AAI Limited t/as GIO v Stanizzo - [2023] NSWPICMP 230

DETERMINATION OF REVIEW PANEL
CITATION:	AAI Limited t/as GIO v Stanizzo [2023] NSWPICMP 230
CLAIMANT:	Vincent Francis Stanizzo
INSURER:	AAI Ltd t/as GIO
REVIEW Panel
PRINCIPAL MEMBER:	John Harris
MEDICAL ASSESSOR:	Geoffrey Stubbs
MEDICAL ASSESSOR:	Michael Couch
DATE OF DECISION:	26 May 2023
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; claim for neck surgery and associated treatment; the claimant had a long history of neck pain with scans showing pre-existing degenerative spinal canal stenosis; motor accident involved a minor sideswipe collision which exacerbated neck symptoms without aggravating underlying pathology; claimant’s underlying severe spinal stenosis and early myelopathy was progressive and fluctuating; scans showed no traumatic changes; minimal impact from motor accident; ongoing symptoms due to underlying pathology; findings made that exacerbation ceased after six months and ongoing condition unrelated to the motor accident; finding made that there was no causal relationship between the accident and the need for surgery; Held – original assessment on cause of surgery revoked; finding made that surgery would assist in recovery.
DETERMINATIONS MADE:	Medical Assessment – Treatment and Care Review Panel Assessment of Treatment and Care and Replacement Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 The Review Panel revokes the certificate dated 10 November 2022 and issues a new certificate determining that: The following treatment and care: · cervical cord decompression surgery recommended by Dr Timothy Steel; · the referral for an MRI scan of the cervical spine by Dr Robert Chester on 10 August 2018 and performed on 24 September 2019, and · the referral for an MRI scan of the cervical spine by Dr Robert Chester on 10 August 2018 and performed on 28 October 2019; DOES NOT RELATE TO THE INJURY CAUSED BY THE MOTOR ACCIDENT. Medical Assessment – Recovery Review Panel Assessment of Recovery Replacement Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 The Review Panel confirms the certificate dated 10 November 2022.

REASONS

BACKGROUND

Mr Vincent Stanizzo (the claimant) suffered injury in a motor accident on 16 May 2018 (the motor accident) when the insured front left wheel collided with the right front wheel of the claimant’s vehicle.[1]
[1] Insured bundle, p 67.
The claimant alleges that the motor accident caused injuries to the neck, right thumb and hand.
The disputes are whether the following treatments are caused by the motor accident and whether they will improve the recovery of the claimant:
·        cervical cord decompression surgery recommended by Dr Timothy Steel;
·        the referral for an MRI scan of the cervical spine by Dr Robert Chester on 10 August 2018 and performed on 24 September 2019, and
·        the referral for an MRI scan of the cervical spine by Dr Robert Chester on 10 August 2018 and performed on 28 October 2019.
The disputes are before a Review Panel having been determined at first instance by a Medical Assessor. The legislation provides that the medical dispute be determined on Review by two Medical Assessors and a Member…

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: [2023] NSWPICMP 230
Decision Date: 26 May 2023

CaseChat Overview and Summary

AAI Limited, trading as GIO, brought a case against the claimant, Stanizzo, regarding a claim for neck surgery and associated treatment following a motor accident. The dispute centered on whether the accident caused the need for the surgery, given the claimant's pre-existing condition of degenerative spinal canal stenosis. The matter was heard in the relevant Australian court.

The court was tasked with determining whether the minor sideswipe collision had caused the claimant's need for neck surgery, despite his history of neck pain and degenerative condition. The legal issues involved whether the accident exacerbated the claimant's condition to the extent that it necessitated surgery, or if the surgery was due to the progression of the underlying pathology. The court had to assess the impact of the accident on the claimant's condition and whether there was a causal relationship between the accident and the need for surgery.

The court found that the accident did not cause the need for surgery as the underlying condition and early myelopathy were progressive and fluctuating. Scans showed no traumatic changes, indicating the accident's minimal impact. The exacerbation of the claimant's symptoms ceased after six months, and the ongoing condition was unrelated to the accident. The original assessment on the cause of the surgery was revoked. However, it was determined that the surgery would assist in the claimant's recovery.

The court ultimately ruled in favor of the claimant, revoking the original assessment on the cause of the surgery and finding that the surgery would assist in recovery. The final orders were made accordingly, reflecting the court's determination that the accident did not cause the need for surgery, but the surgery was necessary due to the claimant's underlying condition.

Orders