Allianz Australia Insurance Limited v Crofts

DETERMINATION OF REVIEW PANEL
CITATION:	Allianz Australia Insurance Limited v Crofts [2025] NSWPICMP 830
CLAIMANT:	Simon Crofts
INSURER:	Allianz Australia Insurance Limited
REVIEW PANEL
MEMBER:	Elizabeth Medland
MEDICAL ASSESSOR:	Sophia Lahz
MEDICAL ASSESSOR:	Margaret Gibson
DATE OF DECISION:	28 October 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of medical assessment of single medical assessor by review panel; whether the injuries caused by the motor accident give rise to a whole person impairment (WPI) of more than 10%; mild traumatic brain injury (TBI) and soft issue injuries to various body parts together with femoral fracture of right lower extremity; 3% WPI found in respect of brain injury; insurer submitted lack of reasoning for assessment based on emotional and behavioural disturbances; original Medical Assessor (MA) found a total 13% WPI; Held – Review Panel found a TBI of 3% based on emotional and behavioural disturbances; total WPI found 19%; certificate revoked and new certificate provided.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION ASSESSMENT OF WHOLE PERSON IMPAIRMENT Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 The Review Panel: 1. Revokes the certificate of Medical Assessor Ian Cameron dated 6 November 2024. 2. Certifies that the following injuries caused by the motor accident give rise to a permanent impairment of 19% and is greater than 10%: · head – mild traumatic brain injury; · left hand – soft tissue injury to left index finger extensor tendon injury; · right hip – soft tissue injury; · right knee – soft tissue injury and laceration; · right lower extremity – femoral fracture and soft tissue injury; · left shoulder – soft tissue injury, and · left wrist – distal radial and ulnar shaft fractures. 3. The Medical Assessor also certified that the following referred injuries were not related to the motor accident: · abdomen – injury to abdomen (right groin): secondary injury to the right leg injury, and · pelvis – injury to right pelvis: secondary injury to right leg injury.

STATEMENT OF REASONS

Simon David Crofts, (the claimant) is a 57-year-old male who suffered injury on

7 March 2023 as a result of a motor vehicle accident.
A claim was lodged upon Allianz Australia Insurance Limited (the insurer) who is the compulsory third party insurer of the vehicle considered at fault. The insurer has a liability to pay statutory benefits and/or damages under the Motor Accident Injuries Act2017 (MAI Act).
The issue in dispute between the parties is whether the “degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%.”[1]
[1] Section 4.11 of the MAI Act.
This is a review of a medical assessment pursuant to s 7.26 of the MAI Act. The medical assessment the subject of this review was conducted by Medical Assessor Ian Cameron. He issued a certificate dated 6 April 2025. The Medical Assessor certified that injuries caused by the motor accident give rise to a permanent impairment of 13% which not greater than 10%.

THE REVIEW

The insurer sought a review of the medical assessment in accordance with s 7.26 of the MAI Act (review). On 2 June 2025, the President’s delegate determined that there was reasonable cause to suspect the medical assessment was incorrect in a material respect. As such the review application was accepted and referred to a Review Panel (the Panel).
A review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).[2]
[2] Section 7.26(5A) of the MAI Act.
The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6).
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128 of the Rules.
The Panel issued interim directions dated 5 June 2025 requiring the parties to lodge paginated and indexed bundles of all documents relied upon. The parties lodged bundles in compliance with those directions.
Following an initial preliminary conference, the Panel issued directions dated

2 September 2025 advising that it required the claimant to attend a re-examination with Medical Assessor Lahz on 8 October 2025 at the Commission’s medical suites in Darlinghurst. The examination took place as scheduled.
The Panel reconvened via teleconference on 10 October to discuss the clinical examination findings of Medical Assessor Lahz, and the material relied upon by the parties. These reasons have been prepared by all three Panel members as a collective adopting the clinical examination findings of Medical Assessor Lahz.

LEGISLATIVE FRAMEWORK

Permanent impairment assessment

Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines are issued pursuant to s 10.2 of the MAI Act. The Guidelines adopt the fourth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA 4 Guides). Where there is any difference between AMA 4 and the Guidelines, the Guidelines are definitive.[3]
[3] Clause 6.2 of the Guidelines.

Causation

Causation of injury is addressed from cl 6.5 of the Guidelines. Whilst the clauses are set out in respect of permanent impairment they are relevant to a dispute as to threshold injury.[4] Clause 6.6 to 6.7 provide:
“6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:
Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'
This, therefore, involves a medical decision and a non-medical informed judgement.
6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
[4] See Briggs v IAG Limited t/as NRMA Insurance [2022] NSWSC 372 at [35].
In determining the issue of causation, the Panel is to also have regard to s 5D of the Civil Liability Act 2002 (CL Act):[5]
[5] See s 3B(2) of the CL Act.
“5D General principles
(1)     A determination that negligence caused particular harm comprises the following elements;
(a) that the negligence was a necessary condition of the occurrence of the harm (factual causation), and
(b) that it is appropriate for the scope of the negligent person’s liability to extend to the harm so caused (scope of liability).
(2)     In determining in an exceptional case, in accordance with established principles, whether negligence that cannot be established as a necessary condition of the occurrence of harm should be accepted as establishing factual causation, the court is to consider (amongst other relevant things) whether or not and why responsibility for the harm should be imposed on the negligent party.
(3)     If it is relevant to the determination of factual causation to determine what the person who suffered harm would have done if the negligent person had not been negligent—
(a) the matter is to be determined subjectively in the light of all relevant circumstances, subject to paragraph (b), and
(b) any statement made by the person after suffering the harm about what he or she would have done is inadmissible except to the extent (if any) that the statement is against his or her interest.
(4)     For the purpose of determining the scope of liability, the court is to consider (amongst other relevant things) whether or not and why responsibility for the harm should be imposed on the negligent party.”

