AAI Limited t/as AAMI v Huang - [2024] NSWPICMP 802

DETERMINATION OF REVIEW PANEL
CITATION:	AAI Limited t/as AAMI v Huang [2024] NSWPICMP 802
CLAIMANT:	Yi Sang Huang
INSURER:	AAI Limited t/as AAMI
REVIEW PANEL
MEMBER:	Belinda Cassidy
MEDICAL ASSESSOR:	Doron Samuell
MEDICAL ASSESSOR:	John Baker
DATE OF DECISION:	27 November 2024
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; insurer’s application for review under section 7.26 of Medical Assessor (MA) Canaris’ decision about treatment (allowed) and threshold injury (non-threshold persistent depressive disorder); Panel determined that it would hear and determine this Review with the Review in the related proceedings; re-examination with both MA’s conducted; current diagnosis was of adjustment disorder; other potential diagnoses identified and discussed; Panel satisfied adjustment disorder was caused by the accident; Held – adjustment disorder is a threshold injury; clause 4(2) of the Motor Accident Injuries Regulation applied; Panel determined claimant had not had, at any time since the accident, a non-threshold injury; David v Allianz Australia Insurance Limited and Lynch v AAI Limited t/as AAMI applied; treatment allowed as related to the accident and reasonable and necessary in the circumstances; MA Canaris’ certificate about treatment confirmed, certificate about threshold injury revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 The Review Panel: 1. Confirms the certification by Medical Assessor Canaris dated 3 July 2023 with regards to the treatment in dispute between the parties. 2. Revokes the certification by Medical Assessor Canaris dated 3 July 2023 with regards to the dispute about threshold injury. 3. Certifies that the claimant’s psychological or psychiatric injury caused by the motor accident is a threshold injury for the purposes of the Act.

STATEMENT OF REASONS

INTRODUCTION

Background to the Review

Yi Sang Huang was involved in a motor accident on 18 February 2020.
Mr Huang says he injured his neck, back and shoulders in the accident and developed a psychological injury as a result of the accident. Mr Huang made a claim for statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act) against AAMI, the third-party insurer of the vehicle that Mr Huang says caused his accident. In due course, Mr Huang also made a claim for damages (lump sum compensation) against AAMI.
Three medical disputes have arisen in connection with the claims and Mr Huang referred those disputes to the Personal Injury Commission (the Commission) for assessment in two separate proceedings as follows:
(a) proceedings numbered M104085/93 commenced on 20 April 2021 concerning:
(i)a dispute about whether the claimant’s injuries were or were not threshold injuries for the purposes of the Act;
(ii)a dispute about whether a number of different treatments and consultations were reasonable and necessary and related to the accident, and
(b) proceedings numbered M22233/23-01-01 commenced on 18 December 2023 involving a dispute about the degree of the claimant’s whole person impairment (WPI) resulting from the injuries caused by the accident.
Medical Assessor Canaris determined on 3 July 2023 that the claimant had a non-threshold psychological injury and that all the disputed psychological…

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.

Keep reading for free

Create a free CaseChat account to read AAI Limited t/as AAMI v Huang and more:

Read every judgment in full
Ask AI and get answers linked to paragraphs
See how each paragraph was cited in later cases
Download judgments as PDF or Word

Continue with Google

One click creates your free account or signs you in.

By continuing you agree to the Terms and Privacy Policy.

Details

Case: [2024] NSWPICMP 802
Decision Date: 27 November 2024

CaseChat Overview and Summary

The case of AAI Limited trading as AAMI versus Huang involved an application for review of a decision made by a Medical Assessor regarding treatment and the classification of an injury sustained in a motor accident. The decision was made under the Motor Accident Injuries Act 2017, and the case was heard in the relevant court. The insurer, AAI Limited, sought to challenge the Medical Assessor's determination that the treatment provided was reasonable and necessary, and that the claimant's condition did not meet the threshold for a serious injury.

The primary legal issues the court had to address were whether the claimant's condition, initially diagnosed as a persistent depressive disorder, was indeed a non-threshold injury and if the treatment provided was appropriate and necessary. The court needed to determine if the Panel's decision to classify the condition as an adjustment disorder, and thus a threshold injury, was correct. Furthermore, the court had to consider whether the treatment provided was related to the accident and whether it was reasonable and necessary.

In its reasoning, the court found that the Panel's decision was justified in classifying the claimant's condition as an adjustment disorder, which is considered a threshold injury under clause 4(2) of the Motor Accident Injuries Regulation. The court concluded that the claimant did not have a non-threshold injury at any time since the accident. The decision relied on precedents such as David v Allianz Australia Insurance Limited and Lynch v AAI Limited t/as AAMI, which supported the notion that the treatment was related to the accident and was reasonable and necessary in the circumstances. Consequently, the court allowed the insurer's application for review concerning the threshold injury but upheld the Medical Assessor's certificate regarding the treatment.

The final orders of the court were that the Medical Assessor's certificate concerning the treatment was confirmed, while the certificate about the threshold injury was revoked. The Panel's determination that the claimant's condition was an adjustment disorder, and thus a threshold injury, was upheld. This meant that the claimant was entitled to the benefits associated with a threshold injury, and the insurer was required to continue to provide the treatment deemed necessary and reasonable by the Medical Assessor.

Orders