Allianz Australia Insurance Limited v Hill
[2025] NSWPICMP 663
•1 September 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Allianz Australia Insurance Limited v Hill [2025] NSWPICMP 663 |
CLAIMANT: | Gordon Hill |
INSURER: | Allianz Australia Insurance Limited |
REVIEW PANEL | |
MEMBER: | Hugh Macken |
MEDICAL ASSESSOR: | David Gorman |
MEDICAL ASSESSOR: | Drew Dixon |
DATE OF DECISION: | 1 September 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of medical assessment certificate; whole person impairment (WPI); fracture right ankle and heel; impact right side of bike right ankle and foot; post traumatic arthritis; surgical scar; partial ankylosis of the subtalar joint; injury to superficial peroneal nerve; left calf atrophy; Held – certificate revoked; 13% WPI. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION 1. The panel revokes the certificate of Medical Assessor Alan Home dated 13 March 2025. 2. The following injuries caused by the motor accident give rise to a permanent impairment of 13% and is greater than 10%: · right leg – fracture right ankle and heel 12%, and · scarring 1%. |
STATEMENT OF REASONS
BACKGROUND
Gordon Hill (the claimant) is a 62-year-old man who was injured in a motorcycle accident on 1 August 2021. Following the accident, he lodged an Application for Personal Injury Benefits and thereafter the parties agreed that he had sustained non-threshold injuries.
The claimant sought a concession from the insurer that his injuries sustained in the accident left him with a degree of whole person impairment (WPI) of greater than 10%. Following an internal review, the insurer declined to make this concession and consequently the claimant lodged an Application for Assessment of Whole Person Impairment.
The claimant was examined by Medical Assessor Alan Home on 3 March 2025. In a Certificate dated 13 March 2025 Medical Assessor Home determined that the claimant had suffered injuries caused by the major accident which gave rise to a permanent impairment of 15%.
The insurer sought a review of this determination and, in a certificate dated 20 May 2025, President’s delegate Rachel Brittliff decided that there was a reasonable cause suspect that the medical assessment was incorrect in a material respect and consequently the matter was referred to this Medical Review Panel.
The Panel issued directions on 28 May 2025 to the parties to upload the material which was before Medical Assessor Alan Home. This material was before the Panel at the preliminary conference on 17 July 2025 at which time it was determined that it was appropriate for the claimant to be re-examined and thereafter for the Panel to reconvene to consider the examination report.
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 the 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 that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission).
Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC 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 matter solely based on the written application.
The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
EXAMINATION
The claimant was examined at the Commission’s Medical Suites, 1 Oxford Street, Darlinghurst on 12 August 2025 by Medical Assessor David Gorman. He was unaccompanied.
HISTORY
Pre-accident medical history and relevant personal details
He is a 62-year-old right-hand-dominant man who lives at Willow Tree, near Scone in NSW.
He was a self-employed mechanic for 33 years at the time the accident. Now he only works three hours a week sweeping the floor of a local shop.
He is divorced with three children aged 27, 30 and 33 years. He lives in shared accommodation with a female housemate.
He is a non-smoker.
He does not drink alcohol.
He was previously well.
He occasionally had some low back pain from leaning into cars as a mechanic – he did not require treatment for this.
He had removal of a spur of bone from the left upper tibia when he was a child.
History of the motor accident
Mr Hill states that he sustained injuries in a motorcycle accident on 1 August 2021. He was riding a Hyosung 650cc road bike on Leggetts Drive in Quorrobolong turning left into Sandy Creek Road when his bike struck the driver’s side of a car that was turning from Sandy Creek Road into Leggetts Drive.
There was impact between the right side of his bike, and his right ankle and foot, and the rear driver’s-side aspect of the car. He did not fall from the bike but managed to stop his bike. He was accompanied by a pillion passenger at the time the accident.
History of symptoms and treatment following the motor accident
He was transferred by ambulance to Maitland Hospital where CT scans demonstrated a severe ankle fracture dislocation with posterior displacement of the talus at both the ankle and subtalar joints.
He underwent initial debridement, reduction and external fixation on 1 August 2021. This was followed by definitive open reduction internal fixation performed under the care of Dr Tarrant (orthopaedic surgeon) at the Lake Macquarie Hospital on 11 August 2021.
He remained in a CAM boot between two and three months.
He then attended physiotherapy in Morisset.
X-rays taken on 23 October 2023 and CT scans taken 15 November 2023 demonstrated early post-traumatic arthritis at the talocrural and subtalar joints.
