Allianz Australia Insurance Limited v MA

DETERMINATION OF REVIEW PANEL
CITATION:	Allianz Australia Insurance Limited v Ma [2023] NSWPICMP 652
CLAIMANT:	Seung In Ma
INSURER:	Allianz Australia Insurance Limited
REVIEW PANEL
MEMBER:	Belinda Cassidy
MEDICAL ASSESSOR:	Ian Cameron
MEDICAL ASSESSOR:	Peter Yu
DATE OF DECISION:	5 December 2023
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; insurer’s review of assessment by Medical Assessor (MA) Tamba-Lebbie that one of the claimant’s lumbar spine injury was a non-threshold injury; claimant involved in accident on 9 December 2020 alleged injury to neck, back and left hip; no issue about any injury other than lumbar spine injury; alleged claimant had nerve root injury manifesting in radiculopathy and “complete or partial rupture” of a disc and therefore a non-threshold lumbar injury; Held – claimant was examined and did not have two or more of the five signs of radiculopathy at the time; review of medical records did not reveal evidence of two or more of the five signs of radiculopathy at any time since the accident; David v Allianz and Lynch v AAI Limited followed; while claimant’s radiology did report two “tears” of the lumbar disc the Panel was not satisfied the mechanism of accident could have caused a lumbar spine injury which tore the disc at two levels; in the alternative, the Panel also not satisfied the accident did cause the tears due to the absence of an immediate complaint of pain, the nature and pattern of treatment provided, the radiology, the claimant’s occupation and distribution of symptoms; the claimant’s lumbar spine injuries were found to be threshold injuries and MA’s certificate confirmed; Briggs v IAG t/as NRMA applied.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 The Review Panel: 1. Revokes the certificate issued by Medical Assessor Tamba-Lebbie dated 22 March 2023. 2. Certifies that the injuries sustained by Mr Ma in the motor accident on 9 December 2020 are threshold injuries.

STATEMENT OF REASONS

INTRODUCTION

Seung In Ma was involved in a motor accident on 9 December 2020. Mr Ma was the driver of a vehicle stopped at an intersection when a rear end collision occurred.
Mr Ma says he injured his neck, back and left hip in the accident. He made a claim for statutory benefits against Allianz, the insurer of the vehicle that ran into the back of his vehicle.
Allianz accepted liability for the claim and commenced paying Mr Ma his statutory benefits. Allianz denied liability to pay Mr Ma any statutory benefits after the first 26 weeks because Allianz was of the view that all of the claimant’s injuries were threshold injuries. Mr Ma did not agree and referred his medical dispute with Allianz to the Personal Injury Commission (the Commission) for assessment.
On 22 March 2023 Medical Assessor Tamba-Lebbie determined that one of the claimant’s injuries (the lumbar spine injury) was a non-threshold injury.
The insurer lodged an application with the Commission seeking a review of the Medical Assessor’s decision. On 17 May 2023, a delegate of the President of the Commission determined there was reasonable cause to suspect a material error in the assessment and has allowed the Review and on 19 May 2023 the President’s delegate convened this Panel to conduct the Review.

LEGISLATIVE FRAMEWORK

Jurisdiction

Mr Ma’s claim is governed by the provisions of the Motor Accident Injuries Act2017 (the MAI Act). This legislation provides a scheme for the compulsory third-party insurance of all motor vehicles registered in New South Wales and a scheme of statutory benefits (under Part 3) and compensation by way of lump sum damages (under Part 4) for persons injured in motor accidents in New South Wales.
The statutory benefits available under the MAI Act are not unlimited. For persons like Mr Ma who were injured in an accident that occurred before 1 April 2023, statutory benefits cease 26 weeks after the accident if the only injuries sustained by the injured person were “threshold” injuries.[1]
[1] Sections 3.11(1) and 3.28(1).
The issue of “threshold injury” is also relevant to a common law damages claim. While a claim can be made regardless of the severity of the injury, no damages are recoverable if the claimant’s only injuries are “threshold” injuries.[2]
[2] Section 4.4 of the MAI Act.
The Motor Accidents Injuries Amendment Act 2022 provided for a number of adjustments to the scheme of statutory benefits as follows:
(a) the payment of statutory benefits was extended from 26 weeks to 52 weeks for accidents occurring on or after 1 April 2023, and
(b) the term “threshold” injury was introduced to replace the term “minor” injury, and this applies to all accident regardless of when they occurred.

Threshold injury

A threshold injury is defined in s 1.6(1) of the MAI Act as a “soft tissue injury”. Section 1.6(2) of the MAI Act defines a soft tissue injury to mean:
“[A]n 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.”
In other words, if a person injured in a car accident sustains soft tissue injuries only then, unless one of those soft tissue injuries falls within the exclusion contained in s 1.6(2) (highlighted in italics in paragraph 10 above), the injured person’s statutory benefits cease in accordance with ss 3.11 and 3.28 of the MAI Act.
Section 1.6(4) provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) says that “an injury to the spinal nerve root that manifests in neurological signs (other than radiculopathy)” is a threshold injury.
Clause 5.8 defines radiculopathy and adopts the method of assessment provided for in the whole person impairment chapter of Part 6 of the Guidelines[3]. Clause 5.9 then provides:
“Where the neurological symptoms associated with the injured person’s injury of the neck or spine do not meet the assessment criteria for radiculopathy, the injury will be assessed as a threshold injury.”
[3] Chapter 6 of the Guidelines.
In summary, if the person injured in the car accident sustains a spinal nerve injury this is a threshold injury unless the particular nerve injury manifests in signs of radiculopathy in accordance with cl 4 of the MAI Regulation in which case it is not.

Dispute resolution

If there is a dispute about whether an injured person’s injuries are threshold injuries or not, that matter is declared to be a medical assessment matter which may be referred to the Commission for determination.[4]
[4] Schedule2, clause 2(e) in the MAI Act.
Chapter 7, Division 7.5 of the MAI Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as Medical Assessor Tamba-Lebbie’s, further medical assessments and the Review of medical assessments by this Panel.[5]
[5] Sections 7.20, 7.24 and 7.26 of the MAI Act.

