CHB v QBE Insurance (Australia) Limited
[2025] NSWPICMP 577
•7 August 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | CHB v QBE Insurance (Australia) Limited [2025] NSWPICMP 577 |
CLAIMANT: | CHB |
INSURER: | QBE (Insurance) Australia Limited |
REVIEW PANEL | |
MEMBER: | Terence O’Riain |
MEDICAL ASSESSOR: | Shane Moloney |
MEDICAL ASSESSOR: | Les Barnsley |
DATE OF DECISION: | 7 August 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); permanent impairment; MAC assessed 6% whole person impairment (WPI); bilateral shoulders with cervical, lumbar, and thoracic spine soft tissue injuries; claimant’s history before accident demonstrated consistent pain in referred body parts; claimant re-examined; submissions on causation and calculating pre-injury impairment; Held – different clinical findings to original assessment; MAC revoked; permanent impairment not greater than 10%; Review Panel satisfied claimant was vulnerable person; decision de-identified. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Review Panel Assessment of Degree of Permanent Impairment Certificate issued under s 7.26(7) of the Motor Accident Injuries Act 2017 (MAI Act) 1. The Panel has found that the degree of permanent impairment of the claimant that has resulted from referred injuries caused by the accident is 3%. 2. Accordingly, the Panel revokes Medical Assessor Alexander Woo’s certificate dated 3. The claimant applied for de-identifying this decision. Having weighed the matters referred to in rule 132(4) of the PIC Rules, the Panel is satisfied that the decision should be de-identified before it is published. |
REASONS
BACKGROUND
The claimant was injured in an accident on 19 March 2020 when the claimant was the seat belted driver of a vehicle. She was stopped at red light when the insured’s car struck her car in the rear. Her vehicle was one of the three vehicles involved in the accident.
She was able get out of her vehicle by herself and the Police and ambulance did not attend the scene.
The insurer is responsible for loss arising from the claimant’s injuries from the subject accident under the Motor Accidents Injuries Act 2017 (MAI Act)
The insurer and the claimant are in a dispute about the level of permanent impairment for the claimant’s injuries caused by this accident.
The claimant applied to the Personal Injury Commission (the Commission) to resolve this dispute.
The Commission referred the following injuries for assessment:
· Cervical spine – Soft tissue injury/discal injury with radiculopathy into the upper limbs/shoulders, a mild broad disc osteophyte with an annular tear at the C3/4 and a mild broad disc osteophyte with mild foraminal stenosis at the C4/5, C5/6, C6/7;
· Thoracic spine – Soft tissue injury/Musculo-ligamentous strain;
· Lumbar spine – Soft tissue injury/musculoligamentous strain with radiculopathy;
· Right shoulder – Rotator cuff injury due to referred pain from the cervical spine/partial thickness tear of the subscapularis and supraspinatus tendons, and
· Left shoulder – Rotator cuff injury due to referred pain from the cervical spine.
On 31 August 2024 Medical Assessor Alexander Woo certified he assessed the claimant’s injuries as 6% permanent impairment, being less than 10%.
After the claimant applied for review on the basis there was a material error in the assessment, the President of the Commission’s delegate on 30 October 2024 constituted this Review Panel (the Panel) to review the original certificate (the Review).
Following rule 128(1) of the Personal Injury Commission Rules, 2021 (the PIC Rules) the Panel ‘is to conduct and determine the proceedings in accordance with procedures determined by the panel’.
The Panel met on 23 January 2025 to discuss how this matter will proceed. The Panel is aware that injury causation is a major dispute issue.
The Commission has referred body parts for assessing permanent impairment, where the medical history frequently refers to those body parts before as well as after the accident. To ensure procedural fairness any examiner must ask questions about that history and do what can be reasonably done to facilitate an environment where the claimant can answer them as reliably as she can.
The Panel noted too that the voluminous clinical notes included sensitive and personal information about the claimant before and after the accident.
Most of that history is not relevant to assessing permanent impairment arising from the accident, however the Panel contemplated that the claimant’s capacity to answer questions about her relevant medical history before the accident may be compromised due to the nature of the material. This concern was disclosed to the parties’ legal advisers with a course of action to ensure procedural fairness to the parties.
