Allianz Australia Insurance Limited v Ibrahim

DETERMINATION OF REVIEW PANEL
CITATION:	Allianz Australia Insurance Limited v Ibrahim [2025] NSWPICMP 539
CLAIMANT:	Gerges Ibrahim
INSURER:	Allianz Australia Insurance Limited
REVIEW PANEL
MEMBER:	Jeremy Lum
MEDICAL ASSESSOR:	Margaret Gibson
MEDICAL ASSESSOR:	Christopher Oates
DATE OF DECISION:	24 July 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); wedge compression fracture of thoracic spine not caused by the motor accident; fracture incidental finding from chest radiology; nil thoracic spine complaints following motor accident; Held – motor accident did not acutely cause or aggravate a thoracic spine compression fracture; fracture likely to be constitutional condition of osteoporosis; diagnosed by DEXA bone density scan; MAC revoked; new certificate issued.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor James Bodel dated 24 October 2024 and issues a new certificate as follows: (a) The Review Panel certifies the following injuries were caused by the motor accident: (i) sternum – fracture/ minimally displaced lower manubrium fracture – resolved. (b) The Review Panel finds that the above injuries result in a whole person impairment of 0% which is not greater than 10%.

STATEMENT OF REASONS

BACKGROUND

Gerges Ibrahim (the claimant) was involved in a motor accident on 20 August 2022. He was the left back seat passenger in a car his daughter was driving. There were two cars in front of them in what appears to be a line of traffic. He says the frontmost car braked suddenly with the second car also suddenly braking to avoid a collision. His daughter was unable to stop in time and ran into the back of the second car. There was no further impact from the car behind them.
The claimant says he suffered fractures in his sternum and thoracic spine as a result of the motor accident. The claimant also says he injured his neck, lower back and both shoulders.
He made a claim for personal injury benefits with Allianz (the insurer), the third-party insurer of the vehicle that he says caused the accident.
A medical dispute arose about whether the degree of the claimant’s whole person impairment (WPI) is greater than 10% WPI. If there is a dispute about the degree of a claimant’s WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor for determination.
[1] See Division 4.3 of the MAI Act.
On 24 October 2024, Medical Assessor James Bodel assessed the claimant’s injuries as 14% WPI which is a WPI greater than 10%.
The insurer lodged an application with the Personal Injury Commission (Commission) seeking a review of the medical assessment.
On 3 February 2025, a delegate of the President, Ms Tajan Baba, accepted the application for review and referred the matter to this Review Panel (the Panel) to conduct the Review proceedings.

MEDICAL ASSESSMENT UNDER REVIEW

Medical Assessor Bodel was referred the following injuries for assessment of WPI:
·        thoracic spine – 33% wedge compression fracture of T7 / soft tissue injury;
·        cervical spine – soft tissue injury;
·        lumbar spine – soft tissue injury;
·        sternum – fracture / minimally displaced lower manubrium fracture, and
·        shoulders – soft tissue injury / referred pain from cervical spine.
Medical Assessor Bodel noted that the claimant was a 72-year-old retiree who had previously worked in construction labouring. He has a pre-accident medical history of Behcet’s disease in 1994 with a mitral valve replacement (a metal valve) in 2000. He also has spondylosis involving the entire spine and has been diagnosed with osteoporosis for which he is taking Prolia. The claimant reported that he was not aware of any spinal pain until the motor accident.
Following the motor accident, ambulance arrived at the scene however the claimant decided to go home, as his pain was not very severe at the time. After a brief period of time, he had severe chest pain and was driven to Westmead Hospital.
Hospital X-rays showed a minimally displaced fracture of the sternum. There was mention of minor wedging which was thought to be long-standing and age-related but no significant wedge compression fracture.
The claimant told the Medical Assessor that he also had neck pain from the beginning but did not develop lower back pain until a year later. He also had stiffness in the shoulders.
He came under the care of his general practitioner (GP). He had physiotherapy and a month later had a CT scan which showed a 33% wedge compression fracture of the T7. The Medical Assessor noted that there was no intervening accident or injury that led to that apparent change in the appearance of the T7 vertebral body between the assessment at Westmead Hospital and the CT scan done a month later.
Medical Assessor Bodel was satisfied the claimant suffered injuries to his neck, the interscapular region of the thoracic spine and both shoulders as a result of the motor accident.
The cervical spine and thoracic spine were both assessed as DRE category II due to asymmetrical loss of range of motion (5+5=10%WPI).
The Medical Assessor could not assess the T7 wedge compression fracture because the actual CT films were not available.
The left shoulder and right shoulder were both assessed as 2% WPI due to loss of range of motion (2+2=4%WPI).
The lumbar spine was assessed as 0% WPI.
The final combined WPI was 14%.

