Con v AAI Ltd t/as GIO

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	CON v AAI Ltd t/as GIO [2025] NSWPIC 327
CLAIMANT:	CON
INSURER:	AAI Ltd t/as GIO
MEMBER:	David Ford
DATE OF DECISION:	Replacement Certificate issued on 16 July 2025
CATCHWORDS:	MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; miscellaneous claims assessment; insurer’s merit review application challenging entitlement to statutory benefits under Division 3.3; claimant alleged injuries from motor vehicle accident but did not remain at the scene; personal injury benefits claim lodged later; claimant’s explanations found inconsistent and implausible; Held – injury did not result from a motor vehicle accident in this state; claimant not entitled to statutory benefits under section 3.1.
DETERMINATIONS MADE:	1. The reviewable decision concerns the amount of statutory benefits that are payable under Division 3.3 of the Motor Accident Injuries Act 2017 (the Act) and is therefore a miscellaneous claims dispute matter under Schedule 2.3(b) of the Act. 2. The reviewable decision dated 14 March 2025 is affirmed. I determine the claimant is not entitled to statutory benefits pursuant to s 3.1 of the Act. 3. For the purposes of Schedule 2.3(b) of the Act whether for the purposes of s 3.1(statutory benefits payable in respect of death or injury resulting from motor accident) the injury to the claimant has not resulted from a motor accident in this state.