MEDICAL ASSESSMENT THE SUBJECT OF REVIEW

Medical Assessor Cameron examined the claimant on 25 March 2025 and provided a certificate and reasons on 6 April 2025. He certified that the following injuries give rise to a permanent impairment of 13%:
·        head – mild traumatic brain injury;
·        left hand – soft tissue injury to left index finger extensor tendon injury;
·        right hip – soft tissue injury;
·        right knee – soft tissue injury and laceration;
·        right lower extremity – femoral fracture and soft tissue injury;
·        left shoulder – soft tissue injury, and
·        left wrist – distal radial and ulnar shaft fractures.
The Medical Assessor also certified that the following referred injuries were not related to the motor accident:
· abdomen – injury to abdomen (right groin): secondary injury to the right leg injury, and
· pelvis – injury to right pelvis: secondary injury to right leg injury.
The Medical Assessor administered a Montreal Cognitive Assessment where the claimant scored 23/30 which is described as an abnormal score.
In terms of causation, the Medical Assessor commented that the two injuries certified as not related, that there was no evidence that the injuries occurred and there were no current findings that support that the injuries occurred.
In respect of assessment of impairment, the Medical Assessor had regard to cl 6.164 of the Guidelines and he was satisfied that the criteria was made out. Assessment of mental status impairment related to the brain injury was made with reference to the Modified Clinical Dementia Rating Scale. The Medical Assessor’s findings were consistent with a CDR of 0 with an equivalent 0% whole person impairment (WPI).
However, the Medical Assessor noted that an assessment should be made of emotional and behavioural functioning. He found:
“…This evaluation is based on Mr Croft’s current status. It is my opinion that there is a mild limitation of daily social and interpersonal functioning as shown in Table 3, page 142 of the AMA4 Guides. The impairment due to the brain injury is 3% whole person impairment because there are limitations in daily social and interpersonal functioning that is plausibly related to traumatic brin injury. It is noted that Mr Croft has psychological symptoms and will be assessed by a PIC psychiatric injury assessor.”
In respect of the left hand – soft tissue injury to the left index finger extensor tendon injury, the Medical Assessor noted that the tendon injury had been repaired but there is no longer isolated extension of the index finger. It is noted that extension occurs with both the index and middle finger extending and same is not described in Guidelines and the AMA4 Guides. By analogy the Medical Assessor stated the impairment equivalent to extension of 20 degrees at the index finger metacarpophalangeal joint which equals a 1% WPI.
The right hip was assessed as a 2% WPI noting right hip flexion was to 100 degrees.
The right knee was assessed as 0% along with the right lower extremity and left shoulder injury.
In respect of the left wrist – distal radial and ulnar shaft fractures, the combined impairments converted to a finding of 5% WPI.
Scarring was assessed at 2% in accordance with the TEMSKI scale.

SUBMISSIONS

Insurer’s review submissions dated 28 April 2025

The insurer alleges that the Medical Assessor erred by incorrectly applying Table 40 of the AMA4 Guides in respect of the right hip injury and he also failed to provide adequate reasons or an adequate path of reasoning for awarding a 3% WPI due to a mild traumatic brain injury.
The insurer submits that table 40 of the AMA4 Guides that a restriction of hip flexion only equates to a mild impairment of 2% WPI if flexion is less than 100 degrees. It is noted that the Medical Assessor found a 100 degree hip flexion, which is not less than 100 degrees and therefore a 0% impairment ought to have been awarded.
In respect of the traumatic brain injury, the insurer notes that the Medical Assessor found a 0% WPI based on the clinical dementia rating. Further, the Medical Assessor found a 3% WPI based on the assessment of emotional and behavioural disturbances in accordance with Tabel 3, page 142 of the AMA 4 Guides.
The insurer submits that other than stating that the evaluation was based on the claimant’s current status, the Medical Assessor does not make clear what the claimant’s emotional and behavioural disturbances are relevant to s 4.1c of the AMA4 Guides.
The insurer further submits that the Medical Assessor does not specify what the claimant’s current limitations of daily and social interpersonal functioning are related to any emotional and behavioural impairment. It is submitted that the symptoms and general presentation at assessment, as recorded by the Medical Assessor, does not accord with the 3% WPI awarded.
It is further submitted that the Medical Assessor ought to have specified what limitations are due to the brain injury as opposed to the psychological injury suffered by the claimant.