SUBMISSIONS
Insurer’s submissions

The insurer submits that Medical Assessor Bodel was incorrect to find that causation was established for each of the alleged injuries that were referred for medical assessment.
The insurer says the Medical Assessor erred in accepting the claimant’s self-reported history in the face of contradictory objective evidence. Namely, the claimant stated he was symptomatic in his cervical spine, thoracic spine, lumbar spine and both shoulders immediately after the motor accident in circumstances where there is no record of immediate complaint of symptoms in any of those bodily regions. In fact, the insurer says in some cases it is specifically recorded that the claimant had no pain.
The only complaint contemporaneous with the motor accident was in relation to the chest sternum fracture which has since resolved.
In addition, the insurer says the mechanism of the motor accident is incompatible with permanent injury being suffered. The insurer notes the impact occurred at 40kmph and caused minimal damage to the claimant’s vehicle. The claimant was wearing a seatbelt and no airbags were deployed. The claimant self-extricated from his vehicle, was ambulant at the scene and refused to go to hospital on the basis that his pain improved with just 1g of paracetamol.
The insurer refers to imaging which showed degenerative pathology in the claimant’s thoracic spine and lumbar spine. The claimant also had pre-existing osteoporosis (a constitutional condition which causes vertebral wedging). The insurer submits that the thoracic spine pathology had progressed since the motor accident and the diagnosis of osteoporosis was unrelated to the motor accident and was most likely a manifestation of age-related or other constitutional factors.
The insurer says despite determining that the 33% wedge compression fracture of T7 could not be determined at the time of the medical assessment, the Medical Assessor went on to attribute the entirety of the thoracic spine restriction of movement to the motor accident. The insurer submits that this approach is erroneous because the Medical Assessor confirmed in his reasons that he could not determine on the available evidence the nature and extent of the pathology in the claimant’s thoracic spine and, most importantly, its cause. Nor has the Medical Assessor provided sufficient reasoning to enable the reader to understand how the Medical Assessor was satisfied that the restricted range of motion was entirely causally related to a soft tissue injury sustained in the motor accident.
The above matters, in the insurer’s view, go against the Medical Assessor’s positive finding that the motor accident caused the claimant’s injuries.

Claimant’s submissions

The claimant submits there is no overlap of any prior or subsequent complaints in the thoracic spine. There is accordingly no unrelated event that can be argued to be responsible for the compression fracture of the T7. It is submitted that the mere fact that the fracture was not immediately identified at the hospital is in itself neutral. The subject collision was severe enough in nature for the claimant to sustain a fracture of the sternum which is not disputed by the insurer. The claimant says it is medically plausible for the T7 fracture to have occurred given the significant force of the motor accident.
The claimant relies on the report of Dr Porteous dated 29 February 2024 who assessed the claimant’s permanent impairment as 21% WPI. This comprises of:
(a)    cervical spine injury – 5%;
(b)    thoracolumbar injury (33% wedge compression fracture of T7) – 15%;
(c)    right shoulder injury - 1%, and
(d)    left shoulder injury – 1%.

REVIEW OF THE EVIDENCE

On 10 February 2025, the Panel issued a direction to the parties requiring indexed and paginated bundles of the information they relied upon. The Panel stated that unless documents are uploaded to the review file, the Panel would not be able to read and consider those documents. The parties responded with the lodgement of bundles – the claimant’s bundle comprising of pages 1-4 and the insurer’s bundle comprising of pages

