Ciantar v QBE Insurance (Australia) Limited
[2025] NSWPICMP 90
•17 February 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Ciantar v QBE Insurance (Australia) Limited [2025] NSWPICMP 90 |
CLAIMANT: | Doris Ciantar |
INSURER: | QBE Insurance (Australia) Limited |
REVIEW PANEL | |
MEMBER: | Gary Victor Patterson |
MEDICAL ASSESSOR: | Les Barnsley |
MEDICAL ASSESSOR: | Ian Cameron |
DATE OF DECISION: | 17 February 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; degree of permanent impairment dispute; claimant was a passenger in a motor vehicle involved in a rear-end collision of a relatively minor nature; claimant was wearing a seatbelt; airbags did not deploy; claimant complained of limited movement and pain in the left shoulder; diagnostic scans demonstrated failure of surgical fixation of the left humerus following surgery for a left humerus fracture a few weeks prior to the accident; claimant experienced left-sided lower back pain and pain over the right lateral thigh; claimant previously had radiotherapy and chemotherapy to her neck and had no sensation around the shoulder girdle whether relevant to assessment of whole person impairment (WPI); insurer admitted liability for the claim; absence of evidence to assess pre-existing impairment in injured left shoulder; assessment of impairment in uninjured right shoulder; lacuna in Motor Accident Guidelines; Held – Review Panel assesses 11% WPI (Medical Assessor 4% WPI); issues as to causation of injuries; explanation why findings of Review Panel on left shoulder and lumbar spine impairment significantly different to those of Medical Assessor; Medical Assessment Certificate revoked. |
DETERMINATIONS MADE: | CERTIFICATE REVIEW PANEL ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT Certificate issued under s 7.26(7) of the Motor Accident Injuries Act2017 (the Act) 1. The Review Panel revokes the certificate dated 28 June 2024 and issues a new certificate determining that: (a) the following injuries caused by the motor accident give rise to a permanent impairment of 11% and is greater than 10%: · left shoulder – proximal neck of humerus fracture initially internally fixed with subsequent failure of fixation and revision fixation, soft tissue, residual possible rotator cuff tear; · lumbar spine – soft tissue/spondylosis with radicular symtoms, and · left shoulder – scarrring. |
·
STATEMENT OF REASONS
INTRODUCTION
Doris Ciantar (the claimant) was a passenger in a motor vehicle being driven by her friend on Newbridge Road at Liverpool. The friend braked heavily to avoid a car that had stopped in front of her at an intersection. They were rear-ended by the vehicle behind them. The claimant was wearing a seatbelt. The airbags did not deploy.
Subsequent to the accident, the claimant complained of limited movement and pain in the left shoulder. Diagnostic scans demonstrated failure of surgical fixation of the left humerus following a prior trip and fall at work. The claimant also experienced left-sided lower back pain and pain over the right lateral thigh. The claimant previously had radiotherapy and chemotherapy to her neck and had no sensation around the shoulder girdle.
QBE (the insurer) indemnifies the owner and/or the driver of the at-fault vehicle for liability to pay to the claimant any damages under the Motor Accident Injuries Act 2017 (the Act). The insurer admitted liability for the claim.
ASSESSMENT UNDER REVIEW
As there is a dispute between the parties about the degree of permanent impairment under Schedule 2, cl 2(a) of the Act, the claimant was referred to Medical Assessor Robert Kuru for assessment. Medical Assessor Kuru certified on 28 June 2024 as follows:
The following injuries caused by the motor accident give rise to a permanent impairment of 5% and IS NOT GREATER THAN 10%:
· Left shoulder – proximal neck of humerus fracture initially internally fixed with subsequent failure of fixation and revision fixation, soft tissue, residual possible rotator cuff tear
· Lumbar spine – soft tissue/spondylosis with radicular symptoms
· Left shoulder – scarring
Medical Assessor Kuru assessed 1% whole person impairment (WPI) for the left shoulder, 3% WPI for the lumbar spine and 1% WPI for scarring. That was after allowing an apportionment of 1/2 due to a pre-existing left shoulder condition and 2/5 for a pre-existing condition of the lumbar spine. Medical Assessor Kuru made no adjustment for treatment effects.
