Allianz Australia Insurance Limited v Maggiotto
[2023] NSWPICMP 84
•7 March 2023
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Allianz Australia Insurance Limited v Maggiotto [2023] NSWPICMP 84 |
| CLAIMANT: | Gianluca Maggiotto |
INSURER: | Allianz Insurance (Australia) Limited |
| REVIEW Panel | |
| MEMBER: | Alexander Bolton |
| MEDICAL ASSESSOR: | Drew Dixon |
| MEDICAL ASSESSOR: | Shane Moloney |
| DATE OF DECISION: | 7 March 2023 |
| CATCHWORDS: | MOTOR ACCIDENTS – Review of decision of Medical Assessor Harrington dated 11 April 2022; claimant involved in car versus motorbike accident on 19 April 2018; claimant suffered compound fracture of the right forearm, fractured jaw and four broken teeth, deep laceration to chin requiring stitches, laceration and bruising to left testicle, reasoning and abrasions to left inner thigh and testicles, bruising to rib cage around chest, clicking pelvis area, injury to his lumbar spine; claimant nearly 20 years old at time of accident; seven months post-accident, claimant developed deep vein thrombosis of left leg and urinary incontinence; Review Panel satisfied that as a result of the collision due to the claimant riding a motorbike that he could have suffered the injuries claimed; the Review Panel was not satisfied that the deep vein thrombosis and urinary incontinence diagnosed seven months post-accident was causally related to the accident as there was no evidence to this effect; Held – whole person impairment assessed at 13% with diagnosis related estimate (DRE) Category II assessment of lumbar spine at 5% and 4% for the wrist and 4% for facial and wrist scarring. |
| DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Determination The Panel revokes the certificate of Medical Assessor Harrington dated 11 April 2022. The Panel determines that the following injuries were caused by the motor accident and have a whole person impairment assessment: (a) lumbar spine; musculoligamentous injury to the lower back, the buttocks and the pelvis; (b) wrist; displaced fracture of the distal radius and ulna in the region of the right wrist, and (c) scarring. The Panel finds a combined whole person impairment assessment of 13%. The Panel determines that the following injuries were not caused by the accident: (a) left leg – DVT (swelling in the legs and not being able to move) and developed urinary incontinence. The injuries caused by the motor accident have a total whole person impairment of 13%. |
Background
The insurer has sought a review of Medical Assessor Harrington’s (the MA) Certificate dated 23 February 2022 on the following grounds:
(a) failure to consider relevant and available material;
(b) failure to provide adequate reasons and articulate the path of reasoning for the determination, and
(c) failure to appropriately evaluate the current impairment with a deduction for pre-existing impairment, in accordance with s 6.31 of the Permanent Impairment Guidelines (the Guidelines).
The MA found as follows;
“The following injuries caused by the motor accident give rise to a permanent impairment of 13 % and is greater than 10%:
a) Right Wrist fracture – 9% WPI
b) Left Hip – 2% WPI
c) Scarring – 2% WPI.”
The following injuries were referred by the Personal Injury Commission (the Commission) for assessment:
(a) lumbar spine; musculoligamentous injury to the lower back and the buttocks and the pelvis;
(b) wrist; displaced fracture of the distal radius and ulna in the region of the right wrist;
(c) left hip;
(d) scarring, and
(e) left leg – deep vein thrombosis (DVT).
At page 235 of the claimants bundle of documents, the claimant provided a submission to the effect that there is correspondence between the claimant solicitors and insurers solicitors dated 21 and 22 June 2022 confirming that an agreement had been reached to include scarring on the claimant’s left hip in the list of injuries to be reviewed by the Panel. It is stated that these injuries are assessed by the MA in his certificate dated
23 February 2022. The insurer consented to this by letter dated 22 June 2022.
The accident
The accident occurred on 19 April 2018. The claimant was riding a motor bike in Adamstown near Newcastle. The driver of the insured car turned right, across the path of the claimant and a collision occurred.