1-199.
For the reasons detailed in the Panel re-examination report below, the Panel called for the clinical records of GP, Dr John Psarommatis. This was duly uploaded by the insurer.
The Panel also called for digital copies of the following films:
(a)    chest X-ray taken at Westmead Hospital;
(b)    CT chest dated 21 August 2022;
(c)    CT chest dated 21 September 2022 reported by Dr Liu, and
(d)    CT lumbar and pelvis dated 15 December 2022.
No films were provided.
The Panel has read the documentation relied upon by the parties. Given the voluminous nature of the material, the Panel will only specifically refer to material that is relevant to the resolution of the permanent impairment dispute and the issues in dispute.
NSW Ambulance report dated 20 August 2022 – C/O central chest pain, exacerbated on movement, palpation and mild exacerbation on inspiration. Denies head strike, denies c-spine tenderness, full ROM in neck, mobilising independently w/nil impaired gait. Secondary survey found tenderness isolated to central chest, w/nil further abnormalities on assessment of head, neck, back, chest wall, abdomen, pelvic region and limbs. Patient did not want to go to hospital as pain improved and is feeling a lot better. Paracetamol and ibuprofen administered.
Westmead Hospital records dated 20 August 2022 – presenting problem of chest pain. Previous history of sternotomy with metal valve replacement. Nil LOC or headstrike. Ongoing chest pain central. Sternal fracture. Independently ambulating. Nil pain at time of report as per patient. Patient’s family reports that endone worked well for pain.
CT Chest dated 21 August 2022 – minimally displaced acute fracture through the lower manubrium. No acute rib or included shoulder girdle fracture. Slight loss of vertebral body height at T3, T4, T7, T8 and T10, likely long-standing.
CT Chest dated 20 September 2022 – wedging of T7 vertebral body with up to 33% loss of vertebral body height.
CT lumbar spine and pelvis w/o contrast dated 15 December 2022 – degenerative changes are seen in the lumbar spine. Most significant changes are seen on the right side at L4-5 and L5-S1 level. This likely explains the patient’s symptoms.
Records from Healthcare Greenacre – History of Behcet’s disease in 1994. T7 vertebral crush fracture – 23 September 2022. Osteoporosis – 28 September 2022. Spondylosis, lumbosacral – 16 December 2022.
Relevant entries of general practitioner Dr Nafi Musa:
14 September 2022 – new patient, recently moved to Australia. 3 weeks ago had MVA, seen by doctor in hospital. Severe [sic] sternal pain (fracture). Cough with yellow sputum for 3 weeks. Chest pain. PH: metallic heart valve. Imaging request printed: CT scan – chest (recent MVA, cough with sputum).
23 September 2022 – CT chest: T7 vertebral crush fracture. Review in 1 day. Check for osteoporosis with DEXA.
27 September 2022 – imaging request printed: bone densitometry – DEXA. (wedging of the T7 vertebral body with up to 33% loss of vertebral body height).
28 September 2022 – phone consultation. Osteoporosis – results of bone mineral densitometry given to patient. Need treatment for osteoporosis. Already taking vit D.
29 September 2022 – Polia administration. Osteopororis. T7 vertebral crush fracture.
14 December 2022 – right sided buttock pain since Friday after doing endoscopy. Unable to walk. Deny previous sciatica. Imaging referral – CT scan – sacro-iliac joint, bilateral (right sided buttock pain).
16 December 2022 – CT L-S spine. Degenerative changes seen in L-spine. Most significant seen on right side at L4-5 and L5-S1 level. This likely explains the patient’s symptoms. Diagnosis: spondylosis, lumbosacral.
11 July 2023 – Workcover. Lawyer requested certificate of fitness and capacity to work. Still in pain. T7 fracture. Sternal fracture. Whiplash.
25 July 2023 – back pain after MVA. T7 fracture [sic]. Wants referral to spine centre in Burwood under CTP. Referral given – letter written to neurosurgeon.
Application for personal injury benefits signed 14 April 2023 – indicates injuries as “T7 broken, chest bone broken, whiplash [sic] in my neck, headache”.
Certificate of capacity/fitness dated various in 2023 –
noted first seen for injury on

14 September 2022. Diagnosis of “T7 vertebral crush fracture, sternal fracture, neck whiplash… Car accident impacted on his spine.”
Medico-legal report of Dr Andrew Porteous dated 29 February 2024 – found evidence of aggravation, exacerbation of pre-existing degenerative change in the cervical spine, evidence of a T7 compression fracture and evidence of a sternal fracture caused by the motor accident. The WPI assessment is summarised above in the claimant’s submissions.