He was referred on to Dr Nicholson for consideration of further surgery but did not keep the appointment as he was not keen to undergo either ankle replacement or fusion at that stage.
Current symptoms
He reports pain in the right foot particularly if he rolls it. The sole of his right foot gets sore when he walks.
He gets a nerve pain over his right great toe and top of foot. It can shoot to the back of his leg. He says that this can be “shocking” pain. There is numbness he describes over the top of the right foot.
There is marked restriction of motion of the ankle. He cannot tolerate walking on uneven ground. There is increased ankle pain in cold weather.
The left knee can cause pain particularly when going up and down stairs.
He walks with a stick in the left hand to take the weight off his right ankle.
His housemate performs the heavy domestic chores for him. He operates a ride-on lawn mower. His housemate performs the remainder of the gardening activities.
Current treatment
Physiotherapy treatment ceased in August 2024.
He currently takes Panadol Osteo regularly with occasional Nurofen. If severe he takes codeine, but he finds that this gives him a “hangover”.
His ankle cramps so he takes magnesium. He tries to keep his ankle mobile through home stretching exercise.
CLINICAL EXAMINATION
General presentation
His height is 176cm and weight 92.7kg.
He walked with a stick in his left hand. He had a supportive boot on extending well above his ankles.
He had an antalgic gait favouring his right side.
Lower extremities
His right foot was externally rotated as he walked. There is no sensory or vascular abnormality.
The ankle and hindfoot ranges of motion are outlined below. There was no swelling of either ankle. There was a flexion contracture on the right side with no active hindfoot movement:
| RANGE OF ANKLE AND HINDFOOT MOVEMENT | Right (degrees) | Left (degrees) |
| Plantar flexion | 30 | 50 |
| Dorsiflexion (extension | -10 | 15 |
| Inversion | 0 | 30 |
| Eversion | 0 | 20 |
There was decreased sensation with dysaesthesia over the medial side and dorsum of the right foot.
Right and left knees were normal on examination. There was no swelling. There was a 5cm scar medial to the left tibial tubercle from childhood surgery. There was no ligamentous instability. The range of motion of both knees was from 0 to 130 degrees.
The thighs were both at 44cm in circumference. The right calf is 35.5 cm and left calf 38cm.
Scarring
There is a healed surgical scar over the medial right ankle and foot which was 18cm in length, paler than the surrounding skin, with surrounding dark staining extending 5cm posterior to the scar and 3cm anterior to the scar. There is no contour defect. There are no visible suture marks.
There is a further 18 x 7mm pale oval scar, posterior to the medial malleolus. That area of scarring is also flat, with no contour defect, mild atrophic change and no visible suture marks. There is no tethering of either scar.
Comments on consistency
Mr Hill was consistent and cooperative throughout the assessment.
Summary of relevant radiological and medical imaging and other investigations
X-ray of the right ankle dated 1 August 2021
Lateral view of the ankle demonstrates a comminuted talar fracture. CT scan is recommended.
CT scan of the right ankle dated 1 August 2021
There was a severely comminuted significantly displaced fracture of the body and neck of the talus. The proximal fragment is displaced posteriorly by about 4 cm. There is also superior displacement by about 1.9cm. The fracture involves a distal articular surface laterally with mild loss of joint congruity. There is a comminuted displaced fracture at the medial malleolus and intraarticular medial malleolus fracture is displaced medially by 10mm, and superiorly by 6mm. The lateral malleolus is intact. Soft tissue haemorrhage noted around the ankle, as well as some gas in the medial aspect of the calcaneal spur, and traction spurring at the Achilles tendon insertion with the calcaneum. No widening of the syndesmosis. There is rupture of the medial collateral ligament. The anterior talofibular ligament is not visualised, consistent with rupture.
X-ray of the left knee dated 21 April 2023
Dorsal traction osteophytes of the patella, otherwise normal patellofemoral joint. Medial and lateral compartments are satisfactory. No osteochondral lesion. No other significant finding of note.
MRI of the left knee dated 1 June 2023
There is a grade 2 chondromalacia at the apex and medial facet of the patella. Trochlear articular cartilage is normal. Minor tendinosis involves the patella tendon proximally, with more prominent tendinosis in the quadriceps tendon distally, with bony ossicles within the inserting tendon. Tibiofemoral cartilage is well preserved. No meniscal tear is identified.
X-ray of the right ankle dated 23 October 2023
Interval fixation of right distal tibia, including medial malleolus and talus fractures. No acute fracture or bony malalignment is identified. No ankle joint effusion. There are degenerative changes around the ankle joint with osteophytosis.