The injuries
In the personal injury claim form, the claimant says that he suffered the following injuries;
(a) compound fracture of the right forearm (ulna and radius bones);
(b) fractured jaw and four broken teeth;
(c) deep laceration to chin requiring numerous stitches;
(d) laceration and bruising to left testicle;
(e) bruising and abrasions to left inner thigh and testicles, and
(f) bruising to rib cage around chest, clicking in pelvis area.
Insurer’s submissions
The insurer notes that on the last page of the MA’s certificate he has assessed 9% whole person impairment (WPI) for impairment caused by the motor vehicle accident, which it says seems inconsistent with the first page which recorded 13% WPI.
The insurer says that it is unclear if the MA has considered the insurer’s documents. Whilst the assessor refers to the “Claim Form, Complete Application (226 pages) and the Reply Form”, there is no reference to the additional material relied upon by the insurer, for example, the report of Dr Mitchell who examined the claimant on its behalf.
The insurer says that it is unclear if the MA considered the contemporaneous treating notes, not referred to specifically but presumably those of John Hunter Hospital, when assessing range of motion. The insurer noted that the MA recorded the following wrist movements on examination by him;
| Wrist Movements | Active ROM Measured RIGHT | Active ROM Measured LEFT |
| Flexion | 30° | 60° |
| Extension | 30° | 60° |
| Radial Deviation | 10° | 20° |
| Ulnar Deviation | 15° | 30° |
The insurer says however, that there is no reference to pre-accident wrist movements which are divergent to the MA’s findings.
The treating notes of John Hunter Hospital confirms that the claimant had previously broken his right wrist following an earlier motor vehicle accident in 2016. An entry of
8 February 2016 recorded the following, concerning right wrist range of motion:(a) flexion - 50°;
(b) extension - 55°;
(c) pronation - 80°, and
(d) supination – full.
The insurer submits that whilst the MA says that the claimant’s right wrist was asymptomatic at the date of the accident, an entry from Broadmeadow Medical Centre dated 15 December 2017 (four months pre-accident) recorded “right wrist pains and noted positive finklesteins (suggesting a diagnosis of De Quervain's Tenosynovitis which can limit range of motion)”.
The insurer says that there was reference to the claimant having had a plate two years earlier for a distal radius fracture.
Post-accident, the insurer submits that there have also been different reports on the claimant’s range of movement. An entry by an occupational therapist of 4 June 2018 contained within the treating notes of John Hunter Hospital confirmed ongoing ache over ulna side of wrist, but pain free supination. The range of motion was recorded as follows:
(a) flexion - 60°;
(b) extension - 70°;
(c) pronation - 80°, and
(d) supination - 90°.
The insurer submits that Dr Mitchell, who examined the claimant on 13 February 2020 recorded;
“The elbows, wrists and hands examined normally, with normal movement in the
right elbow and wrist. Right wrist joint movements were normal.”The insurer also submits that the claimant’s own expert, Dr Bodel who examined the claimant on 2 December 2019 recorded the following:
| Wrist Movements | Active ROM Measured RIGHT | Active ROM Measured LEFT |
| Flexion | 40° | 60° |
| Extension | 40° | 60° |
| Radial Deviation | 20° | 20° |
| Ulnar Deviation | 25° | 30° |
| Pronation | 70° | 80° |
| Supination | 70° | 80° |
The insurer says that the MA has made no comment in relation to the above discrepancies, nor has he provided any explanation as to why they differ to his assessment. The insurer says that the MA makes no mention at all to Dr Mitchell’s report, suggesting that it was not considered in his assessment.
The insurer submits, further, that the MA has failed to address a similar issue concerning the claimant’s range of motion in the hip. In relation to the left hip,
Dr Mitchell reported that “The left leg was clinically normal, with normal movement in the left hip”. The insurer says that Dr Bodel also confirmed “There is no restriction of hip…”The insurer submits it is unclear how the MA has measured this reduced range of motion of the hip, and why it has differed from the prior assessments.