RE-EXAMINATION REPORT

At the initial teleconference on 1 April 2025, the Panel determined that the claimant be re-examined. This took place on 8 May 2025 and the re-examination report of Medical Assessor Oates is as follows:
“Date of Accident: 20 August 2022
Year of Birth: 1952
Injuries referred for permanent impairment assessment:
·    Cervical spine – soft tissue injury
·    Lumbar spine – soft tissue injury
·    Shoulder – shoulders soft tissue injury, referred pain from cervical spine
·    Sternum – fracture/ minimally displaced lower manubrium fracture
·    Thoracic spine – 33% wedge compression fracture in T7 / soft tissue injury
Details of who attended the Assessment
Mr Ibrahim, the claimant, attended accompanied by his daughter, Charblieh.
An Arabic interpreter (NAATI No. CPN2VL86W) was present for the duration of the assessment.
HISTORY
Pre-accident medical history and relevant personal details
Mr Ibrahim is 73 years of age. He came from Lebanon to Australia in the 1990s and thereafter divided his time between the two countries until November 2021, when he re-entered Australia and has been here permanently since that time.
In Australia, he was doing labouring at the time of the motor accident and was helping his son in the son’s construction business, and worked almost full-time hours. He has not worked since the motor vehicle accident because of pain in his left rib cage, neck and low back pain, and he can’t stand still for periods of time.
Initially after the motor vehicle accident, he tried to return to work but could not lift any weights. He is not eligible for Centrelink benefits so his family support him financially.
Before the accident he said he had no problem with the body parts affected by injuries referred for this matter.
He had a minor motor vehicle accident over 15 years ago in Lebanon when he was a passenger. He had bruises only and did not even need to see the GP and made a full recovery.
He has had a mitral valve replacement involving a sternotomy in about 2000. He has had abdominal fistula repair for Crohn’s disease in about 2017. He has had inguinal and umbilical hernia repairs in the past, and currently has double inguinal herniae and recti divarication. (There was an observed prominence in the central abdomen but this was not examined, as it was not a referred condition).
He takes colchicine and cortisone and explained that he has a condition which causes ulcers in the stomach and also at the mouth. He had one epileptic seizure about 20 years ago and since then has been taking anti-convulsant medication.
Before the accident, he lived with his wife at his son’s house. He has five daughters and one son. One of the daughters lives in Lebanon. He would work around the house in his time off work and would help his wife with house chores and also look after the yard work.
He has a licence to drive a motor vehicle but now only drives occasionally and in the local area.
History of the motor accident
The claimant confirmed he was involved in a motor vehicle accident on 20/8/2022. He was in the left rear seat of a sedan, wearing a seatbelt. His wife was a front seat passenger and one of his daughters was driving.
His daughter was driving below the speed limit and a car two in front of them braked suddenly. The car behind that vehicle was able to stop in time without hitting the vehicle, but Ms Ibrahim, who was driving the vehicle the claimant was in, was unable to stop and ran into the back of the car in front of them. That impact caused the car in front of them to run into the first car which had braked suddenly.
The car behind the claimant’s vehicle in the line of traffic was able to quickly switch to the right hand lane and there was no collision from behind.
He says he felt stabbing pain in the central chest and towards the left side. He had some bruising come out on the chest. He was not bleeding and doesn’t recall any impact injury.
The police did not attend. An ambulance attended.
I went over the details of the ambulance record with the claimant, including that tenderness was localised to the central chest with complaints of central chest pain. There was no complaint of cervical spine tenderness and there was full range of movement in the neck with no further abnormalities on assessment of the head, neck, back, chest wall, abdomen, pelvis and limbs. He was able to walk normally.
The claimant agreed with the ambulance record that the problem was his chest. He said he did not recall any other pain at the time after the accident.
Their car was towed away and subsequently repaired. Another daughter came and picked them up and drove them home.
He then developed more severe chest pain and was driven by one of the daughters to Westmead Hospital where he was observed overnight.
History of symptoms and treatment following the motor accident
