In Brief
- A Claimant is entitled to weekly benefits only if they can demonstrate that they are an "earner."
- An "earner" includes a person who was employed or self-employed for at least 13 weeks during the year immediately preceding the motor accident (Clause 2(a)(iii), Schedule 1 of the Motor Accident Injuries Act 2017 (MAIA)).
- Payslips alone may not be sufficient to establish that a Claimant is an "earner" — supporting documents such as bank statements and tax returns must be consistent and verifiable.
Facts
The Personal Injury Commission (PIC) published its decision in Kozlov v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMR 2 on 28 January 2025.
A Claimant was involved in a motor vehicle accident on 1 March 2024, where he sustained injuries to the head, lower back, and knees.
The Claimant applied for weekly statutory benefits, asserting that he met the definition of an "earner" under the MAIA Schedule 1 Clause 2(a)(ii) and (iii). To support the claim, the Claimant provided payslips, which purportedly demonstrated that he was employed during the relevant period.
However, the payslips showed inconsistencies and errors, which prompted the Insurer to request further documentation, including bank statements (to show deposit of wages) and tax records (to verify the Claimant's earnings).
The Claimant failed to provide bank statements covering the full period of alleged employment and a Direction for Production was issued to NAB and ANZ Bank.
The records obtained from the banks did not align with the Claimant's submissions and ANZ Bank had no records for the Claimant.
The key issue was whether the Insurer had sufficient evidence to determine whether the Claimant was an "earner" and whether payslips and incomplete bank statements alone were adequate proof of employment.
Relevant Definitions
The definition of 'earner' in s1.2(a)(ii) and (iii) of MAIA outlines that an earner is employed or self-employed for at least:
- 13 weeks during the year immediately preceding the motor accident, or
- 26 weeks during the 2 years immediately preceding the motor accident,
And, at the date of the motor accident, had not retired permanently from all employment
The Member's Decision
The Member found that the Claimant failed to provide sufficient evidence to establish "earner" status under the MAIA. Given discrepancies in the payslips and the absence of corroborating evidence, the Member determined the Insurer was justified in concluding there was insufficient proof of employment.
The Member also ruled that it was reasonable for the Insurer to request additional evidence, such as bank statements, ATO income statements, or tax returns, to verify employment status.
Ultimately, the Member found that the Claimant was not an "earner" under the MAIA and was not entitled to weekly statutory benefits.
Why This Case is Important
This case reinforces that payslips alone may not be sufficient to establish "earner" status under the MAIA. It highlights the importance of providing consistent and verifiable financial records – such as bank statements and tax returns – to support a claim for statutory benefits.
The decision also confirms that Insurers are entitled to request additional evidence when inconsistencies arise in a claimant's financial documentation. Where a claimant fails to provide sufficient proof, the Insurer may reasonably determine that a Claimant has failed to establish that they are an "earner".
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