The insurer submits the MA’s failure to consider the insurer’s material evidence, goes to the failure to consider the relevant material at hand, as well as the failure to adequately articulate his path of reasoning as to the restriction of range of movement in relation to both the right wrist and hip, is an error.
The insurer says that the claimant has failed to appropriately evaluate the current impairment with a deduction for pre-existing impairment, in accordance with s 6.31 of the Guidelines. In this regard the insurer notes that the MA recorded that following the accident, the plates from the claimant’s previous wrist fracture were removed and an open reduction with internal fixation of the right distal radius and ulna was performed.
The insurer has raised that there was no deduction for the pre-existing injury or scarring. The insurer relies on s 6.31 of the Guidelines which states:
“If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident, then its value must be calculated and subtracted from the current WPI value.”
The insurer confirmed that there had been no deduction for the claimant’s prior wrist fracture.
The insurer had previously provided submissions with respect to the claimant’s initial application for WPI assessment. These submissions are to the effect that the claimant has made a good recovery from his injuries and that these would not exceed 10% WPI.
Claimant’s submissions
The claimant submits that it is clear that the MA has considered the material attached to the insurer’s reply form as he has quoted sections of it in his certificate.
The claimant submits that the MA has provided sufficient reasoning in respect of his assessment of the left hip. Concerning the evaluation of permanent impairment of the claimant’s wrist, the claimant relies on the Guidelines which say that this may be complicated by the presence of an impairment in the same region that existed prior to the relevant motor accident. If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident, then its value should be calculated and subtracted from the current WPI value. If there is no objective evidence of pre-existing symptomatic permanent impairment, then its possible presence should be ignored.
The claimant submits that with regard to his right wrist, the insurer has submitted that the MA is obligated to assume that the prior injury to the claimant’s right wrist caused a permanent impairment.
The claimant says that the insurer relies on a recording of the right wrist range of motion from two and a half years prior to the subject motor vehicle accident and one entry in Dr Sait’s clinical records of right wrist pain.
The claimant says that regarding the entry on 15 December 2017 referred to by the insurer, whilst the claimant does not deny making such a complaint, equally, he cannot recall it. The claimant says that there were no investigations of the right wrist carried out in the four months leading up to the accident and the claimant did not wear a brace at this time.
Further the claimant submits that his employment records indicate no days absent from work at this time.
Following on from this submission the claimant notes the gap in the clinical records of Dr Sait between 27 March 2015 and 13 July 2016. The claimant submits this is indicative of the lack of ongoing issues the 2016 right wrist fracture caused. The claimant also notes that the first mention of the 2016 wrist fracture in Dr Sait’s clinical records is two years later on 16 December 2017.
The claimant submits that the MA gives his reasoning for not making a deduction to the assessment of the right wrist as follows:
“Although he had a previous fracture with internal fixation, he denies any restricted movement or reduced capacity for work as a motor mechanic prior to the subject motor accident in 2018. Therefore, there are no deductions.”
The claimant submits that the insurer has failed to identify any subjective evidence which would indicate the above statement is incorrect. Further, the claimant says that the recording of some pain in the right wrist might at best give rise to the possibility of an impairment, however, the claimant submits that the MA is not obligated to make that assumption and in this circumstance was correct to ignore it.
Medical evidence
The claimant relies on a report of Dr Bodel dated 2 December 2019.
The claimant reported that he had ongoing pain, stiffness and weakness in the region of his right wrist and arm. His grip strength was slightly weak and he said that he has difficulty applying torsional forces with his right arm because of the fracture. The claimant said that he cannot do push-ups because of problems with his right arm. He said that he has lower back pain aggravated by bending, twisting or lifting. He has stiffness in the back of the pelvis.
A restricted range of wrist movement was reported as follows;
| Wrist Movements | Active ROM Measured RIGHT | Active ROM Measured LEFT |
| Flexion | 40° | 60° |
| Extension | 40° | 60° |
| Radial Deviation | Z0° | Z0° |
| Ulnar Deviation | Z5° | 30° |
| Pronation | 70° | 80° |
| Supination | 70° | 80° |
Dr Bodel reported the scarring as being mildly complex surgical scarring with some tenderness in the scar and some pigmentation but no tethering to underlying deep structures. The Panel presumes this is a reference to scarring of the right wrist and not scarring on the claimant’s chin.