The Westmead Hospital discharge summary refers to a 70-year-old male with sternal fracture and small haematoma for conservative management. Scans showed a small anterior mediastinal haematoma. There was a minimally displaced fracture through the lower manubrium and evidence of mitral valve replacement. There was no acute rib or included shoulder girdle fracture. There was slight loss of vertebral body height at T3, T4, T7, T8 and T10, likely long-standing.
There were old left lateral rib fractures with callus. I asked the claimant about the old left lateral rib fractures with callus, indicating they were old fractures, and he said that he may have hurt himself doing concreting at work. He then recalled falling about 1 metre from a structure, injuring his left ribs, at about the age of 20 in Lebanon. He made a full recovery.
He was treated with analgesics at Westmead Hospital and discharged the day after the accident.
He then attended a GP. The file evidence refers to a Dr Nafi Musa, first consultation 14/9/2022, indicating he was a new patient, recently moved to Australia, and that he had had a motor vehicle accident three weeks ago and was seen by a doctor in hospital with severe sternal pain from fracture. The presenting complaint was cough with yellow sputum for three weeks and chest pain.
I asked the claimant whether this was the first GP visit after the accident and he thought that he had at first seen Dr John Psarommatis at Harris Park, who was a GP that he sometimes attended as it was close to one of his daughters’ place. There are no records from this doctor in the file of evidence. He said when he saw Dr Psarommatis, he was given analgesics and told that everything will heal up over time.
He then, as mentioned above, saw Dr Nafi as a new patient at Greenacre on 14/9/2022, as this was near another daughter’s place and he had cough with yellow sputum, along with central chest pain. The claimant confirmed he had no other pain at this time to direct questioning. He was treated with said antihistamines but more likely this was antibiotics, and was sent for a CT scan of the chest.
He then said he complained also of neck pain and low back pain radiating to the left leg. I asked him why the GP had not recorded this and his response was that he may have told Dr Psarommatis about this pain but not Dr Nafi.
Dr John Psarommatis’ handwritten notes make no mention of low back pain related to the motor accident. There was an entry dated 12 December 2022 where the diagnosis was given of right lumbago and right inguinal hernia “mild pain” post colonoscopy but there is no indication that this had any connection with the motor accident.
He then elaborated that he had left-sided neck pain radiating to the trapezius and left middle to lower lumbar pain, which was non-radiating, and said he didn’t recall any pain in the mid-thoracic area. It was noted that the first mention of mid thoracic pain from Dr Psarommatis’ notes was in June 2024. This was almost two years after the motor accident.
CT scan of 19/9/2022 performed for cough and yellow sputum investigation showed wedging of the T7 vertebral body with up to 33% loss of vertebral body height. There was also a cortical step of the anterior and posterior cortices of the bony manubrium, possibly related to prior or recent injury. There was also a mild hiatus hernia and several left renal cysts, and linear opacities of the lower lung zones bilaterally, presumed post-inflammatory in nature, but no lobar consolidation.
After the CT scan result was known, he was sent for a DEXA bone mineral densitometry scan done on 27/9/2022 which showed osteoporosis of the appendicular skeleton and osteopaenia of the axial skeleton. He was then put on Prolia six-monthly injections for treatment of osteoporosis, commonly used for elderly men.
He had a gastroscopy and colonoscopy by Dr Rahme, gastroenterologist, but this was not related to the motor vehicle accident.
He had four physiotherapy sessions with treatment directed to the neck and lower back, but did not help, so thereafter he continued medications.
Consistency
I reviewed the GP records of Dr Nafi with the claimant and told him that there was no mention of the neck and asked him why this was so. He said that this is ‘weird’, because he mentioned neck pain many times.
I also said to the claimant that the first mention in the records from this GP of low back pain was 14/12/2022, which referred to right-sided buttock pain since Friday after doing endoscopy and unable to walk. Denies previous sciatica. Reason for visit was back pain and imaging referral. The claimant said this was not correct, as he had complained of low back pain before that and that he did not recall any connection between having the endoscopy and the onset of low back or buttock pain. The Panel notes that this consultation triggered the first referral for imaging of the lumbar spine following the accident. The CT scan lumbar spine showed degenerative changes, most significantly on the right side at L4/5 and L5/S1 levels.