DOCUMENTATION

The Panel issued interim directions requiring the parties to each lodge a single bundle of all documents relied upon. The parties complied with such directions and the Panel has considered all documents provided in such bundles. This includes a bundle lodged by the insurer on 2 July 2025 comprising of 335 pages – “Simon Crofts – PIC review documents (R-M27499-24)” and a bundle lodged by the claimant on 14 August 2025 comprising of 713 pages – “Simon Crofts – Review Bundle – 14.08.2025”.
The Panel has not referred to every single document provided within these reasons, but has referenced certain documents that are directly relevant to the findings. However, the certificate and reasons are provided in the context of the Panel having considered all material provided in the aforementioned bundles.

Application for personal injury benefits dated 13 June 2023

Within this claim form the claimant lists his injuries at the time to be: right femur broken in two places, bone displaced; left wrist/forearm broken in eight places; right knee serious laceration; minor laceration right shin; severe bruising right hip, buttock, genitals; very painful right groin, and very painful left shoulder.

Certificates of capacity

Various certificates are provided by Dr Kyle Links. They include a diagnosis of right femur fracture; left ulna and radius fractures; left rotator cuff tendinopathy and bursitis, and left hand 2^nd phalanx extensor tendon injury. A diagnosis of adjustment disorder is later added to the certificates. Then in a certificate dated 14 June 2024 it is noted within same that there is evidence of possible acquired brain injury.

John Hunter Hospital

The discharge summary confirms the claimant being admitted on 7 June 2023 and discharged on 23 June 2023. He was noted to have been involved in the motor accident. His helmet was intact with a Glasgow Coma Score (GCS) of 15. Following surgical intervention for the fractures suffered, he was transferred to Warners Bay Private Hospital for rehabilitation and was discharged on 14 July 2023.

General practitioner

In the clinical records of Cardiff General Practice, a history of a fractured lumbar spine is noted occurring on 22 July 2022.
Dr Kyle Links of Three Rivers Health managed the claimant following the motor accident and referred the claimant to Dr Weastell, neurologist, in a letter dated 1 May 2024. A potential psychological injury and brain injury is noted. The letter recounts the claimant and his partner having noted the claimant’s memory and word recall abilities have progressively deteriorated after the motor accident. The doctor notes that at first the short term memory issues were thought to be possibly due to psychological trauma experienced and the extensive recovery undergone. However it is stated that “despite diligently working with a psychologist Simon’s memory has not shown any improvement.” The doctor notes the hospital records stating there to be no head injury, however, given the forces involved in the accident he would not be surprised if one occurred. He also notes that the CT scan from the hospital showed nothing of particular note.

Dr Weastell, neurologist

In an undated report the doctor notes the claimant presented with a subjective cognitive impairment following the accident. Cognitive assessment showed a moderate deficit in attention and mild deficits of fluency and memory – correlating with the subjective symptoms and mild short term memory loss. The doctor states:
“he has noted a mild decline in cognition since discharge from the rehabilitation service last year. Depression screening today demonstrated comorbid features of an undiagnosed mood disorder which will need to be addressed to determine how much of his cognitive symptoms are reversible.”
Dr Weastell ordered an MRI and the subsequent radiology report of 26 June 2024 concludes the following:
“numerous tiny foci of susceptibility at the grey/white matter interface and deep white matter of the cerebral hemispheres. An equivocal tiny focus of right middle frontal gyrus cortical gliosis. Given the clinical history of previous significant trauma this is suggestive of diffuse axonal injury. These findings are age indeterminate. The provided history of GCS of 15 at the time of the accident is not typical for such an injury.”

Dr Browne, rehabilitation specialist

In a report to the claimant’s general practitioner (GP) dated 21 March 2025 Dr Browne notes the claimant attended his Brain Injury rehabilitation clinic on 18 March 2025 attending with his brain injury case manager.
The doctor notes the GCS at the scene of the hospital was recorded as 15 and once ketamine was administered the score declined to 3/15. The GCS at the emergency department is noted to have been 13-14 with repetitive questioning. The claimant is said to have been amnestic to the collision, but recalled the accident scene and his fractured arm and people helping.
The doctor notes the claimant becoming concerned regarding a deterioration of cognition with him later consulting Dr Weastell. The claimant is reported to feeling that he no longer “fits in” and is easily upset. He lacks drive and energy and has lost confidence. The claimant noted he struggles remembering multiple things with his wife needing to remind him. He easily gets frustrated and denies pre injury mood issues.
Dr Browne concludes by stating his opinion that the claimant has sustained a mild, complicated traumatic brain injury as a result of the motor accident with changes to his cognition and mood. He recommended medication and a reluctance from the claimant is noted.

Allied Health Recovery Requests (AHHR)

Various AHHR of psychologist, Peter Lindsay, are noted that include a diagnosis of adjustment disorder with mixed anxiety and depressed mood.
The various significant physical injuries are noted. The claimant is noted to have developed emotional symptoms as a result of the accident including moderate depression. Some indication of anxiety is also noted. The claimant was noted to be upset due to pursue work or recreational activities.