ASSESSMENT UNDER REVIEW

Medical Assessor Tamba-Lebbie examined the claimant on 22 March 2023 and issued his certificate on the same day. He confirms at [2] that he was asked to assess a neck injury, a particular lumbar spine injury and an injury to the left hip.
The Medical Assessor records the following histories:
(a)    the claimant had occasional lower back pain before the accident treated with acupuncture but he never had constant lower back pain [8];
(b)    the claimant was a self-employed builder [9];
(c)    the claimant was hit from behind while stationary at an intersection. He was wearing a seatbelt and was driving. He was able to move his car and exchange details afterwards [9];
(d)    he says he saw his doctor the next day, had an MRI and CT scan and has had 10 sessions of physiotherapy [9];
(e)    the claimant continued to have pain in his neck and lower back and into his shoulders and left trochanteric area [10];
(f)    the claimant currently experiences pain in his neck and lower back, along his shoulder blades and in his left hip. He complained of occasional numbness down the right arm [12], and
(g) the claimant takes the occasional Voltaren [13].
On examination the Medical Assessor records at [14]:
(a)    in the cervical spine there was no spasm or tenderness and there was a full range of active motion with slight pain when looking to the right. There was a full range of shoulder, elbow, wrist and finger movements;
(b)    in the lower back there was no spasm, normal power, sensation and reflexes and equal straight leg raising to 80 degrees, and
(c)    in the left hip there was slight pain with some movements but otherwise normal movements.
At [16] Medical Assessor Tamba-Lebbie reviewed the 5 February 2021 MRI report which stated there was a tear of the annulus at L5/S1 and said this constitutes a non-threshold injury. At [17] he summarised the radiological findings.
He diagnoses at [18] injuries to the cervical and lumbar spines and left hips but provides no specific reasons. In his findings on causation, at [20] he says these injuries are “likely” to be caused by the accident.
Medical Assessor Tamba-Lebbie cites the legislation at [23] and says the lumbar spine injury is not a threshold injury and the other two injuries were threshold injuries.

ISSUES FOR DETERMINATION

Submissions in support of the original application for assessment

The claimant’s submissions in support of the original application included the following arguments and submissions:
(a)    the first certificate of capacity dated 10 February 2021 listed injuries to Mr Ma’s neck, trapezius, whole back, left hip and gluteal with decreased sensation in his lower left leg and foot and a positive “SLUMP/SLR” test;
(b)    while the claimant had listed the cervical spine – no specific submissions were made with this note “the claimant reserves the right to make further submissions … upon receipt of the clinical notes”;
(c)    in respect of the lumbar spine, the claimant relied on the MRI scan which showed an annular tear, bulge and mild foraminal stenosis, and
(d)    there were no submissions about the hip injury.
The insurer’s submissions in support of its reply said:
(a)    in respect of the alleged cervical spine injury, as there is no evidence in support of this injury, it should not be referred for assessment;
(b)    in terms of the lumbar spine, the insurer says the pathology detected on the radiology was “not acute or traumatic but rather degenerative” and the clinical signs do not correlate with the radiological findings, and
(c)    the claimant provides no submissions in relation to the hip and the injury should not be referred for assessment. If it is to be assessed the insurer says the claimant has not provided evidence of anything other than a soft tissue hip injury.

Submissions in respect of the Review proceedings

The insurer alleges the Medical Assessor Tamba-Lebbie erred in the finding of causation and failed to explain his reasons as to why the lumbar spine injury was a non-threshold injury.
The insurer says:
(a)    at [5] that the Medical Assessor diagnosed “lumbar spine” but did not indicate which level or structure of the lumbar spine had been injured in the accident;
(b)    at [13] that the Medical Assessor has not explained why the imaging findings correspond with the symptoms and findings on examination;
(c)    at [15] that the Medical Assessor has said that the L5/S1 annular tear seen on imaging is not a threshold injury but has not explained why it was caused by the accident. The insurer says at [16] the assessor said the lumbar spine was “likely” to have been caused by the accident;
(d)    at [18] the Medical Assessor has not referred to or considered the mechanism of injury or at [19] the insurer’s submissions that the tear is degenerative, and
(e)    at [21] – [23] the insurer had made submissions about the degenerative lumbar spine condition which the assessor has not addressed.
The claimant provided “submissions” in respect of the review stating the claimant neither opposed nor consented to the review proceeding.

First preliminary conference

The Panel met on 7 August 2023. The Panel notes that the insurer’s submissions raised issues only with the Medical Assessor’s finding of the lumbar spine issue as a non-threshold injury and not the neck and hip injury which were found to be threshold injuries.
The Panel asked the parties to confirm:
(a)    that the only injury to be assessed is the claimant’s lumbar spine injury;
(b)    the only issue to be assessed in relation to that lumbar spine injury concerns the MRI findings of “annular tears” at L4/5 and L5/S1, and
(c)    the real issue in the assessment is whether those “annular tears” were caused by the accident.
The Panel identified issues concerning the documents and requested bundle of documents from both parties.
The Panel issued directions and set a date for a further teleconference on 24 October 2023 to discuss the documents.

Claimant’s response

In a message to the parties dated 14 September 2023, the claimant advised:
(a)    the only injury to be reassessed is the lumbar spine injury;
(b)    one issue to be assessed in respect of that injury is the MRI findings of “annular tears” at L4/5 and L5/S1 and whether there was a tear, or further tear caused by the accident, and
(c)    the second issue to be assessed in respect of the lumbar spine injury is whether there is a nerve or nerve root injury manifesting in radiculopathy as a result of the injury.
The claimant uploaded a preliminary bundle of documents and confirmed that general practitioner (GP) records had been requested. These documents were uploaded on 13 and 15 September 2023.

Insurer’s response

By way of a message in the portal dated 5 October 2023, the insurer advised:
(a)    the only injury to be assessed is the claimant’s lumbar spine injury and the issue concerning the MRI findings of “annular tears” at L4/5 and L5/S1. The Insurer submits that the “annular tears” identified on the MRI were not caused by the subject motor accident;
(b)    a bundle of documents was provided;
(c)    in response to the claimant’s submissions, if it is found that the claimant sustained an aggravation injury to the lower back which was not conceded, that this would be a threshold soft tissue injury;
(d)    the claimant does not satisfy the criteria for radiculopathy under cl 5.8 of the Guidelines and no radiculopathy was found upon assessment by Medical Assessor Tamba-Lebbie. If any radiculopathy is found this should not be attributed to the motor accident.

