Allianz Australia Insurance Limited v Hamdan
[2023] NSWPICMP 564
•9 November 2023
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Allianz Australia Insurance Limited v Hamdan [2023] NSWPICMP 564 |
| CLAIMANT: | Muhammad Hamdan |
| INSURER: | Allianz Australia Insurance Limited |
| REVIEW PANEL | |
| MEMBER: | Elizabeth Medland |
| MEDICAL ASSESSOR: | Shane Maloney |
| MEDICAL ASSESSOR: | Margaret Gibson |
| DATE OF DECISION: | 9 November 2023 |
| CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; Panel review of Medical Assessor (MA) certificate certifying physical injuries as not threshold injuries; claimant sustained injury as a result of a rear-end collision at an intersection; injuries alleged to have been sustained to the cervical spine, thoracic spine and left shoulder; MA had found a partial rupture of the annular fibrosis (ligament) on examination of an MRI scan of the cervical spine; such finding was not reported by the radiologist; the scans were reviewed by the MA’s of the Review Panel who also did not identify such finding; Panel considered the opinion of the specialist radiologist should be preferred over the medical assessor and furthermore on their own examination of the radiology such finding was not observed; no signs of radiculopathy found; soft tissue injuries to the cervical and thoracic spine and shoulder found to be threshold injuries; Held – original certificate revoked. |
| DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION The Review Panel revokes the certificate of Medical Assessor Bodel dated 18 October 2022 and issues a new certificate determining that: · cervical spine – soft tissue injury; · thoracic spine – soft tissue injury, and · left shoulder – soft tissue injury. |
STATEMENT OF REASONS
INTRODUCTION
Mr Muhammad Hamdan (the claimant) is a 35-year-old male who alleges injury as a result of a motor vehicle accident which occurred on 9 October 2019. He was the driver of a vehicle that was stationary at an intersection in Greenacre, NSW. The insured vehicle collided with the rear of the claimant’s vehicle.
The claimant subsequently lodged an Application for personal injury benefits (claim form) with the insurer of the vehicle, Allianz Australia Insurance Ltd (Allianz), on or about 3 December 2019. Within the claim form the claimant alleged injury to his neck, left shoulder and mid back.
The issue in dispute between the parties is whether any physical injury suffered by the claimant as a result of the accident is a threshold injury (previously known as a minor injury – any reference to ‘minor injury’ in this determination is a reference to ‘threshold injury’.
A threshold injury determination is an important one in terms of an injured person’s entitlements under the Motor Accident Injuries Act 2017 (MAI Act). If a determination finds that the motor accident has caused a non-threshold injury then the gateway to ongoing statutory benefits beyond 26 weeks and an entitlement to claim common law damages is opened.
It appears that liability for payments of statutory benefits was initially accepted by the insurer. However, on or about 16 March 2020, the insurer denied liability for ongoing statutory benefits after 26 weeks on the basis that the claimant’s injuries were deemed as minor injuries (now known as a “threshold injury”) for the purposes of ss 3.28 and 3.11 of the MAI Act.
An internal review decision of the insurer dated 10 July 2020 affirmed the original decision.
Subsequently an application was lodged with the Personal Injury Commission (the Commission) to determine the dispute.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter including whether “the injury caused by the motor accident is a threshold injury for the purposes of the Act.”
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor.
The dispute about whether the claimant’s accident caused psychological injury is a threshold injury, is a medical dispute, as defined by s 7.17 of the MAI Act, and a medical assessment matter: Schedule 2 cl 2(e) of the MAI Act.
The medical dispute was assessed by Medical Assessor James Bodel (Medical Assessor). The Medical Assessor gave a certificate dated 18 October 2022 wherein he certified that the claimant suffered an injury to the left shoulder and thoracic spine/mid back, and were minor injuries (now known as threshold injury) for the purposes of the MAI Act.
THE REVIEW
The claimant sought a review of the medical assessment in accordance with s 7.26 of the MAI Act (review). On 11 January 2023 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).
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of Schedule 1 of the PIC Act. As the medical assessment the subject of the review was made on or after 1 March 2021, the new review provisions apply.
The new review provisions provide[1] that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission.
[1] 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 28 March 2023 requesting paginated and indexed bundles of all documents relied upon by the parties.
Following an initial teleconference, the Panel issued interim directions dated 11 April 2023 to the parties requesting submissions on an issue identified by the Panel not previously addressed by the parties. In this regard, the parties were asked to comment on whether the findings of the radiologist, Dr Younis in his MRI of the cervical spine report dated 26 November 2019, should be preferred over the observations of Medical Assessor Bodel of the radiological films. Submissions from both parties were received on this issue.