I brought to his attention the report of Dr Porteous, IME, in February 2024 where one of his daughters, acting as the interpreter, told the doctor that low back pain and leg pain had come on a year after the motor vehicle accident. The daughter who told Dr Porteous this was not the daughter who was present at the Medical Panel re-examination today. The claimant said he did not recall his other daughter telling Dr Porteous this.
Note – In circumstances where the claimant cannot recall a particular incident, the Panel has no option but to rely on the documented medical evidence.
Details of any relevant injuries or conditions sustained since the motor accident
Nil relevant.
Current symptoms
The claimant said he had left-sided neck pain, worse with turning his head to the right, but not radiating out of the neck. He had pain in both feet and ankles which felt like they were on fire, with pins and needles in both feet. He had pain down the side of his left leg, which was worse when standing more than 15 minutes.
He had left-sided low back pain. He said he had to take two Panadol before this Panel examination for back pain. He said he had no right leg symptoms. He said the main problem is chest discomfort if he bends forward.
He still lives with his wife in his son’s house. At home he will set the table but doesn’t do any yard work. He only drives occasionally in the local area.
He sleeps through the night but does have some back discomfort when he wakes up in the morning. He doesn’t smoke cigarettes and will have an occasional beer to drink.
Current and proposed treatment
Panadol Osteo two tablets per day, Panadol six tablets per day for neck, low back and lateral left leg pain radiating to the foot.
He says his left leg hurts when walking.
He takes Vitamin D and when I asked him about file records of previous ingestion of Vitamin D, his daughter clarified that he has been on Vitamin D and a multi-vitamin tablet in view of his age from long before the accident.
Since the CT scan showed a wedge compression of T7, and DEXA confirmed the constitutional condition of osteoporosis, he has been placed on Prolia six-monthly injections, used for treating osteoporosis particularly in elderly males.
At this point, I asked him if there was anything he wanted to add to the history taking and he said ‘no’.
CLINICAL EXAMINATION
General presentation
He sat comfortably and rose freely from the chair and moved his head fairly freely to speak to the interpreter, his daughter and to face me. He had very limited command of English.
He was right hand dominant. He was of solid build with height 161cm and weight 69.5kg.
Cervical spine (cervicothoracic)
Flexion and extension two-thirds of normal. Rotation two-thirds of normal bilaterally. Lateral flexion to the right was two-thirds of normal and in the left one-half normal.
There was tenderness in the left upper trapezial area at the base of the cervical spine but no guarding. Power, sensation and reflexes in the upper extremities were normal. Upper arm girth; right 27cm at 10cm above the elbow, left 26cm.
Forearm girth; right 25.5cm at 5cm below the elbow and left 24.5cm – consistent with stated right-hand dominance.
There were no signs of radiculopathy. There were no non-verifiable radicular complaints. There was dysmetria present.
Thoracic spine (thoracolumbar)
There was no thoracic spine tenderness and no guarding. Rotation in the thoracic spine was two-thirds of normal bilaterally. Truncal sensation was intact.
There was no significant sternal tenderness. There was no rib or chest cage tenderness or complaint on springing the ribcage.
Lumbar spine (lumbosacral)
There was tenderness at left L3 and L4 and centrally at these levels. Flexion two-thirds, extension one-third, lateral flexion two-thirds bilaterally. There was no guarding.
Power, reflexes and sensation in the lower limbs was normal. Plantar responses were both flexor. Straight leg raising showed negative sciatic nerve stretch test but complaint of left leg pain on sitting straight leg raising at 90°.
Thigh girth; right 42cm at 10cm above the patella, left 43cm.
Calf girth; right 35cm at 13cm below the patella (maximal circumference); left 35.5cm.
There were no signs of radiculopathy. There were no non-verifiable radicular complaints.
Shoulders
The right shoulder showed full range of movement in flexion 180°, extension 50°, adduction 40°, abduction 180°, internal rotation 80°, external rotation 90°.
The left shoulder showed full range of movement apart from abduction 140° and flexion 140°.
This was said by the claimant to be the result of discomfort from the left paracervical area.
Consistency of presentation
Various points of inconsistency have been brought to the claimant and his response recorded in the body of the report above.
IMAGING
There was no additional imaging brought to this examination.”

