Avgoustis v Insurance Australia Limited t/as NRMA Insurance
[2023] NSWPICMP 161
•27 April 2023
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Avgoustis v Insurance Australia Limited t/as NRMA Insurance [2023] NSWPICMP 161 |
| CLAIMANT: | Nick Avgoustis |
INSURER: | Insurance Australia Limited t/as NRMA Insurance |
| REVIEW Panel | |
| MEMBER: | Terence O’Riain |
| MEDICAL ASSESSOR: | Shane Moloney |
| MEDICAL ASSESSOR: | Margaret Gibson |
| DATE OF DECISION: | 27 April 2023 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; medical dispute about whole person impairment (WPI) assessment review under section 7.26; claimant driving in traffic when his car was T-boned on left side; issue of causation of injuries involved; pre-existing left shoulder pain; work and motor accidents before subject accident; re-examined; Held – claimant sustained soft tissue injuries to right shoulder, lumbar spine, cervical spine aggravating degenerative disc disease; WPI less than 10%; previous impairment Certificate revoked. |
| DETERMINATIONS MADE: | Review Panel Assessment of Degree of Permanent Impairment The Review Panel revokes the certificate dated 21 November 2021 and issues a new certificate determining that: · Right shoulder – soft tissue injury · Left knee –soft tissue injury · Lumbar spine - soft tissue injury · Cervical spine – soft tissue injury with aggravation of degenerative disc disease |
REASONS
History of the motor accident
The following are undisputed facts.
On 5 April 2018 Mr Avgoustis (the claimant) was driving in traffic when his car was t-boned on his left by a vehicle failing to give way.
He was wearing his seatbelt, airbags did not deploy, he did not lose consciousness, but he was cut out of his car with full spinal precautions.
Mr Avgoustis was transported to St George Hospital for assessment, complaining of headache and neck and back pain. Scans showed a posterior fracture of the 1st right rib. He was discharged on 6 April 2018 to the care of his general practitioner (GP).
He attended his local general practitioner (GP), Dr Costa, on 9 April 2018, complaining of anxiety and pain in the head and neck, the lower back, the right hip and knee. His GP continued to see him and referred him to a specialist for additional treatment, which consisted of injections.
The insurer insured the owner and/or driver of the motor vehicle for liability to pay to the claimant any damages/statutory compensation under the Motor Accident Injuries Act 2017 (the MAI Act).
The insurer disputed Mr Avgoustis claim for non-economic loss and the level of permanent impairment. Mr Avgoustis applied to the Personal Injury Commission (the Commission) to assess the permanent impairment level.
Mr Avgoustis made an application to refer Medical Assessor David Gorman’s Medical Assessment Certificate dated 21 November 2021 to a Review Panel pursuant to s 7.26(1) of the MAI Act, on the basis that Assessor Gorman’s assessment and determinations on whole permanent impairment (WPI) were incorrect in a material respect.
The application was lodged within 28 days after the parties were issued with the original certificate for the medical assessment.[1]
[1] Section 7.26(10) of the MAI Act.
The President’s delegate Stephanie Wigan referred the medical assessment to a Review Panel (this Panel) on 28 February 2022.[2]
[2] Section 7.26(5) of the MAI Act.
Pre accident medical history
· 1983: a work related low back injury from driving a forklift, for which he underwent a variety of treatments including manipulation under anaesthetic and discography.
· 2010: a previous motor vehicle accident in 2010 in which he injured his neck, left shoulder and lower back. He saw orthopaedic surgeon, Dr Vijay Maniam in 2011 and was diagnosed with musculo-ligamentous cervical spine strain with aggravation of underlying degenerative disease and musculo-ligamentous lumbar spine strain with aggravation of pre-existing degenerative disease without any neurological involvement. There was also a diagnosis of traumatic impingement of the left shoulder.
· 2013: a second motor vehicle accident in which he injured his neck and back.
· Type 2 Diabetes managed with Metformin.
· Ischaemic heart disease requiring a stent and cardiac surgery in 2018 with advanced peripheral vascular disease affecting his lower limbs and limiting his walking to 200 meters before pain arises.
· Hepatitis B.
· Chronic depression.
· Hypertension.