Panel’s further consideration of the issues.

The Panel further considered the matter and resolved that a medical re-examination needed to take place in order to assess the presence or absence of radiculopathy.
A date for the re-examination was set and the parties were advised.

REVIEW OF THE EVIDENCE

Claim form and claim documents

The application for personal injury benefits (claim form) is dated 14 December 2020[6] five days after the accident. The claimant provides a history of the accident that is consistent with other records.
[6] Page 5 of the claimant’s bundle.
Mr Ma said that his neck, back and hip hurt. He denied any previous claim and said he had no illness or injury affecting the same or similar parts of his body at the time of the accident.
The claimant said he did not go to hospital and had five days off work after the accident.
The police report has been provided[7] which includes details that neither car was towed from the scene and the claimant’s airbags did not deploy but little else of relevance to the dispute. It was a late report made at the station on 14 December 2020, police did not attend the accident scene. The police report also provides details of the vehicles involved as follows:
(a) the claimant was driving a Toyota Hilux utility with a number plate ending with the letter “J”, and
(b) the insured was driving an Audi Q7 station wagon.
[7] Page 26 of the claimant’s bundle.
The insurer has provided within its bundle a photograph of what appears to be the rear of a utility vehicle the number plate of which ends with the letter “J”. There is a tow bar attached to the vehicle and a locked tray.

Treatment records

Pre-accident

Dr Lee of the J Medical and Cosmetic Centre Parramatta Road at Lidcombe has provided his records commencing March 2017 they show:
(a)    on 15 May 2017 the claimant attended with acute hip pain after bending his back but no radiation. The claimant was tender in the lateral gluteal region and was referred for physiotherapy. Mr Ma also complained of “tennis elbow” which was stated to be “recurrent and chronic”;
(b)    there were multiple attendances for tonsilitis;
(c)    on 9 August 2018 the claimant complained of upper back symptoms between the scapular and spine for two to three days and there was mild tenderness, and
(d)    on 12 June 2020 he complained of acute right arm pain.
The Panel notes, while there were occasional attendances for musculo-skeletal issues before the accident, there is no record of imaging studies, no suggestion of prescribed medication and no copies of any referrals for allied health treatment for those issues.

Post-accident - Sydney

The copy of Dr Lee’s records attached to the claimant’s bundle[8] had details of only two attendances,14 December 2020 and 13 January 2021.
[8] Page 10 of the claimant’s bundle.
Dr Lee completed the first certificate of fitness stating that the claimant was seen on

14 December 2020 and that he had injuries to the neck, trapezius, back, left hip and gluteal region with decreased sensation in the “left lower leg, left foot, SLUMP/SLR positive.” No previous problems were declared.
The pain chart completed by Dr Lee has shading of the neck and over both trapezius (from the neck to the shoulder), the middle back, the lower back and left buttock with “severe tender” noted and a downwards arrow next to the word “sensation” in the left lower limb indicated from the knee to the foot.
On 14 December 2020 the claimant was referred by Dr Lee to Recare for, “OT assessment and rehabilitation review”. The claimant was also referred for physiotherapy with Rapid Therapy due to injuries to the “neck/trapezius/whole back/left hip and gluteal”.
An MRI was arranged with the clinical details of “post MVA, severe tenderness on left lumbar, decreased sensation on lateral side of left lower leg and left foot. SLUMP/SLR positive on left side.”
On 13 January 2021 Dr Lee records that there had been some progress and no new symptoms. The claimant was off work due to there being no suitable duties. He was awaiting rehabilitation review.
Dr Lee’s records suggest he saw the claimant again on 10 February 2021 in his surgery, on 8 March 2021 by telehealth, on 27 March and 30 April 2021 in the surgery and 28 May 2021 by telehealth.
On 27 July 2022 the claimant attended the surgery for “acute neck pain and radiation” with a referral given for and MRI scan noting “recent worsening with left arm radiation.”
The claimant next attended the surgery on 16 May for his “CTP issues” and then on

17 May 2023 by telehealth and physiotherapy was advised and it was noted the claimant had moved from Brisbane.
The claimant attended the surgery for a flu vaccination on 14 July 2023 and on 31 July 2023 for this CTP claim and again on 10 and 29 August 2023.
It would appear the claimant has had physiotherapy from Ms Oh and Mr Han at the J Medical and Cosmetic Centre [9] in Lidcombe.
[9] Page 78 of the claimant’s bundle is the first attendance. The records then jump to 29 August 2023 with further attendances in reverse date order.
Ms Ho’s first consultation with the claimant was on 15 December 2020. She records complaints of neck and lower back pain, numbness on the left lateral leg down to the knee made worse with sitting and driving. Lower thoracic pain and shoulder numbness on the lateral side were also reported.

The next consultation at this practice was with Mr Han on 28 July 2022. He records neck and left sided upper back pain with paraesthesia for two to three days. The Panel notes “recent [aggravation of lumbosacral] pain ongoing” and left sided gluteal region pain. There is another consultation on 1 August 2022 with similar complaints.
There is then a gap until 18 May 2023 when the claimant attended with ongoing shoulder and neck pain and left gluteal region pain. The physiotherapist appears to adopt a practice of repeating the previous history (from December 2020). The final attendance in these notes was 29 August 2023.
An allied health request (AHRR) was submitted to the insurer on 10 August 2023 noting the injury, MRI findings and that on 16 May 2023 treatment had resumed due to “worsened physical conditions.” There was limited cervical spine function and a paraesthesia like sensation in the upper third of the upper limb. Limited thoracic spine function and limited lumbar spine function. The first physiotherapy treatment was said to have occurred on