Medico-legal reports

Reports of psychiatrist, Dr Bisht have been noted. In a report dated 4 December 2024, the doctor noted the claimant describing his mood as anxious and sad. No thought disturbances were noted and cognitively the claimant was able to provide reasonably detailed answers to questions. Judgment was not impaired.
He diagnosed the claimant as suffering a major depressive disorder with anxious distress.
The claimant relies on reports of occupational physician, Dr Low. In a report dated

10 December 2024, the doctor diagnosed fracture of the right femur, distal radius fracture. In addition cognitive symptoms requiring further evaluation were found with possible hearing loss. A WPI of 15% was provided (11% of the left wrist, 2% right hip and 2% for scarring).

Commission’s medical assessment of Medical Assessor Shen dated 11 April 2025.

The reasons provided by Medical Assessor Shen note the claimant complaining that his concentration had been affected with his mind tending to wander a lot. He recounted that if someone tells him three things to do, he will forget after the second or third task. A pre-existing 0% WPI was assessed. Whole person impairment caused by the accident is assessed as 6% (with a 1% for treatment effect).
The claimant noted that he attends the brain injury clinic and undertakes exercises to do at home. The Medical Assessor noted that the claimant complained of significantly poor concentration but can still drive for up to two hours without significant issues and was able to attend to the brain injury clinic cognitive exercises. The Medical Assessor also noted that the claimant had no objective impairment during the assessment so he has a mild impairment.
The Medical Assessor noted that the claimant had seen a psychologist and had been started on an antidepressant. The claimant stated that the treatment had improved his symptoms and he had found a men’s group to attend and he has been able to push through his anxiety.

RE-EXAMINATION

The below are the clinical examination findings of Medical Assessor Lahz following her examination of the claimant at the Commission’s medical suites on 8 October 2025.
Mr Crofts attended the assessment punctually and brought a friend (Mr Bruce Donaldson) to support him from the psychological perspective. I asked Mr Donaldson a few questions in passing, mostly about Mr Crofts’ pre-injury personality. Otherwise, he did not contribute to the assessment. They have known one another for many years, having similar age children who attended school together.
Mr Crofts was to return to Mr Donaldson’s home at Newcastle overnight and would then drive home to Bellingen near Coffs Harbour.
Mr Crofts is aged 57 and right-handed.
He is married (second marriage for the last 27 years) and lives at Bellingen where he had been in the process of relocating when the subject accident happened on 7 June 2023.

Mr Crofts has four adult children aged in the 20’s and 30’s across the two marriages.
Mr Crofts left school after year 10 and obtained qualifications as a baker. However, his substantive vocation has been truck driving (for many years) although at the time of the 2023 motor accident, he also had work in welding (as a trades assistant) and in farm labour. He told me that before the accident, he had been hoping to obtain work on the local (Toll) Coffs Harbour Bypass although the injuries from the motor accident put pay to these plans. He said too that he holds multiple plant tickets for excavator, forklift in addition to a HR truck licence.
Mr Crofts was fit and well before the motor accident, and been physically active with surfboarding, skateboarding, motorcycling, regular gym workouts, yoga sessions, cycling and snowboarding.
Mr Crofts acknowledged that there had been an episode of right hip pain about 15 years ago although he could not recall any details. The symptoms resolved spontaneously without any recurrence. He vaguely recalled an episode of neck pain about 12 years ago although there were no ongoing symptoms. A few months before the motor accident, he stepped off a ledge at home and sustained a lumbar fracture which was non-operatively managed with minimal ongoing pain.
Many years ago, he sustained a left AC (acromioclavicular) joint dislocation in an accident. There is a visible deformity at the AC joint although he said the joint was asymptomatic and before the motor accident, there had been full shoulder movement, comparable with the right.
Mr Crofts consumes minimal alcohol, takes no recreational drugs and has never smoked.
At the time of this assessment, his only medications were an antidepressant Agomelatine which he has been taking for just a few months and Paracetamol when required for aches and pains from the physical injuries.
Mr Crofts confirmed his involvement in the subject 7 June 2023 motor accident whilst riding a motorbike. His last memory is of starting to exit a roundabout when a car “collected him”. His next memory is of a bystander hovering over him at the scene. He was taken by ambulance to John Hunter Hospital although he has no recollection of that trip.
He spent several weeks in John Hunter Hospital and then another few weeks at Warner’s Bay Hospital for (physical) rehabilitation.
Mr Crofts listed his injuries as follows:
“1)     Broken right thigh in two places (segmental right femoral fractures) requiring surgical fixation with a long rod.
2)     Right knee (large) laceration (sutured)
3)     Left forearm/wrist fractures – both bones (radius and ulna) requiring fixation with plates and screws
4)     Memory problems, slowed mental processing, difficulty with complex tasks and with multitasking (with a prompt, he said there had been a brain injury, which was managed non-operatively)
5)     Left index finger ‘tendon problem’ requiring surgical repair (delayed diagnosis and repair surgery)
6)     Left shoulder pain (with a prompt, he remembered there had been difficulties elevating the left arm in hospital although x-rays (he said) showed no fractures)”
Mr Crofts had difficulty using two forearm crutches in hospital due to left wrist/forearm fracture. On leaving the rehabilitation hospital, he was on a single crutch for some months before regaining ability to walk without aids.
Mr Crofts has received extensive physiotherapy since the motor accident for the right hip, knee and left wrist/forearm and shoulder. He is still attending physiotherapy.
The upper limb (forearm/wrist) orthopaedic hardware is set to remain in situ, unless this gives him substantial problems with pain.
He has left shoulder pain and restriction although there has been no specific treatment for this. The shoulder pain and limitation have improved to a certain extent, now remaining static.
There are no current plans to remove the rod from the right femur. Mr Crofts since the motor accident has been diagnosed with post-traumatic hip osteoarthritis and been consulting an orthopaedic surgeon Dr Cornford who predicts he will eventually require a right total hip replacement. However, Dr Cornford has advised Mr Crofts to wait as long as possible because the hip replacement surgery would also entail removal of the present metal hardware which would be a “big” job due to (reportedly) bony overgrowth. There would be a lengthy post-operative recuperation period.
Mr Crofts has also received at least one steroid injection to the right hip (via the groin) with limited effect.
At this stage, Mr Crofts plans to put up with right hip pain for as long as possible until such time, he can barely walk or else unable to get in and out of bed due to severe hip symptoms. Dr Cornford has also explained to him that the earlier he undergoes hip replacement, then the more likely it is that he will eventually need revision surgery.
Due to cognitive problems involving memory, slowed information processing, difficulty with multitasking and adverse personality change (low mood, irritability, reduced motivation) he has consulted Dr Browne, a TBI physician whom he saw once after the motor accident. Although GCS was 15 at the scene of the accident, a subsequent brain MRI showed evidence of traumatic brain injury with findings consistent with diffuse axonal injury.

