Allianz Australia Insurance Limited v Sekar

DETERMINATION OF REVIEW PANEL
CITATION:	Allianz Australia Insurance Limited v Sekar [2025] NSWPICMP 675
CLAIMANT:	Vidhya Sekar
INSURER:	Allianz Australia Insurance Limited
REVIEW PANEL
MEMBER:	Bianca Montgomery-Hribar
MEDICAL ASSESSOR:	Drew Dixon
MEDICAL ASSESSOR:	David Gorman
DATE OF DECISION:	5 September 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury dispute; application for review under section 7.26; degree of permanent impairment also assessed in MAC; agreed by parties for permanent impairment to be assessed by Review Panel if non-threshold injury found; injury to cervical spine; issue as to causation; issue as to potential inconsistency between reports and contemporaneous documents; claimant re-examined; David v Allianz Australia Insurance Ltd considered and followed; Held – injuries non-threshold for the purposes of the Act; no inconsistency between reports by claimant and contemporaneous documents; no reports of subsequent injuries; accident caused injuries; permanent impairment assessed at 5% being not greater than 10%; no allowance for pre-existing or subsequent injuries; MAC revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 1. The Review Panel: a. revokes the certificate of Medical Assessor Mohammed Assem dated 17 March 2025; b. certifies that the claimant has a tear of the annulus of the C6/7 disc, right paracentral disc protrusion, and a previous finding of radiculopathy caused by the accident, being a non-threshold injury for the purpose of the Motor Accident Injuries Act 2017, and c. certifies that the claimant’s degree of permanent impairment arising from the injury caused by the accident is 5%, being not greater than 10%. A statement setting out the Panel’s reasons is included with this certificate.

STATEMENT OF REASONS

INTRODUCTION

On 13 September 2023, Vidhya Sekar (claimant) was involved in a motor vehicle accident on Old Windsor Road, Kellyville, when the vehicle she was driving was hit from behind by a 12-seater van (accident).
Allianz Australia Insurance Limited (insurer) is the third-party insurer liable to pay Ms Sekar statutory benefits under the Motor Accident Injuries Act 2017 (NSW) (MAI Act).
A dispute has arisen between Ms Sekar and the insurer as to whether her cervical spine injuries were caused by the accident and, if so, whether this is a threshold injury for the purposes of the MAI Act.
Whether Ms Sekar has suffered threshold injuries as a result of the accident affects her entitlement to both statutory benefits and damages: see ss 3.11, 3.28 and 4.4 of the MAI Act.
The dispute was referred to Medical Assessor Mohammed Assem. By certificate dated 17 March 2025, Medical Assessor Assem determined that the cervical spine – soft tissue injury, right C6/7 radiculopathy is not a threshold injury for the purposes of the MAI Act. Medical Assessor Assem also assessed Ms Sekar’s degree of permanent impairment arising from this injury.
The insurer lodged a review application in relation to the certificate of Medical Assessor Assem under s 7.26 of the MAI Act in respect of his assessment of threshold injury. On 1 May 2025, a delegate of the President determined there was reasonable cause to suspect that the medical assessment was incorrect in a material respect and the matter was referred to a review panel.
This review panel (the Panel) has been constituted to conduct a review of Medical Assessor Mohammed Assem’s certificate dated 17 March 2025 in respect of his assessment of threshold injury (Review).

LEGISLATIVE FRAMEWORK

Threshold injury

A threshold injury is defined in s 1.6 of the MAI Act and includes a “soft tissue injury”.
Section 1.6(4) of the MAI Act provides that the regulations may exclude or include a specified injury from being a threshold injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the Regulations) further defines threshold injury as follows:
“4 Meaning of ‘threshold injury’, section 1.6(4) of the Act
(1)An injury to a spinal nerve root that manifests in neurological signs (other than radiculopathy) is included as a soft tissue injury for the purposes of the Act.
…
Note— See section 1.6 (5) of the Act in relation to the making of Motor Accident Guidelines for or with respect to the assessment of whether an injury is a threshold injury.
…”
Sub-section 1.6(5) of the MAI Act provides that “[t]he Motor Accident Guidelines may may provision for or with respect to the assessment of whether an injury is a threshold injury for the purposes of this Act”.
The Motor Accident Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. Version 9.3 of the Guidelines is applicable to the current accident.[1]
[1] The Panel notes that version 10 of the Guidelines has been published, but does not commence until 15 September 2025.
Part 5 of the Guidelines sets out the procedure for assessing whether an injury caused by the accident is a threshold injury for the purposes of the MAI Act, and provides the following general provisions for assessment:
“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.4    Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. Diagnostic imaging is not considered necessary to assess threshold injury.
5.5    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.
5.6    The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b) a review of all relevant records available at the assessment
(c) a comprehensive description of the injured person’s current symptoms
(d) a careful and thorough physical and/or psychological examination
(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
Relevantly, cls 5.7 to 5.9 regard “Soft tissue assessment – injury to a spinal nerve root” and provide:
“5.7 In assessing whether an injury to the neck or spine is a soft tissue injury, an assessment of whether or not radiculopathy is present is essential.
5.8 Radiculopathy means 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 when they are assessed in accordance with ‘Part 6 of the Motor Accident Guidelines: Permanent impairment’.
(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
(e) reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.
5.9 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.”

Review procedure

Pursuant to Schedule 2, cl 2(e) of the MAI Act, whether the injury caused by the accident is a threshold injury for the purposes of the Act is a medical assessment matter.
Section 7.1 defines a medical assessment matter as “a matter declared by Schedule 2 to be a medical assessment matter for the purposes of this Part”.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act, at first instance by a Medical Assessor,[2] and on review by a review panel.[3]
[2] Section 7.20, MAI Act.
[3] Section 7.26, MAI Act.
Section 7.26(5A) of the MAI Act provides that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (the Commission).
Part 5 of the Personal Injury Commission Act 2020 (PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a panel reviewing a decision of a Medical Assessor: s 41(2) PIC Act. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5. A review panel determines how it conducts and determines the proceedings.

PROCEDURAL HISTORY

On 9 May 2025, the Panel made directions for the filing of a bundle of documents by each of the parties containing the documents and submissions they relied upon for the purposes of the Review.
On 23 June 2025, the Member of the Panel convened a preliminary conference with the parties. It was noted that, on 9 May 2025, a separate review panel found Ms Sekar’s request for a C6/7 anterior cervical discectomy and fusion surgery related to injury caused by the accident and is reasonable and necessary in the circumstances (matter M22364/24). Noting the findings of the review panel in matter M22364/24, the Panel wished to understand whether Ms Sekar intended to undergo the surgery and, if so, the timing of the surgery. This was to enable the Panel to schedule any medical examination at an appropriate time.
Ms Furfaro confirmed that Ms Sekar does wish to proceed with the surgery, however she anticipated that it would not be arranged for several months and requested that the Panel proceed with its Review rather than await the surgery. The insurer also put on written submissions contending that the Panel should proceed with the Review prior to the surgery.
Accordingly, the Panel confirms that it is conducting the Review on the basis that Ms Sekar has not had the surgery approved in matter M22364/24. Any potential impact of the surgery does not form part of the medical dispute before the Panel.[4] It is unnecessary for the Panel to determine whether the surgery could constitute or exacerbate an injury for the purposes of the MAI Act.
[4] See Mandoukos v Allianz Australia Insurance Limited [2024] NSWCA 71 at [73] to [78] and [90].
Also at the 23 June 2025 preliminary conference, the Panel noted the insurer’s submissions as to causation. Ms Davis confirmed that the insurer was relying on the same documents that were before the review panel in matter M22364/24, with the addition of the supplementary bundle.
On 10 July 2025, the Panel met in relation to the Review. The Panel determined that an examination of Ms Sekar was required and proposed to conduct this examination via MS Teams. The Panel also noted s 7.26(6) of the MAI Act and that Medical Assessor Assem determined Ms Sekar’s degree of permanent impairment as part of his assessment. Accordingly, the Panel informed the parties that, should the Panel find that Ms Sekar’s injuries caused by the accident are not threshold, the Panel proposed to review the totality of the assessment and determine the resulting degree of permanent impairment. The Panel provided the parties with the opportunity to make submissions on both this issue and Ms Sekar’s degree of permanent impairment.
On 17 July 2025, the insurer noted that it did not object to the Panel determining Ms Sekar’s degree of permanent impairment in the event the Panel finds that Ms Sekar has sustained a non-threshold injury. However, the insurer submitted that the re-examination of Ms Sekar should take place in person rather than via video, given cl 6.20 of the Guidelines.
Ms Sekar did not make submissions on the issue of the Panel determining Ms Sekar’s permanent impairment, but provided submissions dated 27 November 2024 in respect of Ms Sekar’s permanent impairment.
After consideration of the insurer’s submissions, the Panel varied its directions made on 17 July 2025 and directed for the medical examination of Ms Sekar to occur in person on 21 August 2025.
Following this medical examination, Medical Assessor Gorman provided his examination report to the other members of the Panel. The Panel then met a second time on 25 August 2025 to discuss the medical examination and determine its findings.

