BUQ v QBE Insurance (Australia) Ltd - [2025] NSWPICMP 482

DETERMINATION OF REVIEW PANEL
CITATION:	BUQ v QBE Insurance (Australia) Ltd [2025] NSWPICMP 482
CLAIMANT:	BUQ
INSURER:	QBE Insurance (Australia) Limited
REVIEW PANEL
MEMBER:	Bianca Montgomery-Hribar
MEDICAL ASSESSOR:	Dr Melissa Barrett
MEDICAL ASSESSOR:	Dr Steven Yeates
DATE OF DECISION:	3 July 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of threshold injury; Medical Assessor (MA) diagnosed adjustment disorder caused by the accident (threshold injury); claimant’s application for review under section 7.26; previous diagnoses considered; claimant examined by MA’s of Review Panel; Held – diagnosis of specific (simple) phobia caused by accident; non-threshold injury; post-traumatic stress disorder (PTSD) considered, and Review Panel satisfied criterion A not met; MAC revoked; new certificate issued.
DETERMINATIONS MADE:	1. The Review Panel: a. revokes the certificate of Medical Assessor Surabhi Verma dated 20 June 2024; b. determines that the claimant’s specific (simple) phobia caused by the accident is a non-threshold injury, and C. directs that, pursuant to rule 132 of the PIC Rules, its certificate and reasons be de-identified prior to publication.

STATEMENT OF REASONS

INTRODUCTION

On 28 February 2023, BUQ (claimant) was driving along Oran Park Drive when his vehicle, owned by a friend, was hit by a car exiting an underground carpark at Oran Park Shopping Centre (accident).
BUQ made a claim for statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act) on QBE Insurance (Australia) Limited (insurer).
A dispute has arisen between the insurer and BUQ as to whether his psychological injuries are “threshold injuries” within the meaning and for the purposes of the MAI Act.
Whether BUQ has suffered threshold injuries as a result of the accident affects his 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 Surabhi Verma. On 20 June 2024, BUQ was assessed by Medical Assessor Verma, who issued a certificate of same date. The Medical Assessor concluded that the injury caused by the motor accident, being Adjustment Disorder with mixed anxious and depressed mood, is a threshold injury for the purposes of the MAI Act
BUQ lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Verma’s assessment under s 7.26 of the MAI Act. On 26 July 2024, a delegate of the President determined there was reasonable cause to suspect that the medical assessment was incorrect in a material respect, based on the diagnosis of post-traumatic stress disorder by CHL and the Medical Assessor’s assessment of threshold injury. Accordingly, the delegate referred the application to a review panel.
This review panel (the Panel) has been constituted to conduct a review of Medical Assessor Verma’s certificate dated 20 June 2024 (Review).

LEGISLATIVE FRAMEWORK

Threshold injury (formerly minor injury) provisions

The Motor Accident Injuries Amendment Act 2022 (the MAI Amendment Act) was assented on 28 November 2022 with various amendments commencing on 1 April 2023. From 1 April 2023, the MAI Amendment Act provides that…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

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Details

Case: [2025] NSWPICMP 482
Decision Date: 3 July 2025

CaseChat Overview and Summary

In the case of BUQ v QBE Insurance (Australia) Ltd, the applicant, BUQ, sought a review of a Medical Assessment Certificate (MAC) issued under the Motor Accident Injuries Act 2017. BUQ argued that the initial assessment by a Medical Assessor (MA) did not correctly identify the injury caused by a motor accident. The MA had diagnosed BUQ with an adjustment disorder resulting from the accident, which was considered a threshold injury under the Act. BUQ applied for a review of this decision, challenging the diagnosis and arguing that the correct injury should have been identified.

The primary legal issue before the court was whether the diagnosis of adjustment disorder as a threshold injury was correct or if another condition, such as a specific phobia, should have been diagnosed. The court had to consider the evidence presented by BUQ and the review panel, including expert medical opinions. The Review Panel had examined BUQ and concluded that a specific (simple) phobia, caused by the accident, was the appropriate diagnosis. The court needed to determine whether this conclusion was reasonable and supported by the evidence.

The court found that the Review Panel's diagnosis of a specific (simple) phobia was supported by the evidence. The Review Panel had considered the previous diagnoses and concluded that the criteria for a threshold injury were not met as BUQ did not satisfy the criteria for post-traumatic stress disorder (PTSD). The Review Panel was satisfied that BUQ did not meet criterion A of the PTSD diagnosis. Consequently, the court upheld the Review Panel's decision to revoke the original MAC and issue a new certificate reflecting the correct diagnosis. The court determined that BUQ had not sustained a threshold injury, and the new certificate accurately reflected the nature of the injury sustained.

The final orders of the court included the revocation of the original MAC and the issuance of a new certificate recognising a non-threshold injury. The court's decision was based on the Review Panel's findings that BUQ had sustained a specific (simple) phobia as a result of the accident, which did not meet the criteria for a threshold injury under the Motor Accident Injuries Act 2017.

Orders