STATUTORY PROVISIONS & GUIDELINES
Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed
Causation of injury is addressed under Part 6 of the Guidelines dealing with permanent impairment:
“6.6 Causation is defined in the Glossary at page 316 of the AMA 4 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.”
Clause 6.138 of the Guidelines defines radiculopathy as the impairment caused by dysfunction of a spinal nerve root or nerve roots. To conclude that a radiculopathy is present, two or more of the following signs should be found:
(a) loss or asymmetry of reflexes;
(b) positive sciatic nerve root tension signs;
(c) muscle atrophy and/or decreased limb circumference;
(d) muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution, and
(e) reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.
Sections 5D and 5E of the Civil Liability Act 2002 apply to the MAI Act regarding causation.
The decision in Peet v NRMA Insurance Ltd[3] provides further guidance to the Panel on causation. Peet reviewed a number of Supreme Court decisions including the observations of Justice Campbell in Owen v Motor Accidents Authority of NSW[4] who stated it was “well to emphasise the question to be assessed is one of legal causation involving mixed questions of fact and law arising principally from the law of negligence as modified by the Civil Liability Act, 2002, s 5D”.
[3] [2015] NSWSC 558.
[4] [2012] NSWSC 560.
Further, in the recent case of Hunter v Insurance Australia Ltd[5] the Court observed (at [16]) a Panel was obliged to apply the Guidelines which incorporated “common law principles of causation.”
[5] [2021] NSWSC 623.
The review
The Panel members met 13 April 2022 in a telephone conference and agreed to make the following directions:
Pursuant to rule 70 of the Personal Injury Commission Rules t (PIC Rules) the parties were directed to confer and on or before 15 May 2022 to lodge a joint signed statement setting out:
(a) the facts and issues on which the parties agree, and
(b) the facts and issues that continue to be in dispute.
Among other issues the parties were to advise in writing whether it is accepted or disputed that the Panel can adopt any of Medical Assessor Gorman’s findings and conclusions that the accident caused or aggravated the following injuries:
· Body Area: Cervical spine
Injury Description: tenderness on the right side- aggravation of an underlying degenerative condition including multiple IV-disc lesions with nerve root irritation to both upper limbs.· Body Area: Knee
Injury Description: left sided disc protrusion affecting L5 nerve root/sciatica.· Body Area: Lumbar spine
Injury Description: tenderness on the right side - fracture of the posterior right first rib with aggravation of multiple IV-disc lesions, especially L4/5 and L5/S1.· Body Area: Right Shoulder
Injury Description: nerve root irritation with chronic post traumatic impingement.The Panel noted that the claimant’s treating GP referred him to see a physiotherapist and Associate Professor Papantoniou. However, there were no notes or correspondence related to those treaters in the bundle marked AD3.
The Panel directed that on or before 15 May 2022 the claimant was produce notes from those treaters if he attended for treatment.
The Panel considered it was necessary to re-examine the claimant. The assessment was eventually set down for 26 October 2022 at the Personal Injury Commission (Commission) examination rooms with Medical Assessor Moloney.
The parties were notified that the assessment would address whether Mr Avgoustis suffered a separate injury to the right shoulders and whether the rib fracture was a pre-existing injury.
The claimant was directed to take all relevant imaging studies to the appointment.
Part 5 of the Personal Injury Commission Act, 2020 (the 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 merit reviewer or a medical assessor.[6]
[6] Section 41(2) of the PIC Act.
Rules 127 to 130 of the PIC Rules are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[7]
[7] Rule 128 of the PIC Rules.
The assessment of permanent impairment under the MAI Act is undertaken in accordance with version seven of the Motor Accidents Guidelines (Guidelines).[8] The Guidelines adopt the AMA 4. Where there is any difference between AMA 4 and the Guidelines, the Guidelines prevail.[9]
[8] The Guidelines are issued pursuant to s 10.2 of the MAI Act. Section 10.1 of the MAI Act provides that the assessment of the degree of permanent impairment is to be made in accordance with the Guidelines.
[9] Clause 6.2 of the Guidelines.