ASSESSMENT UNDER REVIEW

Medical Assessor Mohammed Assem examined Ms Sekar on 14 March 2025 and issued a certificate on 17 March 2025. The assessment referred to the Medical Assessor was “Injury to the cervical spine – radiculopathy and disc herniation” in respect of disputes regarding threshold injury and permanent impairment.
The Medical Assessor certified that the cervical spine – soft tissue injury, right C6/7 radiculopathy, is not a threshold injury for the purposes of the MAI Act, and that it gave rise to a permanent impairment of 10%, being not greater than 10%.
The Medical Assessor referred to Ms Sekar’s past history, including her neck pain, and her symptoms and treatment following the accident. The Medical Assessor noted that the gap in medical records between 14 September 2023 to 23 November 2023 presented a challenge in precisely determining the onset of Ms Sekar’s neurological symptoms and assessing whether her engagement in weight training played a contributory role.
The Medical Assessor opined that, based on the evidence provided by Ms Sekar, there appeared to be a direct causal relationship between the accident and Ms Sekar’s current neurological deficits. He noted that, while she had a prior history of left-handed symptoms, she developed a distinct and new onset of right-handed symptoms post-accident, which correlate with radiological findings. He found the presence of sensory loss in the C6/7 dermatomal distribution, combined with a reduction in her triceps jerk reflex, is consistent with radiculopathy as outlined in the Guidelines. The Medical Assessor opened that the cervical spine – soft tissue injury, right C6/7 radiculopathy was caused by the accident and not a threshold injury.
The Medical Assessor opined that the injuries sustained in the accident give rise to an impairment that is now permanent. He opined that Ms Sekar’s presentation with chronic neck pain and right C6/7 radiculopathy warranted a DRE Cervicothoracic Category III classification and an impairment rating of 15%.
The Medical Assessor noted Ms Sekar’s longstanding history of neck pain requiring treatment, and that pre-accident she was symptomatic, undergoing investigations and receiving treatment for numbness in her left hand. He noted that there was insufficient evidence to confirm radiculopathy prior to the accident and that the available medical records suggest she had non-verifiable radicular complaints, consistent with a DRE Cervicothoracic Category II classification and a pre-existing impairment rating of 5%.
The Medical Assessor opined a final impairment rating of 10% after deducting the pre-existing impairment of 5% from the total impairment rating of 15%.

SUBMISSIONS

Insurer’s submissions

The insurer relies on two sets of submissions dated 5 June 2025 and 26 June 2025. The Panel has also considered the insurer’s submissions dated 2 April 2025 regarding the application for review of Medical Assessor Assem’s assessment.
The insurer submits that, if Ms Sekar sustained any injuries in the accident, those injuries were limited to threshold injuries.
The insurer submits that Ms Sekar’s pre-accident medical records confirm significant and long-standing pre-existing injuries to her cervical spine, which extend to over seven years prior to the accident. In support of this submission, the insurer refers to extracts of Ms Sekar’s pre-accident medical history, including references to neck pain with radiculopathy in the records of her previous general practitioner (GP), Dr Packiam.
The insurer notes the records of Rouse Hill Family Medical Practice refer to Ms Sekar having previously experienced compression in her cervical spine and that she “had traction 10 years ago”.
The records of Merindah Medical Centre (MMC) included a report of a CT of the cervical spine and a CT of the lumbosacral spine undertaken on 1 June 2020, which referenced cervical spine degenerative changes, mild canal stenosis at C4/5 and C5/6, minor foraminal narrowing, and disc bulging indenting the thecal sac, partially effacing the L5 nerve roots in the lateral recesses.
The insurer notes a June 2020 appointment with Dr Packiam where Ms Sekar reported she had not done any exercises for her neck and back.
The insurer also references a GP management plan provided in June 2020 for “CT scan - cervical spine degenerative changes – C4/C5-C6, lumbar disc herniation, muscles spasm – neck and back”. The treatments included physiotherapy, remedial massage, exercises and relaxation of the muscles of the back and neck.
The insurer references the records of Ms Sekar’s physiotherapist and chiropractor from 2020 and 2021, both of which record Ms Sekar reporting neck pain and low back pain. This includes records which note Ms Sekar had been waiting with stiffness in her arm and her range of motion on examination was recorded to be 75% in extension, rotation and lateral flexion.
The insurer refers to the notes of Dr Packiam dated 19 November 2020 that Ms Sekar had right side hand pain and weakness, no tremors and that the “right side hand was heavier than the left side”, and the records of 5 September 2022 where it was recorded that Ms Sekar had neck pain with shoulder issues and cervical spondylosis. Ms Sekar was referred for a "CT scan neck (cervical radiculopathy?)".
The insurer refers to Ms Sekar’s post-accident medical evidence and submits that the first report of the accident was to Dr Aman Madan at the Rouse Hill Family Medical Practice on 14 September 2023. The insurer submits Dr Madan’s impression was Ms Sekar had suffered whiplash and no imaging was required. On examination there was no palpable tenderness and it was recorded Ms Sekar had full range of motion.
The insurer refers to Ms Sekar’s chiropractic treatment post-accident on 18 September 2023 and submits this treatment was for pain in the lumbar spine and trapezius muscles and did not involve the cervical spine. On 21 September 2023, Ms Sekar is alleged to have reported a restricted range of motion in the cervical spine, pain in the upper back and neck, and pain with left neck movements. The insurer notes her new patient form responded “No” when asked if she had currently or previously been diagnosed with any medical conditions.
The insurer notes Ms Sekar consulted Dr Hawkins, GP, on seven occasions regarding her cervical spine and submits no reference was ever made to Ms Sekar being involved in a motor vehicle accident. The insurer refers to the reason for contact on 23 November 2023 as “cervical radiculopathy” and highlights Dr Hawkin’s reference to “severe cervical radiculopathy” on 23 January 2024.
The insurer notes Dr Hawkins’ consultation notes dated 23 November 2023 which record Ms Sekar complained of numbness and pins and needles radiating from the fingers to the neck for the past two weeks, and refer to the clamant “going to the gym and doing weightlifting last month”.
The insurer submits that it appears Ms Sekar never reported being involved in a motor accident to Dr Hawkins and Ms Sekar’s cervical spine injury was treated as an injury sustained while exercising and lifting weights at the gym a month prior to her first consultation on 23 November 2023.