3 August 2023 and eight further sessions of physiotherapy were requested.

Post accident - Queensland

The Brisbane Spine Clinic submitted an AHRR to the insurer dated 16 February 2021.[10] This includes a history of the claimant being rear ended on 9 December 2020. It was said the claimant works as a builder and carpenter and has not been able to work due to pain. Services had started on 13 January 2021 and four services had been provided. The goal was said to be to “reduce the neck/back/left hip and glute pain and improve function to promote optimal return to work and ADLs”. Twelve sessions were requested.
[10] Page 98 of the claimant’s bundle.
The Brisbane spine clinic records[11] show the claimant had eight sessions of physiotherapy between 13 January and 16 September 2021 for the neck, back and left hip. Four of these were in January 2021, two in February, one in March and one six months later in September. There are no further AHRR forms from this practice.
[11] Page 92 of the claimant’s bundle.
The notes of the treatment contain details including positive FABER tests, SLR tests and complaints of pain including “electrical pain even at rest” (25 January 2021). There are complaints of pins and needles around the left calf (29 January 2021).
The claimant attended doctors at the Wellbeing Medical Centre in Acacia Ridge in Queensland. The claimant first attended on 13 December 2021 with gastro-intestinal issues. The next attendance on 22 February 2022 due to an injury to the right hand. On

13 September 2022 there was an attendance for right elbow pain.
Of the 14 attendances at the Wellbeing Medical Centre, there are no complaints of any accident-related injuries or symptoms that is no complaints of neck, back, shoulder or hip pain.
There are a number of certificates of fitness from Dr Lee provided by the insurer:
(a)    14 December 2020 – the claimant’s address was in Telopea. Dr Lee wrote of injuries to “neck/trapezius/whole back/ left hip and gluteal, decreased sensation on left lower leg left foot slump / SLR positive”. There was the referral to physiotherapy (Rapid Therapy) Recare and MRI noted;
(b)    10 February 2021, Dr Lee wrote that injuries were “increased” to neck/trapezius/whole back/ left hip and gluteal, decreased sensation on left lower leg left foot slump / SLR positive. There is also a reference to the disc bulge at L4/5 and tear at L5/S1. The claimant had a Queensland address;
(c)    8 March 2021 - Dr Lee notes the Queensland address and the certificate of fitness and capacity is in similar terms (four hours a day five days a week);
(d)    27 March 2021 - Dr Lee certified that he had examined the claimant (Mr Ma’s address was given as in Queensland) and Mr Ma was fit for work four hours a day for five days a week. He noted physiotherapy treatment with Rapid Therapy, Recare rehabilitation and medication (Voltaren tablets and gel and Paracetamol) was required;
(e)    30 April 2021– the claimant was certified fit to work eight hours a day five days a week and his address was noted as in Queensland;
(f)    16 May 2023 – the claimant was certified fit to work for four hours a day give days a week and physiotherapy and medication were advised. The claimant was said to be still living in Queensland, and
(g)    31 July 2023 – the claimant was certified fit for work four hours a day five days a week and his address was noted as in Queensland.

Radiology

The claimant had an MRI of his lumbar spine in Auburn on 5 February 2021.[12] It was requested by Dr Lee on 14 December 2020. The clinical history was said to be “post MVA, severe tenderness left side of the lumbar spine with reduced sensation left lower leg.” The claimant’s address was stated as being Telopea in NSW. The results were:
(a)    L2/3 mildly disc hydrated no disc protrusion;
(b)    L3/4 small disc bulge without neurocentral compression and mild foraminal stenosis abutting but not deviating the exiting L3 nerve roots;
(c)    L4/5 shows disc dehydration, a broad based disc bulge indenting the thecal sac but not causing canal stenosis. There was mild bilateral foraminal stenosis and a left “extraforaminal annular tear” adjacent to the exiting left L4 nerve root. Facet joints were mildly arthritic, and
(d)    at L5/S1 the disc height was reduced and there was a small bulge indenting the ventral sac without compression, mild foraminal stenosis more marked on the left without deviation of the L5 nerve root and a postero central annular tear.

RE-EXAMINATION FINDINGS

[12] Page 101 of the claimant’s bundle.

General

Mr Ma was re-examined by Medical Assessor Yu on 31 October 2023 on behalf of the Panel. Mr Ma was accompanied by an interpreter of the Korean language. Mr Ma relied heavily on the interpreter.
Mr Ma was identified from his unexpired Queensland driver’s licence.

Medical history

Pre-accident medical history and relevant personal details

Mr Ma was born in Korea and served with the Korean Army before emigrating to Australia.
He has worked as a carpenter and builder for 15 years but not always full-time. For at least the past three years, he has worked in a self-employed capacity. He neither found, nor did as much work during the COVID-19 pandemic than before. He has a current builder’s licence.
He lives with his wife and three sons the youngest of whom is seven years old. His wife and children are each independent with their self-care. Before the subject accident, his home had level access without any step or stairs. Just before the subject accident, he had committed to relocating his family to Queensland early in 2021.
Mr Ma reports that he had and still has happy relationships with all of his family. He has not used alcohol, has never smoked or vaped and has never used any illicit substance.
Mr Ma says has never received or applied for a disability support pension. Before the subject accident, he was independent with his self-care. Each driver’s licence he has held to date has been medically unconditional.
Before the accident, the claimant’s usual share of home duties included lawn-mowing, taking out the rubbish and handling the council-issued rubbish bins, washing dishes, drying the household’s laundered clothing.
Leading up to about five years ago, he felt recurrent pain in his abdomen, low back and one of his hips. He recalled his treating doctor at the time, Dr Lee, diagnosing that gallstones were the exclusive cause of those symptoms. A surgeon whose name he cannot recall treated him for this and he had a laparoscopic cholecystectomy at Concord Repatriation General Hospital. Mr Ma said he recovered from that surgery and his recollection is that he did not feel any symptom in his back, hips or legs until after the subject accident.
Other than that, Mr Ma reiterated that he never felt any significant symptoms in his back, hips or legs at any time before the subject accident. He has never been involved in any motor vehicle accident to date other than the accident the subject of these proceedings.

History of the motor accident

Mr Ma said the accident occurred around lunchtime on a weekday (9 December 2020). He was travelling to work for his company. When asked him which company this was, or whether he was working as a sole trader under his own name, he could not recall.
Because of the COVID-19 pandemic, he said he did not have any project or task to do that day, but he still intended to travel from his home to his office. He said it was a sunny day, there was no rain, and the ground was dry as he drove.
He was driving his Toyota utility. There were no other occupants in his vehicle. He was wearing a three-point seatbelt. There were airbags fitted to his vehicle. He stopped his vehicle at a red traffic signal.
The claimant says his vehicle was stationary when the front of another vehicle collided with his vehicle’s rear. He felt his body suddenly move forward. His seatbelt stopped his body’s further forward movement. He said his body did not collide with any part of the inside of his vehicle’s cabin. He did not hit his head or lose consciousness.