The Panel convened a second time and decided that an examination of the claimant was required. A re-examination conducted by Medical Assessor Maloney was arranged to occur at the Commission medical suites on 9 August 2023.
LEGISLATIVE FRAMEWORK
The term ‘threshold injury’ is defined in s 1.6 of the MAI Act. It provides that a threshold injury is a soft tissue injury or a threshold psychological or psychiatric injury. Section 1.6(2) of the MAI Act defines a soft tissue injury to mean:
“…an injury to tissue that connects, supports or surrounds other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia, fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.”
Section 1.6 also provides that the regulations may exclude or include a specified injury from being a soft tissue injury or a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the Regulations) further defines threshold to include “an injury to the spinal nerve root that manifests in neurological signs (other than radiculopathy)” and an acute stress disorder and an adjustment disorder.
Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by a motor accident is a threshold injury for the purposes of the MAI Act. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:
“General provisions for assessment
5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.4 Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b) a review of all relevant records available at the assessment
(c) a comprehensive description of the injured person’s current symptoms
(d) a careful and thorough physical and/or psychological examination
(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
Clauses 5.7 to 5.9 of the Guidelines relate to whether an injury to a spinal nerve root in the context of neurological symptoms is classified as a threshold injury. An injury resulting in radiculopathy will not be classified as a threshold injury.
Clause 5.6 of the Guidelines provides: “in assessing whether an injury to the neck or spine is a soft tissue injury, an assessment of whether or not radiculopathy is present is essential.”
Radiculopathy is defined in cl 5.8 of the Guidelines as follows:
“…radiculopathy means the impairment caused by dysfunction of a spinal nerve root or nerve roots when two or more of the following clinical signs are found on examination when they are assessed in accordance with ‘Part 6 of the Motor Accident Guidelines Permanent Impairment’.
a)Loss or asymmetry of reflexes (see the definitions of clinical findings in Table 6.8 in these Guidelines)
b)Positive sciatic nerve root tension signs (see the definitions of clinical findings in Table 6.8 in these Guidelines)
c)Muscle atrophy and/or decreased limb circumference (see definitions of clinical findings in Table 6.8 in these Guidelines)
d)Muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution.”
Clause 5.9 of the Guidelines provides that neurological symptoms of the neck or spine that do not meet the assessment criteria for radiculopathy, will be assessed as a threshold injury.
Sections 5D and 5E of the Civil Liability Act2002 apply to the MAI Act.[i]
ORIGINAL MEDICAL ASSESSMENT
Medical Assessor Bodel in a certificate dated 18 October 2022, found the following injuries to be a minor injury for the purposes of the Act:
(a) left shoulder: radiating from neck, and
(b) thoracic spine/mid back: pain after the motor accident.
The following injury was found to be not a minor injury for the purposes of the MAI Act:
(a) cervical spine: disc protrusion.
In respect of the cervical spine, the Medical Assessor found no convincing signs of radiculopathy. However, from viewing of the radiological films of the claimant’s MRI to the cervical spine of 26 November 2019, the Medical Assessor formed the view that there was additional pathology than that reported by the radiologist. He stated:
“The appearance that I have seen also shows damage to cartilaginous endplate of the C5/6 disc space and partial-thickness tear of the annulus fibrosis, which is a ligament by definition in this circumstance, and that is caused by the motor vehicle accident.”
The Medical Assessor also found no signs of radiculopathy on clinical examination of the thoracic spine and the lumbar spine.
In respect of the left upper extremity the Medical Assessor found no signs of reflex abnormality or sensory impairment in the upper limbs and no clinical signs of radiculopathy in the upper limbs.
On clinical examination of the lower limbs, the Medical Assessor found no leg length inequality or spinal deformity and there was no impairment of straight leg raising or neurological abnormality.
SUBMISSIONS
Insurer’s original submissions dated 10 July 2020
The insurer disputed that the claimant had suffered a cervical spine injury as a direct result of the motor accident. The insurer noted prior complaints of neck pain. It was also submitted that evidence suggests an absence of radiculopathy of the cervical spine.
In respect of the thoracic spine it was submitted that there was no evidence that any injury to such area of the body constitutes a non-minor injury. Similar submissions were made in respect of the left shoulder.
Insurer’s application for review submissions dated 16 November 2022
The insurer submits that the Medical Assessor failed to take into account relevant pre-accident medical evidence. It is also submitted the Medical Assessor failed to properly address the issue of causation and there was a failure to set out the path of reasoning.