The insurer submits that the findings of the CT of Ms Sekar’s cervical spine performed on 24 November 2023, particularly at C5/6 and C6/7, are consistent with the results of the CT cervical spine performed on 1 June 2020. The insurer submits that any injury to the cervical spine was pre-existing.
The insurer submits Ms Sekar’s account in the notes of Dr Hawkins that she had been “going to the gym and doing weightlifting last month” demonstrates that for nearly two months following the accident, Ms Sekar had no difficulty or injury prohibiting her from carrying out exercises at the gym and undertaking weightlifting. Even if Ms Sekar is suffering from an exacerbation of a pre-existing condition, the insurer says that any exacerbation was not caused by the accident and was caused from an injury sustained while exercising and weightlifting.
The insurer submits that in the history obtained from Dr Raoul Pope on 13 February 2024 it is reported Ms Sekar was “previously well”. The insurer submits that Dr Pope was not provided with any details of Ms Sekar’s relevant pre-accident history, and notes that there is no reference to the subsequent injury sustained by Ms Sekar following the accident while she was at the gym and weightlifting.
The insurer notes Dr Pope’s examination and his review of the MRI of the cervical spine dated 23 December 2023. Dr Pope’s recommended a decompression of the nerve to prevent further deterioration.
The insurer notes that the records of Dr Pope’s consultation with Ms Sekar on 27 February 2024 record her symptoms in the neck and right upper limb had “deteriorated”. However, the insurer submits there is nothing in Dr Pope’s findings on examination that are different to his initial findings.
The insurer submits that it is clear Ms Sekar did not suffer any injury to her cervical spine in the accident.
The insurer’s submissions extract and summarise aspects of the certificate and reasons of Medical Assessor Truskett dated 23 October 2024 and the Review Panel in matter M22364/24 dated 12 May 2025.
In respect of the findings of the Review Panel in matter M22364/24, the insurer refers to the Review Panel’s statement that there are signs of radiculopathy with sensory change corresponding to the C6/7 dermatomes and a positive foraminal compression test. As to the positive foraminal compression test, the insurer submits that this is not a clinical sign of radiculopathy under the Guidelines and therefore radiculopathy has not been confirmed.
The insurer’s submissions also summarise the certificate and reasons of Medical Assessor Assem dated 17 March 2025.
The insurer submits that Medical Assessor Assem failed to adequately evaluate the inconsistencies in the history provided by Ms Sekar, particularly in regard to her prior and subsequent injuries to her cervical spine.
The insurer submits that the contemporaneous records very clearly document Ms Sekar’s ongoing symptoms prior to the accident and a gym-related injury sustained while weightlifting after the accident. The insurer further submits that Ms Sekar’s denial of the relevant components of her history is an attempt by her to attribute all her current symptoms to the accident.
The insurer submits that, where a claimant provides an inconsistent history, their evidence must be carefully considered and corroborated with the contemporaneous records, referring to Kemp v Insurance Australia Limited t/as NRMA Insurance [2024] NSWPICMP 260.
The insurer refers to Evans v Braddock [2015] NSWSC 249 and Nominal Defendant v Cordin [2017] NSWCA 6 and submits that greater weight should be placed on contemporaneous records and, where a claimant provides an inconsistent history, their evidence must be carefully considered and corroborated with those records. While the insurer recognises that QBE Insurance (Australia) Limited v Alawia [2016] NSWSC 1875 provides that it is a matter for the Medical Assessor to determine the weight to be placed on evidence, the insurer submits that contemporaneous evidence ought be given the greatest weight, particularly in circumstances where Ms Sekar’s evidence is inconsistent. The insurer submits that this is because Ms Sekar’s treating providers would have no reason to misstate those facts, in comparison with Ms Sekar who is evidently of the view that denying the facts documented in the contemporaneous evidence would be beneficial to her claim.
The insurer further submits that, in addition to addressing inconsistencies with a claimant, an assessment of Ms Sekar’s credibility should be made. In support, the insurer refers to Hartanto v Vodafone Hutchinson Australia Pty Limited [2021] NSWPICMP 71.
Relevantly, the insurer submits that Ms Sekar initially admitted she had returned to weightlifting at the gym in November 2023, as evidenced by the records of Dr Hawkins, Ms Sekar later clarified that she had not been lifting heavy weights and was certain her symptoms were related to the accident.
The insurer also submits that the Medical Assessor failed to provide reasoning why he accepted that the new onset of right-handed symptoms were caused by the accident.
The insurer submits that it was only in late November 2023 that Ms Sekar first reported developing right upper limb symptoms, being two months after the accident. The insurer submits that Ms Sekar’s right sided symptoms were not caused by the accident as she:
(a)    did not have any tenderness or restricted motion in the cervical spine the day after the accident;
(b)    had self-reported symptoms of left-sided trapezius tenderness the day following the accident;
(c)    did not report any right sided symptoms in the two months after the accident;
(d)    was capable of returning to the gym and weightlifting without restrictions after the accident, and
(e)    first reported right-sided symptoms on 27 November 2023, after presenting with symptoms of numbness and pins and needles after a gym injury.
The insurer also submits that the Medical Assessor failed to correctly apply Table 6.8 of the Guidelines in his assessment of whether radiculopathy was present as there was no asymmetry in the triceps jerk reflex.
The insurer was provided with an opportunity to make submissions on whether the Panel should await Ms Sekar’s approved surgery prior to making its determination on the threshold injury dispute. The insurer submitted that the Panel should not delay its determination pending Ms Sekar’s surgery.
The insurer submits that there have been several conflicting Review Panel decisions regarding the impact of surgery on the threshold/non-threshold issue. The insurer places reliance on the obiter comments made by Stern JA in Mandoukos v Allianz Australia Insurance Limited [2024] NSWCA 71 at [99]. The insurer submits that it is clear from these comments that the Court of Appeal strongly doubted whether consequential surgery could transform a threshold injury to a non-threshold injury.
The insurer submits that the fact that Ms Sekar intends to undergo surgery to her cervical spine is not relevant to the threshold/non-threshold issue.

Claimant’s submissions

Ms Sekar relies on her submissions dated 23 April 2025 in reply to the insurer’s application for review, and her submissions dated 27 November 2024 regarding her degree of permanent impairment. These submissions have been considered by the Panel.
Ms Sekar’s submissions dated 23 April 2025 focus on the correctness of Medical Assessor Assem’s assessment and certificate. In summary, Ms Sekar submits that the assertions by the insurer are unsubstantiated, speculative and insufficient in determining whether the Medical Assessor made a material error.
For the purposes of the Panel’s review, Ms Sekar submits that the records post-dating the accident reveal the injuries sustained in the accident, as opposed to any pre-existing issues.
Ms Sekar submits that the Medical Assessor’s findings correlate with the radiological findings, that he considered the available evidence before him, and that he adequately assessed causation.
Ms Sekar submits that the Medical Assessor has correctly applied Table 6.8 of the Guidelines, referring to paragraph 17 of his certificate.
Ms Sekar’s submissions dated 27 November 2024 focus on Ms Sekar’s permanent impairment dispute. Relevantly, Ms Sekar submits that, as a result of the accident, she has sustained injuries to her cervical spine.
Reference is made to her application for personal injury benefits where she reports “After the accident my entire neck became stiff, my hands were paining. Further CT scans / MRI reveal that I have a disc bulge C6/7 on my neck”.
It is noted that Dr Nigel Hawkins reported on 23 November 2023 that Ms Sekar experienced numbness and pins and needles in her fingers, travelling to her back. On 8 December 2023, Ms Sekar reported ongoing pain in the right shoulder to Dr Hawkins and was referred for an MRI of the cervical spine.
Ms Sekar submits that the MRI undertaken on 9 December 2023 concluded:
“Disc bulging of the C6/7 level with broad-based right paracentral/foraminal disc protrusion with high grade right moderate to high-grade left-sided foraminal stenosis and impingement of bilateral C7 nerve roots. If cervical radicular symptoms are present, a CT-guided selective perineural inject may be considered.
Central canal stenosis and mild cord compression of C4/5 without myelomalacia.”
The attendance on Dr Hawkins dated 23 January 2024 reports Ms Sekar experiences severe cervical radiculopathy and ongoing discomfort with no improvements. She continued to report pain down her arm and difficulty sitting for more than ten minutes.
Ms Sekar also relies upon the reports of Dr Raoul Pope from February 2024. Dr Pope determined Ms Sekar had two levels of disc bulging at C6-7 and C5-6, with C6-7 causing severe C7 nerve root compression and chronic C7 radiculopathy.
Ms Sekar submits that Dr Pope’s report dated 30 April 2024 notes Ms Sekar continued to experience neck and right upper limb radicular symptoms. Upon examination, she had tenderness in the cervico-thoracic junction and ongoing mild weakness of her finger extension and triceps.
Reference is also made to the clinical notes of Charbel Daher, which reports sharp pain radiating to Ms Sekar’s hands, and that sitting for long periods aggravates her condition.
Ms Sekar relies on the clinical notes of Newington Chiropractic, and says it is evident that she had significant restrictions as a result of the injury sustained to her cervical spine. The following is recorded: ongoing restrictions to her range of motion, upper back and neck tightness, flare ups, and inflammation of the cervical spine. Sleeping issues as a result of her injury are also recorded.
Ms Sekar submits that her physical injury exceeds the 10% permanent impairment threshold.

