Allianz Australia Insurance Limited v Hussein
[2025] NSWPICMP 318
•7 May 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Allianz Australia Insurance Limited v Hussein [2025] NSWPICMP 318 |
CLAIMANT: | Hassan Siddiq Hussein |
INSURER: | Allianz Australia Insurance Limited |
REVIEW PANEL | |
MEMBER: | Hugh Macken |
MEDICAL ASSESSOR: | Christopher Oates |
MEDICAL ASSESSOR: | Drew Dixon |
DATE OF DECISION: | 7 May 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); whether threshold injury; mild paraspinal tenderness; bruising over chest wall; complaints of lower back pain; diffuse disc bulge at L4/5 and L5/S1; broad base posterior left-sided protrusion; prior back injury; evidence of radiculopathy; stiffness of his lumbar segment; left sciatica; asymmetry of reflexes; muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution; findings of CT scan; Held – non-threshold injury; MAC confirmed. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Review Panel Assessment – Threshold Injury Replacement Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel confirms the certificate of Medical Assessor Ian Cameron dated 2. The following injury caused by the motor accident: • head – soft tissue injury; • cervical spine – soft tissue injury; • left and right shoulder – soft tissue injury; • left and right knee – soft tissue injury; • abdomen – soft tissue injury, and • chest – soft tissue injury, is a THRESHOLD INJURY for the purposes of the Act. 3. The following injury caused by the motor accident: • lumbar spine – soft tissue injury, is not a THRESHOLD INJURY for the purposes of the Act. |
STATEMENT OF REASONS
INTRODUCTION
Hassan Siddiq Hussein (the claimant) is a 49-year-old man who was injured in a motor vehicle accident on 30 October 2022. Following the accident the claimant lodged an application for Personal Injury Benefits and requested that the insurer concede that the injuries he sustained in the motor vehicle accident are non-threshold injuries. The insurer declined to make this concession and, following an internal review, confirmed in a certificate dated 17 July 2023 that the injuries sustained by the claimant are threshold injuries.
Consequently the claimant applied for an of Assessment of Threshold Injury through the Personal Injury Commission (Commission) and, on 26 March 2024, was examined by Medical Assessor Ian Cameron. Medical Assessor Cameron determined that the injuries to the claimant’s head, cervical spine, shoulders, knees, abdomen and chest were caused by the motor vehicle accident and were threshold injuries. He further determined that the injury to the claimant’s lumbar spine is a non-threshold injury.
Thereafter, the insurer sought a review of this determination and President’s delegate Ashley Payne, in a decision dated 21 June 2024, determined that there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect and thereafter the matter was referred to this Medical Review Panel for determination.
The Panel convened on 13 August 2024 at 5.00pm and reviewed the material. It was determined that there is a need to re-examine the claimant in respect to the injuries claimed and as to whether or not they constitute to a threshold or non-threshold injury. The Panel further noted that there was a reference to notes from the claimant’s physiotherapist,
Dr Colovic at Holistic Physiotherapy and seeks access to the clinic notes of Dr Colovic and Holistic Physiotherapy if they are available.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 provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the 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.
STATUTORY PROVISIONS/GUIDELINES
Section 57 of the MAC Act defines a “medical dispute” as a disagreement or issue to which Part 3.4 of the MAC Act applies.
Section 58 and s 60 of the MAC Act together with cls 1.5-1.7 of the Guidelines set out the procedures for referral to one or more Medical Assessors and the principles to be applied at such assessments.
The claimant was assessed by Medical Assessor Drew Dixon on 28 March 2025. An Arabic interpreter was present.
Accident details
The claimant was the driver of an Audi A4 involved in a collision when he was driving along Old Kurrajong Road, approaching Reserve Road at Casula, NSW at 9.30pm on
30 October 2022. He was wearing a seat belt when a black Audi sedan A6 collided with the front near side of his Audi A4 causing considerable damage. There was no head injury but the patient did lose consciousness. The air bag deployed. He was unable to self-extricate and ambulance a paramedics assisted him out of the vehicle and he was taken to Liverpool Hospital. During transit his Glasgow coma score was 15 out of 15.
Post-accident treatment
At Liverpool Hospital he complained of neck pain, back pain, and pain in his knees and found he had mild diffuse paraspinal tenderness of his neck. There was some bruising over the left chest wall. There was no apparent bruising of his abdomen. He did have some tenderness at the lateral right elbow and the proximal ulna.
He complained of pre patella pain of both knees. He complained of pain in his lower back and there was mild tenderness of his lumbar spine. A CAT scan of his abdomen showed no visualised abdominal organ injury nor pelvic fractures nor lumbar spinal injury.
He was discharged after overnight stay and had follow up with his general practitioner (GP). He attended Trinity Healthcare on 25 November 2022 and again on 2 February 2023 where he complained of low back pain and was referred for physiotherapy. On review on
6 March 2022 he complained of ongoing low back pain.
On 29 July 2023 he attended Trinity Healthcare with a CT scan dated 17 May 2023 which showed mild facet joint degenerative changes in the lumbar spine and a diffuse disc bulge at L4/5 and L5/S1. There was a disc bulge with broad based posterior left sided protrusion extending into the sub-articular recess which had been partially impinging on the origin of the S1 nerve root. There was no occult fracture.
The claimant had been seen previously at Trinity Healthcare with low back pain and there was an annotation that he was seen on 8 June 2021 with on and off low back pain following a motor vehicle accident in 2006. At that stage, he had some tenderness at the L5/S1 facet joints bilaterally and reduced range of motion. He had an episode of severe back pain on
5 January 2022 where there was a suggestion that he may have had renal colic.
Relevant medical history
There was a history of a motor vehicle accident in the past in 2006 and a CT of the lumbar spine taken on 29 July 2009 had shown a small left paracentral disc protrusion at L5/S1 level slightly indenting the left anterior aspect of the thecal sac without significant canal stenosis that was slightly displacing the left S1 nerve root. There was a minimal disc bulge L4/5 slightly flattening the anterior aspect of the thecal sac, not causing significant canal stenosis. The L1/2, L2/3 and L3/4 discs defined normally.