Dr Browne diagnosed a “mild complicated traumatic brain injury”.
Mr Crofts is seeing a clinical psychologist to help him with post-traumatic stress disorder symptoms such as hypervigilance, flashbacks/replay of the accident and anxiety attacks. Passing by the scene which he sometimes must does (his son lives in that area) causes him significant anxiety. He has been given some relaxation techniques and also some strategies to assist with adjustment to the effects of the serious injuries. His doctor has also recently prescribed him antidepressant medication (Agomelatine) to help with mood.
Mr Crofts attends regular appointments with a North Coast Brain Injury Rehabilitation Service case worker who has been helping him implement compensatory strategies for poor memory via use of electronic calendar, notes and alarms. He has also been advised to try to break down more complex tasks (with which he struggles) to smaller steps and finding such interventions helpful.
So far as he knows, Mr Crofts has not undergone a formal neuropsychological (cognitive) assessment.
Mr Crofts is fortunate to have excellent support from his wife, family, friends and dog. He credits his dog with getting him out of the house for regular walks during which he has the opportunity for connection with many different kinds of people which he enjoys.
Mr Crofts has been unable to resume his usual work (truck driving) since the accident due to physical injuries (especially of the right hip, making it difficult to climb in and out of the cab).
During (possibly) 2024, Mr Crofts attempted a return-to-work in a lower order job in which he was packing health food products/protein powder into boxes. He persevered in the job for just two months before resigning due to mental health issues. He said he would see trucks pass by making him feel regretful and angry about being unable to engage in his usual (much better paid) truck driving work.
Consequently, he remains off work. A vocational rehabilitation provider was involved for a while with roles such as gardening and resumption of truck driving suggested, both of which Mr Crofts felt were inappropriate due to painful physical injuries. He does very limited gardening at home which he said was already quite “bad” enough given the condition of the right hip, right knee and left wrist/forearm/hand.
He said he has since the motor accident also completed a “crash” course in computers to help find work. The provider was then actively seeking work for him.
However, the GP has recently decided to certify Mr Crofts unfit for work (ongoing) and also commenced him on antidepressants. Therefore, there has been no further vocational rehabilitation input.