THE REVIEW
The claimant sought a review of Medical Assessor Kuru’s certificate, on the grounds that the medical assessment was incorrect in a material respect, under s 7.26 of the Act. The claimant relied on the particulars set out in the application and supporting documentation.
The claimant notes that Medical Assessor Kuru diagnosed a left humeral fracture and loss of fixation as a result of the subject accident. He noted that the claimant had sensate left upper arm due to previous chemotherapy and radiotherapy which increased the chance of her having non-union/failure of fixation. Consequently, Medical Assessor Kuru deducted half of the WPI assessment for the left shoulder, on the basis of pre-existing impairment.
The claimant submitted that is not the correct test which requires the presence of evidence of objective impairment. Therefore, to the extent the Medical Assessor considered the sensate left upper arm because of previous chemotherapy and radiotherapy in assessing pre-existing impairment, it was submitted that he erred.
In relation to pre-existing impairment in the lumbar spine, the claimant submitted that the Medical Assessor erred because he did not provide adequate reasons with respect to his deduction of 2/5 of the impairment in the lumbar spine.
The claimant’s application for review was opposed by the insurer which submitted the Medical Assessor had accurately assessed the claimant’s permanent impairment.
In relation to the left shoulder, the insurer submitted that the certificate, when read as a whole, clearly demonstrates that the Medical Assessor deducted pre-existing impairment in relation to the claimant’s objective pre-existing restriction, that existed as a result of the claimant’s prior internal fixation.
In relation to the lumbar spine, the insurer disputes that Medical Assessor Kuru failed to provide adequate reasons for deducting 2/5 impairment for pre-existing injuries to the claimant’s lumbar spine. The insurer also disputes the assessment of the claimant’s pre-existing injuries was not performed in accordance with cl 6.31 of the Motor Accident Guidelines (Guidelines)
President’s delegate Tajan Baba issued a Determination of an Application for Review of a Medical Assessment on 19 August 2024 which stated the satisfaction of the President’s delegate that there is reasonable cause to suspect that Medical Assessor Kuru’s assessment was incorrect in a material respect. The basis of that decision was stated to be the claimant’s submission that the Medical Assessor applied an incorrect test for the assessment of pre-existing impairment of the left shoulder. Accordingly, the claimant’s review application was accepted.
The Review Panel is to re-assess all of the injuries that were referred to Medical Assessor Kuru for assessment.
STATUTORY PROVISIONS
A medical assessment matter is determined in accordance with Division 7.5 of the Act. The matter is determined at first instance by a Medical Assessor pursuant to s 7.20 of the Act and, on review, pursuant to s 7.26 of the Act, by a Review Panel consisting of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
Part 5 of the Personal Injury Commission Act 2020 (the PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a Panel, reviewing a decision of a Medical Assessor.[1]
[1] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the 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 proceedings solely based on the written Application.[2]
[2] Rule 128 of the PIC Rules.
The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[3]
[3] Section 7.26(6) of the Act.
All members of the Review Panel had no previous involvement with the claimant or with this matter.
CAUSATION OF INJURY
Causation of injury is addressed in the Guidelines as follows:
“6.5 An assessment of the degree of permanent impairment is a medical assessment matter under cl 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 motor 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 AMA 4 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 AMA 4 Guides as follows:
Causation means that a physical, chemical or biological 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 contributed to the worsening of the impairment, which is a non-medical determination.
This, therefore, involves a medical decision and non-medical informed judgment.
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 motor accident. The motor 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.”
In Briggs v IAG Limited t/as NRMA Limited,[4] see also Insurance Australia Limited t/as NRMA Insurance v Trkulja [2023] NSWSC 956,[5] his Honour Justice Wright stated at [35]:
“The question of causation of injuries was not dealt with in Part 5 of the Guidelines but causation was addressed in Part 6, which related to assessment of permanent impairment. There is no reason to think that different principes were intended to be applied when a medical assessment was being made in relation to causation of minor injuries.”