Assessment under review
Medical Assessor Gorman certified the following about the motor accident related injuries:
Permanent Impairment was not greater than 10% based on the following:
· right shoulder – soft tissue injury with referred symptoms from the neck with possible nerve root irritation;
· left knee – soft tissue injury;
· lumbar spine – fracture of the posterior right first rib – the fracture of the first rib was secondary to the accident and the accident caused a soft tissue injury and aggravation of degenerative disc disease, and
· cervical spine – soft tissue injury with aggravation of degenerative disc disease.
In the cervical spine there was symmetrical restriction in movement. There was radiation of pain to the shoulders, particularly on the left. Medical Assessor Gorman assessed the cervical spine as having a DRE II impairment giving him 5% whole person impairment (WPI) based on the Table 73 on page 110 of the AMA 4.
He has had previous motor vehicle accidents and awards for injury to the cervical spine. Dr Costa in his report of 19 March 2011 assessed him as DRE II in the cervical spine. Medical Assessor Gorman estimated that his pre-existing spinal impairment would have been DRE II (WPI 5%) and therefore his impairment due to the subject accident, when this is subtracted, gave 0%.
In the right shoulder there was restriction in movement. However, the range of movement in the left was identical to the right. Both Dr Costa and Medical Assessor Gorman recorded greater pain in the left than the right side. The Guidelines note that the opposite, uninjured side is to be used as a baseline and the calculated impairment on the un-injured side is subtracted from the injured side. Therefore, the whole person impairment of the right shoulder was 0%.
In the left knee there was no abnormality on examination apart from patellar tenderness. The range of motion was reasonable. There was no patellar crepitus. The WPI based on AMA 4 was 0%.
In the lumbar spine there was symmetrical reduction in range of motion. There was pain in the lumbar spine. There was leg pain on movement consistent with the effects of the peripheral vascular disease as well as referred pain from the lumbar spine. I assessed the lumbar spine as DRE II giving a 5% WPI.
However, he has had long-standing lumbar pain both from work injuries and previous motor vehicle accidents. Dr Costa on 19 March 2011 assessed him as DRE III impairment in the lumbar spine. Medical Assessor Gorman assessed the pre-existing lumbar spinal impairment as at least DRE II and therefore the WPI, when this is subtracted, is 0% secondary to the accident.
A healed fractured rib does not result in any impairment unless it causes respiratory compromise – see paragraph 6.229 on page 137 of the 2020 NSW Motor Accident Guidelines. There was no respiratory compromise.
Disputes and issues identified by the parties
In relation to Medical Assessor Gorman's WPI assessment of the right shoulder, it was submitted that he erred in making a deduction on account of there being restriction of movement in the left shoulder. Guideline 6.51 refers to subtraction in respect to restriction in the "contralateral uninjured joint". In the present case, Medical Assessor Gorman recorded a history of an earlier injury to (and of consequent impingement in) the left shoulder. It is submitted that in the circumstances, the claimant's left shoulder was not ''uninjured" within the terms of the Guidelines, so no such deduction should have been made.
It is submitted that this Guideline was inserted to make allowance for restriction of motion occurring naturally and would be expected to occur bilaterally and is not applicable in circumstances such as the present case, where there has been an earlier injury.
Further, the claimant submitted that Medical Assessor Gorman erred in how he made a deduction for pre-existing disability in relation to the cervical spine and lumbar spine. The error was in this regard:
(a) Guideline 6.31 says that where "If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident" then a deduction should be made.
(b) Further, Guideline 6.32 says that "The capacity of a medical assessor to determine a change in physical impairment will depend upon the reliability of clinical information on the pre-existing condition". Further, the AMA Guidelines say, "Using this approach to apportionment would require accurate information and data on both impairments".
(c) In the present case, Medical Assessor Gorman had based his decision to make deductions for pre-existing impairment purely upon one examination conducted by Dr Costa on 19 March 2011, some seven years prior to the subject accident. Medical Assessor Gorman has not recorded a history from the claimant as to his condition immediately prior to the subject motor vehicle accident. Further, he has not cited any GP notes entries which might indicate whether or not his symptoms were ongoing immediately prior to the subject motor vehicle accident.
( d) In the circumstances, it is submitted that there was no "objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident" cited by Medical Assessor Gorman. There is therefore no evidence cited upon which he could make the deductions which he has made.