STATEMENT OF REASONS

INTRODUCTION

The insurer does not accept the injury sustained by the claimant was because of a motor accident as defined under the Motor Accident Injuries Act 2017 (the Act). The matter is to be determined as a miscellaneous claims dispute under Schedule 2.3 (b) of the Act, as follows,
“Whether for the purposes of section 3.1(statutory benefits payable in respect of death or injury resulting from motor accident) the death of or injury to a person has resulted from a motor accident in this State.”
Dean Webster Kimpton (the claimant) has alleged he sustained injuries in a motor vehicle accident on 28 April 2024. The circumstances of this accident have already been the subject of a Merit Review decision by Member Medland in the matter of Dean Webster Kimpton v AAI Ltd trading as GIO dated 27 February 2025 (unreported). Member Medland determined, for the purposes of s 6.24 of Act, a request for the claimant to provide the name of his mobile service provider was reasonable. Subsequently in this matter, records from Telstra were produced and lodged on the portal.
The claimant was born in 1968 and is presently 57 years of age. The claimant bears the onus of proving his injuries resulted from a motor vehicle accident. He lodged an Application for Personal Injury Benefits dated 18 June 2024. On page 3 of the Application, he stated the accident occurred 28 April 2024 at 5.00pm on the Cahill Expressway. He described the motor vehicle accident as follows,
“Front wheel washed out and I was attempting to enter an emergency area safety zone on the Cahill Expressway. There is a 10-centimetre gutter while entering the off ramp my wheel washed out. Unsafe”
He described his injuries as being broken collarbone (L) 8 ribs broken (L). He also states he was taken by ambulance, to initially, Hornsby District Hospital, and thereafter to the Royal North Shore Hospital.
The insurer has denied liability for the claim and have provided detailed reasons in their liability notice dated 27 February 2025. In this notice, the insurer sets out several inconsistencies regarding the information provided by the claimant and other parties which had led the insurer to conclude the injury sustained by the claimant did not arise from a motor accident.
It is not disputed between the parties the fact the claimant sustained injuries on 28 April 2024 and, hereafter, I will refer to what transpired on 28 April 2024 as being an “incident”. The claimant has stated following the incident, another motorist helped him right his motorcycle and he rode it to his home at Wahroonga, despite sustaining his injuries. He provided a statutory declaration dated 10 September 2024 in answer to a query as to why an ambulance was not called to the scene. He stated as follows,
“I have been diagnosed a mental health condition with acute anxiety after the accident, I was in a highly anxious state and panic. Due to my military training kicked in, it was a fight or fright situation I wanted to be home and back to base with my wife. All I could think about was getting home to my wife and family”
Upon arrival at his home, he spoke with his wife, Choye Ito Kimpton. She has provided a statutory declaration dated 8 August 2024. The solicitor for the insurer at the assessment conference initially objected to paragraph 5 of the statutory declaration. However, after further discussion, it was agreed the statutory declaration could be submitted in the papers without objection. I refer to the following paragraphs in the statutory declaration,
“2.     Dean came into our unit. Although Dean usually unlocks the door himself but, on that day, he knocked. When I opened the door, Dean entered the room, he looked like he was in shock and his face was pale and he had his arm bent so I immediately realised something bad had happened. Dean first asked me to help him take off his leather motorbike jacket which was damaged and had scratches from his shoulder down to his left arm.
3      Despite appearing to be in significant pain and with my help we managed to remove his leather bike jacket. He then asked me to help him take off his shoes I loosened the laces for him, and he removed the shoes himself with his feet. At that point, Dean then said he had he had been in a motorcycle accident, and he said need to call an ambulance. It was around 8:40pm. My daughter and I were shocked to see Dean in such pain and clearly injured, when Dean called the 000., I was in the bedroom to get ready to out.
4.     Dean and I went outside for the ambulance, it felt like we waited for more than 30 minutes. I think it was after 9:00pm when again Dean made another call to emergency services to inquire about the delay. Eventually the ambulance arrived but Dean was in so much pain that he couldn't lie down on the stretcher. The paramedics admitted some pain relief, and which looked like a green whistle, but it was not effective, and Dean remained unable to lie down on the stretcher for about 20. 30 minutes
5.     I was told by Dean to say that the injury was caused by falling down the stairs. This was because Dean had explained it that way to the paramedics. I was confused but followed his instructions. We were in a state of panic.
8.     The NSW ambulance report confirms a call was received at 8:54pm on 28 April 2024. It is recorded the claimant has reported he sustained injuries to his ribs and collarbone as he fell down (not on) the stairs, and the fall was accidental. The report confirms the ambulance crew arrived at his home at 9.23pm and I note the following from the report,
‘ called to -- falls serious O/A pt , leaning on car, alert and responsive obvious distress/grimacing PT states that at 2045 pt was taking garbage out when he started felt lightheaded , and fell , landed L side elbow into ribs, heard crack.PT unsure if he suffered LOC 10/10 pain in L rib ,back ,L hand side thoracic region .PT states he heard ? crunching noise from ribs.PT initially very rude to crew.’
9.     The claimant was then transported to Hornsby Hospital, arriving there at 10:33pm. The records state the following
‘BIBA From home after a fall down 4 stairs landing on left side. NIL head strike, NIL LOC injuries left clavicle pain& left posterior rib pain worse on inspiration. Given 3ml methoxy 200 mcg fentanyl IV o/e lungs clear bilaterally tachy tachypnoiec’
10.    Subsequently, he was transported from Hornsby Hospital to Royal North Shore Hospital via ambulance on 29 April 2024 at 2:04 am. The hospital records as follows
‘56 M – t/f from HKH With multiple left sided rib fractures and left clavicle fractures following fall down 4 stairs DOI 28/4/24.’
11.    I also refer to the clinical records from the Heritage Medical Practice Wahroonga dated 10 July 2024. There is a telephone consultation with Dr Valerie Tung on 6 May 2024 and recorded on that date, which states as follows
‘Telehealth consult verified identity, confirmed discharge letter having multiple rib fractures from serious MVA. Reason for visit MVA.’
12.    There is a subsequent consultation by telephone with Dr James Shin on 18 June 2024 recorded on 18 June 2024. Dr Shin is the claimant's General Practitioner. He records as follows,
“CTP, Motorbike rider, while pulling into emergency lane on Cahill Expressway hit curb/ gutter with unexpected raised edge roughly 10cm then fall onto left side.
Left clavicle fracture, left 2-9 rib fractures with flail segment ,3-5 ,haemo-pneumothorax ;non healing fractures, pain much better controlled on targin 10 had one breakthrough endone in the afternoon the other day but has not needed since higher targin also review given non healing/ Reason for visit CTP.
13.    I held a preliminary conference with the parties on 12 May 2025 and I determined the matter should be listed for a miscellaneous claims assessment hearing on

27 May 2025. The assessment conference proceeded as arranged on that date and a transcript was taken and has been made available to both parties.
...”

DOCUMENTATION

I have reviewed and considered all documentation included in the application and reply and all additional information provided by the parties.

LEGISLATIVE FRAMEWORK

Section 1.4 of the Act defines “motor accident” as:
“Motor accident means an incident or accident involving the use or operation of a motor vehicle that causes the death of or injury to a person where the death or injury is as a result of and is caused (whether or not as a result of a defect in the vehicle) during
(a) the driving of the vehicle or
(b) a collision or action taken to avoid a collision with the vehicle or
(c) the vehicles running out of control or
(d) a dangerous situation caused by the driving of the vehicle a collision or action taken to avoid a collision with the vehicle or the vehicles running out of control.”
Section 1.9 of the Act provides:
“This Act (including any third-party policy under the Act) applies in respect of the death of or injury to a person that results from the use or operation of a motor vehicle only, if the death or injury is as a result of and is caused (whether or not as a result of a defect in the vehicle) during
(a)    The driving of the vehicle or
(b)    a collision or action taken to avoid a collision with the vehicle or
(c)    the vehicles running out of control or
(d)    a dangerous situation caused by the driving of the vehicle a collision or action taken to avoid a collision with the vehicle or the vehicle’s running out of control.”