The pre-accident medical evidence does not contain any reference that the Panel could identify that the prior lumbar spine condition was anything other than a soft tissue injury. There was no reference to lumbar radiculopathy in the clinical records, and pre-accident lumbar spine scans did not refer to rupture of intervertebral disc fibrocartilage. Hence there is no evidence of a pre-existing non-threshold condition affecting the lumbar spine.
The claimant came to have assessment for threshold injuries with Medical Assessor Ian Cameron and in his certificate dated 7 April 2024, following his assessment of the claimant on
26 March 2024, it was found his injuries caused by the subject motor vehicle accident to the head, cervical spine, left and right shoulders, left and right knees, abdomen and chest were soft tissue injuries and were threshold injuries, for the purposes of the Act, but the injury to the lumbar spine was not a threshold injury, for the purposes of the Act, as there was evidence of left S1 radiculopathy with evidence of low back pain developing after the subject motor vehicle accident, together with left sided radicular complaint.
On review on 28 March 2025 the claimant reiterated the accident details as above.
He reports there has been no subsequent accident or condition.
Current symptoms
He reports there was no head injury but he does have residual intermittent mild frontal headaches. He reports residual neck pain which he localised to the lower cervical spinous processes and facet joints and he has pain radiating to the trapezius muscles more marked on the left. He reports no radicular complaint down the arms and no paraesthesia in the hands.
He reports that his chest and abdomen have settled, as have both knees.
He reports pain in his lower back with lumbar stiffness with difficulty bending and stooping which aggravates his back pain as does heavy lifting and carrying. His back pain disturbs his sleep and impacts on his ADLs. He is able to drive an automatic car short distances. He has a walking tolerance of 20 minutes on level ground and a standing tolerance of 15 minutes but needs to move about and a sitting tolerance of 30 minutes.
He reports persisting low back pain with left sciatica.
He has difficulty putting on his shoes and socks and doing his toe nails and has assistance from his wife for these tasks. He is unable to do heavy cleaning which is done by his wife and he is unable to lift or carry heavy groceries or laundry and has difficulty with meal preparation, cooking, washing up, laundry, ironing and bed making, which are all done by his wife.
He lives in a unit so he does not have to do gardens and lawns and he has difficulty cleaning the car and with prolonged driving. He has no sports or recreations.
Examination findings
On examination on 28 March 2025, he was 165cm tall and weighed 75kg.
There was stiffness of his cervical spine with flexion and extension decreased by one half and lateral rotation decreased by one third bilaterally and lateral flexion by one half bilaterally. There was tenderness of the lower cervical spinous processes and of the trapezius muscles more marked on the left. The supraclavicular brachial plexuses were non-tender and his brachial plexus stretch test was equivocal. The cervical foraminal compression test was negative.
There was no neurological deficit or wasting of either upper extremity. His reflexes were symmetrical and his power was grade 5 out of 5 and thenar power, intrinsic power and grip strength were grade 5 out of 5 bilaterally.
There are no clinical signs present to justify a diagnosis of cervical radiculopathy.
There was a good range of motion of his elbows, wrists and hands. He had a symmetrical range of motion of both shoulders without impingement.
There was stiffness of his lumbar segment with flexion decreased by one third with slow and jerky recovery with erector spinae muscle spasm with pain on back extension which was decreased by one half and lateral rotation to the right was decreased by one third associated with left paralumbar pain and extension was decreased by one half and lateral flexion to the left decreased by one quarter. Straight leg raise was 60 degrees on the left and associated with left sciatica and the sciatic nerve root stretch test was positive. His knee jerks were present as were his medial hamstring jerks and right ankle jerk. His left ankle jerk was unable to be elicited and his power of eversion of the left foot was grade 4 out of 5. Otherwise, power was grade 5 out of 5 in both lower extremities and his plantar responses were negative.
His normal gait was slow. He had difficulty with toe walking on the left and heel walking was associated with low back pain, as was his squat test.
In summary this claimant was in a severe motor vehicle accident without medically documented head injury but had a possible brief loss of consciousness and sustained a whiplash injury to his neck with bilateral shoulder brachalgia due to trapezial muscle pain, and soft tissue injury to the chest, abdomen and both knees. His chest and abdominal conditions have settled, as have both knees.
The referred injuries to the head, cervical spine, chest, abdomen, bilateral knees and bilateral shoulder regions are soft tissue injuries.
It is confirmed that these are threshold injuries.
He has persisting low back pain with lumbar stiffness and clinically has left S1 radiculopathy.
On the balance of probabilities, the L5/S1 disc protrusion, which is noted on the old CT of 2009, has been aggravated by the subject motor vehicle accident with further impaction on the left S1 nerve root and now, on the balance of probabilities, has developed left sided radiculopathy as a consequence of the severe motor vehicle accident.
There were three signs of left-sided lumbar radiculopathy at S1 level confirmed at the Panel’s re-examination. These are (i) asymmetry of reflexes, (ii) positive sciatic nerve root tension sign, (iii) muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution. Guideline cl 6.138 is satisfied by these findings.
The findings on CT scan of the lumbar spine dated 17 May 2023 of left S1 nerve root partial impingement by a disc protrusion is consistent with the clinical examination findings.
Conclusion
It is confirmed that this is a non-threshold injury.
The Medical Review Panel adopts the findings of Medical Assessor Dixon.
This confirms the MAC dated 7 April 2024.
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