AAI Ltd t/as GIO v Pinarbasi - [2025] NSWPICMP 470

DETERMINATION OF REVIEW PANEL
CITATION:	AAI Ltd t/as GIO v Pinarbasi [2025] NSWPICMP 470
CLAIMANT:	Pinarbasi
INSURER:	AAI Ltd t/as GIO
REVIEW PANEL
MEMBER:	Maurice Castagnet
MEDICAL ASSESSOR:	Dr Les Barnsley
MEDICAL ASSESSOR:	Dr Mohammed Assem
DATE OF DECISION:	1 July 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant suffered injury in a motor accident when the bus he was driving was hit in the rear by another bus; dispute about whether the injuries caused by the accident were threshold injuries; whether the motor accident caused a rotator cuff tear in the right shoulder; mechanism of injury; absence of direct trauma or abnormal shoulder movement; delayed reporting or lack of evidence of early reporting of symptoms in the right shoulder; McTye v Ching Yu Chang by his tutor Leo Alexander Birch considered; Held – MAC revoked; injury to the right shoulder not caused by the motor accident.
DETERMINATIONS MADE:	1. Revokes the certificate of Medical Assessor Jonathan Herald dated on 28 April 2022. 2. Certifies that the following injuries caused by the motor accident are threshold injuries for the purposes of the Act: · cervical spine – soft tissue injury, and · lumbar spine – soft tissue injury. 3. Certifies that the injury to the right shoulder – rotator cuff tear, was not caused by the motor accident and a determination of whether it is a threshold injury is not required.

STATEMENT OF REASONS

INTRODUCTION

The claimant, Ahmet Duran Pinarbasi, was involved in a motor accident on 30 July 2018 when the bus he was driving was rear-ended by another bus, insured by GIO (the insurer).
The claimant claimed that as a result of the accident, he sustained injuries to the neck, lower back and right shoulder. As the accident occurred in the course of his employment, the claimant initially lodged a claim for benefits with his workers compensation insurer, EML.
On 10 September 2019, the claimant decided to make a claim with GIO for statutory benefits under the Motor Accident Injuries Act 2017 (the MAI Act). The insurer accepted liability to pay the claimant those benefits for the first 26 weeks.[1]
[1] Sections 3.11 and 3.28 of the MAI Act. For motor accidents occurring on or after 1 April 2023, the period of 26 weeks has been amended to 52 weeks.
Statutory benefits by way of loss of earnings and treatment and care expenses, cease after 26 weeks if “the person’s only injuries resulting from the motor accident were threshold injuries”.[2] An injured person cannot recover damages under the MAI Act if the “only injuries resulting from the motor accident were threshold injuries”.[3]
[2] At the time the claim was made, a “threshold injury” was known as a “minor injury”. The MAI Act was amended by the Motor Accident Injuries Amendment Act 2022 to provide that from 1 April 2023, the term “minor injury” is to be expressed as a “threshold injury” and “minor injuries” as “threshold injuries”. The…

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 470
Decision Date: 1 July 2025

CaseChat Overview and Summary

In the matter of AAI Limited trading as GIO versus Pinarbasi, the dispute centred around the validity of a Medical Assessment Certificate (MAC) issued in relation to a motor accident injury claim. The case was heard in a court of appropriate jurisdiction. The claimant, Pinarbasi, was involved in a motor accident where the bus he was driving was struck from behind by another bus. The central issue was whether the injuries Pinarbasi claimed to have sustained were indeed caused by the accident, specifically whether the motor accident resulted in a rotator cuff tear in his right shoulder.

The court needed to determine the mechanism of injury, considering the absence of direct trauma or abnormal shoulder movement during the accident, and evaluate the claimant's reporting of symptoms. The court also needed to examine whether the delay in reporting or the lack of evidence regarding early symptoms undermined the claim. It referenced the case of McTye v Ching Yu Chang by his tutor Leo Alexander Birch to aid in its decision-making process.

After careful consideration, the court found that the claimant's injury to the right shoulder was not caused by the motor accident. The reasoning hinged on the absence of direct trauma, the delayed reporting of symptoms, and the lack of early evidence supporting the claimant's assertions. Consequently, the court revoked the MAC, ruling that the injury did not meet the statutory criteria as an accident-related injury under the Motor Accident Injuries Act 2017. This decision effectively dismissed the claimant's entitlement to compensation for the alleged shoulder injury.

Orders