[4] Briggs v IAG Limited t/as NRMA Insurance [2022] NSWSC 372.
[5] Insurance Australia Limited t/as NRMA Insurance v Trkulja [2023] NSWSC 956.
Wright J then described the Review Panel’s role in a medical review which is to:
“Consider whether the motor accident did cause or contribute to (the claimant’s condition). This require, not a consideration of material derived as a result of an internet search… but rather a consideration of the material referred to in 5.6 of the Guidelines, namely all the evidence available to the Panel, including all relevant findings derived from:
(1)a comprehensive, accurate history, including pre-accident history and pre-existing conditions;
(2)a review of all relevant records available at the assessment;
(3)a comprehensive description of the injured person’s current symptoms;
(4)a careful and thorough physical examination;
(5)diagnostic tests available at the assessment, noting that imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
MATERIAL BEFORE THE REVIEW PANEL
The claimant relied upon the following material which the Review Panel has considered:
(a) review submissions dated 19 July 2024 (previously summarised).
(b) Application for personal injury benefits dated 25 May 2022.
(c) claimant’s statement dated 29 March 2023.
(d) Report dated 9 November 2022 by Dr Jonathan Herald to the claimant’s solicitor.
Dr Herald records the history of the subject motor accident on 25 March 2022 and the prior fall on 8 February 2022 when the claimant injured her left arm. The claimant underwent internal fixation of the proximal humerus fracture following that earlier incident. Dr Herald records that, following the subject motor accident, the claimant’s left arm pain worsened and she developed back pain. Further investigation revealed that the plate in her left arm had moved. In regards to her back pain, Dr Herald records that the claimant was developing radiculopathy symptoms down the left leg. She was referred to a neurosurgeon, Dr McKechnie, who continued conservative treatment. In regards to her left shoulder, the claimant underwent revision surgery on 28 April 2022.
Dr Herald provides the following assessment:
·proximal neck of humerus fracture initially internally fixed with subsequent failure of fixation as a result of moto, and.
·lumbar spondylosis with radiculopathy symptoms in her left lower limb.
Dr Herald estimated the costs of further indicated treatment and, in a separate report, assessed WPI as follows:
Body part
Percentage (%)
Left shoulder
10% WPI
Lumbar spine
5% WPI
Scarring
2% WPI
This results in a combined 17% WPI from which no deduction was made for any pre-existing condition.
(e)Letter dated 13 June 2023 from QBE to the claimant’s solicitor confirming its inability to concede that the claimant’s injuries result in permanent impairment exceeding the 10% threshold.
The insurer relied upon the following material which the Review Panel has considered:
(a) insurer’s submissions in response to application for review (previously summarised).
(b) insurer’s submissions to Medical Assessor Kuru dated 11 December 2023.
Under the heading MEDICAL SUMMARY, the insurer noted the following:
(i)the claimant is on medication for Type 2 Diabetes and blood pressure issues and has a history of a left parotid carcinoma and lap band surgery.
(ii)The claimant was a passenger in a vehicle that was rear-ended by the insured vehicle.
(iii)The claimant was not attended by ambulance personnel nor did she attend hospital.
(iv)The airbags did not deploy and damage to the back of her vehicle was minor in nature.
(v)Police attended the incident but did not investigate or make a report that day.
(vi)The insurer notes the history of a previous internal fixation surgery and that the claimant refractured her left humerus in the subject accident requiring re-surgery.
The insurer submitted there are significant causation issues in relation to the left shoulder. It was the insurer’s primary submission that a left humerus fracture was not caused by the subject accident. It was the insurer’s secondary submission that the claimant had not reached maximum medical improvement at the time of Dr Herald’s assessment and that her range of movement since had improved.
The insurer then refers to its report by Dr Raymond Wallace, orthopaedic surgeon, who found that the claimant had 6% WPI equally attributable to her initial injury at home and the subsequent motor accident. As such, the insurer makes the following submissions:
(i)the pre-existing condition in the left shoulder is of far greater significance to any ongoing symptoms than any injury arising from the subject accident.