RELEVANT PROVISIONS

Assessment of permanent impairment

The assessment of the degree of permanent impairment is to be made in accordance with the Guidelines.[2]
[2] See section 7.21 of the MAI Act.
Version 9.3 of the Guidelines applies to the Review. Part 6 deals with the assessment of permanent impairment.

Causation

Causation is dealt with at cls 6.5-6.7 of the Guidelines. An abridged form of the requirements is contained in cl 6.7 which states:
“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.”
Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and 5E.

FINDINGS

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.[3]
[3] Section 7.26(6) of the MAI Act.
The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[4]
[4] Section 7.26(7) of the MAI Act.
The Panel refers to the above re-examination report of Medical Assessor Oates and adopts his findings in their entirety. The Panel reconvened on 20 May 2025 and 21 July 2025 and discussed the re-examination report findings before collectively making the below determinations.

Diagnosis, causation and reasons

Cervical spine

With respect to the cervical spine, the condition is a soft tissue condition. The accident is not considered to be a cause of this condition, as there is no evidence on file that it was reported to the GP, based on the records available.
The cervical spine was said to be not tender or painful and had full range of movement according to ambulance records, and there was no reference to cervical spine in the hospital records.
If the neck had been injured in the accident, the Medical Assessors would expect there to be symptoms and complaints recorded within hours of the accident.
As noted above, the claimant did mention possibly having seen a different GP initially after the accident, a Dr John Psarommatis. Upon review of Dr Psarommatis’ file, the Panel could find no reference to any cervical spine symptoms.

Thoracic spine

With respect to the thoracic spine, a wedge compression deformity of T7 was found incidentally on a CT scan chest which was taken to investigate a complaint of cough with yellow sputum after the accident. This is a pathological fracture and has never been symptomatic. No pain or tenderness at T7 has been recorded in any of the evidence.
This wedge compression appearance is more likely than not the result of the constitutional condition of osteoporosis, which was diagnosed by DEXA bone mineral densitometry scan after the T7 deformity was found on CT scan. The accident was not a cause of this T7 wedge compression fracture.
If such a fracture had been caused acutely or aggravated by the accident, there would have been immediate severe onset of pain in the mid to lower thoracic region and there is no evidence on file of there ever having been any complaints of pain in the multiple records presented.

Lumbar spine

With respect to the lumbar spine, this is a soft tissue condition. There is no evidence presented that the accident was a cause of this condition. Both Medical Assessor Bodel and IME Dr Porteous indicate that the low back pain developed one year after the accident.
There was no report of low back pain to the ambulance, the hospital, or to the GP in the early contemporaneous records available. The claimant did not agree with a link made in the GP records between the onset of left buttock pain and recent endoscopy.
In short, there is no evidence for a lumbar spine condition being related to the accident.

Sternum fracture

The accident was a cause of this condition. There was complaint of central chest pain to the ambulance officers and at the hospital, where the manubrial fracture of the sternum was diagnosed on scan.
This condition has resolved.

Right and left shoulders

With respect to right and left shoulders, there is said to be discomfort in the shoulders with some limitation of movement in the left shoulder on account of referred symptoms from the cervical spine.
There was no evidence in the file of any reference to shoulder injury or shoulder symptoms. The loss of left shoulder movement on examination today is more likely than not constitutional.
Even if it were referred from the cervical spine, the cervical spine has been found not related to the motor vehicle accident. Therefore, it follows that shoulder complaints are not related to the accident.

Summary of injuries referred by the parties

The following injuries were caused by the motor accident:
• sternum – fracture/ minimally displaced lower manubrium fracture – resolved.

PERMANENT IMPAIRMENT

As the thoracic spine, cervical spine, lumbar spine and shoulder conditions have been found to be not caused by the accident, there is no assessable permanent impairment arising from these regions.
The manubriosternal fracture, which was caused by the accident, has resolved leaving 0% WPI.

CONCLUSION

The claimant’s WPI as a result of the motor accident is 0% and is not greater than 10%. Apart from the sternum fracture, the Panel’s findings on causation of injury differ to that assessed by Medical Assessor Bodel. The Panel therefore revokes the certificate of Medical Assessor Bodel dated 24 October 2024.
A new certificate is issued at the front of the Panel’s determination.

Actions

Download as PDF Download as Word Document

Citations

Allianz Australia Insurance Limited v Ibrahim [2025] NSWPICMP 539

Cases Citing This Decision

0

Cases Cited

0

Statutory Material Cited

0

[2025] NSWPICMP 539

24 July 2025