SUBMISSIONS BY THE CLAIMANT

The claimant lodged on the portal submissions dated 9 May 2025. The submissions were in relation to the following matters:
·        medical costs.
·        legal costs.
·        his conduct and pre-existing mental health condition, and
·        contemporaneous evidence.
The claimant also lodged on the portal photographs of his motorcycle, helmet and clothing, which depicted damage to the said motorcycle and various clothing items. There was also a photograph of the alleged scene of the incident, and photographs taken earlier on the day of various locations in the eastern suburbs of Sydney.
The claimant served a statement from Garth Callender dated 11 March 2025, who is a colleague of the claimant. Mr Callender is a serving member of the Australian Defence Force holding the rank of Lieutenant Colonel. Under the heading “Conclusion” on page 2 of his statement, he states the following,
“Based upon my long acquaintance with Mr Kimpton, I believe he possesses the strength, endurance, toughness and determination to undertake demanding tasks even in the face of serious injuries such as those sustained by Mr Kimpton in this instance.
I make this statement based on my own observations and clear recollections of Mr Kimpton’s conduct and capabilities over the years.”
He also provided an email regarding his request to the Shangrila Hotel at Circular Quay regarding any retained CCTV footage of the site of the alleged incident. The response from the Hotel was they were unable to support his inquiry.
He also provided a statement to police on 11 July 2024, and I note the following paragraphs,
“4. Around 5:00 pm on 28 April 2024, I was travelling north on the Eastern Distributor toward the Cahill Expressway. It was getting cold and dark at the time, at dusk. As I was cold during this time and wanted to zip up my jacket, I pulled over to the breakdown lane on the left-hand side of the road.
5, The breakdown lane had a concrete lip, roughly 8cm high. My front wheel did not make it over the lip, and when the motorcycle tyre hit this lip, my motorcycle immediately tipped over onto my left-hand side and hit the ground. I sustained serious injuries, including a broken clavicle on both my left and right sides, 8 broken ribs (ribs 2-9) along my left side and displaced my chest. I have also suffered a neck injury, and I'm concerned about pain in my spine, hip and knees which has not subsided since the incident.
6.Following the collision another motorist helped me right my motorcycle and I made it home to Wahroonga.”
I refer to the statutory declaration sworn by the claimant dated 28 August 2024. I note the following paragraphs,
“5. I reduced my speed to approximately 40 km an hour as I wanted to enter this breakdown zone on the Cahill Expressway to zip up my jacket.
11. What time did the accident occur? Approximate 8.13pm
‘We note that your client declared in his Application for Personal Injury Benefits and statement to NSW police that the accident occurred at 5:00pm, whereas you suggest in your correspondence dated 9 August 2024 that the accident occurred at about 8:00pm. If the alleged time of the incident is not 5:00pm, please provide an explanation for the change in circumstances.
I made the statement while on heavy doses of oxycodone. I may have had concussion; I was in extreme pain and had to make the statement at the police station with a broken collarbone and 8 broken ribs. I was in immense pain, distressed and suffering from acute anxiety at the time as I was feeling very apprehensive about how I would look after my wife and daughter during my recovery period and multiple operations that were going to be needed to fix these injuries.
12. Please describe the circumstances of the accident. Please also mark on Google image where your client allegedly entered the breakdown lane and where the alleged impact occurred, see above and attached
13. What is the speed limit for the roadway? I believe it is 70km.
14.. What speed was your client travelling” 40 kms as I was pulling into the breakdown lane
(a)On approach to the breakdown lane. 50km.
(b)When he entered the breakdown lane. 40kms
(c)At the time of impact, See above”
He also swore a statutory declaration dated 10 September 2024, and I note the following paragraph,
“11. What speed was your client travelling at the time of impact. A response of” see above” is inadequate. I was decelerating, so a rough estimate of 40 to 50 kms.”
He subsequently instructed solicitors in Queensland, Taylor Rose, during the first week of August 2024. I refer to the letter from Taylor Rose to the insurer dated 9 August 2024. On page 3 of the letter, I note the following under the heading “Different Versions”;
“22. Ambulance personnel arrived at our client’s residence on the night in question. He did tell them he took his garbage out on the night and slipped and fell and that is how he sustained his injuries. He provides the following explanation for this version of events.
(a)    When the ambulance staff arrived on the night, he was suffering intense pain and wanted to obtain medication from them as soon as possible. He waited quite a while for them to arrive after the first call was made.
(b)    He experienced the actions of the ambulance personnel as aggressive and uncooperative.
(c)    He believes that he also bumped his head during the accident, falling from the motorcycle and this could have contributed to the comments he made, (looking at the damage of the helmet it supports such a version)
(d)    Arriving at the hospital, he confirmed the above version, when he again experienced the treatment and dealings from the hospital personnel as aggressive and unprofessional in his view disregarding the extreme pain that he was suffering,