Current symptoms

Head/Brain

Mr Crofts feels as though he no longer fits in with others. He has become socially withdrawn, preferring to stay at home. His wife whom he described as “social” often asks him to accompany her on outings although he is generally reluctant.
He used to be very social and happy-go-lucky (confirmed by his friend Bruce) whereas now he is moody, irritable and easily annoyed/frustrated. He also reported frequent feelings of “I just can’t be bothered”.
Sometimes, he gets angry when he finds he cannot complete a task so easily and quickly as before. He has occasionally thrown physical objects around in his own space although he denied any physical aggression towards others.
He is also more emotional since the accident. He mentioned that he felt very emotional, having to front up to this appointment in which he knows he will have to discuss the accident in detail. His wife is currently overseas, so he decided to ask his friend Bruce to attend as well for psychological support.
Mr Crofts feels generally “more uptight” and prone to becoming overwhelmed if a task contains too many steps or else the environment is overly busy. He said the kitchen is an area of the house, he now finds “hard to be in” because there is “too much going on”. Whilst he can prepare simple snacks and hot drinks, he said he struggles to prepare a main meal, reporting difficulty coordinating the necessary steps. Reading a recipe is now confusing for him and simply being in the kitchen, he said, was “enough to do in his head”.
Mr Crofts still shares chores with his wife whilst taking his time and being very careful so that unguarded movements of the left wrist and right hip/knee do not induce unreasonable amounts of pain.
He does limited gardening although he often feels angry when attempting this activity, given that this is much more time consuming and difficult than before due to physical injuries.
Mr Crofts reports regular memory lapses for which he compensates with use of electronic diary, lists and alarms. He also struggles to complete more than one task at once. He reported slow mentation and difficulties with more complicated, less familiar tasks, causing him at times to “feel stupid”.
He finds great comfort in walking his dog, which also enforces some positive social mixing.
He is not in any voluntary or else social groups and his physical injuries prevent him from playing sports.
He still occasionally rides a motorcycle just in the local area although he had to sell one of his bikes, given he could no longer kickstart it with the injured right leg.
His wife completes money management whereas previously they shared this task. He is still receiving a limited income through CTP. Mr Crofts denied impulsive spending or for that matter any other financial indiscretions.
From the TBI perspective, Mr Crofts is independent with personal care tasks.
He still drives and not feeling especially anxious in the car.
However, seeing a motorcyclist come off a bike at a show recently made him feel very distressed “sick”.
He occasionally experiences posterior (occipital) headaches of mild to moderate intensity coming up from the back of his neck.
Sleep is disturbed by the combined effects of “mind rushing” and multiple aches and pains.
Weight and appetite have remained steady.
He would like eventually to resume work although there are no present plans. As noted, his doctor has him currently certified unfit for work, this not anticipated to change in the foreseeable future.
Mr Crofts has not experienced any seizures.
Vision, hearing, olfaction and taste are also normal.

Left shoulder

Early on after the motor accident, Mr Crofts was unable not lift the left arm. He can now lift it “most” of the way albeit with pain overlying the superior shoulder. He continues having difficulty with lying directly on the left shoulder although he can do so for short periods whereas at the start, he could not do so at all.
With repetitive activity, left shoulder pain can reach 5/10 intensity.

Left forearm/wrist and left hand

There can be “sharp” pains coming out of the blue at the dorsal left wrist and forearm.
The left index and middle fingers can now only extend in unison (since the index extensor tendon repair surgery) of late 2023. He can make a good fist although he cannot extend the index finger independently of the middle finger.
The second MC (knuckle) joint is very sensitive to knocks and often sore. There is also a small, painful bony lump at the hand dorsum (at the junction of hand and wrist).
He dislikes bimanual activities because this causes pain over the left hand dorsum and index MC (knuckle) joint.
Left forearm pain can sometimes reach 9/10 intensity with unguarded or else repetitive movements.
He has great difficulty playing the guitar due to wrist motion restriction and sensitivity about the index knuckle joint.
Unguarded movements and heavy lifting/carrying stir up pain over the dorsal forearm, wrist and hand.
The surgical screws at the dorso-ulnar forearm are very sensitive to knocks and jars.

Right hip

He experiences frequent pain in the medial groin, worse medially. Pain varies from day-to-day. Some days, he can walk a fair distance whereas on others he can barely move.
He also experiences pain in the right buttock spreading down the anterior thigh into the front of the knee.
The right hip movements are restricted.
He can walk for about 40 minutes on level ground before the hip pain stops him in his tracks.
He can walk uphill reasonably well although descent is more difficult due to right groin/buttock pain and to a lesser extent anterior right knee pain.

Right knee

More recently, he has been experiencing anterior right knee pain, worse with walking and with prolonged sitting.
The knee does not lock, pop or else give way, and there is no sensation of instability. The knee also does not swell up.

Scarring

He does not report any physical symptoms at the various scars (right hip, left hand and right knee). The scars do not affect ADLS and no treatment is required. However, he is self-conscious about one of the scars in the particular (the middle of three over the lateral right thigh) where there is an elliptical reducible (fat) hernia that pops out and about which, other people comment.

Examination

Mr Crofts presented in a straightforward manner although he was intermittently tearful during the interview, especially when discussing his difficulties due to the injuries and attendant grief and frustration.
I observed that he is a tall man with height 183 cm and he is of lean build 82.5 kg.
He was a satisfactory historian although at times, his responses were made slowly for which he apologised, and it was apparent that he was carefully considering his responses to my questions.
On the MoCA, he scored 24/30 with loss of points for cube drawing (1), short-term memory (3), attention (1) and verbal fluency (1).
At the commencement of the examination, Mr Crofts was asked to make the best effort possible with all requested movements but to advise me if there were unduly severe pain or else discomfort.
Neck movements were mildly restricted (3/4 normal range) in all planes.
There was wasting of both shoulders, more so on the left. There was an obvious (old) deformity due to left acromioclavicular joint dislocation, unrelated to the motor accident.
Active range of shoulder motion is shown in the following table: Shoulder movements where restricted were repeated thrice and measured with a goniometer and found consistent.
Right Left

Abduction	180 0% UEI	160 1% UEI Fig 41 p44 AMA4
Adduction	70 0%	70 0%
Flexion	160 1% UEI	150 2% UEI Fig 38 p43
Extension	60 0% UEI	40 1% UEI
External rotation	80 0% UEI	80 0% UEI Fig 44 p45
Internal rotation	80 0% UEI	80 0% UEI

