AAI Limited t/as AAMI v Tassone - [2025] NSWPICMP 397

DETERMINATION OF REVIEW PANEL
CITATION:	AAI Limited t/as AAMI v Tassone [2025] NSWPICMP 397
CLAIMANT:	Zac Tassone
INSURER:	Insurance Australia Limited trading as NRMA
REVIEW PANEL
MEMBER:	Terence Stern OAM
MEDICAL ASSESSOR:	Shane Moloney
MEDICAL ASSESSOR:	Mohammed Assem
DATE OF DECISION:	5 June 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant was injured in a motor vehicle accident; Medical Assessor (MA) issued a certificate assessing 12% whole person impairment (WPI); a medical dispute arose as to total WPI; insurer sought a review of the MAC under section 7.26; Review Panel conducted an examination and considered the factors contributing to the injury according to clause 6.6 of the Motor Accident Guidelines; MAC revoked; Review Panel substituted the determination that the claimant sustained WPI of 11%.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Review Panel revokes the certificate of Medical Assessor Drew Dixon, dated 10 May 2024, and substitutes the determination that the claimant did establish that he, as a result of the accident, sustained whole person impairment (WPI) in excess of 10%. The Review Panel found an 11% WPI due to the injuries sustained in the subject motor vehicle accident.

STATEMENT OF REASONS

INTRODUCTION

The claimant, Zac Tassone (Mr Tassone), was injured in a motor vehicle accident (the accident) on 16 January 2022.
The Insurer (NRMA) seeks a review of the certificate of Medical Assessor Drew Dixon (the Medical Assessor) dated 10 May 2024.
The Medical Assessor determined that the following injuries had been caused by the motor vehicle accident (the Accident) and gave rise to a permanent whole person impairment (WPI) of 12%:
•        left wrist – distal radius fracture and transverse ulnar styloid fracture requiring open reduction and internal fixation surgery/sensory loss in the distribution of the palmar cutaneous branch of the left median nerve;
•        left wrist – surgical scarring;
•        right knee – residual scarring;
•        left knee – residual scarring;
•        left knee – soft tissue injury, and
•        right knee – soft tissue injury.
The following injuries were referred to the Medical Assessor for assessment:
[2.1]   “Left wrist – distal radius fracture and transverse ulnar styloid fracture requiring open reduction and internal fixation surgery/sensory loss in the distribution of the palmar cutaneous branch of the left median nerve
[2.2]   Left wrist – surgical scarring
[2.3]   Right knee – residual scarring
[2.4]   Left knee – residual scarring
[2.5]   Left knee – soft tissue injury
[2.6]   Right knee – soft tissue injury”

The Accident

The Medical Review Panel (the Panel) took the following history of the Accident
“[9] On Sunday 16 January 2022 he was wearing protective equipment and a full face helmet riding along Sunnyholt Road, Blacktown approaching the intersection of Sorrento Drive. [Mr Tassone] wanted to move into the third lane of the traffic (the right hand turning lane) but as he did so, the front wheel of his bike was struck by a Nissan X Trail which came across from lane number 1, adjacent…

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 Tassone 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: [2025] NSWPICMP 397
Decision Date: 5 June 2025

CaseChat Overview and Summary

In the case of AAI Limited trading as AAMI versus Tassone, the dispute centred on the assessment of the extent of whole person impairment (WPI) suffered by the claimant following a motor vehicle accident. The matter was heard in the relevant court, which was tasked with reviewing the process and decision made by the Medical Assessor (MA) and subsequently by the Review Panel under the Motor Accident Injuries Act 2017. The MA had initially issued a certificate assessing the claimant's WPI at 12%, a determination that was contested by the insurer. The insurer initiated a review of the Medical Assessment Certificate (MAC) under section 7.26 of the Act, leading to a hearing before a Review Panel.

The central legal issues before the court were whether the Review Panel's process in revoking the initial MAC and substituting a new determination of 11% WPI was lawful and whether the Panel appropriately considered all relevant factors, including those stipulated in clause 6.6 of the Motor Accident Guidelines. The court had to determine if the Review Panel's decision was based on a proper application of the statutory provisions and if it adhered to the procedural fairness required by the Act.

The court found that the Review Panel had followed the correct procedures in conducting the review and that the substituted determination of 11% WPI was a result of a reasoned and legally sound process. The Panel had appropriately examined the medical evidence and considered all relevant factors contributing to the claimant's impairment. The court concluded that the Panel's decision was not only procedurally fair but also substantively sound, as it was based on a comprehensive evaluation of the evidence and applicable guidelines. The insurer's challenge to the original MAC was thus dismissed.

Consequently, the court upheld the Review Panel's decision, affirming that the claimant's WPI was correctly assessed at 11%. The court did not order any further review or action by the insurer regarding the WPI assessment.

Orders