Dr Bodel said that the diagnosis was a displaced fracture of the distal radius and ulna in the region of the right wrist and a soft tissue musculoligamentous injury to the lower part of the back on the buttocks and pelvis. This occurred in the motorcycle accident on 19 April 2018.
Dr Bodel said the claimant had a rateable restriction of right wrist movement which he assessed using figure 26 on page 36 and figure 29 on page 38 and figure 35 on page 41 of the American Medical Association’s Guides to the evaluation of permanent impairment (AMA4). He said that this constituted a 9% upper extremity impairment which converted to a 5% WPI.
Dr Bodel said that the claimant has a Diagnosis Related Estimate (DRE) lumbosacral category II level of assessable impairment in the lumbosacral spine with the description in table 72 on page 3/110 of AMA4 and that gives a 5% WPI rating.
Regarding scarring, Dr Bodel rated this as a 1% WPI in accordance with the Table for the Evaluation of Minor Skin Impairment (TEMSKI) scale because of the mild pigmentation and sensitivity on palpation but there was no tethering to underlying deep structures.
Combining the three ratings on the combined values chart on page 322 of AMA4 gives an 11% WPI on the assessment of Dr Bodel.
The John Hunter Hospital records note confirmation of the radius, ulna and mandible fractures.
A CT scan of the cervical spine showed a mandibular neck fracture on the left but no other acute fracture or dislocation of the cervical spine.
It was recorded that the claimant underwent surgery consisting of right forearm open reduction and internal fixation and removal of distal radius hardware.
The hospital discharge notes record reference to lower back pain and pelvic pain, amongst other things, at the time of admission.
The clinical records of Dr Sait note a surgery consultation on 15 December 2017. A complaint of right wrist pain is recorded with no reciprocating trauma. The claimant was reported to have a positive Finklesteins test. This is with respect to the claimant’s right hand and unrelated to the accident . The action proposed was for an ultrasound of the right thumb and an X-ray of right wrist noting that the claimant had a plate inserted two years previously for a fracture of his distal radius. The records indicate no further consultation with respect to any complaint to the wrist until after the accident consultation took place on 26 April 2018.
The insurer arranged for a medico legal examination of the claimant with Dr Mitchell who provided a report of 6 March 2020.
The claimant reported occasional left hip/groin pain which is particularly noticed early on some mornings. He also felt tightness and fatigue in the forearm on an occasional basis and particularly after using the right wrist for arduous activities at work. The claimant also complained of intermittent back pain which he said can occur to a level of 4/10 and of which he is particularly aware in the mornings after waking.
Regarding the claimant’s previous fracture of his right wrist, he informed the doctor that this occurred in the motorcycle accident in 2016. He reported that the fracture resolved fully in a short period of time.
Dr Mitchell said that the previous fracture of the right forearm had fully resolved prior to the accident.
Dr Mitchell said that the claimant had made a good recovery from his right wrist fracture involving the distal radius and ulnar bones following open reduction and internal fixation surgery. However, no WPI assessment was provided for this area of injury.
With regard to the claimant’s pain in his lumbar back, left groin and right forearm, the doctor said that this was of an apparent soft tissue nature as there was no current clinical evidence of significant underlying injury.
Dr Mitchell only assessed the claimant’s lumbar spine WPI and said that it had characteristics of a DRE I impairment and that there was 0% WPI with respect lumbar spine.
Dr Mitchell said there was no clinical abnormality in the left groin right forearm and so there was no rateable impairment.
The claimant was assessed by the MA who provided his certificate on 23 February 2022. The MA found WPI of the right wrist at 9%, WPI of the left hip at 2% and scarring at 2%. The right wrist assessment was based on Figures 26, 29 and Table 3 of AMA4.