(e)    He later after proper reflection corrected the version provided to everyone when he submitted his claim to your company.”
The claimant also obtained medical reports from various treating doctors. I refer to the report of Dr Shin dated 2 August 2024, and I note the following,
“In my professional opinion, Dean’s injuries are consistent with his motor vehicle accident as clavicle fractures are result of a high impact force such as those experienced during a fall or collision at speed as would his multiple rib fractures with flail segment. The mechanism of injury involved in a motorcycle accidents generally leads to substantial external forces applied to the body. When Dean fell from the motorcycle, the combination of the high impact force and the subsequent collision with the ground caused the clavicle and ribs to sustain fractures. The specific trauma from the fall and impact resulted in the fractures observed, consistent with the traumatic forces involved in such accidents. As such I am of the view that Dean’s injuries are unlikely from fall downstairs and more likely from a motorcycle accident.”
I also refer to the report of Dr Shin dated 6 August 2024, where he states the following,
“Dean has explained to me that he had reported to the ambulance officers and hospital staff that he had falled downstairs and did not mention that he had had a motor vehicle accident because he had felt that he had been ignored and thus vulnerable thereafter reacting in a defensive manner. He reported that his pain was severe and despite that he felt that he was being improperly attended to, and as such, acted in that manner .Given his underlying mental health conditions of anxiety for which he is on long term treatment for as well as his previous bullying and harassment that he experienced in a previous workplace, this in combination with his severe pain I suspect would had made given a incorrect history to avoid further conversation with the ambulance officer but did not correct this inconsistency also.”
I refer to the report of Dr Richa Rastogi, consultant psychologist, dated 21 August 2024, where she states the claimant remains impaired significantly by his persistent depressive disorder and anxiety with panic attacks.
I also refer to the report of Dr Ian Nicholson dated 16 October 2024, where he states as follows;
“He is going to get his clavicles dealt with surgically first. These injuries are completely consistent with a high impact motor vehicle accident seen in a lot of motorcyclists and even push bike riders were similar injuries. In particular, when they hit a gutter with a raised edge and all the descriptions of Dean’s accident are consistent with this”
I refer to the report of Dr David Duckworth dated 4 November 2024, where he states as follows,
“Dean’s injuries are consistent with the motorcycle accident on 28 April 2024 and are consistent with a high impact collision. It would be unusual for this to occur following a fall down some stairs and I believe Dean’s injury pattern and description as described by his cardiothoracic surgeon and myself is consistent with a high-speed motorbike accident.”
I refer to the further report from Dr Shin dated 27 March 2025, where he states the following,
“Explanation of Initial Inconsistent Statements
In my objective medical opinion, the inconsistencies reported by Dean initially describing a fall down stairs to ambulance dispatches and attending paramedics are fully explainable by a combination of acute concussion, sustained from head trauma, significant pain and pre-existing psychological issue of depressive disorder, an anxiety with panic attacks (cf evidence from Dr Richa Rastogi psychiatrist}. These factors commonly impair cognition, memory judgement and communication significantly affecting Dean's ability to direct his mind to precisely recall the exact timing and details of the incident and as such the inconsistent reporting of his incident is entirely plausible from a clinical perspective.
I want to clarify that concussion is a clinical diagnosis, made on a clinical judgement based on history and examination and in many cases without radiological findings ie a normal CT/ MRI of the brain.
Dean’s well documented injuries including fracture of left clavicle, fractures of left ribs 2-9 with flail segment and haemo- pneumothorax, fracture of the previously injured right clavicle are all medically consistent with a high energy impact such as a motorcycle crash as opposed to what Dean initially reported of a fall down stairs.
Explanation of leaving the scene and subsequent impairment.
My objective assessment of why Dean initially rode his motorcycle away from the scene rather than immediately call for an ambulance can be medically explained by a combination of acute anxiety, shock and sympathetic drive commonly known as an adrenaline surge often observed following acute trauma. There is an inherent response that the body undergoes by activating sympathetic drive ala a fight or flight response to try and avoid further injury. The trauma response Dean has had likely masked the full extent of his injuries to himself, temporarily being able to ride his motorcycle despite his injuries Dean's immediate judgement was impaired though given Dean’s previous military training, I found it entirely plausible that Dean’s thought process was try make it home to safety despite his injuries and not wait for an ambulance to come to him. After getting home and the initial acute trauma response diminished the injuries and pain were no longer masked thus also explaining why Dean was unable to move on to the ambulance stretcher unassisted “