(ii)If it is accepted that the subject accident has given rise to some injury to the left shoulder, a deduction should be made from the assessment of impairment for the pre-existing injury to the left shoulder.
(iii)The findings of Dr Wallace as to the level of permanent impairment should be preferred to those of Dr Herald.
In relation to the lumbar spine, the insurer submitted there are significant causation issues. It was the insurer’s primary submission that lumbar spine spondylosis was not caused by the subject accident. Particulars are given of the claimant’s prior medical history in relation to the lumbar spine. The insurer notes that Dr Wallace did accept that the subject accident may have caused some aggravation of the claimant’s prior lumbar spine condition. The insurer submits that the claimant had a pre-existing impairment of the lumbar spine which was evidenced by recent pre-accident complaints of sciatica. The insurer submitted that any lumbar spine injury deemed attributable to the subject accident should amount to 0% in accordance with the assessment of Dr Wallace.
As to the left shoulder scarring, the insurer made the following submissions:
(i)the claimant already had scarring present in the same location from her prior surgery that pre-dates the accident. Therefore, there would have been scarring present even if the subject accident did not occur.
(ii)Dr Herald’s assessment was completed prematurely, just over six months after the claimant’s last surgery, noting that she underwent multiple surgeries on the same scar in that year.
(iii)Dr Herald did not consider the claimant’s pre-existing scarring from the surgery on 4 March 2022.
(iv)Dr Wallace’s assessment, being almost 17 months after the accident, should be preferred as an accurate assessment of healed scar.
(v)As there is not any ratable permanent impairment in the left shoulder arising solely from the subject accident, there should be a nil finding of permanent impairment for scarring.
(c) Report dated 1 March 2022 by Dr Kuo, orthopaedic surgeon, to Dr Coleman noting that the left humeral fracture was not controlled well by a brace and that open reduction and internal fixation would be performed.
(d) Photograph of damaged to the claimant’s vehicle.
(e) Discharged Summary from Nepean Hospital dated 4 March 2022.
(f) Report dated 14 August 2023 by Dr Wallace to the insurer.
Dr Wallace provided the following opinions/diagnosis arising from the subject accident:
“1. Aggravation of previous proximal humeral fracture left arm.
2.Aggravation of pre-existing symptomatic multi-level degenerative lumbar spondylosis.”
As to causation, Dr Wallace opines as follows:
·the claimant’s left other arm condition is due to injuries sustained as a result of the indexed motor vehicle accident with a significant proportion being due to a previous injury as a result of a fall at home.
·The claimant’s lumbar spinal condition is due to injuries sustained in the indexed motor vehicle accident with a significant proportion being due to pre-existing symptomatic multi-level degenerative spondylosis.
Dr Wallace thought that the claimant’s condition had stabilised and assessed 3% WPI for the left shoulder after deducting the same percentage for the claimant’s pre-existing condition. Dr Wallace assessed 0% WPI for the lumbar spine and surgical scarring.
(g) Allied Health Recovery requests for physiotherapy (x4) various dates.
(h) Clinical notes of Lakeview Private Hospital.
(i) Clinical notes of Dr Cole (handwritten).
(j) Insurer’s WPI position dated 2 June 2023 (see previously).
(k) Insurer’s Certificate of Determination and Reasons dated 19 July 2023.
Confirms decision upon internal review that the degree of permanent impairment as a result of an injury caused by the motor accident on 25 March 2023 is not greater than 10% (impairment threshold).
EXAMINATION REPORT
The report of Medical Assessor Cameron and Medical Assessor Barnsley is as follows:
“MRS DORIS CIANTAR, DOB 05/02/1945
Mrs Ciantar was re-examined by Dr Barnsley and Dr Cameron at Hornsby on 17 January 2025. She attended with her son, Rob.
Information about the Review Panel was provided.
Background
Mrs Ciantar lives alone at Mount Pritchard. She has been widowed for five years.