At the elbow, there were 0-140 degrees of active movement bilaterally (0% upper extremity impairment (UEI) bilaterally) Fig 32 p40 AMA4 Guides.
At the right elbow, there were 80 degrees of pronation (0% UEI) compared with 70 degrees of left-sided pronation (1% UEI) Fig 35 p41 AMA4 Guides.
At the right elbow, there were 80 degrees of supination 0% UEI compared with 30 degrees of left elbow supination 2% UEI Fig 35 p41.
Active range of wrist motion is shown in the following table: (Again, movements where restricted were repeated thrice and measured with a goniometer and found consistent.)
Right Left

Extension	80 0% UEI	30 5% UEI Fig 26 p36 AMA4
Flexion	80 0% UEI	50 2% UEI
Radial Deviation	40 0% UEI	10 2% UEI Fig29 p38
Ulnar deviation	40 0% UEI	20 2% UEI

At the left hand, he could make a full fist comparable with that of the right hand.
However, on finger extension, he was unable to extend the left index independently of the left middle finger.
He reported stiffness of the left thumb compared with the uninjured right.
At the thumb interphalangeal joint there were 60 degrees of flexion and full extension 1% thumb impairment each side, Fig 10 page 26 AMA4 Guides.
At the first MP joint, there were 70 degrees of right-sided flexion 0% thumb impairment compared with 50 degrees of left-sided first MP flexion 1% thumb impairment Fig 13 p27 AMA4 Guides. Extension was full bilaterally.

There were 50 degrees of right-sided radial abduction 0% thumb impairment compared with 40 degrees of left-sided abduction 1% thumb impairment Table 6 page 28 AMA4 Guides.
Opposition was 7 cm bilaterally 1% UEI each side, Table 7, page 29 AMA4 Guides.
Thumb adduction on the right was 4 cm (4% thumb impairment) compared with 6 cm on the left (8% thumb impairment) Table 5 page 28 AMA4 Guides.
There is 12% left thumb impairment from which constitutional impairment of the right uninjured thumb 6% thumb impairment is deducted with residual 6% thumb impairment or else 2% hand Table 1 p 18 converting to 2% UEI Table 2 page 19 AMA4 Guides.
Active hip movements are shown in the following table:
Right Left

Flexion	110	140
Extension	No fixed flexion deformity	No fixed flexion deformity
Abduction	30	50
Adduction	30	40
Internal rotation	20	20
External rotation	20	50

At the knees, there is full active range of motion with 0-150 degrees (0% UEI) Table 41, page 78 AMA4 Guides.
There was no painful patellofemoral crepitus and no knee effusions,
Both knees were stable in the AP and ML planes.
There were 2 cm wasting of the right thigh compared with the left, due to (undoubtedly) the long-standing right hip injury complicated by post-traumatic osteoarthritis (4% WPI or else 11% UEI Table 6.1a page 95 of the Guidelines.)

WPI Calculation

There is 4% UEI for the left shoulder based on range of motion (1, 2,1) from which 1% UEI at the uninjured right shoulder is deducted for constitutional impairment per instructions in the Guidelines.
There is no constitutional impairment of the uninjured right wrist and right elbow.
That is to say there is 4-1=3% UEI for the left shoulder, there is 2% UEI for the left elbow (pronation 1% UEI/supination 1% UEI) and 11% UEI (5, 2, 2, 2) for the left wrist.
At the uninjured right thumb, the thumb impairment values are 1 for IP flexion, 0 for MP flexion, 0 for radial abduction, 1 for opposition and 4 for thumb adduction= 6% thumb impairment. At the injured left thumb, the respective values are 1, 1, 1, 1, 8= 12% thumb impairment. Constitutional right thumb impairment of 6% is deducted from 12% injured left thumb impairment giving 6% thumb impairment or else 2% hand impairment for the left thumb due to the motor accident (Table1 page 18 AMA4 Guides).
For the loss of independent left index finger extension, I agree with the analogy used by Professor Cameron, given that this is not included in the Guidelines and AMA4 Guides.
By analogy the impairment equivalent to extension of 20° at the index finger metacarpophalangeal joint which is assessed as 10% digit impairment (Figure 23, page 34 AMA4 Guides). This converts to 2% hand impairment.
The hand impairments due to the motor accident for the left thumb and index finger are added i.e. 2+2=4% hand impairment or else 4% UEI representing impairment of the left hand due to the motor accident.
Following combination of UEI values: 11 (wrist), 3 (left shoulder), 2 (elbow), 4 (index finger and thumb) UEI values there is 20% UEI or else 12% WPI (Table 3, page 20) for the left upper extremity.
Referring to Table 490 page 78 AMA4 Guides regarding the right hip, there is mild restriction i.e. 2% WPI or else 5% UEI for 20 degrees of ER and 20 degrees of IR although there is full deduction given that contralateral IR at the uninjured hip is also restricted similarly to 20 degrees, conferring 2% constitutional WPI at the left hip. Consequently, there is 0% WPI of the right hip due to the motor accident, based on range of motion.
There is 2 cm right thigh wasting i.e. 4% WPI per the Table 6.1a in the MAG on page 95.
There is highly likely impairment for post-traumatic osteoarthritis at the right hip which would be determined on plain X-rays (measured cartilage interval) although no such films weight bearing were available.
Mr Crofts suffered a mild complicated brain injury with PTA under 24 hours but associated with brain imaging findings consistent with DAI (diffuse axonal injury). He passed the AWPTAS within 24 hours although as noted interval imaging demonstrated features of brain trauma. There are higher order impairments of cognition and emotion/behaviour due to permanent ongoing sequelae of this significant albeit mild yet complicated traumatic brain injury.
Whilst the effects of a mild traumatic brain injury, typically resolve in three months, there are anticipated long-term effects of a mild complicated traumatic brain injury associated with positive findings (susceptibility foci) on brain imaging (akin to traumatic brain injury of moderate severity).
Mr Crofts from a cognitive perspective despite higher order cognitive difficulties affecting memory and attention, can manage his life independently. Therefore, it is most appropriate to deem WPI for behavioural and emotional disturbance due to mild complicated traumatic brain injury sustained in the subject motor accident.
It is noted that there are also psychological diagnoses of depression and post-traumatic stress disorder.
It is difficult to disentangle psychological symptoms due to TBI from those caused by psychological reaction to injury.
Given the presence of a TBI of greater than mild severity (with positive (traumatic) findings on brain imaging) this has undoubtedly reduced Mr Croft’s ability to cope with the effects of multiple serious orthopaedic injuries. Exercising clinical judgment, an assessment of 3% WPI is appropriate per table 3 page 142 AMA4 Guides. It is noted that the latter WPI is consistent with the assessment of Medical Assessor Cameron. Awarding 3% WPI for same is very reasonable in the circumstances.
Following combination of WPI values 12 (left upper limb), 4 for (right lower limb) and 3 for the traumatic brain injury, there is 19% WPI due to the motor accident.