History of symptoms and treatment following the motor accident

At the accident scene, Mr Ma said he felt weak in his entire body. He felt his heart beating rapidly. He said he was not aware of any symptoms in his back or his legs. He got out of his vehicle and walked without assistance to the vehicle that had collided with his Toyota. He spoke to the driver of that other vehicle. They agreed to drive their cars to a side street which they did. After exchanging details, he drove for about 10 minutes and reached his office. He said he lay down on the sofa in his office and felt weak in his whole body. He felt his heart continue to beat rapidly.
While he was lying on the sofa in his office, he called his friends, who he knew to have experience about car accidents. He asked for their advice. They advised him to ring the police and then consult a doctor. He rang the police. He called the office of Dr Lee, who scheduled the earliest available appointment.
Before his shift at work was usually scheduled to finish, he left work driving to his home. He felt frightened. He took Panadol and then slept.
Medical Assessor Yu clarified with the claimant about his symptoms on the day of the accident. Mr Ma made it clear that he did not experience pain anywhere in his back or in his legs. The only symptom that he felt on that day was a whole-of-body weakness.
About two or three days after the accident, Mr Ma said he felt for the first time pain in his low back. On one occasion, he felt pins and needles in both of his legs as he was driving. When he first consulted Dr Lee, he had already started to feel this pain in his low back and these pins and needles.
He followed through with his pre-accident arrangements to relocate his family to Queensland. He was vague about the dates. He said:
“I was in Queensland at the time. The insurance company said, ‘Your accident was in New South Wales, so you should get treatment in New South Wales, not Queensland.’ So, my lawyer took about one month to start my treatment in Queensland.”
Mr Ma said that for about one month after he first consulted Dr Lee in Lidcombe (NSW), he did not receive any treatment. He said he then started to receive physiotherapy in Queensland and saw a doctor in Queensland.
To date, Mr Ma says he has not received any injection, surgery or other invasive form of treatment for his post-accident symptoms of the low back and legs. For those post-accident symptoms, he has not consulted any treating medical physician or surgeon.
He consults a female doctor in Brisbane. He was unsure of that treating doctor’s name and unsure of the address or suburb or name of the practice. He has not used any prescription-only analgesia since early 2023. He last attended physiotherapy about one month ago in Queensland.
While he has been in Brisbane since early 2021, for at least the past six months, he has lived in his current home in Brisbane. It is a two-storey townhouse. His bedroom is upstairs. He continues to work as a licenced builder. He says he allocates to contractors the building tasks that require working on the tools.
His last day of work was about two weeks ago. He worked the whole day. On that most recent shift of work, he patched the ceiling of a residential property. To do that work above the standing height of his head, he climbed and stood on a ladder, which he described as “not very high”.
For his work, he avoids lifting up anything heavy that is on the ground. He attempts to manually handle items only to waist height. He has recently lifted at waist height a bag of cement that weighed about 20kg without difficulty. That is the maximum extent of manual handling that he tolerates otherwise it provokes his low back pain.

Details of any relevant injuries or conditions sustained since the motor accident

Mr Ma told me that he did not sustain any further injury of his low back or legs after the current accident.

Current symptoms

Mr Ma has constant pain in his low back. If 0 indicates no pain and 10 indicates his worst-imaginable pain, he says his low back pain is, and has usually remained at, an intensity of about 6 or 7 out of 10. With respect to his low back, he does not have any symptom other than pain.
He says he has a painless feeling of pins and needles affecting his left thigh only. It does not affect the rest of his left leg. He also feels that pins and needles type sensation in his entire right leg, excluding the right foot and each toe thereof.

Current and proposed treatment

Mr Ma occasionally uses Panadol as required. He would like to continue physiotherapy but does not have enough funding for this. Other than physiotherapy and occasional Panadol as required, there is no other treatment that anyone is proposing for his symptoms of the low back and legs.

Clinical Examination

General presentation

Mr Ma gave his consent to proceed with the examination below.
During examination, he agreed to move only within the limits of his comfort, and to stop participating in the examination whenever he did not feel physically or emotionally at ease. At the first sign of pain or tenderness for a given test, the test would be aborted.
Mr Ma was of lean, muscular build. He stood 1.78m tall and weighed 66kg. He did not appear to be in distress at any point during the interview or examination. All ranges of movement were confirmed by using a goniometer.

Lumbar (lumbosacral) spine

The posture and appearance of Mr Ma’s low back were normal. There was no muscle spasm, muscle guarding or other deformity. He reported no feelings of pain or any tenderness to palpation of the midline and the para-spinal regions of his low back (spinal and paraspinal lumbosacral region).
Upon testing of the active ranges of movement in his lumbar spine, his range of movement was inconsistent across three attempts. When this was mentioend to him, he told Medical Assessor Yu that the variability of his low back pain was the cause of any inconsistency.

Type of active movement in Mr Ma’s lumbar spine

Maximum range as measured with a goniometer

Whether Mr Ma demonstrated the active range of movement consistently across 3 tests

Flexion forward

Half of the normal range

Inconsistent by up to a quarter of the normal range

Extension

Half of the normal range

Inconsistent by up to a quarter of the normal range

Right rotation

Half of the normal range

Consistent

Left rotation

Half of the normal range

Consistent

He walked normally, without a limp. He took four steps whilst demonstrating tandem gait, then four steps only on his heels, and four steps only on his toes. For these tests, he reported not having any test-related symptom. The Trendelenburg sign was negative.
He squatted on three occasions. On each of those occasions, he touched the ground with his right third fingertip. Whilst maintaining a squatting posture, he took four steps forward. He did these tests and reported not having any test-related symptom.
He said he was unable to safely hop on either of his feet due to concerns about aggravating his low back pain.
He stepped onto and off a step that rose 25cm off the ground. He did so only whilst leading each step with his left foot, then only leading with his right foot. He reported not having any stepping-related symptoms.
For each of his lower extremities, the Straight Leg Raise (SLR) test of sciatic nerve root tension did not generate any pain or other symptom in any dermatomal distribution (the SLR test was negative).
Overall, the examination of his lumbar (lumbosacral) spine did not reveal any non-uniform loss of spinal motion (no dysmetria) or positive sciatic nerve root tension sign.
There was no muscle spasm.