The insurer refers to the clinical records of Dr Tsang, which include a record of neck symptoms following an earlier motor accident of 10 January 2019. The insurer states that the Medical Assessor failed to take into account the original submissions which assert that the claimant did not sustain an injury to his cervical spine as a direct result of the subject accident.
The insurer submits that the Medical Assessor has mistakenly taken the summary of the earlier motor accident in the claimant’s statement as being the history of the subject accident. In further support of this submission the insurer notes that the Medical Assessor commented that there was no specific mention in Dr Tsang’s notes of previous neck, arm or upper back pain prior to the subject accident.
The insurer submits that the Medical Assessor failed to determine the issue of causation on a factual basis and has therefore not complied with the statutory provisions. It is submitted that the Medical Assessor failed to address how he came to determine that the claimant sustained a disc injury in the subject accident when the claimant did not seek any medical treatment for the accident until he attended upon Dr Tsang on 25 November 2019, more than six weeks post accident.
Claimant’s reply submissions dated 7 December 2023
The claimant submits that the Medical Assessor had clearly stated that he had reviewed and considered all of the material before him.
The submissions refute the insurer’s assertion that the Medical Assessor was confused between the subject accident and the earlier motor accident.
It is submitted that the Medical Assessor took a history of the accident, canvassed the symptoms of treatment therefrom which provided a foundation for the MRI scan, to establish the causative agent of the claimant’s injury being as a result of the subject accident. Further, it is noted that Dr Tsang, that no radiological scans or significant referrals were made after the first accident of January 2019.
Insurer’s further submissions dated 18 April 2023
These submissions were provided in response to the Panel’s directions dated 11 April 2023.
The insurer submits that the radiologist, Dr Younis’ opinion should be preferred over that of the Medical Assessor in respect of the MRI findings, given that his speciality in radiology is in interpreting radiological investigations.
In the alternative, it is argued that if it is accepted that a partial thickness tear of the annulus fibrosis is present, then it is a pre-existing pathology having regard to the claimant’s complaints of pain after the first motor accident in January 2019.
Claimant’s further submissions dated 4 May 2023
These submissions were also provided in response to the Panel’s interim directions.
It is submitted that the Panel should not prefer the report of Dr Younis over the opinion of Dr Bodel.
The submissions also refer to a report of Dr Herald dated 14 September 2020 which apparently includes an opinion that the C5/6 bulge was causing foraminal impingement. On such basis damage to the right cartilaginous structure would classify the claimant as suffering a non-minor (non-threshold) injury.
The submissions note that the radiological scans have been provided to the Commission and the Review Panel ought to review same and determine whether Medical Assessor Bodel’s interpretation is correct.
MATERIAL BEFORE THE REVIEW PANEL
The clinical records of the claimant’s general practitioner, Dr Tsang, document the claimant attending the practice on 23 January 2019 following a previous motor accident (occurring on 10 January 2019). It is recorded by Dr Tsang, that the claimant felt right sided neck pain within minutes of the impact and the next day experienced left sided neck pain. Bilateral neck pain was noted, with “instrascap pain L>R” and burning down the right arm.
On examination, Dr Tsang noted stiffness on rotation, nil clinical impingement, and pain on flexion f neck across scapulae. He determined that the claimant had likely suffered a mild grade 1/2 whiplash injury.
On 11 March 2019 the claimant was noted to have ongoing right sided neck pain. Dr Tsang thought the claimant had residual whiplash and noted the claimant should persist with physiotherapy and consider a TENS machine.
The subject motor accident is noted by Dr Tsang on 25 November 2019. The accident is described as low velocity but “jolted” with the claimant’s head going forward and back. Neck pain to the left side was noted since the accident with stiffness and some shoulder pain. Headaches were noted and the notes state: “when turn head feels shooting pain down shoulder and L arm.” Dr Tsang thought the symptoms warranted an MRI investigation and he referred the claimant for an MRI of the cervical spine.
A MRI report of radiologist, Dr Younis, is included in the material and is dated 26 November 2019. The report notes disc bulges at the C3/4 level with “no significant neural tissue compression”, and C4/5 “causing minimal impression upon anterior CSF sleeve.”
Dr Younis concludes: “left paracentral disc bulge at C5/6 level causing left sided neural foraminal narrowing and mild compression upon left exiting nerve root.”
There are a number of Certificates of Fitness that list the claimant’s injury to be a disc bulge at C5/6 level with nerve impingement.
Certificates of Fitness in respect of the first motor accident occurring in January 2019, list the diagnosis as whiplash injury to the cervical spine, noting a sudden onset of neck pain after the collision.