The respondent opposed the application and submitted that Medical Assessor Gorman provided reasons to support these deductions for pre-existing impairments.
In addition to Medical Assessor Gorman’s reasons, the insurer refers to its original DRS submissions in relation to WPI dated 15 February 2021 [R2], which was before Medical Assessor Gorman. The summary of the claimant’s pre-accident medical history indicates the following:
· The clinical records of GP Dr Con Costa evidence a long history of cervical and back issues as well as compensation for the same and lack of return to work following the 1984 worker’s compensation claim.
· In 2011, the claimant underwent an L5/S1 anterior spinal fusion performed for management of left sciatica and a destroyed L5/S1 IV disc. The claimant was permanently unfit for work as a result (as per Dr Costa’s report dated 10 March 2011).
As per Clause 6.32 of the Guidelines in relation to pre-existing impairment, “the capacity of a medical assessor to determine a change in physical impairment will depend upon the reliability of clinical information of the pre-existing condition.” The insurer submits the Medical Assessor has considered the pre-accident medical records and has used his clinical judgement to determine that a deduction for pre-existing impairment is substantiated by the medical records which evidence a longstanding history of neck and lower back issues and associated impairment.
As such, the insurer submits the Medical Assessor has not erred with respect to his deduction for pre-existing impairment for the cervical spine and lumbar spine. The Medical Assessor has taken his own history, considered the medical records before him and has provided reasons to support his deduction for pre-existing impairment to the cervical and lumbar spinal injuries.
The parties produced a joint statement in accordance with rule 70 and the Panel's directions made 13 April 2022.[10]
[10] AD5.
The parties agreed Medical Assessor Gorman did not commit an error when he assessed the claimant's permanent impairment arising from the left knee.
The issues that remained in dispute were:
(a) Whether the claimant's permanent impairment arising from the subject accident exceeded 10% permanent impairment.
(b) Whether Medical Assessor Gorman's permanent impairment assessment of the cervical spine, lumbar spine and right shoulder are accurate.
(c) The parties disputed adopting Medical Assessor Gorman's findings on the cervical spine, lumbar spine and the right shoulder injuries.
Documentation
The Review Panel considered the following documentation:
· Medical Assessor Gorman’s certificate dated 21 November 2022;
· application for review and attached documents;
· Reply and attached documents;
· Reasons referring this matter to a Review Panel, and
· all the documents which were provided to Medical Assessor Gorman before the assessment under review.
MATTERS CONSIDERED AND DECIDED BY THE REVIEW PANEL
Review Panel findings
Clinical examination
Mr Avgoustis attended on Medical Assessor Moloney at the medical suites of the Commission on 26 October 2022. He was unaccompanied apart from the interpreter Shirley Zantis (NAATI 9353) who was present for the examination and interview.
Mr Avgoustis walked into the room and sat uncomfortably during interview. He stated he is right-handed. His height was measured at 172cm and weight 85kg.
Pre-accident history
Mr Avgoustis stated that he migrated from Greece at the age of 21 and had been working full-time as a forklift driver until 1984 when he sustained a back injury at work. He is separated from his wife but still lives with her. He had a motor vehicle accident in 2010 when he injured his neck left shoulder and lower back and was treated by manipulation and traction. There was a further motor vehicle accident in 2013 when he injured his neck and back, but he can’t remember the details.
History motor vehicle accident and subsequent treatment
Mr Avgoustis was driving his car when the insured car T-boned him on the left because the driver failed to give way. He was wearing a seatbelt at the time, but the airbags did not deploy. The ambulance and police attended the scene and he had to be cut out of the car due to the collision. The ambulance transported him to St George Hospital with neck and back pain. He stated a few days later he also developed shoulder pain and had trouble walking.
He consulted his GP at the time, Dr Costa who referred him for physiotherapy–which was of little benefit–and an orthopaedic surgeon, Dr Papantoniou who recommended cortisone injections, although Mr Avgoustis cannot recall the meeting.
He states that there have been no further injuries or accidents since the subject accident.
Current symptoms
At present, he has persistent neck pain more so on the left and pain in the left shoulder which prevents him from sleeping on the left side. There is also pain in the right shoulder and he now gets numbness in the fingers which wakes him at night. There is a central low back pain and a global numbness in the legs more so on the left radiating to the toes with pain in the calves after walking up to 250m. He is able to drive up to 30 minutes, being limited by low back pain.