EVIDENCE BEFORE THE PANEL

In response to the Panel’s direction, the insurer lodged a bundle of documents containing the evidence it relied on for the purposes of the Review. Ms Sekar confirmed that she relied on the medical evidence submitted by the insurer.
In addition to the bundle of documents lodged at the direction of the Panel, an Application to Lodge Additional Documents was registered on 17 June 2025 by the insurer. The application consisted of employment records from Ms Sekar’s employer. These were accepted by the Panel on 17 June 2025 and have also been considered.

Statement of Ms Sekar

Ms Sekar relies on a signed statement dated 28 February 2024. This statement sets out Ms Sekar’s recollection of the accident and the injuries she says she sustained, relevantly being “Injury to neck – radiculopathy and disc herniation”. Ms Sekar outlines her disabilities and restrictions that she says result from the injuries.
Her statement also sets out the impact the injuries have had and continue to have on her life.
Ms Sekar sets out her treatment regime, including current medications and treatment providers.
Her statement sets out her previous injuries and medical conditions, as well as previous medical providers. She states she was generally in good health at the time of the accident and “ha[s] not suffered from any prior injuries or medical conditions other than those mentioned above”.
The Panel notes that her statement does not mention any prior injuries or medical conditions except those said to be caused by the accident. Ms Sekar also states she has no prior disabilities.
Ms Sekar states that the accident occurred on a Wednesday and she was not due to return to work until the following Monday. She notes she has a “very sympathetic employer” who allows her to work at her own pace and allowed her to “remain home and take rest from 17 January 2024 to 5 February 2024”. The Panel notes this period is approximately four months post-accident and is not clear why rest was required at this time.
Ms Sekar states that, while she has continued to work following the accident, this is not without difficulty. She says she requires frequent breaks and often needs to change position and move around.

Claim management records

Application for personal injury benefits

In Ms Sekar’s application for personal injury benefits dated 16 February 2024, she describes the accident as follows:
“I was driving my car at the 80kmph speed. Suddenly a 20 seater Renault master van came and crashed my car behind [sic]. I could not control the car and the jerk forced my head. The car was thrown onto the other side of [the] road.”
She outlines the injuries she received as a result of the accident as:
“After the accident, my entire neck became stiff, my hands were paining [sic]. Further CT scans / MRI reveal that I have a disc bulge C6/C7 on my neck.”
In response to the question of whether she was suffering an illness or injury affecting the same or similar parts of her body at the time of the accident, Ms Sekar has ticked “No”.
Ms Sekar reports that she has not been away from work as a result of the accident.

Liability notice – benefits after 52 weeks

The insurer’s Liability Notice – benefits after 52 weeks dated 10 July 2024 informed Ms Sekar that the insurer did not accept liability for payment of statutory benefits beyond 52 weeks from the date of the accident, based on its decision that her injuries are “threshold injuries” for the purposes of the MAI Act.
This notice concluded that the insurer did not accept the injury of radiculopathy to the cervical spine based on information that indicated this injury was preexisting.

Internal review

The insurer’s Certificate of Determination – Internal Review dated 7 August 2024 affirmed the decision that Ms Sekar’s injuries were “threshold injuries” for the purposes of the MAI Act.
It was noted that the internal reviewer had reference to the documents before her, including the clinical notes Ms Sekar’s treating doctors and chiropractor, the reports of Dr Pope, Ms Sekar’s allied health recovery requests, and the Activities of Daily Living Assessment.
The internal reviewer stated that Ms Sekar had a long-documented history of cervical spine pain and radiculopathy.
The internal reviewer states that it appears Ms Sekar’s pre-accident physiotherapy in 2020 and 2021 was not disclosed to her treating practitioners, and Dr Pope was not aware of her previous history of a cervical spine condition.
The internal reviewer noted that, while she accepted that there has been a diagnosis of cervical radiculopathy provided by Ms Sekar’s GP, physiotherapist and Dr Pope, she was not satisfied that this was made on the basis of a full and accurate history of Ms Sekar’s cervical spine condition. The insurer specifically referenced Ms Sekar’s imaging in the three years prior to the accident which concluded the presence of degenerative changes and disc bulging. The insurer also noted that she was not satisfied the diagnoses of radiculopathy were in accordance with the Guidelines, as none of the practitioners identified the presence of two or more clinical signs to warrant the diagnosis.
The internal reviewer was satisfied that Ms Sekar sustained an injury to her cervical spine as a result of the accident, but considered this to be a “soft tissue injury”, being a threshold injury for the purposes of the MAI Act.

Pre-accident medical records

Precision Health Spine and Sports Clinic

The records of Precision Health Spine and Sports Clinic, dated 3 October 2024, have been considered.
Ms Sekar’s new patient form was signed 15 June 2020. It notes her health concerns to be “Low back pain” with severity 7 out of 10 (with 10 being the worst imaginable pain), noting this started while pregnant and was present for three months, and “Neck pain” with severity 8 out of 10, noting this pain started after delivery and was present for seven months. Ms Sekar describes the pain as sharp and that her neck pain radiates to her hands. In terms of her current exercise level, “Nil” has been circled with a note “Boot camp. Weight loss. Working → Volleyball”.
The records include a referral form for Allied Health Services under Medicare for patients with a chronic medical condition and complex needs dated 26 June 2020, prepared by Ms Sekar’s GP.
The records note Ms Sekar attended 13 appointments between 15 June 2020 and 29 August 2020. There are no treatment notes from the clinic.

MyPhysio Baulkham Hills

The records of MyPhysio Baulkham Hills printed 26 July 2024 have been considered. These consist of 13 treatments, commencing 6 June 2020 and concluding 23 March 2021.
The notes dated 6 June 2020 note a history of the presenting illness, which includes “neck P 7 years ago - sitting P burning L shoulder 2min – agg: turning to L – LBP bending+ lifting, walking – nil P limiting – STS P to leg – AM: stiff, first ten steps – PM: - sleep: P pressure on R – 7 /12 c sec, sciatica – 3/12 LBP – nil prev injuries”.
The notes of 4 February 2021 record “Lumbopelvic pain for over a year, started during 2^nd pregnancy, daughter now 14 mo. Has seen chiro 5 months back for about 10 sessions, got a bit better but never resolved. Did not have core and pelvic strengthening exs during or after pregnancy. Also has neck pain another time to R/V”. It is noted she has a sedentary lifestyle, walks for exercise and is a stay at home mum. The provisional diagnosis was lumbopelvic pain. There is no reference to Ms Sekar’s cervical spine.
On 8 February 2021, it is recorded “Felt quite sore in lumbar spine post Rx as warned, but the day after everything started to feel better”.
On 24 February 2021, it is recorded “The lower back is doing better but the neck suddenly became painful 2 days ago, has been struggling with sleep”.
On 26 February 2021, it is recorded “Neck pain was better post treatment but has been feeling worse since yesterday”.
The notes of 3 March 2021 record “Neck pain is getting better but has been waking up very stiff in the am”.
The notes of 5 March 2021 record “Neck pain significantly better, only experiencing some morning stiffness and end of range pain with rotation to the right”.
The notes of 9 March 2021 record “Neck is 90% better, just some end range pain and morning stiffness”.
The notes of 12 March 2021 note “no issues to complain of, keen to start doing Pilates exs”.
The final notes, of 23 March 2021, record “sore neck this morning upon waking, mid upper thoracic when looking down”.