Lower extremities

There was a 5cm-long linear scar in the superolateral part of the anterior aspect of Mr Ma’s right knee. There was a superficial 5.5cm-long red, healing linear wound in the upper third of his right shin, and a superficial 2.5cm-long red, healing linear wound in the upper third of his left shin. There was a 2cm-long healed scar in his right calf’s inferolateral part. Mr Ma had several other smaller, old healed scars in the middle and inferior thirds of each of his shins.
When asked about these scars, Mr Ma could not recall when he developed them or explain how they were caused.
Other than scarring, the appearance of each of Mr Ma’s lower extremities was normal. There was no muscle spasm or gross deformity. There was no sign of leg length discrepancy. The distance from each anterior superior iliac spine to the ipsilateral medial malleolus was 87cm for each of his legs.
There was no muscle wasting evident on examination. Lying supine with the knees fully extended, each of Mr Ma’s thighs had a circumference was 43cm at 10cm proximal to the ipsilateral patella’s proximal-most verge. At 10cm distal to the patella’s distal-most verge, each calf’s circumference was measured at 36.5cm.
Muscle tone was normal throughout each of his legs. Mr Ma’s muscle power rated 5 out of 5 according to Medical Research Council (MRC) criteria, with respect to all of the active movements of each of his hips, knees, ankles and toes.
In the lower extremities, Mr Ma had normal (2 plus), symmetrical reflexes at each patellar tendon (knee jerk reflex), medial hamstring (hamstring jerk reflex), Achilles tendon (ankle jerk reflex) and sole (Babinski reflex).
Throughout each of Mr Ma’s lower extremities, he reported normal sensitivity to touch with ten grams of force that a calibrated monofilament exerted on his skin. He reported insensitivity to tests of pinprick sensation in a non-dermatomal pattern in each of his calves and in his feet.

Consistency

Some of Mr Ma’s movements were inconsistent which he indicated was bacause of varying pain levels.
The Panel noted the claimant’s had difficulty recalling some facts. For example he could not remember the name or details of the medical practice he has been attending in Queensland. He also could not remember whether at the time of the accident he was working for an empoyer or working for himself. Of particular concern to the Panel was the claimant’s inability to recall when or how he sustained four or more scars on his right leg including two scars that were healing (as opposed to healed). Due to this limited recall the Panel has paid careful attention to the documentary evidence.
The Panel also noted inconsistencies in the history of the claimant who says for the first month after he seen Dr Lee on 14 December 2020, he had no treatment when the records suggest he had one physiotherapy treatment in Auburn after he saw Dr Lee. The Panel is somewhat confused by the claimant’s history and the records in relation to his state of residence (Queensland versus NSW). For example the claimant saw Dr Lee in Auburn on
13 January 2021 according to his records[13] and the certificate of fitness.[14] The claimant is also recorded as having attended the Brisbane spine clinic on the same day.[15] The claimant also appears to have seen Dr Lee in the surgery on several occasions at times when the claimant has been living and working in Queensland.

CONSIDERATION OF THE ISSUES

[13] Page 12 of the J Medical records.

[14] Page 106 of the claimant’s bundle.

[15] Page 91 of the claimant’s bundle.

What injuries were caused by the accident?

Mr Ma’s claim form documents pain in his neck, back and hip. Noting the claimant’s concession and the parties’ agreement as to the other injures being “threshold injuries”, Medical Assessor Yu did not canvass with the claimant the injuries to the claimant’s neck and left hip in any great detail and there is no need for the Panel to consider these injuries further.
Mr Ma did not see Dr Lee until five days after the accident. At that time, he complained of neck, lower back, trapezius and left lower limb symptoms. The Sydney-based physiotherapist has recorded similar complaints. There is no mention of the accident in the Queensland GP’s notes, but some limited physiotherapy occurred in that state in 2021 to the neck, left hip and lower back with complaints of pins and needles and numbness.
The Panel accepts that the claimant sustained injury to his lower back in the accident on the basis of his contemporaneous complaints and the history given by Mr Ma.
The claimant says he has sustained two particular injuries to his lumbar spine:
(a) a lumbar nerve root injury manifesting in radiculopathy, and
(b) two lumbar disc injuries at L4 and L5/S1.
Each of these will be dealt with in turn.

Does Mr Ma have lumbar radiculopathy?

Clause 5.8 of the Guidelines defines “radiculopathy” as “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”:
(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 the 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, and
(e)    reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.
In Mr Ma’s case, the re-examination by Medical Assessor Yu revealed:
(a)    no loss or asymmetry of any reflex of the lower extremities;
(b)    no positive sciatic nerve root tension signs;
(c)    no muscle atrophy or any evidence of decreased limb circumference;
(d)    no evidence of any muscle weakness in his lower extremities, and
(e)    no dermatomal sensory loss, that is no reproducible sensory loss in his lower extremities that is anatomically localised to any appropriate spinal nerve root distribution.
Mr Ma therefore did not, on the date of the examination demonstrate he had any of the five signs of radiculopathy within the meaning of cl 5.8 of the Guidelines. There is therefore no evidence of a current nerve root injury which could be a non-threshold injury.

Has Mr Ma had lumbar radiculopathy at any time since the accident?