The Panel also noted that there were references in Dr Barich’s clinical notes to the existence of a paper file that had not been produced:
There was an MRI scan reported on 3 March 2020, i.e. 16 days before the accident. The radiologist’s report includes Dr Barich’s referral, and states that there was “Neck pain with radiculopathy to both shoulders”.
On 18 February 2020 the notes mentioned a request for an MRI scan which stated “diagnostic imaging requested. MRI-Spine Cervical.” (Page 155 of the claimant’s bundle) There were no other clinical notes to explain the symptoms, findings or indications for this imaging.
However, on page 156-157, in a separate entry dated Tuesday May 21, 2019, during a consultation for chest pain, under “Management”, Dr Barich noted “See full notes in paper file”.
This suggested that the claimant’s GP kept a separate paper file which could contain relevant clinical information. The Panel was of the opinion those notes could be relevant to assessing causation and the claimant’s permanent impairment arising from the accident.
The Panel found it necessary to re-examine the claimant. Both Medical Assessors agreed to examine the claimant in tandem on behalf of the Panel on 14 May 2025 at the Commission’s medical suites.
The Commission arranged for a female Lebanese Arabic interpreter, and a chaperone to be present.
Legislative framework
Schedule 2(2)(a) of the MAI Act declares:
“the degree of permanent impairment of the injured person that has resulted from the injury caused by the accident (including whether the degree of permanent impairment is greater than a particular percentage)”
is a medical assessment matter.
If there is a dispute about the degree of permanent impairment of an injured person being sufficient to award non-economic loss damages i.e. greater than 10%, then those damages may not be awarded unless the degree of permanent impairment has been assessed by a Medical Assessor under Division 7.5: s 4.12(1) MAI Act.
Division 7.5 of the MAI Act provides for the Commission to assess declared medical disputes including provisions relevant to an original medical assessment and for appointing Panels to review those medical assessments.[1]
[1] Sections 7.20, 7.24 and 7.26.
Parties may apply to the President of the Commission for review of a medical assessment on grounds that the assessment “was incorrect in a material respect” (sub-s (1)). If the President, or his delegate is satisfied “there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect” then the President refers the application to a review panel consisting of a member of the Commission and two Medical Assessors (sub-ss (2) and (2B)) to reassess the dispute.
The review is not confined to the issues raised in the application (or the reply) but is “a new assessment of all the matters with which the medical assessment is concerned” (sub-s 3A).
Rule 128 of the PIC Rules permits the Panel to determine its own proceedings and the rules of evidence do not bind the Panel, which may inquire into relevant matters as it thinks fit, while observing procedural fairness.
The method of assessing the degree of impairment is dealt with in s 7.21, which is in the following terms:
“7.21 Assessment of degree of permanent impairment
(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.
(2) Impairments that result from more than one injury arising out of the same accident are to be assessed together to assess the degree of permanent impairment of the injured person.
(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment, or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.
(4) A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent.”
Pre-existing impairment is addressed in cls 6.31-6.33 of the Guidelines. Clause 6.34 deals with subsequent injuries.
The Guidelines state as follows with respect to causation of injury:
“Causation of injury
6.5 An assessment of the degree of permanent impairment is a medical assessment matter under clause 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.
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 accident. The 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.”
It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed condition: Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75]. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50]. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.
ASSESSMENT UNDER REVIEW
On 31 August 2024 Medical Assessor Alexander Woo certified he assessed the claimant’s injuries as 6% permanent impairment, not being greater than 10%.
He created a list of the claimant’s medical history in her general practitioner’s Dr Barich (GP) notes dating back to 2007 until 22 March 2019. The GP had managed the claimant’s continuing neck, back and shoulder pain for about 20 years with Chronic Disease Management Plans (CDMP).
Medical Assessor Woo noted the claimant ignored that history when he presented her with her treating doctors notes. He found there were gross inconsistencies in the clinical signs reported by other specialists who had examined her.
He was unable to use range of motion (AROM) to assess permanent impairment due to the unreasonable variation. The claimant had not demonstrated radiculopathy in the upper and lower limbs in earlier examinations.
