AAI Limited t/as AAMI v Davies - [2024] NSWPICMP 231

DETERMINATION OF REVIEW PANEL
CITATION:	AAI Limited t/as AAMI v Davies [2024] NSWPICMP 231
CLAIMANT:	Rodney Davies
INSURER:	AAI Limited trading as AAMI
REVIEW PANEL
MEMBER:	Terence Stern OAM
MEDICAL ASSESSOR:	Shane Moloney
MEDICAL ASSESSOR:	Thomas Rosenthal
DATE OF DECISION:	15 April 2024
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; Claimant suffered injury in a motor vehicle accident on 25 May 2017; Medical Assessor (MA) determined whole person impairment (WPI) at 12%; MA diagnosed physical injuries caused by the accident; supraspinatus tendon tear left shoulder and soft tissue musculoligamentous injury to the cervical spine; Medical Review Panel determined a DRE I classification of the cervical spine and a 6% upper extremity impairment of the left shoulder; Review Panel assessed WPI at 4%; Held – the certificate of the MA was revoked, and a replacement certificate issued; WPI is not greater than 10%.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Medical Review Panel revokes the Certificate of Medical Assessor Rapaport dated 6 May 2023, and instead certifies the injuries caused by the accident give rise to a permanent impairment which is not greater than 10% whole person impairment (WPI).

STATEMENT OF REASONS

INTRODUCTION

On 25 May 2017, Mr Rodney Davies (the claimant) was at the controls of his truck with a trailer attached. The vehicle was stationary, waiting to make a right-hand turn, when another vehicle collided with the rear of the trailer at speed, resulting in two impacts, the first due to the initial impact, the second to the trailer being lifted up.
Mr Davies states that he came out of his seatbelt with the impact and hit the dashboard with his left shoulder.
Police and ambulance attended the scene.
Mr Davies was able to drive the truck and trailer off the road after which a workmate drove him to the Mater Hospital where he was assessed for a few hours and discharged.
Mr Davies alleges that the motor accident caused various physical injuries.
The issue in this medical dispute is whether Mr Davies “degree of permanent impairment as a result of the injuries caused by the motor accident is greater than 10% whole person impairment (WPI)”. This constitutes a medical dispute within the meaning of the Motor Accidents Injuries Act 2017 (MAI Act).
Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be made in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines are issued pursuant to s 10.2 of the MAI Act. The Guidelines adopt the fourth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA 4). Where there is any difference between AMA 4 and the Guidelines, the Guidelines are definitive.
This is a review of a medical assessment pursuant to s 7.26 of the MAI Act. The medical assessment the subject of this review was conducted by Medical Assessor Rapaport and dated 6 May 2023 (the medical assessment). The Medical Assessor assessed the degree of permanent…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

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Details

Case: [2024] NSWPICMP 231
Decision Date: 15 April 2024

CaseChat Overview and Summary

The case of AAI Limited trading as AAMI versus Davies involved a dispute over the assessment of whole person impairment (WPI) following a motor accident. The claimant, Davies, sought compensation under the Motor Accidents Compensation Act 1999, following an incident on 25 May 2017. The central issue was the extent of Davies' WPI as determined by the Medical Assessor (MA), and whether this was correctly assessed in light of the injuries sustained.

The court needed to decide whether the Medical Assessor's initial assessment of a 12% WPI was accurate, considering the diagnosis of a supraspinatus tendon tear in the left shoulder and a soft tissue musculoligamentous injury to the cervical spine. Additionally, the court had to consider the subsequent determination by the Medical Review Panel, which classified the cervical spine as DRE I and assessed a 6% upper extremity impairment of the left shoulder, ultimately determining a 4% WPI. The court's task was to reconcile these differing assessments and determine the appropriate WPI classification.

In reaching its decision, the court examined the medical evidence and the assessments provided by both the MA and the Review Panel. The court concluded that the MA's certificate was revoked and a replacement certificate issued, finding that the WPI was not greater than 10%. This decision was based on a detailed analysis of the medical evidence and the consistency of the findings with the criteria under the Motor Accidents Compensation Act 1999. The court found that the WPI assessment by the Review Panel was more aligned with the overall evidence and thus determined the WPI to be 4%.

The final orders of the court were that the certificate of the Medical Assessor was revoked, and a replacement certificate issued reflecting a WPI not greater than 10%. The court's decision was grounded in a comprehensive review of the medical evidence and the statutory framework governing motor accident compensation in Queensland.

Orders