In David v Allianz Australia Insurance Ltd,[16] at [84 – 105] a Review Panel considered the issue of “whether an injury is not a minor injury if radiculopathy is present at any time following injury.” At [98] the Panel said:
“Radiculopathy is an example [of an injury] where the symptoms fluctuate over time because the extent of the compression of the spinal nerve root may vary due to inflammation on the nerve root. Symptoms may subside if the inflammation reduces and returns because the injured disc is exacerbated by innocuous activities.”
[16] 2021 NSWPICMP 227.
The Panel found at [104] that if it is established (by way of an assessment that complies with cl 5.5 and 5.6 of the Guidelines) that there are at least two clinical signs of radiculopathy (as set out in cl 5.8) present at any time, the injured person falls outside the definition of “minor” now “threshold” injury.
In Lynch v AAI Limited t/as AAMI,[17] the Medical Panel there considered the same issue in respect of a psychiatric injury. After citing David, and considering cl 5.10 -5.11 where the word “present” is required for a psychiatric injury, the panel said at [72]:
“That the psychiatric diagnosis may change over time is not only consistent with the provisions of DSM-5 but otherwise consistent with physical injuries. A simple fracture is a non-minor injury within the meaning of the MAI Act but will normally heal prior to any assessment. It would be an absurd interpretation to conclude that as the fracture has healed there has been change in status from the injury being classified as non-minor, when the injury occurred, to one being classified as minor because the injury had healed.”
[17] 2022 NSWPICMP 6.
The two cases of David and Lynch establish that whether the claimant has a threshold or non-threshold injury on the day of any re-examination by a Panel is only one part of the assessment. The Panels found in those two cases that if, at any time after the accident, the claimant’s accident-related injury falls outside the definition of “threshold injury” contained within s 1.6 of the MAI Act, the claimant must be found to have non-threshold injuries regardless of the state of the injury (healed, recovered or in remission) at the time the Panel undertakes its assessment.
Clause 5.5 of the Guidelines provides that:
“… 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.”
Clause 5.6 provides that the assessment of whether an injury is a threshold injury or not must be based on the relevant evidence and findings from a comprehensive and accurate history, a review of all relevant records, a comprehensive description of symptoms, a careful and thorough examination and diagnostic tests and any imaging findings.
Mr Ma was seen by Medical Assessor Tamba-Lebbie who records there was, “no spasm around his lumbosacral area. His straight leg raising is 80 degrees to left and right. He has normal power in his knees and ankles and normal sensation. His reflexes are normal.” Medical Assessor Tamba-Lebbie does not mention muscle atrophy and decreased limb circumference. Even if there was muscle atrophy and decreased limb circumference that would be only one sign of radiculopathy not two.
Medical Assessor Tamba-Lebbie did not diagnose radiculopathy and the Panel is satisfied that his findings do not suggest there was radiculopathy within the meaning of the Guidelines present when examined.
There are no medico-legal or specialist examinations and reports.
Mr Ma has been treated at two medical practices and by two physiotherapists none of whom have diagnosed radiculopathy. The Panel will therefore examine their records carefully to see if they document any of the signs so that the Panel can make a diagnosis of radiculopathy.
Before doing so, the Panel notes that radiculopathy is a symptom of, or manifests because of, an injury to a nerve root therefore the two signs of radiculopathy must correlate to the same nerve or nerve root. For example, an absent reflex on the left side and muscle atrophy on the right side would not warrant a finding of radiculopathy in respect of an injury to a nerve exiting on the left side. The Panel also notes that signs must also correlate to the imaging studies. For example, if there is an absent reflex and muscle atrophy on the left side indicating an L4/5 nerve root issue, but no foraminal stenosis there might not be a finding of radiculopathy in circumstances where there is significant foraminal stenosis and a disc bulge on the right side at L2/3 compromising the nerve root at that level.
There is no mention of the accident-related injuries or symptoms in the Brisbane GP’s records and therefore no signs of radiculopathy mentioned there.
The claimant has complained from time to time of lower back pain radiating into the left buttock and left upper limb. Radiating pain is not one of the five signs of radiculopathy.
Mr Ma described a whole-body weakness to Medical Assessor Yu immediately after the accident. The Medical Assessors are of the view that this complain is of a shock type reaction to the accident, particularly as the claimant complained at the same time of a racing heart. This is not a sign of radiculopathy within the meaning of the Guidelines.
The claimant complains of pins and needles in his left thigh and a similar sensation in the whole of his right leg. There do not appear to be any complaints of right sided symptoms and there are no radiological findings to suggest an issue in the nerve root exits on the right side.
Medical Assessor Yu administered an appropriate test designed to reproduce (confirm) altered sensation and the relationship of any altered sensation to the appropriate nerve root. However, it is not clear to the Medical Assessors on the Panel whether Dr Lee and the physiotherapists found a decrease in sensation reproduced on objective testing or whether what they have noted is a subjective report from Mr Ma or altered or reduced sensation. The Panel is not therefore satisfied that the claimant has, at any time since the accident, a “reproducible sensory loss in his lower extremities that is anatomically localised to any appropriate spinal nerve root distribution”.
The Panel notes the records of Dr Lee record “SLUMP/SLR positive on left side” on

14 December 2020. There is no other record of any further tests having been undertaken in the attendances (telehealth and in the surgery) thereafter. The physiotherapy records from Brisbane are replete with abbreviations which are not clear to the Medical Assessors but there are references to positive SLR tests at 60 and 70 degrees.
Table 6.8 of the Guidelines provide information about sciatic nerve root tension signs. It says there are a variety of tests than can be used and a straight leg raise test is one of them. It says “The test is positive when thigh and or leg pain along the appropriate dermatomal distribution is reproduced. The degree of elevation at which pain occurs is recorded…Back pain on SLR is not a positive test.”
Dr Lee’s note does not provide enough detail for the medical members of the Panel to determine whether his record of a positive SLR test is a result which would satisfy the requirements of the Guidelines. Similarly, the positive slump test on the left side provided insufficient detail for the Medical Assessors to make a clinical finding that the claimant did have a positive nerve root tension sign indicating a specific nerve root injury.
The Panel is not therefore satisfied on the information currently before the Panel that the claimant has, at any time, had “positive sciatic nerve root tension signs” within the meaning of cl 5.8 and table 6.8 of the Guidelines.
Mr Ma therefore has not satisfied the Panel that he had two or more of the five signs of radiculopathy (within the meaning of cl 5.8 of the Guidelines) at any time since the accident. It is the decision of the Panel that the claimant does not have a nerve root injury manifesting in radiculopathy and that any nerve root injury he may have, is a threshold injury.

Were the L4/5 and L5/S1 annular tears caused by the accident?