Medical Assessor Woo considered the claimant’s non-accident related neck, back and shoulder pain history was the likely cause of her symptoms before and after this accident.
He considered the accident caused soft tissue injuries with aggravation of pre-existing degenerative changes in the cervical, thoracic and lumbar spine. Regarding the claimant shoulders, the accident caused aggravation of pre-existing degenerative changes in some acromial bursitis bilaterally, and a partial thickness rotator cuff tear in the right shoulder.
The right and left shoulders permanent impairment was 3% WPI each, while the remaining injuries were assessed as 0% WPI.
EVIDENCE
Medico-legal evidence
Dr James Bodel, orthopaedic surgeon examined the claimant and produced a report dated 11 April 2023. He found the claimant’s complaints were directly linked with the accident.
He diagnosed bilateral rotator cuff shoulder injuries and a musculoligamentous injury to the cervical spine. The MRI scans confirm at least a partial and possible full thickness tear of the supraspinatus tendon on the right side.
He assessed DRE Cervicothoracic Category II level of assessable impairment in accordance with the description in Table 73 of Page 3/110 of AMA4.
Dr Bodel assessed rateable restriction of shoulder movement in both shoulders using Figure 38 on Page 43, Figure 41 on Page 44 and Figure 44 on Page 45 of AMA4.
On the right side, there was a 10% Upper Extremity Impairment which converts to a 6% Whole Person Impairment and on the left side, a 6% Upper Extremity Impairment which converts to a 4% Whole Person Impairment. That made a total of 15% permanent impairment.
The insurer instructed orthopaedic surgeon Dr Raymond Wallace to examine the claimant on 12 September 2023 and he produced a report dated 18 September 2023.
Dr Wallace refers to the claimant's chronic neck, right shoulder and back pain over the previous 10 years. He refers to scans dating back to September 2013 regarding the referred body parts. This included an MRI of cervical spine two weeks before the accident with a background of neck pain and radiculopathy in both shoulders. Dr Wallace diagnosed that the accident caused muscular ligamentous cervical spine strain and aggravation of pre-existing symptomatic multilevel degenerative cervical spondylosis. He found both conditions had resolved by the time of his examination.
This is based on the claimant's symptomatic conditions existing before the accident, which required regular medical attendances. He assessed nil permanent impairment.
Treatment providers’ records
The claimant regularly saw general practitioners Dr Antwan Barich and Dr Hani Bittar before and since the accident. Those notes were provided to the Panel and are referred to in Medical Assessor Woo’s reasons.
The Panel considered those notes in assessing the claimant’s permanent impairment. The claimant’s history is set out in detail in the original impairment, which can be considered with this decision. Relevant parts of Dr Barich’s notes are referred to in the Panel’s medical report.
The claimant’s medical history recorded in Medical Assessor Woo’s decision.
Other evidence
Biomechanical expert Dr Robert Anderson provided a short-form advice for the insurer dated 14 August 2020 regarding the accident mechanism. He concluded the accident was not severe and any injuries would resolve quickly.
This was not relevant to the Panel's findings.
Claimant’s submissions
The claimant’s submissions dated 3 November 2023 are brief.
In respect to the application for review the claimant submitted on 3 October 2024 that Medical Assessor Woo’s findings did not identify any objective evidence from the period immediately before the subject accident which could demonstrate any symptomatic impairment as required at clause 6.31 of the Guidelines.
Medical Assessor Woo did not identify that evidence or quantify any applicable deductions in relation to any such demonstrable symptomatic impairment.
Medical Assessor Woo speculated as to the cause of the claimant’s post-accident injuries and impairments, when there was no objective evidence that could support that. The submissions also said the Medical Assessor must ignore the pre-existing symptoms unless they include sufficient objective evidence that will allow the calculation of pre-accident permanent impairment.
The claimant referred to the Guidelines provisions on causation set out above, and submitted the Medical Assessor failed to follow that path.