Merindah Medical Centre (MMC)

The records of MMC printed 8 March 2024 have been considered. A summary of relevant extracts are set out below, noting that not all relevant entries have been included:
(a)    on 2 March 2019, Ms Sekar reported positional low back pain. Ms Sekar was pregnant at the time;
(b)    on 24 February 2020, it is recorded “Has underlying cervical spine pain, possible nerve root irritation. Also notised [sic] pain in her mid thoracic region”. She was advised to undergo physiotherapy. On examination she had tenderness in her thoracic spine, no para spinal tenderness, and her range of movements were normal;
(c)    on 26 May 2020, Ms Sekar reported neck pain. Relevantly, the notes record “Cervical spondylosis – traction – cervical – physio. Numbness and burning in the hands – left side is”. A CT scan of the neck and cervical spine and a CT scan of the lower back region was requested due to left hand burning and numbness and severe pain in the lower back, noting Ms Sekar was unable to move after bending. Patient education leaflets regarding exercises for the lower back and neck were printed, and Ms Sekar was encouraged to walk for a few minutes each day;
(d)    on 2 June 2020, it was recorded that Ms Sekar “feels bet[t]er” but had not done her exercises;
(e)    on 23 June 2020, Ms Sekar reported she had commenced physiotherapy and chiropractic sessions, and noted the chiropractic sessions are “helping a bit”;
(f)    on 9 July 2020, Ms Sekar reported neck pain, which is getting better with Panadol, back pain on the right side and left side wrist pain;
(g)    on 21 August 2020, Ms Sekar reported back pain and that sessions with Charbel Daher (chiropractor) are helpful;
(h)    on 19 November 2020, Ms Sekar reported right side hand pain and weakness, and pins and needles, swelling and pain in her hand;
(i)    on 2 August 2022, the records note “back pain lumber unfused L5. Nil other. Chiro”, and
(j)    on 5 September 2022, it was noted “neck pain with shoulder issues. Had cervical spondylosis – in college”. A CT scan of the neck was requested due to suspected cervical radiculopathy.

Post-accident medical and imaging records

Certificate of capacity / certificate of fitness

Ms Sekar’s certificate of capacity / certificate of fitness dated 19 February 2024 has been considered. In respect of diagnosis of motor accident related injuries, it is noted “Disc bulging at C5/6 and C6/7, disc bulge at C6/7 causing severe C7 nerve root compression, chronic C7 radiculopathy”. Ms Sekar is noted to have capacity for eight hours of work per day, three days per week.

Dr Aman Madan

The clinical records of Dr Aman Madan, GP, have been considered.
Relevantly, the records consist of one entry, dated 14 September 2023, which notes:
“Whiplash injury – MVA yday - 2:30pm in car, 16 seater van rear-ended her at 80kmh, was wearing seatbelt – car went forward and she managed to park car – was in SUV, photos seen, car intact – air bags not deployed – sore neck, back – L eye ache- worse on straining / reading. no blurred vision – headache. Pmhx – Cspine- ?compression, had traction 10yrs ago”. Under “Examination” it is relevantly noted “C and T spine- no palp tenderness, fun ROM – c/o tenderness L trapediuz. imp: whiplash – no imaging needed”

Dr Nigel Hawkins

The clinical records of Dr Nigel Hawkins, GP, dated 23 January 2024 have been considered. A summary of relevant extracts are set out below, noting that not all relevant entries have been included:
(a)    on 23 November 2023, it is noted “past 2 weeks - numbness and pins and needles stated in fingers and now going up to neck – headache today – going to gym and doing weight lifting last month – good shoulder movement – wrist and hands ok – diagnostic imaging requested CT c spine”. The “Reason for contact” is listed as “Cervical Radiculopathy”;
(b)    on 27 November 2023, it is noted Ms Sekar attended for the results of CT of neck. The records include “rang Rouse Hill radiology. Cervical spondylosis. Foramenal narrowing at R c6c7. Mri recommended. Consistent with symptoms. Refer to chiropractor [sic]”. Lyrica 25mg was prescribed;
(c)    on 8 December 2023, Ms Sekar reported she was still having pain in her right shoulder, noting “seeing the chiropractor x5 already”. It was noted to “consider steroid injection after ct scan”. In respect of the referral for the MRI C Spine it is stated:
“Cervical spondylotic changes are as described. On the symptomatic right side, the most significant level of foraminal narrowing is at the right C6/7 foramen, however the exact degree of foraminal stenosis is difficult to assess due to artefact. I would suggest, given the patient’s symptomology, more accurae evaluation with an MRI of the cervical spine”;
(d)    on 13 December 2023, Ms Sekar attended for the results of her MRI scan of the cervical spine. The report of the MRI scan is extracted. The clinical notes also state “pain is just on the R – just inject the R side – therapeutic and diagnostic option of surgery if not lasting effect”, and
(e)    on 23 January 2024, it is noted “severe cervical radiculopathy – neck injection not helping – cannot sit for more than 10 min – pain goes down her arm – cannot type – still getting quite severe pain – taking lyrica 25mg occasionally – has tried chiro not on care plan – wants a care plan of physio.” Ms Sekar was referred to Body Focus Wellness Centre.

Helical Health / The Hills Doctors

The records of Helical Health / The Hills Doctors as at 29 February 2024 have been considered.
Ms Sekar first attended the practice on 19 February 2024 and saw Dr Kumari Obeyeskera, GP. Ms Sekar noted ongoing pains and discomfort, and that she was awaiting discectomy and fusion. A certificate of capacity was organised. The report of Dr Pope dated 13 February 2024 was included in the notes.

Newington Chiropractic

The records of Newington Chiropractic, printed 23 March 2024, have been considered.
The records include notes from five appointments from 18 September 2023 to 7 December 2023. The notes record several symptoms including restricted cervical range of motion, pain with neck movements and restricted range of motion in neck, and tingling in right pointer, thumb and middle finger.
In respect of “presenting complaint”, it is noted “Tight in the back – can’t sit for very long - Accident Wednesday 3pm – 11pm had headaches – Body Pains – Started feeling pain from Thursday”. In respect of Ms Sekar’s “Physical Activity and Training” it is recorded “Home Exercises – Walking and running”.
On 4 December 2023, it is recorded “Patient progress report: Tingling unchanged; Has been doing gym workouts in the gym – low force”.

Rouse Hill Radiology

The reports of Rouse Hill Radiology have been considered.
On 24 November 2023, Ms Sekar underwent a CT of her cervical spine. Under “Clinical History” it is noted “Past 2 weeks numbness and pins and needles started in fingers but going up neck now. Headache. Going to gym and doing weight lifting last month”. The “Findings” include:
“… At C4/5, there is a small posterocentral disc protrusion with mild central canal stenosis. There is a left uncovertebral osteophyte with mild left foraminal stenosis. There is no significant right foraminal stenosis. At C5/6, there is a broad-based posterior uncovertebral disc osteophyte complex with mild central canal stenosis without significant foraminal stenosis. At C6/7, there is a broad-based posterior osteochondral bar with mild central canal stenosis and moderate right and mild left foraminal stenosis, however assessment is difficult due to streak artefact...”
The CT of the cervical spine concludes “I would suggest, given the patient’s symptomology, more accurate evaluation with an MRI of the cervical spine”.
On 9 December 2023, Ms Sekar underwent an MRI scan of her cervical spine. This included the following findings:
“There is normal cervical spine alignment, no facet joint subluxation or fracture seen. There is no evidence of a Chiari variant. … At the C4/5 level, there is disc desiccation and broad- based disc bulging with mild bilateral foraminal stenosis. There is mild central canal stenosis without cord compression or myelomalacia. No nerve root compression visualised. Facet joints appears unremarkable. At the C5/6 level, there is mild posterior disc bulging with mild to moderate left foraminal stenosis and mild right-sided foraminal stenosis without nerve root compression. There is central canal stenosis without cord compression. The facet joints appear unremarkable. At the C6/7 level, there is broad-based disc-osteophyte complex with a right paracentral/foraminal broad-based disc protrusion with high-grade right and moderate to high-grade left-sided foraminal stenosis with impingement of the bilateral C7 nerve roots, more pronounced on the right side. There is canal stenosis without cord compression. Facet joints appear unremarkable. At the C7/Tl level, there is no notable finding.”
Under “Conclusion” it is noted:
“Disc bulging of C6/7 level with broad-based right paracentral/foraminal disc protrusion with high-grade right and moderate to high-grade left-sided foraminal stenosis and impingement of bilateral C7 nerve roots. If cervical radicular symptoms are present, a CT-guided selective perineural injection may be considered. Central canal stenosis and mild cord compression of C4/5 without myelomalacia.”