Section 1.6(2) of the MAI Act provides a “complete or partial rupture of tendons, ligaments, menisci or cartilage” is not a threshold injury.
The medical members of the Panel note that the discs in the claimant’s spine comprise two parts, a nucleus pulposis and an annulus fibrosis. The latter is a fibrous-cartilaginous ring that surrounds the former. It is the clinical judgment of the Medical Assessors that a traumatic tear in the ring would be, in the Panel’s view a complete or partial rupture of “tendons, ligaments, menisci or cartilage.” If that traumatic tear was caused by the accident this would therefore be a non-threshold injury.
The Medical Assessors note that the annulus fibrosis can degenerate and dry out as a person ages causing fissures in the ring. It is the clinical experience of the medical members of the Panel that radiologists will often use the terms “tear” and “fissure” to describe the same thing.
The real issue in this matter then is whether the extraforaminal annular “tear” at L4/5 and the postero-central annular “tear” at L5/S1 was caused by the accident or not.
The Panel makes the following preliminary observations based on statements from the decision of Briggs v IAG Limited t/as NRMA Insurance[18] in the decision:
(a) the test of causation is whether the accident could have caused the injury (tears) and whether the accident did in fact cause the injury [paragraphs 74 and 75], and
(b) the onus of proving, on the balance of probabilities, that the accident did cause the injury lies with the claimant [paragraph 73].
[18] [2022] NSWSC 372.

Could the accident have caused the tears in the discs of the lumbar spine?

The Panel has limited documentation about the accident itself. There is no documentation of the speed of impact and no statement from the insured driver. The only photograph provided does not appear to show any damage, but there is a tow bar which the Panel notes could have absorbed an impact preventing more significant damage to Mr Ma’s vehicle.
The Panel notes both cars were driveable after the accident and there is a record that

Mr Ma’s airbags did not deploy. It is the Panel’s experience that if the insured’s airbags had deployed then his car would not have been driveable therefore the Panel is proceeding on the basis that the insured’s airbags did not deploy. This then suggests to the Panel that the speed of the insured vehicle at impact is unlikely to be greater than 30 kmph as it is the Panel’s experience that airbags will not deploy at a speed below about 30 kmph. Therefore, the forces involved in the accident do not appear to be significant but in the absence of any expert evidence, the Panel can make no more specific observation.
Mr Ma described a rear end collision with forces being applied directly to the rear of his vehicle. He says he felt his body moving forward but that his seatbelt stopped him moving further forward. He did not hit his head and his body did not hit any part of the inside of the cabin.
The Medical Members of the Panel are not satisfied on this evidence that the tears reported in the MRI of 5 February 2021 could have been caused by the accident because in their clinical experience tears of the annulus fibrosis at two levels would require a significant force and a mechanism of lifting and twisting and Mr Ma did not describe a mechanism of injury with much or any movement of his lower back.

Did the accident cause the tears in the discs of the lumbar spine?

If the Panel is wrong and the mechanism of the accident could have caused the tears in the discs of the lumbar spine, the Panel would not be satisfied that the accident did in fact cause the tears for the following reasons:
(a)    there was no immediate complaint of pain (just a complaint of generalised whole of body weakness which the medical members of the Panel consider to be a shock type response to the accident). The claimant was quite clear that he felt no pain in his back or legs until a few days after the accident. If the claimant had injured his lower back sufficiently to cause two tears to the discs in his lumbar spine or further tear any pre-existing tears, the medical members of the Panel would expect there to be an immediate complaint of severe pain;
(b)    the nature and pattern of the treatment provided. The claimant did not seek more urgent treatment (at hospital for example) and waited five days to see his GP. He then had sporadic treatment and very limited treatment between March 2021 and May 2023. If the claimant had sustained a lumbar spine injury sufficient to cause tears in two discs (or further tears in two discs), the medical members of the Panel would expect greater complaints of pain and more significant levels of treatment;
(c)    the Medical Assessors note the radiology report describes many degenerative changes such as at L2/3 (dehydrated disc), a small bulge at L3/4 with mild foraminal stenosis, a broad-based bulge at L4/5 with stenosis and mildly arthritic facet joints and at L5/S1 reduced disc height, a small bulge and mild foraminal stenosis. These findings at multiple levels with the tears seen at two levels are in the clinical judgment of the medical members of the Panel an indicator that the tears are not traumatic but were pre-existing;
(d)    the claimant indicated to Dr Tamba-Lebbie some lower back symptoms requiring chiropractic treatment before the accident, the claimant said any lower back symptoms he had were at the time of a gall-bladder issue. The Panel notes there is no evidence of any significant pre-accident lumbar spine symptoms, no pre-accident radiculopathy or specialist treatment. However, the claimant is 40 years of age and works as a carpenter. He described relatively heavy work after the accident (including lifting weights of up to 20kg) and would have been involved in heavier work before the accident. It is the clinical experience of the Panel is that persons of the claimant’s age and occupation will often have changes in their spine such as tears or fissures in the annulus fibrosis at multiple levels which are asymptomatic, and
(e)    the claimant describes symptoms since the accident which were predominantly left sided but which now, almost three years after the accident include symptoms of “pins and needles” down the whole of the right leg. The radiology does not, in the clinical judgment of the medical members of the Panel provide a cause for these right sided symptoms.
The Panel is not satisfied that the claimant’s L4/5 and L5/S1 annular tears are caused by the accident and therefore the Panel is of the view that any lumbar spine injury has not resulted in the complete or partial rupture of the annulus fibrosis at either level.

CONCLUSION

While the Panel is satisfied that the claimant sustained a lumbar spine injury in the accident, the Panel is not satisfied that the claimant has sustained an injury to a nerve or nerve root manifesting in lumbar radiculopathy or that the two tears in the discs of his lumbar spine were caused by the accident.
The Panel therefore finds that the claimant’s injuries caused by the motor accident on

9 December 2020 are soft tissue, threshold injuries.
As the Panel has come to a different conclusion to Medical Assessor Tamba-Lebbie, the Panel will therefore revoke his certificate.

Type of active movement in Mr Ma’s lumbar spine	Maximum range as measured with a goniometer	Whether Mr Ma demonstrated the active range of movement consistently across 3 tests
Flexion forward	Half of the normal range	Inconsistent by up to a quarter of the normal range
Extension	Half of the normal range	Inconsistent by up to a quarter of the normal range
Right rotation	Half of the normal range	Consistent
Left rotation	Half of the normal range	Consistent

[2023] NSWPICMP 652

5 December 2023