The claimant submitted that Medical Assessor Woo’s findings were inconsistent with those found in the balance of the claimant’s treating and medico-legal evidence. Those inconsistencies were not put to the claimant to allow a fair chance to respond, which was in breach of the requirements prescribed by Clause 6.41 of the Guidelines.
Medical Assessor Woo did not demonstrate his path of reasoning.
Insurer’s submissions
The insurer’s submissions dated 23 November 2023 emphasised that the impact was not sufficient to injure the claimant.
When the claimant reported the accident to police on 24 March 2020 the report stated that no vehicles were towed and no one required any medical treatment.
The claimant has an extensive medical history before the accident, particularly involving ongoing back and neck symptoms, which are disclosed in the claimant’s clinical notes provided to the Panel.
The insurer relies on Dr Wallace’s opinion, who determined the applicant’s cervical spinal and right shoulder symptoms are due to pre-existing cervical spondylosis which has been symptomatic over the last 10 years.
In respect to the review application, the insurer submitted that Medical Assessor Woo provided a reasoned, comprehensive and thorough certificate, which was easy to follow.
Medical re-examination
The claimant attended the Commission medical suites on 14 May 2025. A certified Arabic interpreter, and a chaperone attended to support the claimant and facilitate the examination. Medical Assessors Moloney and Barnsley interviewed and examined the claimant.
Pre-accident history
The claimant stated she has a poor memory for previous medical attention before the accident. She does recall upper thoracic back pain and neck pain. She states that there was no radiation of pain to the upper or lower limbs.
There was a previous history of bilateral shoulder complaint with bursitis and the left supraspinatus tear in 2018, diagnosed by ultrasound but she did not remember these investigations. She recalls taking Panadol or Panadol osteo for pain before the accident.
History of accident
The claimant was driving her car on 19 March 2020, wearing a seatbelt but the airbags did not deploy at the time of the accident. She was stationary at a red light when a car hit her in the rear. She states that there was a further impact from a truck hitting the car that collided with her initially.
At that time, she recalls a click and pain in the cervical spine. She was able to get out of the car. The police and ambulance did not attend the scene. Her husband collected her and he drove her home. The car was subsequently repaired.
History of symptoms and treatment following the accident
The claimant consulted her GP, Dr Barich the day after the accident. She states at that time she had pain in the upper back, neck and trapezius muscle area, in both shoulders but no limb pain. A few weeks after the accident she developed right arm pain. The claimant stated that there was low back pain after the accident but there was no change compared to her low back pain before the accident.
Her GP referred her to a shoulder specialist Dr Kinzel and later another orthopaedic surgeon Dr Guirgis. She vaguely recalls these consultations but stated that she did not proceed with the suggested right shoulder cortisone injection.
A year before this examination, the claimant had a minor motor vehicle accident when she hit a tree and states that this collision did not cause further injuries.
Current symptoms
She says she feels constant neck pain which sometimes increases in severity. There is a sharp upper central back pain which is constant and shoulder pain is noted with abduction above shoulder height worse on the right shoulder. She states that this is worse since the accident but she can’t remember any pre-accident shoulder injury.
The low back pain is no different before and after the accident. The legs are asymptomatic but she gets occasional numbness in the right arm associated with pins and needles which was of brief duration.
Present treatment
Present medication is Panadol Osteo one tablet three times a day and she consulted her GP when necessary. Physiotherapy was ceased about three years ago. No other manual therapy is being undertaken at present.
Clinical examination
The claimant walked into the rooms with a normal gait and sat comfortably during the interview. The claimant’s height was measured at 147 cm and weight of 58 kg. She states that she is right-handed.
Cervical spine
On inspection of the cervical spine there was a normal contour and on testing range of movement, flexion/extension was 25% of expected range. Side bending and rotation were 20% of expected range bilaterally with no asymmetry. On palpation there was hypertonicity in the trapezius muscles but no guarding or spasm was noted.
On neurological examination of the upper limbs, reflexes were equal bilaterally and on testing for sensation there was a global decrease to light touch in the entire right arm. Power was equal bilaterally with a global give way in both arms with some weakness in the right hand musculature on testing. No muscle wasting was apparent ,the circumference of the upper arms 31 cm on the right and 30.5 cm on the left (10 cm above the olecranon process) and in the upper forearms 24 cm bilaterally (5 cm below the olecranon process).
