AAI Limited t/as GIO v Barnes - [2025] NSWPICMP 273

DETERMINATION OF REVIEW PANEL
CITATION:	AAI Limited t/as GIO v Barnes [2025] NSWPICMP 273
CLAIMANT:	Anna Barnes
INSURER:	AAI Limited trading as GIO
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	David Gorman
MEDICAL ASSESSOR:	Drew Dixon
DATE OF DECISION:	22 April 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; treatment and care dispute; review of Medical Assessment Certificate (MAC); treatment and care in issue related to C5 to C7 anterior cervical decompression fusion surgery including a possible one level cervical disc replacement; claimant injured following a rear end collision; Medical Assessor (MA) found that the treatment and care sought was caused by the accident and was reasonable and necessary; claimant had pre-existing symptoms and treatment of her neck and shoulder however the Review Panel was satisfied that the claimant had not complained about these areas for several years before the accident; claimant subsequently had surgery and indicated her symptoms had improved; Held – Review panel satisfied that the C5 to C7 anterior cervical decompression surgery arose because of the accident and was reasonable and necessary; MAC confirmed.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Panel confirms the certificate of Medical Assessor Home dated 3 June 2024. 2. The following treatment and care do relate to the injury caused by the motor accident: (a) C5-C7 anterior cervical decompression fusion surgery, including a possible 1 level cervical disc replacement. 3. The following treatment and care is reasonable and necessary in the circumstances: (a) C5-C7 anterior cervical decompression fusion surgery, including a possible 1 level cervical disc replacement.

STATEMENT OF REASONS

INTRODUCTION

The insurer seeks a review of the certificate of Medical Assessor Home (the Medical Assessor) dated 3 June 2024.
The Medical Assessor certified the following treatment and care related to the injury caused by the accident and was reasonable and necessary in the circumstances:
(a) a request for C5-C7 anterior cervical decompression fusion surgery, including a possible 1 level cervical disc replacement.

Bundles of documents

The parties have each presented their respective bundles of documents upon which they rely. The Panel have read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel or a Panel Member has not read it, in much the same manner as parties not referring to or not specifically relying on a document in their own bundle and submissions.
The fact that evidence is not referred to in these reasons does not mean it has been overlooked and nor is it required that each piece of evidence be mentioned – see WAEE v Minister for Immigration and Citizenship (2003) 75 ALO 630 at [46].The Panel is not required to “analyse every piece of information from every opinion contained in a document with which he [it] was provided” – see Farr v Insurance Australia Limited t/as NRMA Insurance Ltd [2014] NSWSC 1435 at [46]. The Panel has come to its own conclusion and has taken its own history.

The accident

On 18 March…

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: [2025] NSWPICMP 273
Decision Date: 22 April 2025

CaseChat Overview and Summary

In the case of AAI Limited t/as GIO v Barnes, the dispute arose from a claim concerning the treatment and care for injuries sustained in a motor accident. The claimant, Barnes, had been involved in a rear-end collision and sought treatment and care related to C5 to C7 anterior cervical decompression fusion surgery, which included a possible one-level cervical disc replacement. The insurer, AAI Limited trading as GIO, contested the necessity and reasonableness of the treatment and care. The matter was heard by a Review Panel under the Motor Accident Injuries Act 2017, tasked with reviewing the Medical Assessment Certificate (MAC) issued by the Medical Assessor (MA).

The primary legal issue for the Review Panel to decide was whether the treatment and care sought by Barnes was reasonable and necessary and whether it arose from the motor accident. Specifically, the panel needed to determine if the surgery was necessitated by the accident, considering Barnes' pre-existing symptoms and history of treatment for her neck and shoulder. The MA had found that the treatment was caused by the accident and was reasonable and necessary. However, Barnes had not complained about her neck and shoulder issues for several years before the accident, and she had subsequently undergone surgery which she reported had improved her symptoms. The Review Panel was required to assess the evidence and decide whether the MA's findings were correct.

The Review Panel reviewed the evidence presented and concluded that the C5 to C7 anterior cervical decompression surgery arose because of the accident and was reasonable and necessary. They found that despite the claimant's pre-existing symptoms, there was no evidence that she had complained about her neck and shoulder issues for several years before the accident. Furthermore, the panel took into account that Barnes had undergone surgery which had alleviated her symptoms, supporting the necessity of the treatment. Therefore, the Review Panel confirmed the MAC, upholding the MA's findings that the treatment and care sought by Barnes were both reasonable and necessary and arose from the motor accident.

The final orders of the Review Panel confirmed the Medical Assessment Certificate, affirming that the treatment and care for the C5 to C7 anterior cervical decompression fusion surgery, including a possible one-level cervical disc replacement, was reasonable and necessary and arose from the motor accident.

Orders