Chimata v AAI Limited t/as AAMI - [2023] NSWPICMP 407

DETERMINATION OF REVIEW PANEL
CITATION:	Chimata v AAI Limited t/as AAMI [2023] NSWPICMP 407
CLAIMANT:	Sagar Chimata
INSURER:	AAI Limited t/as AAMI for the Nominal Defendant
REVIEW PANEL
MEMBER:	Belinda Cassidy
MEDICAL ASSESSOR:	Alan Home
MEDICAL ASSESSOR:	Michael Couch
DATE OF DECISION:	22 August 2023
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; medical assessment of treatment dispute by Medical Assessor Shahzad and claimant’s review under section 63; claimant pedestrian, knocked down in Sydney central business district; Insurer referred disputes about past and future domestic assistance, future medication, general practitioner and pain specialist consultations; claimant alleged injuries to his head, neck, lower back, bladder, left and right leg and ankle and both shoulders; issues of consistency raised by the insurer and causation; Held – claimant made no complaint of left ankle, left shoulder, right hip or knee pain; these had resolved and required no further treatment; no ongoing bladder issues and therefore no further treatment; claimant sustained cervical, lumbar spine and right shoulder injuries which were still causing symptoms and required treatment; domestic assistance allowed in part, medication by way of simple analgesics allowed, one GP consultation per year allowed and no pain specialist consultations allowed; general discussion of principles and approach to the resolution of treatment disputes; certificate of MA revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Part 3.4 of the Motor Accidents Compensation Act 1999 The Review Panel: 1. Revokes the certificate of Medical Assessor Shahzad dated 17 November 2022. 2. Certifies that in relation to the claimant’s physical injuries caused by the accident on 29 June 2016: (a) there was an injury-related need for assistance with heavy domestic duties from the date of the accident to the date of this Review and that the assistance provided was reasonable and necessary in the circumstances; (b) there is an injury-related need for assistance with heavy domestic duties to be provided from the date of this Review until the claimant turns 60 and this assistance is reasonable and necessary in the circumstances; (c) there is an injury-related need for simple analgesic medication to be provided from the date of the Review for the remainder of the claimant’s life expectancy and that this medication is reasonable and necessary in the circumstances; (d) there is an injury-related need for one general practitioner review per year from the date of this Review until the claimant turns 70 and this review is reasonable and necessary in the circumstances, and (e) while pain consultations may be related to the injuries caused by the accident, any consultation to be provided after the date of this Review is not reasonable and necessary in the circumstances.

STATEMENT OF REASONS

INTRODUCTION

Sagar Chimata was involved in a motor accident on 29 June 2016. Mr Chimata says he was crossing Pitt Street in Sydney when he was hit by a car.
The claimant says he injured his back and right shoulder in the accident. He says he suffers from headaches and has a significant psychiatric injury.
Mr…

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: [2023] NSWPICMP 407
Decision Date: 22 August 2023

CaseChat Overview and Summary

The case of Chimata v AAI Limited t/as AAMI involved a dispute over the assessment of treatment for a claimant who was injured as a pedestrian in the Sydney central business district. The dispute was evaluated by Medical Assessor Shahzad and subsequently reviewed under section 63 of the Motor Accidents Compensation Act 1999. The claimant alleged injuries to various parts of his body, including his head, neck, lower back, bladder, legs, ankles, and shoulders. The insurer contested the necessity of past and future domestic assistance, medication, general practitioner and pain specialist consultations. The court was tasked with resolving these disputes and determining the appropriate level of treatment and assistance for the claimant.

The primary legal issues revolved around the consistency of the claimant's complaints and the causation of his injuries. The insurer argued that certain injuries, such as those to the left ankle, left shoulder, right hip, and knee, had resolved and did not require further treatment. They also contended that the claimant's bladder issues had subsided, negating the need for ongoing treatment. The court had to assess these arguments against the claimant's assertions regarding the persistence and severity of his injuries.

In its reasoning, the court determined that the claimant had not complained of pain in his left ankle, left shoulder, right hip, or knee, and that these conditions had indeed resolved. The court found that there were no ongoing bladder issues, and thus, no further treatment was warranted in these areas. However, the court acknowledged that the claimant had sustained injuries to his cervical and lumbar spine and right shoulder, which were still causing symptoms and necessitated treatment. The court allowed for partial domestic assistance, permitted the use of simple analgesics, and allowed one general practitioner consultation per year, but disallowed any pain specialist consultations.

The final orders included the allowance of certain domestic assistance, medication by way of simple analgesics, and one GP consultation per year, while prohibiting any pain specialist consultations. The court's decision also included a revocation of the certificate issued by the Medical Assessor.

Orders