Lumbar spine
The claimant walked with a normal gait and can stand on her heels and toes. On testing range of movement, flexion/extension was 50% of expected range as was side bending bilaterally with no asymmetry. On palpation there was no guarding or spasm in the lumbar musculature. Straight leg raise was 40° bilaterally and limited by shoulder pain. Straight leg raise when seated was 80° with negative sciatic nerve root tension signs.
On neurological examination of the lower limbs, reflexes were equal bilaterally with normal power and no sensory changes were noted. No muscle wasting was apparent with the circumference of the lower thighs 45 cm bilaterally (10 cm above the superior patella pole) and at the maximum circumference of the calves 35 cm bilaterally.
Thoracic spine
On palpation there was tenderness in the paravertebral muscles bilaterally in the thoracic spine region and non-dermatomal hypersensitivity along the thoracic spine to touch. No guarding or spasm was noted in the thoracic musculature. On testing range of movement, flexion/extension was 50% of expected range as was side bending and rotation was restricted to 25% of expected range with no asymmetry. There were no signs of radiculopathy or non-verifiable radicular complaints in the thoracic spine region.
Shoulders
On inspecting her shoulders there was no muscle wasting apparent, but there was generalised tenderness to light palpation of both shoulders. Active measurements were measured with a goniometer and repeated. On passive movement no crepitus was detected. On active movement voluntary guarding was noted. The claimant stated that shoulder movements had been deteriorating in the last year or so.
| Shoulder Movements | Active ROM Measured RIGHT | Active ROM Measured LEFT |
| Flexion | 80° | 90° |
| Extension | 30° | 40° |
| Adduction | 0° | 20° |
| Abduction | 60° | 90° |
| Internal Rotation | 30° | 0° |
| External Rotation | 0° | 20° |
The Panel discussed with the claimant how some previous examiners had reported a full range of movement in the shoulders after the accident. She could not explain why there had been such a deterioration more recently. The Panel then explained to her that due to inconsistency over time since the accident of shoulder movement that range of movement could not be used to assess impairment. Another method would have to be used by analogy and she stated that she understood this via the interpreter.
Discussion
Cervical spine – soft tissue injury
There is documentation that supports the claimant sustaining a soft tissue injury to her cervical spine in the subject accident. She reported immediate pain after the accident and in the consultation with the treating GP. The treating GP had investigated neck pain with the MRI of the cervical spine 3 weeks before the accident.
There is a symmetrical reduction in range of movement with no dysmetria and no guarding or spasm on palpation. There were no signs of radiculopathy or non-verifiable radicular complaints that conformed to a dermatomal pattern in the upper limbs.
At the time of the Panel’s examination a classification of DRE l was made which is 0% WPI.
Thoracic spine – soft tissue injury
The day after the accident, the treating GP recorded upper back pain and investigated with an MRI 2 months after the accident. The Panel noted an earlier thoracic spine CT scan one year before the accident.
On examination there was no dysmetria on testing range of movement, no guarding on palpation and no signs of radiculopathy or non-verifiable radicular complaints in the thoracic spine region.
The Panel accepts that the claimant sustained a soft tissue injury to her thoracic spine in the subject accident. This gave a classification of DRE l which is 0% WPI.
Lumbar spine – soft tissue injury
The treating GP recorded low back pain one day after the accident and later investigated this with a CT of the lumbar spine.
At the time of the Panel’s examination, there was no dysmetria on testing range of movement, no guarding on palpation and no signs of radiculopathy or non-verifiable radicular complaints in the lower limbs.
The Panel accepts that the claimant sustained a soft tissue injury to the lumbar spine in the subject accident. This is determined by classification DRE l which is 0% WPI.
Right shoulder – soft tissue injury
The claimant complained of right shoulder pain one day after the accident to her treating GP. This was investigated by an ultrasound 10 days after the accident and later an MRI.
At the time of the Panel’s examination, there was limited range of movement of the right shoulder. However, Drs Jeffries and Cunningham recorded in 2020 that both shoulders had a full range of movement.
