Bollineni v AAI Ltd t/as GIO
[2025] NSWPICMP 459
•27 June 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Bollineni v AAI Ltd t/as GIO [2025] NSWPICMP 459 |
CLAIMANT: | Bollineni |
INSURER: | AAI Ltd t/as GIO |
REVIEW PANEL | |
MEMBER: | Hugh Macken |
MEDICAL ASSESSOR: | Dr Christopher Oates |
MEDICAL ASSESSOR: | Dr Drew Dixon |
DATE OF DECISION: | 27 June 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of degree of permanent impairment; pedestrian hit by car; right thigh haematoma; right knee reconstruction; difficulty with activities of daily living; mild laxity, medial collateral ligament; retro patellar crepitus; sensory loss in the right knee; multiple visible scars around the right knee; reduced range of motion right knee; wasting of the right leg; claimant walks with a limp; scarring including dimpling (loss of contour); Held – MAC revoked; new MAC issued with 12% whole person impairment (WPI). |
DETERMINATIONS MADE: | 1. The Panel revokes the certificate of Medical Assessor Robert Kuru dated 6 September 2024 and issues a new certificate determining that the following injuries were caused by the motor vehicle accident and give rise to a whole person impairment of 12% which is greater than 10%: · right right lower extremity right knee – 10%, and · scarring – right leg 2%. |
STATEMENT OF REASONS
INTRODUCTION
Raviteja Bollineni (the claimant) is a 30-year-old man who was injured in a motor vehicle accident on 27 January 2022. The claimant was injured when he was struck by the insured’s vehicle whilst walking across the road.
The claimant lodged an Application for Personal Injury Benefits, and the parties agreed that the claimant sustained non-threshold injuries. The claimant sought a concession from the insurer that his injuries ought to be considered greater than 10% whole person impairment. Following a review the insurer declined to make this concession and thereafter an assessment of whole person impairment was lodged with the Personal Injury Commission (Commission).
On 20 August 2024 the claimant was assessed by Medical Assessor Robert Kuru. He issued a certificate dated 6 September 2024 determining that the claimant had sustained injuries which gave rise to a whole person impairment of 11%. Body parts referred to the claimant were right lower extremity, right thigh and scarring.
The insurer sought a review of this certificate and, in a decision dated 6 September 2024 President’s delegate Ahley Payne determined that there is a reasonable cause to suspect the medical assessment is incorrect in a material respect. Thereafter the matter was referred to this Medical Review Panel (Panel).
On 29 October 2024 the Panel issued directions to the parties to upload to the portal all material which was included in the application and was before Medical Assessor Kuru. This was done and the Panel is satisfied that all relevant material is now before it.
The Panel convened on 11 February 2025 and determined that it was appropriate for a re-examination of the claimant to occur and particularly noting that there is a requirement to assess the degree of posterior lateral subluxation as well as scarring to the claimant.
The Panel notes that the claimant resides in Singleton and considers that it is easier and will enable an earlier examination, if the claimant is examined at the Hornsby rooms of Medical Assessor Drew Dixon.
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Commission.
Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (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 matter solely based on the written application.
The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
STATUTORY PROVISIONS/GUIDELINES
Section 57 of the Motor Accidents Compensation Act 1999 (MAC Act) defines a “medical dispute” as a disagreement or issue to which Part 3.4 of the MAC Act applies.
Section 58 and s 60 of the MAC Act together with clauses 1.5-1.7 of the Guidelines set out the procedures for referral to one or more medical assessors and the principles to be applied at such assessments.
The claimant was examined by Medical Assessor Drew Dixon on behalf of the Panel on 28 April 2025.
This 30-year-old claimant was hit by a motor vehicle at approximately 6.30pm on 27 January 2022 when he was walking across the pedestrian crossing with the green light when a vehicle turning right on his right-hand side hit him on the right knee and thigh laterally, as well as his right upper side where he had car keys in his pocket. He was thrown heavily to the ground onto his left-hand side and hit his head and without loss of consciousness.
