claimant was not entitled to weekly benefits because their post-accident earnings exceeded their PAWE. The Merit Reviewer found that the statutory formula in sections 3.6 and 3.7 did not permit any potential increase in the Claimant’s post-accident earnings to be taken into account.

Principles

✅ Claims for weekly benefits must be assessed pursuant to the formula in section 3.6 and  section 3.7 of the Motor Accident Injuries Act 2017 (MAIA).

✅ Sections 3.6 and 3.7 require a comparison between the Claimant’s pre-accident weekly earnings (PAWE) and their post-accident earnings or their post-accident capacity “whichever is the greater”.

✅ The words “whichever is the greater” in sections 3.36(3) and 3.7(2) are designed to address situations where the injured person has a residual capacity but fails to exercise that capacity.

✅ The formula in sections 3.6 and 3.7 does not allow a Claimant to claim weekly benefits on the basis that they would have earned income in excess of the PAWE had they not been injured.

Facts

The Claimant was injured in a motor accident on 18 September 2025. At the time of the accident, the Claimant operated a short-term accommodation management business. She alleged that her injuries caused a reduced capacity to carry out this work, which was productive of a loss of income. She claimed weekly benefits accordingly.

The Insurer calculated the Claimant’s pre-accident weekly earnings at $703.25 gross per week. The Claimant did not dispute this assessment.

The Insurer found, however, that the Claimant was not entitled to recover any weekly benefits because her average earnings post-accident exceeded her PAWE. That decision was confirmed on Internal Review.

The Claimant sought a merit review.

The Merit Reviewer’s Decision

The Merit Reviewer agreed with the Insurer’s assessment for the following reasons:

🟪 The claim for weekly benefits must be determined pursuant to the formula prescribed by section 3.6 and section 3.7  of MAIA.

🟪 Schedule 1, clause 3 of MAIA merely sets out the types of income, if not received, which may be considered “loss of earnings” and types of income that are excluded.

🟪 Schedule 1, clause 3 is not, of itself, a mechanism for calculating whether there has been a loss of earnings.

🟪 Pursuant to schedule 1, clause 3, the proceeds received from the Claimant’s business may be taken into account when calculating whether there has been any loss of earnings under sections 3.6 and 3.7.

🟪 The Claimant’s argument that she could have earned more, but for the accident, is not relevant to the calculation of weekly benefits because sections 3.6 and 3.7 only permit a comparison between the Claimant’s PAWE and her post-accident capacity.

🟪 The Claimant’s argument that her injuries caused an increase in expenses is also irrelevant in circumstances where her post-accident earnings exceed her PAWE (irrespective of her increased expenses).

🟪 The purpose of the words “whichever is the greater” in sections 3.36(3) and 3.7(2) is to address situations where the injured person has a residual capacity but fails to exercise that capacity.

    My Perspective

    The decision in Cameron is important because it confirms two aspects relevant to the calculation of weekly benefits.

    Firstly, the formula in sections 3.6 and 3.7, unlike a claim for damages, does not allow for an argument that the Claimant might have earned income greater than their PAWE had they not been injured. Based on the structure of Part 3.3 of MAIA, PAWE is a point in time calculation based on the various calculation methods in Schedule 1, clause 4. In most claims, the calculation is based strictly on historical earnings rather than potential future earnings. The exception is where the Claimant the accident has entered into an arrangement to commence new employment (self-employment) and the accident intervenes.

    Secondly, the words “whichever is the greater” in sections 3.36(3) and 3.7(2) is designed to take into account circumstances where the Claimant’s actual post-accident earnings are different from their post-accident capacity.

    If the Claimant’s post-accident capacity exceeds their actual post-accident earnings – for example, because they work 20 hours per week when they are certified fit to work 30 hours per week – then the dollar value of their post-accident capacity is compared to their PAWE to assess their weekly benefits.

    If, however, the Claimant’s actual post-accident earnings exceed their post-accident capacity – for example, because they manage to work 30 hours per week even though they are only certified fit to work 20 hours per week – then their actual earnings are compared to their PAWE in order to calculate their weekly benefits.

    PJH