Dr Raoul Pope

On 13 February 2024, Ms Sekar attended upon Dr Raoul Pope, neurosurgeon and spine surgeon. Dr Pope prepared a report for Dr Obeyesekera, noting that Ms Sekar presented with neck pain for four months and right upper limb pain for three months.
Dr Pope’s report notes that approximately three to four weeks after the accident Ms Sekar developed symptoms of radicular component down the right arm in the right triceps, posterior forearm and to the wrist and thumb, forefinger and middle fingers. Her daily symptoms include burning aching pain, pins and needles, numbness and weakness of the arm. It is noted that her left upper limb is normal and there are no lower limb symptoms.
It was noted that chiropractic treatment initially helped but then worsened Ms Sekar’s symptoms. A cortisone injection targeting C7 in December 2023 offered minimal benefit.
On examination, it was noted that Ms Sekar had a range of movement of her neck to less than 75% in all directions, Positive Spurling’s manoeuvre towards the right and no Lhermitte’s sign. There was some tenderness in the interscapular zone to deep palpation. Her rotator cuff examination was unremarkable. Tone in her upper limbs was normal. There was a weakness of triceps and finger extension grade 4/5 on the right and an absence of triceps jerk on the right side with diminished sensation over C7 on the right side. Finger release test, alternating finger test, tandem gait normal. There were no sensory changes in the thoracic or abdominal dermatomes.
Dr Pope’s opinion was Ms Sekar has two levels of disc bulging at C6-7 and C5-6, with C6-7 causing severe C7 nerve root compression and chronic C7 radiculopathy.
On 27 February 2024, Ms Sekar attended a follow up consultation with Dr Pope. Dr Pope’s report to Dr Obeyesekera notes Ms Sekar had deteriorated with her symptoms of neck and right upper limb radiculopathy consistent with C7. She was reported to have ongoing weakness and altered sensation in the right upper limb down to the fingers.
On examination, Dr Pope noted a weakness of finger extension and triceps grade 4/5 on the right, 1cm of wasting around the mid biceps on the right side and an absent triceps jerk on the right side and diminished sensation over C7 on the right. Positive Spurling's manoeuvre towards the right and tenderness in the interscapular zone. It was noted her lower limb examination was unremarkable.
Dr Pope reported a large C6-7 disc rupture on the right side with foraminal stenosis, and a C5-6 and C4-5 central disc bulging but minimal foraminal stenosis. There was noted to be some mild foraminal stenosis on the right C5-6 level.
Dr Pope advised he had offered Ms Sekar a C6/7 anterior cervical discectomy fusion to prevent further deterioration and help current symptoms.
Dr Pope recommended Ms Sekar continue with her physiotherapy exercises, keep her lifting to less than 5kg, and continue working as much as she can.
On 27 February 2024, Dr Pope referred Ms Sekar to Dr Alan Nazha, pain specialist, for opinion and management of Ms Sekar’s pain.

Allied Health Recovery Request

The Allied Health Recovery Requests dated 11 March 2024 and 11 June 2024 of Mrs Silvia Salama of Bodyfocus Wellness Centre has been considered.
These note the diagnosis as “cervical radiculopathy affecting the right upper limb”. Under pre-existing factor(s) relevant to the injury it is noted “Nil”.

Greenlight Activities of Daily Living Assessment Report

The Greenlight Activities of Daily Living Assessment Report dated 24 June 2024 was considered. The symptoms reported by Ms Sekar are recorded as:
“Headaches, radiating down the right side of the body down to her chest and ribs, described as a feeling of ‘being pulled apart’ occurring on average twice a week, exacerbated with prolonged driving and heavy lifting and cold weather, rated as 7-8 on the Visual Analogue Scale for pain where 0 equates to no pain and 10 equates to worst pain imaginable.
Pain and stiffness in the neck.
Numbness down the right arm with numbness in the right thumb and second and third digits, described as constant in nature, rated as a 7-8 on the VAS.
Weakened grip strength on the right.”
The report notes a discussion was conducted with Ms Sekar’s GP, Dr Obeyeskera, on 20 June 2024 in which Dr Obeyeskera advised that Ms Sekar had nil pre-existing conditions. Dr Obeyesekera noted Ms Sekar underwent a CT scan of the cervical and lumbar spine in 2020, but advised that “…as noted by Dr Pope, [Ms Sekar’s] current symptoms are due to the MVA occurring on the 13 September 2023”.
The reported / observed abilities of Ms Sekar during the assessment have been considered and evaluated by the Panel.
In respect of Ms Sekar’s leisure activities, it is recorded that Ms Sekar enjoyed running, walking, gardening, painting and cooking prior to the accident. It is stated that she has not been able to resume any of these activities since the accident. The Panel notes there is no reference to Ms Sekar weightlifting or attending the gym pre- or post- accident.

Employment records

The bundle of records from Ms Sekar’s employer, The Salvation Army Australia Territory, have been considered. These records include Ms Sekar’s Statement of Earnings from her join date, being 22 August 2023, to 22 May 2025. The records also include Ms Sekar’s leave, position description and a response to questions. While it is unclear who asked and responded to these questions, the Panel has assumed these were questions posed by the insurer and responded to by Ms Sekar’s employer.

Certificate and reasons of Medical Assessor Truskett

The certificate resulting from the Medical Assessment – Earning Capacity and Treatment (Physical) undertaken by Medical Assessor Phillip Truskett dated 23 October 2024 has been considered by the Panel.
Medical Assessor Truskett examined Ms Sekar on 12 September 2024. The Medical Assessor was asked to assess:
“whether the claimant’s C6/7 anterior cervical discectomy and fusion in relation to the physical injury:
(a) relates to the injury caused in the motor vehicle accident; and
(b) …is reasonable and necessary in the circumstances.”
The Medical Assessor noted Ms Sekar’s psychosocial and pre-accident history. Relevantly, it was reported that Ms Sekar denied previous neck symptoms, but indicated she had previous pain in the left side of her neck and left shoulder in 2019. This pain persisted for approximately eight months and was due to feeding her newborn son. She attended Dr Prarthana Packiam at MMC and had ten treatments with a chiropractor, but did not seek specialist treatments. Ms Sekar reported she had fully recovered and by mid-2020 was pain free and fully active.
The Medical Assessor noted the history of the accident and Ms Sekar’s symptoms and treatment following the accident. He concluded that although she had previous neck pain, it was left-sided and had resolved.
The Medical Assessor noted Ms Sekar was consistent throughout the presentation.
The Medical Assessor concluded that Ms Sekar had a demonstrated disc lesion compressing the C7 nerve root which is symptomatic. Given Ms Sekar’s clinical symptoms and their persistence, the Medical Assessor concluded that a C7 discectomy and spinal fusion would be considered appropriate. The Medical Assessor concluded that the surgery is causal to the accident and reasonable and necessary in the circumstances.

Certificate and reasons of the review panel in M22364/24

The certificate and reasons of the review panel in M22364/24 have been considered. It is noted that this review panel had the same constitution as the current Panel.
The dispute in M22364/24 was a treatment and care dispute for the purposes of the MAI Act regarding proposed C6/7 anterior cervical discectomy and fusion surgery (the proposed surgery).
Ms Sekar was examined for the purposes of the Review Panel’s assessment in M22364/24. That Review Panel found that the proposed surgery related to injury caused by the accident, and was reasonable and necessary in the circumstances.

