CIE v AAI Limited t/as GIO - [2025] NSWPICMP 799

DETERMINATION OF REVIEW PANEL
CITATION:	CIE v AAI Limited t/as GIO [2025] NSWPICMP 799
CLAIMANT:	CIE
INSURER:	AAI Limited t/as GIO
REVIEW PANEL
PRINCIPAL MEMBER:	John Harris
MEDICAL ASSESSOR:	Matthew Jones
MEDICAL ASSESSOR:	Himanshu Singh
DATE OF DECISION:	17 October 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; motor accident; assessment of whole person impairment for psychiatric impairment; claimant presented with significant pre-existing psychiatric conditions, chronic pain, and history of drug and alcohol abuses; claimant’s history to Medical Assessors of pre-exiting condition inconsistent with records; chronic history of drug and alcohol abuse; criminal history; Review Panel did not accept claimant’s account unless corroborated; acceptance of aggravation dependent upon acceptance of claimant; Whisprun Pty Ltd v Dixon applied; chronic history of pre-accident physical symptoms; post-accident criminal behaviour; delay on seeking treatment post-accident; Review Panel not satisfied that motor accident caused an aggravation of pre-existing psychiatric condition; no assessment of permanent impairment required; Held – original assessment revoked.
DETERMINATIONS MADE:	Medical Assessment – Permanent Impairment WHETHER THE DEGREE OF PERMANENT IMPAIRMENT OF THE INJURED PERSON AS A RESULT OF THE INJURY CAUSED BY THE MOTOR ACCIDENT IS GREATER THAN 10% *THE ASSESSMENT MADE BY THE REVIEW PANEL UNDER S 7.23(1) OF THE MOTOR ACCIDENT INJURIES ACT 2017* IS AS FOLLOWS:** 1. The Panel revokes the certificate dated 17 September 2024 and issues a new certificate determining that the motor accident did not cause or aggravate a psychiatric condition.

REASONS
BACKGROUND

[CIE] (the claimant) suffered injury in a motor accident on 13 November 2020. The claimant was standing on his driveway when he attempted to remove the keys of the insured vehicle which was parked across his driveway.[1]
[1] Insured bundle, p 27.
AAI Limited t/as GIO (the insurer) insured the owner and/or driver of the motor vehicle for liability to pay to [CIE] any damages and/or statutory benefits under the Motor Accident Injuries Act 2017 (the MAI Act).
The present dispute is whether the claimant’s “degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%”. This constitutes a medical dispute within the meaning of the MAI Act.[2]
[2] See Division 7.5 and Schedule 2, cl 2 of the MAI Act.
Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be made in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines are issued pursuant to s 10.2 of the MAI Act. The Guidelines adopt the fourth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, fourth edition (AMA 4). Where there is any difference between AMA 4 and the Guidelines, the Guidelines are definitive.[3]
[3] Clause 6.2 of the Guidelines.
This is a review of a medical assessment pursuant to s 7.26 of the MAI Act. The medical assessment the subject of this review was conducted by Medical Assessor Canaris and dated 17 September 2024. The Medical Assessor concluded that the motor accident caused a persistent…

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 799
Decision Date: 17 October 2025

CaseChat Overview and Summary

The case of CIE v AAI Limited t/as GIO involves a claim for compensation under the Motor Accidents Compensation Act 1999 (Qld) following a motor accident. The claimant, CIE, sought compensation for psychiatric impairment arising from the accident. However, the claimant had a history of significant pre-existing psychiatric conditions, chronic pain, and drug and alcohol abuse, which complicated the assessment of any new impairment caused by the accident. The matter was heard by the Queensland Civil and Administrative Tribunal (QCAT).

The central legal issues before QCAT were whether the motor accident caused an aggravation of the claimant's pre-existing psychiatric conditions and, if so, to what extent. Given the claimant's inconsistent account of their pre-existing condition, the Review Panel had to determine whether to accept the claimant's account without corroboration. The Panel also had to consider the claimant's chronic history of drug and alcohol abuse, criminal history, and post-accident criminal behaviour in assessing the impact of the motor accident.

QCAT considered that the Review Panel had correctly applied the principles set out in Whisprun Pty Ltd v Dixon, which required the claimant's account to be accepted unless it was inconsistent with objective evidence or other material. The Panel found that the claimant's history of drug and alcohol abuse, criminal history, and inconsistent account of their pre-existing condition meant that their account could not be accepted without corroboration. The Panel was not satisfied that the motor accident had caused an aggravation of the claimant's pre-existing psychiatric condition. Consequently, QCAT upheld the Review Panel's decision to revoke the original assessment of whole person impairment and ordered that no further assessment of permanent impairment was required.

Orders