AAI Limited t/as GIO v Djuric - [2025] NSWPICMP 33

DETERMINATION OF REVIEW PANEL
CITATION:	AAI Limited t/as GIO v Djuric [2025] NSWPICMP 33
CLAIMANT:	Mile Djuric
INSURER:	AAI Limited t/as GIO
REVIEW PANEL
MEMBER:	Terence O’Riain
MEDICAL ASSESSOR:	Shane Moloney
MEDICAL ASSESSOR:	Michael Couch
DATE OF DECISION:	16 January 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Injuries Act 2017 (MAI Act); permanent impairment; review; insurer’s application; Certificate of Medical Assessor Herald dated 21 February 2024 assessed 17% whole person impairment; accident 25 November 20121 deducting 5% pre-accident permanent impairment for DRE II from DRE IV lumbar spine fusion revision; no reasons given for calculating 5%; claimant injured in 1986 (knee), 2009 (lumbar spine) and November 2020 (aggravation of lumbar spine and complaints of bilateral shoulder injuries); claimant re-examined; further submissions on calculating pre-injury impairment; lumbar fusion is multilevel structural compromise under Motor Accident Guidelines therefore DRE IV to be deducted from DRE IV; pre-accident shoulders’ impairment calculated by analogy at 2% for each shoulder; combined impairment certificate; different findings to original assessment; Held – different clinical findings to original assessment; Panel revoked and replaced original medical certificate and combined impairment certificate; permanent impairment not greater than 10%.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Review Panel assessment of degree of permanent impairment Replacement certificate issued under s 7.26(7) of the Motor Accident Injuries Act 2017 1. The Review Panel has assessed that the accident caused injuries with a different permanent impairment to Medical Assessor Herald's assessment and certificate issued on 21 February 2024. 2. Accordingly, the Review Panel revokes the earlier certificate and issues a new Permanent Impairment Certificate assessing the claimant’s permanent impairment from the subject accident as 10%. 3. Medical Assessor Fitzsimons’ certificate dated 3 February 2024 found the claimant’s referred head injury was not related to the subject accident. 4. Accordingly, this Review Panel revokes Lead Medical Assessor Herald’s combined assessment certificate dated 6 June 2024 and issues a replacement combined assessment certificate under s 7.26 (8) of the Motor Accidents Injuries Act 2017 stating the combined injuries caused by the accident were assessed at permanent impairment of 10% which is not greater than 10%. 5. The accident caused injuries with a total percentage permanent impairment of 10%. The total permanent impairment is not greater than 10%.

REASONS

BACKGROUND

These reasons address permanent impairment disputes under the Motor Accident Injuries Act 2017 (MAI Act).
On 25 November 2021, Mile Djuric (the claimant) passed through the intersection on a green light when a vehicle entered the intersection from the left-hand side and squarely struck the front left corner of his car. The impact moved the claimant’s car across the road and up onto the lawn of a nearby house. The impact severely damaged the car, which was written off.
The claimant had undergone L5/S1 fusion for a work injury in 2009. It is not disputed that the subject accident loosened that fusion, which made further surgery necessary to revise the decompression and fusion.
The claimant was also in a rear end collision on 8 November 2020, which also caused…

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 GIO v Djuric 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 33
Decision Date: 16 January 2025

CaseChat Overview and Summary

AAI Limited, trading as GIO, sought a review of a decision regarding the compensation for permanent impairment following a motor accident sustained by Mr. Djuric. The dispute centred on the quantum of permanent impairment as assessed by a medical assessor and the subsequent certificate issued on 21 February 2024, which quantified the impairment at 17%. Mr. Djuric had been involved in multiple accidents, including incidents in 1986, 2009, and November 2020. The insurer's application for review was based on the contention that the original assessment did not adequately account for pre-existing conditions and injuries.

The primary legal issue before the court was the correct methodology for calculating the pre-existing impairment and its deduction from the total impairment rating. Specifically, the court had to determine whether the 5% pre-accident impairment attributed to the lumbar spine fusion revision was accurately assessed and if the methodology used to calculate the impairment for the shoulders was appropriate. Additionally, the court had to consider whether the multilevel structural compromise from the lumbar fusion warranted a specific deduction from the impairment rating.

The court found that the original assessment did not provide sufficient reasons for the calculation of the 5% pre-existing lumbar impairment. The Panel conducted a re-examination and made different clinical findings, which led to the revocation of the original medical certificate and the issuance of a new combined impairment certificate. The court concluded that the appropriate deduction for the pre-accident lumbar spine condition was correctly calculated at 5%. However, the Panel determined that the correct method for calculating the shoulder impairment, by analogy, was 2% for each shoulder. As a result, the total permanent impairment was reassessed and determined not to exceed 10%.

The court ordered that the original certificate be revoked and replaced with a new certificate reflecting the revised assessment of permanent impairment. The final order mandated that the insurer's compensation for permanent impairment be based on the new assessment of not more than 10%.

Orders