Dr Bodel’s report to the claimant’s lawyers in 2023 recorded that there was a slight limitation range of movement in the right shoulder but much better than the Panel observed.
The Panel has determined that there may have been a soft tissue injury to the right shoulder with initially full range of movement six months after the accident and a slight deterioration in 2023 but in the last six months there has been a significant decrease in range with no apparent further injury.
There was also pre-existing bursitis diagnosed with an ultrasound two years before the accident and six years before the accident.
Due to this inconsistency chronologically, the Panel has determined that it was not appropriate to assess impairment using range of movement so a more appropriate method by analogy would be undertaken.
Using table 18 of AMA 4, the acromioclavicular joint has a WPI of 15%. The moderate crepitation severity using table 19 is 20% of the total which is 3% WPI. Medical Assessor Woo came to the same conclusion.
Left shoulder – soft tissue injury
The claimant stated that she had pain in both shoulders the day after the accident but at the first consultation with the treating GP, he only recorded pain in the right shoulder. The treating orthopaedic surgeon Dr Kinzel examined her one year after the accident and noted pain in the right shoulder but a full preserved range of movement.
There was no documentation of the left shoulder injury. Two years before the accident the treating GP referred the claimant for a left shoulder ultrasound which reported the left supraspinatus tear. Dr Jeffries and Cunningham within six months of the accident recorded the claimant had full range of movement in both shoulders.
In 2023 Dr Bodel reported he found a near normal range of movement of the left shoulder.
The Panel therefore concluded that the motor vehicle accident did not cause any injury to the left shoulder. On the basis of the claimant’s own reporting of difficulty recalling her symptoms, the Panel’s consideration puts weight on the contemporaneous medical records which do not support a new injury to the left shoulder.
DETERMINATIONS
Diagnosis and reasons
The Panel considered all the available information including information that the Medical Assessors obtained at the examination.
Summary of injuries referred by the parties
The accident caused the following injuries:
· Right shoulder
· Neck
· Lumbar spine
· Thoracic spine.
The accident did not cause or materially contribute to the claimant’s left shoulder condition.
PERMANENCY OF IMPAIRMENT
Permanent impairment is defined in the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Fourth Edition) (AMA 4 Guides) (p 315) as follows:
“Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment.
A permanent impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment.”
DETERMINATION
The Panel has considered the evidence relating to the claimant’s pre-accident condition
The Panel has considered the evidence relating to the claimant’s pre-accident physical condition history.
The Panel has also considered the claimant’s treating doctors’ opinions and the insurer’s IME.
The Panel has given weight to its medical members’ opinion who, following a thorough consideration of the claimant’s medical history concluded that there was insufficient objective evidence to calculate any existing impairment at the date of the accident, which could be deducted.
The Panel is satisfied that the claimant suffered physical injury as a result of the accident, because the accident mechanism was capable of causing such injuries, and there were sufficiently contemporaneous complaints regarding the referred body parts.
The Panel is satisfied that the accident caused aggravation of pre-existing conditions affecting the referred body parts, but that this aggravation has ceased.
Conclusion
The Panel notes the clinical judgment of its medical members, and agrees with and adopts their findings, and the reasons they have given in support of those findings.
The Panel has found that the degree of permanent impairment of the claimant that has resulted from referred injuries caused by the accident is 3%, and that the permanent impairment is not greater than 10%.
Given those findings, the Panel revokes Medical Assessor Alexander Woo’s certificate dated
31 August 2024 and issues a new certificate certifying that the degree of permanent impairment of the claimant that has resulted from the injuries caused by the accident is not greater than 10%.The claimant has also applied for de-identifying the decision.
These reasons do not refer to irrelevant sensitive personal information, but due to matters disclosed in the claimant's treating clinical notes the Panel is satisfied that the claimant is a particularly vulnerable person.
Having weighed the matters referred to in r 132(4) of the PIC Rules, including the safety, health and wellbeing of the claimant, and whether the public interest in giving the direction significantly outweighs the public interest in open justice, the Panel is satisfied that the decision should be de-identified before it is published.
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