Allied Health Recovery Requests are included in the material completed by Dr Tsang. They include a diagnosis of: “cervical whiplash injury/facet joint irritation post MVA and a C5/6 disc bulge with radiating arm symptoms and dizziness.”
The insurer has included a report of Michael Griffiths, biomechanical engineer, dated 20 March 2020. The content of the report has been considered. Mr Griffiths considered some limited medical documents, including the MRI report and records of Dr Tsang. He also had photographs of the claimant’s vehicle depicting damage from the motor accident.
The findings of Mr Griffiths can be briefly summarised as an opinion that the claimed neck pathology resulting from the accident is a result of a degenerative condition, which can be substantiated from the records as being symptomatic well before the subject accident.
Statements of the claimant
The material includes statements of the claimant. The first, dated 12 December 2019, mentions the first motor accident of January 2019. The claimant explains that he had pain in his neck and after a few sessions of physiotherapy and remedial massage, chiropractic and acupuncture treatment, the injuries resolved within a few months. He notes he was not taking medication for the injury.
In respect of the subject accident, he explains that he felt immediate pain in his neck. He explains that he may have sought treatment from a physiotherapist or chiropractor, but cannot specifically recall. He states that he eventually consulted with Dr Tsang who ordered the MRI of the cervical spine.
The second statement of the claimant has been prepared by investigators engaged by the insurer. The statement is not signed. Being not signed diminishes the value of the statement and it therefore offers little reliable information.
The material includes several photographs of the damage to the claimant’s vehicle (a white Toyota van) from the accident.
RE-EXAMINATION
The claimant attended the re-examination conducted by Medical Assessor Shane Maloney on 9 August 2023 at the Personal Injury Commission Medical Suites. He was unaccompanied.
Pre-accident history
Mr Hamdan stated that he was married and lives with his wife and four children aged 12, 10, 8 and 3. He was qualified as an electrician but did not work in that industry. He had worked for Virgin Blue as a ground baggage employee. At the time of the accident, he was working as a wholesale fruit and vegetable distributor and also ran a farm growing plums.
He states that prior to the accident he had been playing Oz Tag and had recurrent bursitis in both shoulders. An ultrasound of the left shoulder had been organised by his treating general practitioner prior to the accident and was undertaken on the day of the accident due to chronic bursitis without any evidence of a rotator cuff tendon tear.
History of motor vehicle accident
Mr Hamdan was the driver of his car and was stationary when hit from the rear. He was wearing a seatbelt at the time but airbags were not deployed. He states he immediately felt pain in the left side of his neck but was able to drive home. The police and ambulance did not attend the accident scene.
History of subsequent treatment
Mr Hamdan consulted his general practitioner who organised an MRI of the cervical spine and then referred him to a neurosurgeon, Dr Damodaran. He diagnosed intermittent mild C6 radiculopathy but suggested that surgery wasn’t appropriate. He also suggested cortisone injection to the cervical spine but Mr Hamdan declined this intervention. He was referred for physiotherapy, acupuncture and massage. All of which gave temporary relief.
Mr Hamdan stated that he had had no further accidents or injuries since this motor vehicle accident.
Current symptoms
At present, he has persistent left-sided neck pain which radiates into the left occipital region and parietal area of his skull. This increases after carrying anything heavy and is associated with generalised headaches. There was a dull ache in the left middle forearm region which radiates down to the dorsum of the left hand and in particular the lateral three fingers. Sometimes he feels a shock like feeling in this region. The pain in the neck increases with turning to the left or extension.
Mr Hamdan states that the right side is asymptomatic. The neck pain often wakes him at night. He has no difficulty walking or driving his car. Since the accident he no longer plays football as running aggravates the neck pain after the game.
Mr Hamdan works four hours a day for three days a week continuing his wholesale deliveries and uses mechanical aids such as a forklift for the heavy lifting. Since the accident he also gets extra manual help on the farm.
Present medication
Mr Hamdan has a Mobic 15mg One-A-Day and occasionally Voltaren 25mg or Nurofen plus. He also has Panadol extra two to four per day. He gets relief with local heat applied to the shoulder region and has Thera gun massage machine which his wife applies to the neck and shoulder.
He consulted his general practitioner when necessary but has no specialist appointments.
Clinical examination
Mr Hamdan stated that he was right-handed and his height was 176cm with shoes and 83.5kg.
Cervical spine
On inspection, there was a normal contour and on testing range of movement, flexion/extension was 75% of expected range, side bending was 60% of expected range bilaterally and rotation was 80% of expected range bilaterally with no asymmetry. On palpation, there was tenderness over the left lower paravertebral muscles and in particular in the suboccipital region on the left. No guarding or spasm was noted in the cervical musculature.
