CAK v AAI Limited t/as AAMI - [2025] NSWPICMP 727

DETERMINATION OF REVIEW PANEL
CITATION:	CAK v AAI Limited t/as AAMI [2025] NSWPICMP 727
CLAIMANT:	CAK
INSURER:	AAI Limited t/as AAMI
REVIEW PANEL
MEMBER:	Terence O’Riain
MEDICAL ASSESSOR:	Brian Williams
MEDICAL ASSESSOR:	Thandavan Raj
DATE OF DECISION:	19 September 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; accident 8 July 2023; claimant incurred gradual hearing loss; dispute related to causation; original certificate did not accept link with hearing loss and accident; claimant’s review application; whether accident as it is alleged to have happened could cause gradual hearing loss; medical opinions were that forceful head injury with significant loss of consciousness was necessary prerequisite to condition having a traumatic aetiology; no evidence supporting necessary trauma occurring; claimant refused to be re-examined; on the papers; Held – accident did not cause hearing loss; original assessment confirmed.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Review Panel Assessment of Treatment and Care Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Panel affirms Medical Assessor Payten’s certificate dated 9 January 2025. 2. The Review Panel finds that the following treatment and care: · BICROS hearing aids, does not relate to the injury caused by the motor accident. 3. The Review Panel finds the following proposed treatment and care: · BICROS hearing aids, is not reasonable and necessary in the circumstances.

REASONS

BACKGROUND

The claimant was injured in the subject accident on 8 July 2023 as the back seat passenger on the insured driver’s side of a rideshare vehicle he shared with his partner, when it collided with the rear of another rideshare vehicle.
The insurer is responsible for loss arising from the claimant’s injuries from the accident under the Motor Accidents Injuries Act 2017 (MAI Act).
The insurer and the claimant are in a dispute under s 3.24 of the MAI Act relating to the provision of treatment and care from injuries caused by the accident.
The claimant applied to the Personal Injury Commission (Commission) to resolve this dispute.
On 9 January 2025 Medical Assessor Robert Payten provided findings on treatment and care pursuant to cl 2 (b) of Schedule 2 of the MAI Act certifying the claimant’s entitlement to treatment and care.
Medical Assessor Payten's certificate listed the Commission's referred treatment disputes for assessment as follows:
“(a) Whether the physical injuries give rise to a need for BiCROS trial to evaluate whether BiCROS hearing aids can effectively enhance hearing capabilities relates to the injury caused by the motor accident
(b) Whether the physical injuries give rise to a need for BiCROS trial to evaluate whether BiCROS hearing aids can effectively enhance hearing capabilities is reasonable and necessary in the circumstances.”

The Medical Assessor could not find a causal nexus between all the referred injuries and the accident, and accordingly all proposed treatment was not reasonable and necessary in the circumstances.
The claimant applied for review on the basis the assessment was incorrect in a material respect, submitting that Medical Assessor Payten failed to provide sufficient reasons and…

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 727
Decision Date: 19 September 2025

CaseChat Overview and Summary

The case of CAK v AAI Limited t/as AAMI involved a claimant who alleged that a motor accident on 8 July 2023 caused their gradual hearing loss. The dispute centred on whether the accident was the cause of the hearing loss, as the original certificate did not acknowledge a connection. The claimant applied for a review of this decision, arguing that the accident as alleged could have led to the gradual hearing loss. The matter was heard on the papers, as the claimant refused to be re-examined.

The court had to determine whether the accident, as it was alleged to have happened, could cause gradual hearing loss. Medical opinions presented in the case indicated that a forceful head injury accompanied by significant loss of consciousness was a necessary condition for the hearing loss to have a traumatic origin. However, there was no evidence to support the occurrence of such necessary trauma. The claimant's refusal to undergo a re-examination further complicated the issue.

The court concluded that the accident did not cause the claimant's hearing loss, thereby confirming the original assessment. The court's reasoning was based on the absence of evidence showing that the alleged accident involved the necessary trauma to cause the condition. The claimant's refusal to be re-examined meant the court could not rely on new evidence to overturn the original decision.

The final orders of the court confirmed the original assessment, denying the claimant's application for a review. The claimant was not found to have incurred gradual hearing loss due to the motor accident, and the decision remained unchanged.

Orders