CT of the right ankle dated 15 November 2023
Medial and anterior distal plates and screws transfix the distal tibia, and four screws transfix the talus are noted. There is severe joint space narrowing of the tibiotalar joint with subchondral cyst formation/cortical irregularity. There are severe degenerative changes in the mid-subtalar joint. There is calcification within the sinus tarsi with partial ankylosis of the subtalar joint. There are degenerative changes at the first TMT joint. There is osteophytic lipping from the anterior and posterior tibial plafond. There is degenerative osteophyte formation at the dorsal aspect of the talonavicular joint.
DETERMINATIONS
Diagnosis, causation and reasons
The claimant suffered traumatic fracture dislocation of the right ankle and subtalar joints, necessitating surgical open reduction and internal fixation.
CT scan imaging on 15 November 2023 demonstrates post-traumatic degenerative change in the ankle and subtalar joints – there was “partial ankylosis” of the subtalar joint.
There has been injury to the superficial peroneal nerve on the right after the injury and subsequent surgery.
There is consequential pain in the left knee due to prolonged abnormal gait.
Summary of injuries referred by the parties
The following injuries WERE caused by the motor accident:
· right leg, intra-articular fracture right ankle with displacement. Intra-articular fracture subtalar joint with displacement. Treatment with open reduction and internal fixation. Post-traumatic degenerative change;
· skin, scarring, and
· left knee, consequential pain due to prolonged abnormal antalgic gait.
Permanency of impairment
Permanent impairment is defined in the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Fourth Edition) (AMA4 Guides) (p 315) as follows:
“Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment. A permanent impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment.”
Mr Hill’s symptoms and signs have been stable for at least a year. There are no plans for further specific treatment in the foreseeable future. His impairment is stable.
Permanent impairment
The determination as to permanent impairment is made in accordance with the AMA4 Guides and Part 6 of the Motor Accident Guidelines.
Right leg - fracture right ankle and heel
Using Table 42 on page 78 of AMA4 Guides there is a 10-degree flexion contracture giving 6% WPI.
There is 0 degrees active hindfoot movement. The subtalar joint on scanning has “partial ankylosis”. Sub-talar ankylosis in optimal position gives 4% lower extremity impairment (page 81 of AMA4 Guides and Table 6.2 on page 96 of the NSW Guidelines.
There is left calf atrophy with a 2.5cm difference which would attract a 4% WPI rating based on Table 6.1(b) on page 95 of the NSW Guidelines. Impairment for calf atrophy and for restricted motion or ankylosis cannot be combined.
He has dysaesthesia in the distribution of the superficial peroneal nerve distribution on the right. It causes severe pain on occasions. Using Table 68 on page 89 of the AMA4 Guides gives 2% WPI.
Left leg - left knee
There is a 0% WPI rating with a normal range of motion and no abnormal findings.
Scarring - on right leg, ankle and heel
There is also a 1% WPI rating for scarring using the TEMSKI scale as follows:
· the claimant is conscious of his scar;
· some parts of the scar or skin condition contrast with the surrounding skin as a result of pigmentary change;
· the claimant is able to locate the scar or skin condition;
· there is minimal trophic change;
· the suture marks are not visible;
· the anatomic location of the scar is visible with clothing such as shorts;
· there is no contour defect;
· there is no effect on any activities of daily living arising from the scar itself;
· there is no treatment required for the scar, and
· there is no adherence.
Using the principle of best fit a 1% WPI rating arises.
Combined
The combined WPI rating is 6% for flexion contracture with 4% for subtalar ankylosis with 2% for superficial peroneal dysaesthesia combined with 1% for scarring which equals 13% WPI.
Permanent impairment
| Body Part or System | AMA Guides/ Guidelines References (chapter/ page/table) | Permanent (YES/NO) | Current %WPI* | %WPI* from pre-existing OR subsequent causes | %WPI* due to motor accident |
| Right leg | Table 42 on page 78 of AMA 4th Ed; page 81 of AMA 4th Ed and Table 6.2 on page 96 of NSW Guides; Table 68 on page 89 of the AMA 4th Ed | Yes | 12% | 0% | 12% |
| Left leg | Nil relevant | Yes | 0% | 0% | 0% |
| Scarring | TEMSKI | Yes | 1% | 0% | 1% |
* %WPI = percentage whole person impairment
Pre-existing/subsequent impairment
Not applicable.
Apportionment
Not applicable.
Effects of treatment
Not applicable.
CONCLUSION – PERMANENT IMPAIRMENT
Degree of permanent impairment caused by the motor accident is 13%.
0
0
0