The MA noted a well healed scar over his right ulna. The plates are subcutaneous on that ulnar side. The MA said that the claimant might feel better with the hardware removed, although it will not change his range of movement. It was reported that the claimant had lost a significant amount of wrist movement.
Wrist measurements were as follows;
| Wrist Movements | Active ROM Measured RIGHT | Active ROM Measured LEFT |
| Flexion | | |
| Extension | | |
| Radial Deviation | | |
| Ulnar Deviation | | |
For restricted movement of the right wrist the MA relied on figure 26;
“Flexion to 30° - 5% upper extremity impairment (UEI)
Extension to 30° - 5% UEI
Figure 29;
Radial deviation to 10° - 2% UEI
Ulnar deviation to 15° - 3% UEI”These were added and equate to 15% upper extremity impairment. Using Table 3 this converts to 9% WPI for the right wrist.
The MA found a 20° loss of external rotation of the left hip, by way of comparison to the right hip which had normal range of motion. The MA said that given the timeframe, the restricted movement of his left hip was unlikely to change. The MA did not provide a specific WPI assessment for the left hip when discussing this. However, in his summary, he provided a WPI assessment of 2% for the left wrist which the Panel assumes is an incorrect reference and which should have been to the left hip.
The MA said that although the buttocks and pelvis had been included in the assessment for the lumbar spine, the restricted range of movement of the claimant’s hip was likely to be a separate injury given the extensive bruising down his leg and the laceration to his left testicle. Although the left hip was not specifically included in the assessment details, the MA believed the restricted movement was causally related to an impact injury.
The MA noted that the claimant had an impairment for the tender scar on the ulnar side of his right forearm, which is painful when resting his wrist. The claimant was also reported to be conscious of the appearance and location of the scars with occasional unwelcomed comments. Using the TEMSKI guide, this was calculated by the MA at 2% WPI.
The MA also found a 2% WPI for restricted movement of the left hip.
Adding the three WPI assessments gives a total of 13%.
Within the claimant’s bundle of documents was a four page statement dated
2 March 2021. Only three of four pages have been attached to the bundle.
The claimant reported that he had trouble at work undoing bolts, he is a mechanic, and that he became fatigued more easily. He said that most of the work he carries out as a mechanic involves use of his right hand and the work causes constant aggravation of his injuries.
The claimant refers to scars on either side of his arm where he had surgery. He is self-conscious about them.
In the mornings he has pain in the area of his pelvis radiating mostly to the left side.
Panel medical examination of the claimant
The claimant was examined on behalf of the Panel by Medical Assessor Dixon. His report follows:
“This claimant was involved in a motor vehicle accident when he was riding his motorbike through an intersection when hit by a car, knocked off his bike, landing onto the road. He was taken to John Hunter Hospital at Newcastle and scans showed a compound fracture of his right distal radius and ulnar fracture and also there was a left subcondylar mandible fracture. There was a laceration to the right side of his chin together with broken teeth, low back strain and pelvic pain with left testicle haematoma and abrasion.
The following day, he had open reduction and internal fixation and debridement of his radius and ulna fractures on the right and his mandible fracture did not require operative intervention.
On 22 April 2018 he was discharged and had follow up at the fracture clinic and review by his GP. He subsequently had dental treatment for his left upper molar tooth with removal of an implant and crowns for broken teeth. He did attend his GP, Dr Samuel Nosike, on 24 June 2019 complaining of pain in the left testicle, left hip and right forearm and was prescribed Escitalopram which he preferred not to take. He had an ultrasound arranged of his scrotum on 26 June 2019 which was normal but still continued to have groin pain on the left.
He was referred for physiotherapy for his left hip and forearm and for psychological counselling for ongoing post traumatic anxiety.
He was working as a full time apprentice motor mechanic at the time of the subject accident. He had a few days off work after the accident and did light duties for two months before returning to normal duties. His main difficulty at times has been leaning and stooping while doing automotive assessments for repairs and pink slips for registration.