MEDICAL EXAMINATION

Who attended the assessment

On 21 August 2025, Medical Assessor David Gorman examined Mrs Vidhya Sekar at the Commission’s medical suites. She attended in the company of her husband, Fraizal.

History since last examination

She had continued to work.
She has decided not to have the surgery previously found to be reasonable and necessary by the Commission at present. This is mainly as her family in India are unwell and she may need to return to see them.

Current symptoms

Her symptoms are similar to previously described to the Medical Assessor in relation to the treatment and care dispute.[5] She describes pain in her neck which is present all the time. It was up to 9/10 but it is now better.
[5] See the examination reports in Allianz Australia Insurance Limited v Sekar [2025] NSWPICMP 329.
The pain is on the right side of her neck and will radiate down to the shoulder. There is numbness particularly in the thumb, index and middle fingers on the right side. She had an episode where she burnt her fingers when cooking when she picked up a very hot item.
Her arm feels weak. She could only pick up the 1kg weight at physiotherapy.

Current and proposed treatment

She takes Lyrica 75mg three times daily. She takes Palexia 50mg only occasionally.
She takes Nurofen or Maxigesic as required.
She is no longer having physiotherapy.

Clinical examination

General presentation

She was a well looking woman who walked with a normal gait.
She is 157 cm tall and weighs 69.7 kg. She was 58kg before the accident.

Cervical spine

On examining her neck muscles guarding was not present.
There was no wasting of the muscle of the upper limb. The right arm measured 29 cm in circumference 10 cm above the lateral epicondyle and the left arm 28cm. The right forearm measured 24 cm (5cm below the lateral epicondyle) and the left measured 23.5cm.
There was a reasonable range of neck movement but with dysmetria. Neck flexion was normal but neck extension was 2/3 normal. Lateral flexion left and right was normal. Rotation left and right was normal.
Power and tone were normal. Biceps, triceps, and supinator jerks were present and equal.
There was decreased sensation in the right upper limb over the palmar aspect of the thumb, index and middle finger. Sensation over the dorsum of the right hand was normal and over the right forearm was normal.
Sensation of the left upper limb was normal.
Nerve stretch tests were negative. Previously turning her head to the right and laterally flexing caused pain to radiate down to the fingers – that no longer occurred.

Consistency on presentation

She was consistent and cooperative throughout presentation.

Summary of relevant imaging

MRI cervical spine performed by Rouse Hill Medical Imaging on 9 December 2023 showed disc bulging of C6/7 level with broad-based right paracentral foraminal disc protrusion with high-grade right and moderate to high-grade left-sided foraminal stenosis and impingement of bilateral C7 nerve roots.

PANEL’S DETERMINATION

The Panel review is not limited to a review of only that aspect of the first instance medical assessment that is alleged to be incorrect and is to be by way of a new assessment of all matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act.
The Panel, comprised of two specialist medical practitioners and a legal practitioner, is required to form its own opinion on the medical question in dispute by reflecting on the professional judgment of the specialist medical practitioners; it is not to choose between competing opinions, nor to assess the correctness of such opinions.[6]
[6] Insurance Australia Group Ltd t/as NRMA Insurance v Keen [2021] NSWCA 287 (Keen) and Insurance Australia Ltd v Marsh [2022] NSWCA 31.
As the High Court noted, with respect to a medical panel:
“The function of a Medical Panel is neither arbitral nor adjudicative: it is neither to choose between competing arguments, nor to opine on the correctness of other opinions on that medical question. The function is in every case to form and to give its own opinion on the medical question referred to it by applying its own medical experience and its own medical expertise.”[7]
[7] Wingfoot Australia Partners Pty Ltd v Kocak (2013) 252 CLR 480; [2012] HCA 43 at [47].
As was stated in Keen, the function of a medical panel is neither arbitral or adjudicative; it is neither to choose between competing arguments, nor to opine on the correctness of other opinions on that medical question. The function is in every case to form and give its own opinion on the medical question referred to it by applying its own medical experience and its own medical expertise.
The Panel adopts the examination findings and conclusions of Medical Assessor Gorman as set out in the above report based on his medical examination of Ms Sekar on 21 August 2025.

Threshold injury determination

C6/7 disc protrusion

The Panel finds that Ms Sekar has had an episode of injury and a demonstrated disc lesion compressing the C7 nerve root which is symptomatic.
The Panel finds that there are disc changes of a significant protrusion of the C6/7 disc, visible on MRI scans undertaken after the accident, causing radicular symptoms. This indicates a partial rupture of the disc fibrocartilage.
This is not a threshold injury for the purposes of the MAI Act.

Radiculopathy

Radiculopathy is defined in the Guidelines at 5.8 to mean impairment caused by dysfunction of spinal nerve root or nerve roots when two or more of the following clinical signs are found on examination when assessed in accordance with Part 6:
“(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
(e) reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.”
Clause 5.9 continues that, where the neurological symptoms associated with an injured person’s injury of the neck or spine do not meet the assessment criteria for radiculopathy, then the injury will be assessed as a threshold injury.
The Panel notes the previous finding of radiculopathy by Medical Assessor Gorman at the examination on 11 April 2025 in matter M22364/24. This included that, on turning to the right and laterally flexing her neck, Ms Sekar had tingling in the fingers (“foraminal compression test”). She also had pressure on the trapezius while laterally flexing to the left causing tingling to the fingers (“brachial plexus stretch test”). There was loss of sensation in the right upper limb along the radial aspect of the arm to the thumb, index and middle finger, corresponding to the C6 and 7 dermatomes.
The Panel believes that the “foraminal compression test” positivity and “brachial plexus test” positivity are analogous in the cervical spine to the positive sciatic nerve root tension signs in the lumbar spine per Table 6.8 of the Guidelines.
Therefore, as per cl 5.8 of the Guidelines, there were two signs of radiculopathy at the 11 April 2025 medical examination, being positive nerve root tension signs (criterion b), and reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution (criterion e).
Accordingly, Ms Sekar’s cervical spine injury met the assessment criteria for radiculopathy as set out in the Guidelines, constituting a non-threshold injury per cl 5.9 of the Guidelines.
The Panel also notes that Dr Pope’s examination on 27 February 2024 recorded weakness in finger extension, triceps function, reduced grip strength, and muscle wasting of 1 cm in her right mid-biceps. Additionally, there was an absent right triceps reflex and diminished sensation in the C7 dermatome. Based on these findings, Dr. Pope recommended an anterior cervical discectomy and fusion (ACDF) at C6/7 with decompression of the C7 nerve root. This has three of the criteria for radiculopathy - reflex abnormality, weakness in the relevant dermatome and loss of sensation in the relevant dermatome, satisfying the assessment criteria set out in the Guidelines.
While the Panel finds that Ms Sekar no longer has symptoms of radiculopathy, there is no requirement that the radiculopathy be present at the time of the current medical examination and a finding of threshold injury can be made based on radiculopathy being present at any time since the accident.[8]
[8] David v Allianz Australia Insurance Ltd [2021] NSWPICMP 227 (David) at [104]; Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6 at [70].
The fact Ms Sekar no longer showed signs of radiculopathy at the medical examination on 21 August 2025 does not change the Panel’s view. As noted in David at [98]:
“Radiculopathy is an example where the symptoms fluctuate over time because 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 return because the injured disc is exacerbated by innocuous activites”.

Are Ms Sekar’s injuries caused by the accident?