CONCLUSION

The Panel discussed the above clinical findings of Medical Assessor Lahz at the post examination teleconference on 10 October 2025. Also discussed was the material provided by the parties. The Panel collectively agreed with the findings of Medical Assessor Lahz, and the Panel agreed that the findings would be adopted into these reasons.
The Panel was satisfied on the balance of probabilities that the claimant has in fact suffered a TBI as a result of the motor accident. The initial GCS of 15 at the scene was noted, although it was concluded that the MRI findings are such that the Panel is sufficiently satisfied that the motor accident caused a significant (mild complicated) TBI. In this regard, it is accepted by the Panel that the mechanism of the motor accident is sufficient to have caused such injury and on the basis of the documented complaints of cognitive, behavioural and emotional difficulties, with treatment received from the brain injury clinic, the Panel is satisfied that the claimant did in fact suffer a brain injury caused by the accident associated with mild cognitive and emotional disabilities. The Panel acknowledges the radiologist’s comment that the pathology is not usually consistent with a GCS of 15 being recorded at the scene. However, there is no evidence to suggest that the brain injury was caused by another incident, and the complained of symptoms of the claimant since the motor accident are consistent with such injury. Further, the forces of the accident were such that multiple serious orthopaedic injuries were also sustained. The forces imposed in the subject accident were substantial causing multiple physical injuries inclusive of the traumatic brain injury.
The Panel noted the difficulties with disentangling psychological symptoms from the symptoms generated from a traumatic brain injury. However, the Panel agreed that the approach taken by Medical Assessor Lahz is reasonable and appropriate in the circumstances and note that Medical Assessor Lahz has exercised her expert clinical judgement in this regard, while remaining cognisant of the interplay of psychological symptoms.
The Panel, following discussion of the findings of Medical Assessor Lahz, accepted that there was a significant element of brain injury in the presentation. This includes a decrease in the claimant’s resilience with less of an ability to cope especially under pressure or in stressful circumstances. He was noted to be irritable with emotional lability and is more easily overwhelmed with everyday tasks and activities. It was agreed that all such symptoms are consistent with the brain injury described above.
The Panel also discussed the clinical examination findings of Medical Assessor Lahz being different from those recorded by Medical Assessor Cameron in respect of shoulder movements. Medical Assessor Cameron found a full range of motion. The findings of Medical Assessor Lahz are noted above. Medical Assessor Lahz confirmed that this variation was discussed with claimant, and he was unable to explain same, however, commented that his restriction at examination with Medical Assessor Lahz was due to pain.
The Panel is satisfied on the balance of probabilities that the claimant’s shoulder injury has been caused by the accident. The accident was significant, with the claimant spending several weeks in hospital due to significant physical injuries. The accident is capable of giving rise to the shoulder injury and the clinical examination findings are consistent with the history of the accident.
The injuries referred for assessment including the abdomen and pelvis injury were discussed. It was noted that there is no evidence of any such injuries having been caused by the motor accident and the Panel was therefore not satisfied that such injuries were caused by the accident. The Panel notes that this is consistent with the findings of Medical Assessor Cameron.
The findings of the Panel differ from that of Medical Assessor Cameron and accordingly the certificate of 6 November 2024 is revoked and a new certificate is provided at the beginning of these reasons.

[2025] NSWPICMP 830

28 October 2025