On review today he was 173cm tall and weighed 72kg.
There was a depigmented 3cm hypertrophic scar at his chin that was readily visible as there was no hair growing in the scar. He reports that when he shaves, this scar is tender and is prone to bleed on occasion with the occasional nick and he is conscious of the scar which he is readily able to localise and is readily visible.
He reports pain and stiffness in his right wrist and is aware of longitudinal at scarring at his right wrist on the volar side and on the dorsum. Both scars are tender and he reports are painful if bumped and he finds them disfiguring and they are visible with summer clothing.
He did have an injury to his right wrist in 2016 when involved a motorbike accident and sustained a fracture of his right radius which required open reduction and internal fixation. That plate and screws remained in situ until he came to have surgery for his compound fracture in April 2018. The hardware inserted for this fractured radius and ulnar on the right remain in situ.
He reports that his injury to his left hip has not completely settled although he feels there has been some improvement to his lumbar spine with some residual stiffness and has difficulty with repetitive bending and stooping while doing motor mechanic assessments and has difficulty with heavy lifting and carrying of backpacks, particularly up and down steps. He reports persisting pain in his left groin which is aggravated by prolonged running and he is unable to jog without discomfort and although he has a walking tolerance of one hour, he has ongoing groin pain.
He reports a sitting and standing tolerance of one hour. He has a driving tolerance of over one hour. He has been able to perform recreations such as fishing and photography but has great difficulty cleaning the toilet and bathroom, spring cleaning, cleaning windows, lifting and carrying heavy groceries and doing the garden and lawns and cleaning the car and difficulty with repetitive tasks including meal preparation, cooking and playing team sports. He has some difficulty with foot care.
There were two longitudinal scars at the right forearm, 12cm on the volar side where the scar was pigmented, showing colour contrast, and was hypertrophic and was tender to the touch and was irregular. It was superimposed on a previous shorter scar for his radial fracture previously in 2016.
The dorsal longitudinal scar of the right forearm and wrist is also hypertrophic and irregular and is tender and shows colour contrast. Both scars are visible with summer clothing and he remains conscious of them and both scars are painful if bumped, impacting on his activities of daily living (ADLs).
There was stiffness of the right wrist with dorsi flexion 50 degrees, palmar flexion 40 degrees, ulnar deviation was 30 degrees and radial deviation 15 degrees and pronation was full but supination was decreased by one quarter. He had full flexion and extension of his right elbow and full range of motion of the shoulders, left elbow, left wrist and full range of motion of the fingers and thumbs of both hands. He had a full range of motion of the cervical spine and there was no neurological deficit of either upper limb. There was 2cm of wasting of his left upper arm (he is right handed).
There was no neurovascular deficit in his right hand with thenar power, intrinsic power and grip strength grade 5 out of 5 and no objective sensory changes.
There was stiffness of his lumbar segment with flexion decreased by one third with pain on back extension which was in the left paralumbar area where there was slow and jerky recovery with erector spinae muscle spasm.
There was tenderness adjacent to the mid line in the region of the L4/5 facet joints.
Lateral flexion to the left was decreased by one quarter and that to the right by one third and associated with left paralumbar pain. His straight leg raise was 70 degrees bilaterally and there was no neurological deficit or wasting of either lower limb. His toes were down going and his reflexes were symmetrical, sensation was normal and there was no wasting.
There was pain in his left groin on hip rotation particularly internal rotation. The range of motion of both hips was symmetrical. His Trendelenberg test for both hips was negative. His normal gait was satisfactory and toe walking was satisfactory but heel walking was associated with tightness in the right groin and his squat test was satisfactory. There was deep tenderness in his right groin.
There was no apparent inguinal hernia or cough impulse. There was no flexion contracture of the left hip and the range of motion of both hips was flexion of 120 degrees without flexion contractures and adduction was 30 degrees, abduction 35 degrees of both hips, external rotation was 35 degrees and internal rotation 25 degrees for both hips, that is, symmetrical.
