What happened: The ACT Supreme Court ruled NRMA failed to complete a mandatory benefits process for a motorist injured in two car accidents.
Who's involved: NRMA Insurance (insurer) and an injured motorist who brought the claim.
What's at stake: Quality of life benefits starting at $7,730 for one accident, with a potential 25% whole person impairment assessment post-surgery.
Where it stands: Decided on October 15, 2026 - NRMA ordered to make the final offer it never issued.
Why it matters: Private insurers exercising statutory functions can now be compelled by court order if they skip mandatory steps.
An insurer approved and paid for a motorist's spinal surgery - then told him his injury benefits claim was already closed.
The ACT Supreme Court disagreed, at least in part. In a decision handed down on October 15, 2026, the court ordered NRMA to go back and complete a quality of life benefits process it had never finished for one of two car accidents involving the same claimant.
The case turned on the Motor Accident Injuries Act 2019 (ACT), which sets out a detailed, step-by-step process insurers must follow when assessing an injured person's whole person impairment and making benefit offers. The court found NRMA had skipped a step it was never allowed to skip.
The claimant was involved in two motor vehicle accidents - the first in June 2020, the second in March 2021. NRMA was the third-party insurer for both. He lodged quality of life benefits applications for each accident in November 2021.
What followed was a prolonged dispute over how badly he was hurt. NRMA's independent medical examiner assessed the claimant's whole person impairment at 5%, all attributable to the first accident - and zero for the second. The claimant arranged his own assessment, which came back at 7%, with a recommendation for spinal fusion surgery and a projected 25% impairment if the surgery went ahead.
NRMA referred the second opinion back to its own assessor. The assessor held firm at 5%.
Here is where the timeline gets interesting. NRMA's own neurosurgeon, brought in separately, agreed the claimant's condition had not stabilised and that surgery was both reasonable and necessary. NRMA approved the surgery and paid for it. The claimant had a cervical disc replacement in February 2024.
Then NRMA told him his benefits process was finalised and his notice of common law claim was rejected.
The court split its answer across the two accidents. For the first accident, the claimant lost. Under the Act, once an insurer makes a "final offer" on quality of life benefits, the claimant has 28 days to either accept or apply to the ACT Civil and Administrative Tribunal for review. There is no third option. The claimant's solicitor had written back rejecting the offer and saying they were "considering options." That was not enough. Because the claimant neither accepted nor applied for tribunal review within 28 days, he was deemed to have accepted the offer. His first-accident claim was finally dealt with - and when NRMA later paid him the $7,730 it had originally offered, that payment was properly made.
The second accident was a different story. The court found NRMA had never made a final offer for that accident at all. The insurer's own assessor had attributed the entire 5% impairment to the first accident but offered no express reasoning for assessing the second at zero. When the claimant's second assessment - covering both accidents - came in, NRMA was required under the Act to work through the full final-offer process. It never did.
The court ordered NRMA to go back and complete the process: decide a whole person impairment figure, make a final offer, and deal with the claimant's second benefits application, all according to law.
The broader significance sits in the court's ruling on jurisdiction. NRMA argued that mandamus - a court order compelling a body to perform a duty - could not apply to a private insurer. The court disagreed. Drawing on the English Datafin principle and the High Court's reasoning in NEAT Domestic Trading v AWB, the court held that when a private insurer exercises decision-making power delegated by statute, its decisions are subject to judicial review.
The effect of the MAI Act, the court found, is to delegate to private insurers the function of determining whether an injured person can access common law damages. That is a public function, regardless of who performs it.
Two further findings carry practical weight. First, the Act does not limit a claimant to a single quality of life benefits application per accident. Where fresh evidence emerges and a prior application has not been finally dealt with, a new application can be made within the statutory time limits.
Second, the 10% whole person impairment threshold in the Act is a constraint on the making of an award of damages - not a bar to commencing proceedings. A claimant can file a common law claim without meeting the threshold, though those proceedings remain vulnerable to being struck out if the threshold is never met.
Claims teams administering statutory CTP schemes now have a clear signal: every step in the legislative process must be completed, and a court can compel the ones that are missed.
The allegations and findings in this decision are as characterised by the court. The matter may be subject to further proceedings.