On neurological examination of the upper limbs, reflexes were equal bilaterally with normal power and no sensory changes were noted. No muscle wasting was apparent with the circumference of the upper arms 29cm bilaterally (10cm above the olecranon process) and in the upper forearms 26cm bilaterally at the maximum circumference of the forearms.
Thoracic spine
On inspection of the thoracic spine, there was a normal contour and on testing range of movement, flexion/extension, side bending and rotation were all 80% of expected range with no asymmetry. On palpation, there was no guarding or spasm and no signs of radiculopathy or non-verifiable radicular complaints in the thoracic spine region.
Shoulders
On inspection of the shoulders, both shoulders areas were well muscled with no wasting noted. On passive movement, no crepitus was detected and impingement tests were negative. Active movement was measured with a goniometer and repeated three times.
Shoulder Movements Active ROM Measured
RIGHT
Active ROM Measured
LEFTFlexion 160° 160° Extension 50° 50° Adduction 60° 50° Abduction 180° 170° Internal Rotation 70° 80° External Rotation 90° 80°
CONSISTENCY
At the time of the examination, no inconsistency was noted when testing range of movement.
DIAGNOSIS AND CAUSATION
Cervical spine – soft tissue injury
There is record of left sided neck pain after the motor accident, as documented by the treating general practitioner and physiotherapist. The symptoms reported by the claimant were sufficient enough for the treating general practitioner to have the cervical spine investigated by an MRI. Whilst the prior complaints of neck pain are noted, on balance the Panel accepts that the claimant suffered an injury to his cervical spine as a result of the accident, noting the contemporaneous general practitioner notes recording complaints. The Panel concludes that the claimant suffered a soft tissue injury to the cervical spine but there have been no signs of radiculopathy recorded.
Thoracic spine – soft tissue injury
Mr Hamdan also complained of mid back pain due to the accident which has now resolved.
Left shoulder – soft tissue injury
There was a pre existing left shoulder complaint. An ultrasound of the left shoulder was undertaken on the day of the motor accident but had been ordered prior to this by the general practitioner. Thus, there was pre-existing bursitis. The Panel accepts that the claimant may have aggravated this pre-existing bursitis as a result of the motor accident.
Comments and findings
Mr Hamdan considered that he had chronic bursitis in both shoulders but does not think that he had ongoing neck pain at the time of the accident. He did have a CT scan of the cervical spine on 20 June 2018 which was basically normal and the MRI on 26 November 2019 reported a left paracentral disc bulge at C5/6 and mild compression upon the left exiting nerve root.
At the time of re-examination and that undertaken by Dr Damodaran, neurosurgeon, no signs of radiculopathy have been noted. Medical Assessor Bodel recorded no signs of radiculopathy.
Mr Hamdan brought a CD copy of the MRI of the cervical spine, however, it could not be opened at the time of the examination. However, since such date both Medical Assessors have been provided access to copies of the relevant films by the Commission. Both Medical Assessors have examined the relevant films.
In the absence of radiculopathy, the issue of threshold injury must focus on whether there has been an “…injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage” pursuant to s 1.6(2) of the MAI Act. This enquiry includes a consideration of Part 1, cl 4 of the Regulations that specifies that an injury to the nerve root that manifests neurological signs (other than radiculopathy) is a threshold injury.
The issue that remains centres on whether there has been a partial rupture of the annular fibrosis (ligament) as concluded by Medical Assessor Bodel. The Panel notes that no such finding was reported by the specialist radiologist, Dr Younis in his report of the MRI of the cervical spine. The Panel considers that the specialist opinion of Dr Younis should be preferred. Moreover, the Medical Assessors of the Review Panel, upon review of the relevant films, did not conclude there to be a rupture of the annulus fibrosis, as found by Medical Assessor Bodel. Accordingly, it is the Panel’s conclusion that the injury to the cervical spine is a threshold injury for the purposes of the MAI Act.
The injury to the thoracic spine is a soft tissue injury and is now asymptomatic and is therefore a threshold injury.
In respect of the left shoulder, the claimant had pre-existing bursitis noted on ultrasound immediately prior to the motor accident. A further soft tissue injury may have been caused by the motor accident but it is still a threshold injury.
CONCLUSION
For these reasons the Panel revokes the certificate of Medical Assessor Bodel. A new certificate is attached at the commencement of these Reasons.
[i] See s3B(2) of the Civil Liability Act 2002.
0
0
0