In summary this claimant has sustained multiple injuries in the subject motor vehicle accident. Clinically his compound fractures of his right forearm have consolidated with post traumatic stiffness of the right wrist.
There is considerable hypertrophic scarring of his volar and dorsal scars at his right forearm which remain tender and impact on his ADLs and are readily visible with summer clothing and he finds them disfiguring.
The scar on his chin impacts on his ADLs such as shaving and is readily visible as hair does not grow in the area so there is a very visible pale line on his chin, which remains hypertrophic and tender.
He has groin pain with a full range of motion of the left hip.
There is mild lumbar stiffness with some erector spinae muscle spasm on the left but no sciatica nor radiculopathy.
His impairment assessment is as follows:
That for his facial scar on the chin is from Table 4, AMA IV, 2% WPI.
That for the forearm scars is from Table 8.1 which impact on his ADLs, is 3% WPI less 1% for his previous scar at the distal radius, giving 2% WPI.
That for the restricted range of motion of his right wrist is from Pie Charts 26, 29 and 35, AMA IV, 7% upper extremity impairment which equates to 4% WPI on table 3. Pie chart 35 refers to the restricted rotation at the wrist namely supination and is included in the wrist assessment. Pie Chart 35 is relevant as the stiffness of rotation (pronation and supination) is at the wrist and is due to stiffness at the distal radio-ulnar joint after wrist injury, there being no injury to the elbow in this case.
The Panel accepts that the claimant would have suffered a back injury after the motor bike accident and the findings of dysmetria, erector spinal spasm and tenderness of the lumbar spine (although without sciatica). He has sufficient clinical signs to be DRE II, for the lumbar spine, 5% WPI.
That for his lumbar spine is from Table 72, AMA IV, DRE Category II, 5% WPI.
That for the left hip, where he has groin pain without stiffness, is from Table 40, AMA IV, 0% WPI.
This gives a total of 4% (wrist), 2% + 2% (facial and wrist scarring) plus 5% (for the lumbar spine), giving a combined total of 13% WPI.
There is a total from the Combined Values Chart of 13% WPI.
There were no symptomatic pre-existing conditions.”The Panel adopts the findings of Medical Assessor Dixon.
The Panel notes that the findings of Medical Assessor Dixon are different to the measurements recorded by other doctors. The Panel attributes this to an improvement of condition of the claimant from the time of the accident to the time of examination. There were no inconsistencies of presentation.
Causation
The claimant was involved in a motor vehicle accident on 19 April 2018. He was riding a motorbike. The insured car turned in front of the claimant and the ensuing collision caused him to be thrown onto the road. He was taken to John Hunter Hospital .
The Panel has concluded that it would not be unreasonable for the claimant to suffer the following injuries arising out of the accident;
(a) compound fracture of the right forearm (ulna and radius bones);
(b) fractured jaw and four broken teeth;
(c) deep laceration to chin requiring numerous stitches and scarring;
(d) laceration and bruising to left testicle;
(e) bruising and abrasions to left inner thigh and testicles;
(f) bruising to rib cage around chest, clicking in pelvis area, and
(g) injury to his lumbar spine, as a direct consequence of this accident.
In the particular circumstances of this accident, the Panel is satisfied that the injuries suffered by the claimant are causally related to the accident occurring on
1 September 2018.The Panel has seen no evidence to link the subsequent diagnosis of a deep vein thrombosis and urinary incontinence some seven months post accident as being causally related to the accident.
Determination
The Panel revokes the certificate of the MA dated 11 April 2022.
The Panel determines that the following injuries were caused by the motor accident and have a WPI assessment:
(a) lumbar spine; musculoligamentous injury to the lower back, the buttocks and the pelvis;
(b) wrist; displaced fracture of the distal radius and ulna in the region of the right wrist, and
(c) scarring.
The Panel finds a combined WPI assessment of 13%.
The Panel determines that the following injuries were not caused by the accident:
(a) left leg – DVT (swelling in the legs and not being able to move) and developed urinary incontinence
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