Mrs Ciantar said that she was active and exercising regularly prior to the motor accident.
There is a past history of left parotid carcinoma treated with radiotherapy and chemotherapy prior to the motor accident. She could not remember the date of the diagnosis and treatment and she did not have long term effects of the treatment. There is long standing diabetes treated with insulin.
Mrs Ciantar said that she had past low back pain and left buttock pain. She said that there were no past shoulder problems.
Mrs Ciantar has impaired hearing. She uses two hearing aids.
History of injury
Mrs Ciantar had a fall at home on 8 February 2022 and fractured her left humerus. She tripped on a step. Initial treatment was immobilisation in a sling.
There was an open reduction and internal fixation on 4 March 2022 with a plate. This was done at Nepean Hospital. The left arm was in a sling post-surgery. Mrs Ciantar could not remember how long the sling was used.
The motor vehicle crash occurred on 25 March 2022. She was a front seat passenger with a friend driving. Her vehicle was hit from behind. Mrs Ciantar was not wearing a sling and put her left arm on the dashboard to brace herself. There were two impacts. The first from the vehicle behind and the second occurred when the vehicle behind was itself hit from behind.
Mrs Ciantar went to her scheduled physiotherapy appointment that week. The physiotherapist said that there was a problem with the left arm. X-ray demonstrated failure of fixation.
Dr Phillips, orthopaedic surgeon, removed the plate and inserted an intramedullary nail.
Mrs Ciantar said that there were no other injuries sustained in the subject motor accident.
Current status
Mrs Ciantar cannot lift the left arm. There is markedly reduced movement at the left shoulder. She said that this caused problems with activities of daily living and difficulty sleeping.
Current medications are Rhyzodeg insulin, Lyrica 150mg bd, Forxiga 10mg, irbesartan, Panadol Osteo two tablets twice daily.
GP is Dr Mohamed and was previously Dr Cole.
Mrs Ciantar has assistance at home via a home care package. She is driving short distances.
Examination
Mrs Ciantar is right handed, 150cm in height and weights 77kg.
There was a 17cm surgical scar on the medial aspect of left upper arm. A second scar very difficult to see.
At the left shoulder, range of motion was flexion 60 degrees, extension 30 degrees, abduction 60 degrees, adduction zero degrees, external rotation 10 degrees, internal rotation 70 degrees. It was noted that on the left there was early scapular recruitment to assist movement.
At the right shoulder, range of motion was flexion 160 degrees, extension 60 degrees, abduction 160 degrees, adduction 50 degrees, external rotation 70 degrees, internal rotation 90 degrees.
Movements at the shoulders were consistent.
At the lumbar spine there was a full range of motion in all planes, with no muscle spasm, no muscle guarding, no dysmetria, no non-verifiable radicular complaints present. Nerve tension signs were negative.
There was a full range of movement at lower extremity joints.
Circumferences of the lower extremity were, above knee right and left 51cm; below knee right 33cm, left 33cm.
Lower extremity reflexes were difficult to elicit but there were no neurological deficits detected in the lower extremities.
There were no imaging studies available for review at the time of the re-examination.
Diagnoses
Left shoulder – proximal humeral fracture and soft tissue injuries
Lumbar spine – soft tissue injury
Left upper extremity – surgical scarring
Dr Barnsley and Dr Cameron concluded that the history of cancer and its treatment was not relevant to the evaluation of permanent impairment because the humeral fracture was clearly caused by the subject motor accident.
Permanent impairment assessment
Left shoulder – proximal humeral fracture and soft tissue injuries
At the left shoulder permanent impairment is assessed with reference to abnormal motion. The range of motion is flexion 60 degrees, extension 30 degrees, abduction 60 degrees, adduction zero degrees, external rotation 10 degrees, internal rotation 70 degrees. Using Figures 38, 41 and 44 (pages 42 to 44 AMA4 Guides) these movements are equivalent to 8%, 1%, 6%, 2%, 2% and 1% upper extremity impairment respectively. These are added to give 20% upper extremity impairment which converts to 12% whole person impairment using Table 3, page 20 AMA4 Guides.