Causation is not specifically addressed in Part 5 of the Guidelines. However, it is generally accepted that it is appropriate to apply the test for causation as set out in cls 6.5 to 6.7 in a threshold injury assessment.[9] These clauses of the Guidelines provide:
[9] Briggs v IAG Ltd (t/as NRMA Insurance) [2022] NSWSC 372 (Briggs) at [35]. See also the discussion of Stern JA (Mitchelmore and Ball JJA agreeing) in Insurance Australia Limited t/as NRMA Insurance v Le [2025] NSWCA 121.
“…
6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:
'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'
This, therefore, involves a medical decision and a non-medical informed judgement.
6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
The provisions of the Civil Liability Act 2002 (NSW) (CL Act) apply in determining causation.[10] It is therefore necessary to consider whether the accident caused or contributed to Ms Sekar’s diagnosed injuries. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.[11]
[10] Sections 5D and 5E CL Act.
[11] Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50].
Causation of injury is required to be established on the balance of probabilities. Ms Sekar is not required to establish causation to the level of medical certainty.[12]
[12] Briggs v IAG Ltd (t/as NRMA Insurance) (2024) 106 MVR 203; [2024] NSWSC 3 at [43]-[44].
The accident was a major accident. Ms Sekar’s vehicle was written off. Following this, she had sustained pain in her neck with radicular complaint developing along the distribution of the right C6 and C7 nerve roots. Imaging demonstrated compression of the C7 nerve root from the C6/7 disc. The Panel finds that disc protrusion could have been caused by an accident of this severity.
The Panel finds that, although Ms Sekar had previous neck pain, it was usually left-sided and that it had resolved by the time of the time of the accident in 2023.
Ms Sekar’s radicular pain on the right side developed over three to four weeks following the accident. The Panel considers this delayed pain is not unusual as the pain develops gradually with increased ischaemia and release of cytokines from the disc irritating the nerve. The pain does not need to develop acutely.
The C6/7 disc protrusion was not visible on scans undertaken prior to the accident.
The Panel finds that Ms Sekar’s cervical spine and right arm pain could have been caused by the accident.
The Panel then must determine whether the accident did cause or contribute to the injuries.
The Panel notes the submissions of the insurer regarding purported inconsistencies between Ms Sekar’s reports and the contemporaneous documents, and the submissions as to Ms Sekar’s credibility. It also notes the insurer’s submission that Ms Sekar sustained an injury while weightlifting after the accident.
A summary of Ms Sekar’s response when asked about this inconsistency at the medical examination undertaken by Medical Assessor Gorman in matter M22364/24 is set out at paragraph [132] of the Panel’s decision in that matter:
“The claimant was asked about her visits to Dr Nigel Hawkins. Specifically, the claimant was asked by the Medical Assessor about her consultation on 23 November 2023 where Dr Hawkins’ clinical notes record that the claimant had developed ‘pins and needles’ following a gym workout with weightlifting. Both the claimant and her husband were adamant that the claimant had not been to her personal trainer in the months after the accident. The claimant recalls that she may have asked Dr Hawkins ‘could she start’ gym work and weightlifting again. She noted that, while her English is good, on occasions she can have difficulty communicating correctly. Medical Assessor Gorman agreed that her English is good but spoken with a strong accent and accepted there could be a miscommunication. The claimant emphasised that her weightlifting was only with light weights before the accident and supervised by her personal trainer.”[13]
[13] Allianz Australia Insurance Limited v Sekar [2025] NSWPICMP 329.
At the medical examination on 21 August 2025, Ms Sekar was again asked about the purported inconsistency in the clinical notes of Dr Hawkins and her reports. Ms Sekar and her husband reiterated that she had not been weightlifting after the accident. She may have asked Dr Hawkins whether she could start doing so, however she had not returned to her personal trainer between the time of the accident and her attendance upon Dr Hawkins.
The Panel notes that, contrary to the insurer’s submission, Dr Hawkins does not report that Ms Sekar presented “with symptoms of numbness and pins and needles after an injury sustained at the gym”. Rather, Dr Hawkins’ notes on 23 November 2023 record “past 2 weeks; numbness and pins and needles stated in fingers but now going up to neck; headache today; going to gym and doing weight lifting last month; good shoulder movement; wrist and hands ok; diagnostic imaging requested: CT c spine”.
There is no link drawn by Dr Hawkins between Ms Sekar’s numbness and pins and needles, and Ms Sekar’s attendance at the gym and weight lifting. There is also no reference in the notes of Dr Hawkins of Ms Sekar having injured herself at the gym.
The Panel is cognisant of the notes of Newington Chiropractic which note, on 4 December 2023, that Ms Sekar “has been doing gym workouts in the gym – low force”. The Panel notes that this entry also states “tingling unchanged” and refers to upper back and neck tightness and pain on palpation “Cs left”. That Ms Sekar’s injuries were caused by the accident and not a subsequent weightlifting injury is supported by the balance of the contemporaneous records of Newington Chiropractic where Ms Sekar reported consistent symptoms at her first appointment on 18 September 2023, being five days after the accident.
The consultation notes from Dr Madan on 14 September 2023, being the day after the accident, record “sore neck, back”.
There is no reference in the notes of Dr Hawkins, Newington Chiropractic or Dr Madan of Ms Sekar injuring herself at the gym or weight lifting post-accident. Nor is there any evidence that Ms Sekar otherwise injured herself post-accident.
The Panel finds that there are no contemporaneous documents to suggest that Ms Sekar’s symptoms are related to or caused by the gym or weight lifting, nor caused by any event other than the accident.
The Panel finds that Ms Sekar is a credible historian who appears to be doing her best to recall events which occurred close to two years ago. The Panel also finds that there is nothing to suggest Ms Sekar has provided an inconsistent history, noting that she has maintained that she only did weightlifting under the supervision of her personal trainer. While she may have returned to the gym doing other “low-force” exercises post-accident, she has consistently reported that she did not re-commence seeing her personal trainer or weight lifting in the period between the accident and her visit to Dr Hawkins. This aligns with the contemporaneous medical records.
The Panel refers and adopts the Medical Assessors findings at paragraph [207] that it is not uncommon for pain in relation to this type of injury to be delayed due to increased ischaemia and release of cytokines from the disc irritating the nerve.
The Panel notes that low level gym exercise is commonly recommended for recovery of a musculo-skeletal injury and would be highly unlikely to cause injury of the nature experienced by Ms Sekar.
The Panel finds that Ms Sekar’s cervical spine and right arm pain were caused by the accident.
In making its determination on causation, the Panel has given weight to both the contemporaneous documents, which do not record any evidence of an injury incurred while at the gym or weightlifting, and the statements of Ms Sekar, whom the Panel finds to be a credible witness.

Permanent impairment

An assessment of Ms Sekar’s impairment is based on an evaluation of her functionality on the day of the assessment.[14]
[14] Clause 6.21 of the Guidelines.

Permanency

Her symptoms have continued in the neck and right upper extremity.
Her signs are similar to previously but with some improvement such that she no longer has definite radiculopathy, although she still has symptoms in the right upper extremity. No surgery is planned at present. It is approaching two years since the subject accident. The Panel believes that her condition is stable for the assessment of permanent impairment.

Degree of permanent impairment

She has dysmetria and some radiation of non-verifiable radicular symptoms to the right shoulder and hand.
She no longer has radiculopathy meeting the criteria set out in cl 5.8 of the Guidelines. She no longer has a positive nerve compression test or positive brachial plexus test. She has normal and equal power and reflexes. The sensory change is not exactly corresponding to the C6 and C7 dermatome now. It only affects the palmar surface of the hand over the 1st, 2nd and 3rd fingers.
The Panel finds that she has a DRE category II impairment giving her 5% WPI based on Table 73 on page 110 of the AMA 4th Edition Guides.
There is no deduction to be made for pre-existing impairment. The Panel finds that, although she had previous neck pain, it was usually left-sided and had resolved by the time of the accident in 2023. Therefore, the Panel does not agree with Medical Assessor Assem’s conclusion that Ms Sekar had a DRE II category impairment before the accident.

CONCLUSION AND CERTIFICATION

For the above reasons, the Panel revokes the certificate of Medical Assessor Mohammed Assem dated 17 March 2025.
The Panel finds that Ms Sekar has a tear of the annulus of the C6/7 disc, right paracentral disc protrusion and a previous finding of radiculopathy caused by the accident, being a non-threshold injury for the purpose of the MAI Act.
Ms Sekar’s degree of permanent impairment arising from the injury caused by the accident is 5%, being not greater than 10%.

[2025] NSWPICMP 675

5 September 2025