Current treatment
Present medication is Panadol osteo three per day and Lyrica, but he is unsure of the dose. He also takes medication for hypercholesterolemia and diabetes. There has been coronary bypass surgery in the past.
No manual therapy is being undertaken at present and he consults his GP when necessary. He has consulted a vascular surgeon due to peripheral vascular disease in the legs.
Cervical spine (cervicothoracic)
On testing range of movement, flexion/extension side bending and rotation were all 50% of expected range with no asymmetry. On palpation there was tenderness over both trapezius muscles but no guarding or spasm was noted in the cervical musculature.
On neurological examination of the upper limb reflexes were equal bilaterally with normal power. There was a global decrease in sensation below the elbows in both arms and particularly in the thumbs and fingers. Phalen’s test was positive indicating carpal tunnel syndrome bilaterally. No muscle wasting was apparently with the circumference the upper arms 25cm bilaterally (10cm above the olecranon process) and in the upper forearm 24.5cm bilaterally (5cm below the olecranon process).
Lumbar spine (lumbosacral)
Mr Avgoustis walked with a normal gait but had difficulty standing on his heels and toes. He was unable to squat due to poor balance. On lying straight leg raise was 30° bilaterally but 80° when seated. Sciatic nerve root tension signs were negative. On palpation, there was tenderness over the entire lumbar spine but no guarding or spasm was noted in lumbar musculature. There is no surgical scar over the lumbar spine.
On neurological examination of the lower limbs, reflexes were equal bilaterally with the uniform decrease in power (3/5) in both legs. There was a global decrease in sensation in both legs below the knees which is not dermatomal and related to the poor peripheral vascular circulation. No muscle wasting was apparently with the circumference of the lower thighs 35cm bilaterally (10cm above the superior patella pole) and at the maximum circumference of the calves 33cm bilaterally.
Upper extremity
On palpation, there was tenderness over both acromioclavicular joints and a generalised tenderness over both shoulders. No crepitus was detected on passive movement and active movement was measured using a goniometer and repeated three times. There was no referral of pain from the cervical spine with shoulder movement. Shoulder movement did not cause neck pain.
On testing range of movement, flexion was 120°/110°/100° on the right and 110 degrees on the left. Extension was 30° bilaterally. Adduction was 30° on the right and 20° on the left. Abduction was limited to 90° bilaterally and internal and external rotation of 80° bilaterally.
The variation in shoulder range of movement was discussed with Mr Avgoustis. He could not explain why the variation occurred with different examiners but stated that sometimes it just feels better. I explained to him that due to inconsistency in shoulder movement that this could not be used to assess range of movement and he states that he understood that another method apart from range of movement would be used to assess shoulder impairment
Lower extremity – Knees
On testing range of movement, flexion was 110° bilaterally and extension 0° bilaterally. Assessor Moloney did not note any ligament laxity and on passive movement he did not detect crepitus of either knee. On palpation, the Assessor found there was tenderness over both patellae.
Panel Deliberations
The Review Panel’s conclusions on the parties’ issues
The Panel met again on 10 December 2022.
The Panel decided it would adopt Medical Assessor Moloney’s examination report as evidence in its conclusions.
INJURIES:
Permanent Impairment
Cervical spine
There was a symmetrical reduction in range of movement with no dysmetria. On palpation there was no guarding or spasm in the cervical musculature and no signs of radiculopathy in the upper limbs. The degree of sensation in the right arm was in a non-dermatomal distribution and therefore there is no non-verifiable radicular complaint. This is a classification DRE l which is 0% WPI using Table 73 of AMA 4.
Lumbar spine
On testing range of movement, no asymmetry was noted and on palpation no guarding or spasm noted in the lumbar musculature. There were no signs of radiculopathy in the lower limbs with a non–dermatomal decrease in sensation below the knee level. Thus there is no non-verifiable radicular complaints. This is a classification DRE l which is 0% WPI using Table 72 of AMA 4.