Mrs Ciantar had a previous left proximal humeral fracture. It had been surgically treated and was healing at the time of the motor accident in which there was a further fracture with loss of fixation. There is no available method to assess the impairment that was present prior to the subject motor accident. Sections 6.31 and 6.32 of the Motor Accidents Guidelines, note that pre-existing impairment must be calculated and subtracted from the current WPI value. For Mrs Ciantar this information is not available.
Mrs Ciantar does have slightly restricted movement at her uninjured right shoulder. Section 6.51 Motor Accident Guidelines is noted and the permanent impairment related to the right shoulder is subtracted from the left.
At the right shoulder, range of motion was flexion 160 degrees, extension 60 degrees, abduction 160 degrees, adduction 50 degrees, external rotation 70 degrees, internal rotation 90 degrees. Using Figures 38, 41 and 44 (pages 42 to 44 AMA4 Guides) these movements are equivalent to 1%, 0%, 1%, 0%, 0% and 0% upper extremity impairment respectively. These are added to give 2% upper extremity impairment which converts to 1% whole person impairment using Table 3, page 20 AMA4 Guides.
The Motor Accident Guidelines and the AMA4 Guides do not state clearly whether the above calculation involving the uninjured joint should be done in upper extremity impairment or whole person impairment percentages. 20% minus 2% upper extremity impairment is 18% upper extremity impairment which converts to 11% WPI. Thus, the two methods give the same result in this case.
There is 11% WPI related to the left shoulder injury.
Lumbar spine – soft tissue injury
The lumbar spine injury (injury to the lumbosacral spine) is assessed with reference to the Diagnosis Related Estimate method. Mrs Ciantar has ‘no significant clinical findings’ with reference to the lumbosacral spine, and therefore DRE Lumbosacral Category I (0% WPI) is the appropriate evaluation. There are no symptoms or signs, that are currently present, that justify assessment of DRE II in this spinal region. Specifically, no atrophy, no muscle spasm, no muscle guarding, no dysmetria were present, while non-verifiable radicular complaints were not present. Reflexes were within normal limits, nerve tension signs were negative and there was no weakness or loss of sensation.
Left upper extremity – surgical scarring
The surgical scar at the left upper arm related to the second operation on the arm was assessed with reference to the TEMSKI scale, Table 6.18 Motor Accident Guidelines. The ‘best fit’ for Mrs Ciantar’s scarring is 0% whole person impairment because, while she is aware of the scar and able to locate it, there is good colour match, no trophic changes, no suture marks, no contour defect, it is not in a position that is usually visible, there is no effect on ADL no treatment requirement and no adherence. It should be noted that section 6.261 Motor Accident Guidelines states, “a scar may be present and rated 0% whole person impairment”.”
FINDINGS
The Review Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[6] The Review Panel adopts the examination findings and reasons of the Medical Assessors. The Review Panel is not required to choose between competing medical opinions and is required to form its own opinion.[7] The Medical Assessors have explained why they have come to different conclusions to that of Medical Assessor Kuru in relation to the left shoulder and lumbar spine.
[6] Section 7.26(6) of the Act.
[7] Allianz Insurance Australia Group v Keen [2021] NSWCA 287.
As the insurer relied upon the opinions of Dr Raymond Wallace, who was satisfied that the claimant injured her left shoulder, and lumbar spine in the subject accident, the Review Panel does not think that causation remains in issue in relation to those injuries. However, for the avoidance of all doubt, the Review Panel is satisfied that, as a matter of medical determination and as a matter of factual non-medical determination, the claimant refractured her left proximal humerus and sustained soft tissue injury to her lumbar spine, in the subject accident.
The Review Panel notes the views expressed by Dr Wallace, in relation to the assessment of whole person impairment of the left shoulder, with which it respectfully disagrees, for the reasons stated.
CONCLUSION
For the above reasons, the Review Panel concludes that the certificate of Medical Assessor Robert Kuru dated 28 June 2024 should be revoked. The new certificate appears at the commencement of these reasons.
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