He was taken by ambulance to the Emergency Department of John Hunter Hospital where he was found to have had a multi-ligament injury to his right knee with subluxation and had a closed injury to his right thigh and had developed a haematoma laterally where the car keys had been in his pocket and was diagnosed with a Morel-Lavallee lesion. He was admitted to John Hunter Hospital and on 3 February 2022 he had right knee reconstruction of the medial collateral ligament (MCL), anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ligaments and a knee brace applied.
He was discharged from hospital after eight days as an inpatient but had attended Singleton Hospital with a haematoma in his right thigh that required surgical drainage. He had physiotherapy in the convalescent period and is now doing exercises at home.
His subsequent progress was that he was confined to his house for some six months after the accident and was unmarried at that time and provisions were brought in to him by his employer, as well as buying necessities online.
He finally returned to his employment after eight months working in a service station but remained on decreased hours and some restriction of work duties and was working 20 hours per week. Recently has started working 38 hours per week.
At the time he was working as a Retail Manager for Sri Krishna Holdings and since the accident has worked as a Retail Manager since 21 August 2023 for DAAS Australia. He has a Bachelor and Master’s degree in business administration.
SOCIAL HISTORY/ACTIVITIES OF DAILY LIVING (ADLs)
He is now married and lives in a one level house with five steps at the front and his wife does most of the home duties including heavy cleaning, heavy grocery shopping and heavy laundry. He has difficulty putting on his shoes and his socks and has difficulty with bathing and showering and has difficulty with heavy cleaning which is done by his wife as well as difficulty with prolonged standing to help with meal preparation, cooking and washing up. He pays someone to do the garden and lawns, which he is unable to do. He has difficulty with prolonged driving and has not been able to return to sport such a cricket, which he played regularly.
PAST HEALTH
There was no past history of right knee or thigh injury.
He reports no other significant motor vehicle accidents in the past that he can recall.
CURRENT TREATMENT
He takes Oxycodone occasionally but usually relies on Voltaren or Nurofen as an anti-inflammatory and Panadol for pain relief and Ice Cool cream and Deep Heat. He does physiotherapy exercises at home.
PRESENT SYMPTOMS
He reports residual difficulty with heavy lifting due to right thigh and knee pain with some discomfort in his lower back. He reports a walking tolerance of 15 to 20 minutes on level ground and a sitting tolerance of 30 minutes but needs to move about in the chair and a standing tolerance of 30 minutes but needs to move about. He has a driving tolerance of up to one hour.
He reports residual pain and stiffness in his right knee with audible retropatellar crepitus and residual mild instability but no locking. He has difficulty squatting and is unable to kneel. His is still concerned about swelling in his proximal thigh and anterolaterally and below this a dimpled area where his drainage took place.
He remains readily conscious of his multiple surgical scars which are tender and painful if bumped and can impact on his ADLs and are visible with summer clothing such as shorts. He is able to readily localise the scars and regards them as disfiguring.
EXAMINATION
On examination on 28 April 2025 he was 185cm tall and weighed 104kg.
He walked with a mild limp on the right and had a moderate limp on toe walking on that side and a moderately severe limp on heel walking on that side and his squat test was associated with some anteromedial knee pain on the right with audible retropatellar crepitus. He had patellofemoral subluxation of the right knee with a positive apprehension test.
There was mild laxity of the medial collateral ligament and a mildly positive posterior drawer sign. He had rotatory stability on pivot shift testing which was mild. There was an effusion in his right knee with retropatellar crepitus. There was tenderness of the anterolateral medial joint line. There was complete sensory loss in the knee inferolaterally, lateral and inferior to the right knee in the distribution of the lateral cutaneous nerve of the thigh.