Left knee
There may have been a soft tissue injury to the knees sustained in the subject accident as the treating GP, Dr Costa mentioned knee pain after the accident. It was not recorded in the hospital notes. At the time of my examination, there was tenderness on palpation of both patellae no crepitus, no ligament laxity and a reasonable range of movement. This gives a classification of 0% WPI using Tables 41 and 62.
Right shoulder
The treating GP recorded shoulder pain a few days after the accident and the hospital notes recorded tenderness over the right medial scapula. No investigations have been undertaken of the shoulders since the accident and there is no referral of pain from the cervical spine related to cervical or shoulder movement which excludes the Nguyen decision[11]. In 2020, Dr Mitchell recorded a full range of movement of both shoulders.
[11] Nguyen v The Motor Accidents Authority of NSW & Zurich Australian Insurance Ltd [2011] NSWSC 351.
There is also a past history of left shoulder impingement recorded by Dr Maniam in 2011 and a note of equivocal shoulder range of movement in 2014 by the treating GP. Mr Avgoustis actually stated that there was more pain in the left shoulder than the right as he had on 28 October 2021 to Medical Assessor Gorman and before that to Dr Costa.
Medical Assessor Moloney assessed variability in the range of motion. There was tenderness to palpation over the right acromioclavicular joint, although no crepitation was noted.
Given there was variability in recorded goniometer measurements at the time of the Panel examination and inconsistency in range of movement chronologically, the Panel were of the opinion that goniometer measurements could not be used. Given this, Assessor Moloney determined that the most appropriate way to assess the right shoulder impairment was by analogy. Table 18 of AMA 4 records that an acromioclavicular joint impairment is 15% WPI. Using Table 19 this is deemed to be a moderate impairment which is 20% of 15% WPI. This is 3% WPI for the right shoulder.
Panel decision
The Review Panel found that the motor accident was a cause of the following injuries:
· right shoulder – soft tissue injury;
· left knee – soft tissue injury;
· lumbar spine – soft tissue injury, and
· cervical spine – soft tissue injury with aggravation of degenerative disc disease.
The Review Panel found that the motor accident was not a cause of the following injuries:
· not applicable.
The Review Panel found that the following injuries were resolved and give rise to no assessable impairment:
· left knee – soft tissue injury;
· lumbar spine – soft tissue injury, and
· cervical spine – soft tissue injury with aggravation of degenerative disc disease.
The Review Panel considered that the following injuries give rise to a permanent impairment:
· right shoulder – soft tissue injury.
The degree of permanent impairment of the injuries caused by the motor accident was calculated as follows:
Body Part or System AMA Guides/ Guidelines References
(chapter/ page/table)Permanent (YES/NO)
Current %WPI* %WPI* from pre-existing OR subsequent causes %WPI* due to motor accident 1 Cervical spine AMA Table 73 yes 0% 0% 0% 2 Lumbar spine AMA Table 72 Yes 0 % 0% 0% 3 Left knee AMA Table 41,62 yes 0 % 0% 0% 4 Right shoulder AMA Table 18,19
MAA Guide 6.24yes 3% 0% 3 % * %WPI = percentage whole person impairment
Determination regarding the degree of permanent impairment of the injured person as a result of the injuries caused by the motor accident
The total percentage permanent impairment for assessed injuries caused by the motor accident is 3%. The total WPI is not greater than 10%.
Permanent impairment ratings take symptoms into account; however the percentage of permanent impairment is not a direct measure of disability. A finding of 0% WPI indicates that the motor accident caused an injury and that there may be continuing symptoms, however, relevant Guides rate the associated impairment at 0% WPI.
Permanent impairment
The Review Panel’s finds the degree of permanent impairment of the injuries, which the motor accident caused are different to Medical Assessor Gorman’s findings as stated in the Permanent Impairment Certificate dated 21 November 2021. Medical Assessor Gorman had determined that cervical and lumbar spines were both DRE ll but then considered these both pre-existing and result was 0% for both. He considered that as right shoulder range of movement equalled left then that equated to 0% WPI.
The Review Panel has determined that this certificate is to be revoked and the Review Panel will issue a new Permanent Impairment Certificate.
Review Panel Certification
Member O’Riain, Medical Assessor Moloney and Medical Assessor Gibson have viewed this certificate and confirmed that they are in agreement.
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