Andrew O’Brien KC appeared for the applicant, instructed by ABKJ Lawyers.
This case concerned an application brought by Rehabilitation Medicine Australia Pty Ltd (RMA), alleging that N I B Health Funds Ltd (NIB) had misapplied the Benefit Rules since 1 September 2018. The Court considered two questions pertaining to the issue of construction. Firstly, whether subclause 3(8) modifies subclause 3(6) such that when the insurer has less than five negotiated agreements with comparable private hospitals in the State, the “episode of hospital treatment” should be identified by reference to its negotiated agreements with all classes of private hospitals in the State was considered. Secondly, the Court considered whether regard should be had to all of the insurer’s negotiated agreements with private hospitals in Queensland in calculating the minimum benefit payable for an episode of hospital treatment under subclause 3(4). After identifying the correct construction, the Court held that this matches that which was contended for by RMA. The Court ordered that the respondent pay the applicant’s costs of the proceeding.
The judgment can be read by clicking here