There were multiple visible scars around his right knee with a 6cm longitudinal scar medially with visible suture marks and colour contrast with pallor. There was a 6cm scar below the patella with visible suture marks and pallor and both scars were hypertrophic. There was a 7cm scar laterally which was reasonably healed and there were two pale scars readily identifiable above the patella of 2cm each. There was an old scar in his lower pre-tibial region from an old injury. The infrapatellar scar showed adherence and this scar, and the medial scar were tender, and he reports they are painful if bumped, impacting on his ADLs.
The range of motion of his right knee was 0 degrees through to 110 degrees today.
The range of motion of his left knee was 0 degrees through to 120 degrees and that knee was stable.
In his upper thigh laterally, there was a soft tissue swelling and below that loss of contour with scar dimpling where his haematoma had been drained. He was able to readily localise this scar which was tender. There was a firm soft tissue swelling at the anterolateral thigh. Quadriceps power was grade 4 out of 5 as was hamstring power and there was 1cm of wasting of the right thigh measuring 55cm, 10cm above the superior pole of the patella, compared with 54cm on the left. There was 1cm of wasting of his right leg below the knee measuring 38cm on the right and 39cm on the left.
There was no tenderness over the trochanteric bursa of his right thigh so any bursitis in this area appears to have resolved.
He had popliteal fullness and difficulty achieving full recurvatum of the left knee on standing and had full recurvatum of the other knee.
He had full range of motion of both hips which were symmetrical. He had bilateral pes planus and made a modest arch on toe standing.
He walked with a limp on the right with a moderate limp on toe walking and moderately severe limp on heel walking and his squat test was associated with anterior knee pain and audible crepitus.
RADIOLOGICAL INVESTIGATIONS
X-ray of the right knee and femur on 27 January 2022 showed lateral dislocation of the tibiofemoral joint and lateral dislocation the patellofemoral joint but no associated displaced fractures.
CT angiogram of the right lower extremity on 28 January 2022 showed the tibiofemoral joint of the knee had been relocated successfully. There was a small intra-articular bony fragment and no evidence of popliteal artery injury. There was a medial patella avulsion fracture and lateral femoral condyle injury, in keeping with lateral patella dislocation and medial retinacula injury. There was some irregularity of the tibial diaphysis.
MRI of the right knee on 30 January 2022 showed evidence of acute injury and there was a complete tear of the medial patellofemoral ligament from the femur and the fibular tibial collateral ligament was avulsed from its distal insertion. The anterior cruciate ligament was intact. The posterior cruciate ligament was thickened with abnormal signal, consistent with a posterior cruciate ligament tear.
X-ray of the right knee on 21 October 2022 showed evidence of previous construction of the ligamentous injuries with persisting lateral subluxation of the patella.
WHOLE PERSON IMPAIRMENT
Right knee is from Table 64, American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA IV), Mild medial collateral ligament laxity is 7%, and there is also 7% lower extremity impairment for the mild posterior cruciate ligament laxity from table 64. The retro patella crepitus of his right knee is from table 62, giving 5% lower extremity impairment. Patellofemoral subluxation with persisting lateral subluxation on X-ray with a positive apprehension test is 7% lower extremity impairment. The Panel notes this finding differs from the assessment of Medical Assessor Hyde Page dated 23 May 2024.
The lateral cutaneous nerve of the thigh is from Table 68, page 89, AMA IV, 2% lower extremity impairment.
Total lower extremity combined impairment is 7x7x7x5x2 which is 26%, from the Combined Value Chart.
This equates to 10% whole person impairment.
That for the scarring as described is from TEMSKI Table 6.18, Page 136, 2% whole person impairment which included dimpling (loss of contour) scar at his right upper thigh drainage site.
This gives a total from the Combined Values Chart of 12% whole person impairment. This is consistent with that found by the Medical Assessor in his Medical Assessment Certificate.
The scarring is consistent with that found by Dr Poplauski who found 2% whole person impairment.
Conclusion
The Panel has assessed that the degree of permanent impairment caused by the motor accident is 12% whole person impairment.
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