SUBMISSIONS BY THE INSURER

I refer to the submissions of the insurer dated 11 April 2025, I note the following paragraphs,
“4.2 The contemporaneous evidence as contained in NSW Ambulance reports and hospital records make no reference to a motor accident, rather those records suggest that the claimant's injuries were sustained as a result of a fall down stairs.
4.3 GIO highlights the following inconsistencies in the evidence available and addresses the claimant ‘s explanations provided for those inconsistencies below,
a. The contemporaneous evidence as contained in the records of NSW Ambulance, Hornsby Ku-ring-gai Hospital and Royal North Shore Hospital make no reference to a motor accident. Rather those records suggest that the claimant's injuries were sustained due to a fall. The claimant has attributed his failure to report the alleged motor accident to NSW ambulance or hospital personnel to suffering intense pain and requiring medication from them as soon as possible, the aggressive and uncooperative actions of the ambulance and hospital personnel as well as a possible head injury. GIO does not consider such an explanation as reasonable noting:
* Providing a different mechanism of injury to NSW Ambulance personnel would not have any impact on the time it took for pain medication to be administered,
* The claimant provided the mechanism of injury as being a fall down stairs when initially calling 000 and prior to the arrival of paramedics,
* The Hornsby Hospital and Royal North Shore Hospital records suggest that there was no head strike and no loss of consciousness. The claimant underwent a brain CT on 29 April 2024 at 12:51am which revealed no abnormality
* The claimant maintained the mechanism of injury as being a fall downstairs in his subsequent consultation with Royal North Shore hospital on 17 May 2024 (page 342 insurer bundle)
b. The claimant did not call an ambulance from the scene. He suggests that he was in a state of anxiety and panic and wanted to get home to his wife and family. GIO does not consider such an explanation as reasonable given the significant injuries alleged and the fact the claimant was in extreme pain upon the arrival of paramedics and at the hospital.
c. Based on the claimant's version of events; he drove home following the accident. This suggests that he was able to ride roughly 24km (33 minutes) with alleged left and right clavicle fractures, left 2-9 rib fractures with flail segment. The claimant suggests that he was able to make the trip with a significant injury due to his training and background in the army. GIO does not consider such an explanation as reasonable given the significant injuries alleged and the fact that the claimant was experiencing extreme pain upon arrival of paramedics and at the hospital. The claimant was in fact unable to move his legs onto the NSW ambulance stretcher due to the pain which was reported at/10/10 severity.
The claimant relies on the statement of Lieutenant Colonel Garth Callender. In GIO’s submission, no weight ought to be placed on his opinion that it was plausible that the claimant could have operated a vehicle under adverse circumstances in circumstances where he is not appropriately qualified to provide such an opinion.
d. The claimant initially declared in his Application for Personal Injury Benefits and statement to NSW police that the accident occurred at 5:00pm(consistent with his verbal report to GIO that the accident occurred at dusk ) Whereas he now suggests in his Statutory Declaration that the accident occurred at about 8:00pm. The claimant has attributed the change in circumstance to being in pain, being on pain medications and suffering from psychological symptoms. The version that the accident occurred at 5:00pm was declared in his claim form on 18 June 2024 and statement to Police on 11 July 2024. those versions were provided 3 weeks apart. If the time provided the claimant’s claim form was inaccurate due to the effects of pain and medication, it would be unlikely that he would provide the same inaccurate time to Police some 3 weeks later.
e. The claimant declared that he set off on his journey somewhere at around 4:00- 4:30pm and yet has provided photographs taken at the Gap at 3:19pm and 3:22 pm. He now alleges the accident occurred at about 8:00pm and has provided no explanation as to his actions and whereabouts for the intervening period.
f. The trip history provided from the claimant’s Link Toll account for the period 27 April 2024 to 30 April 2024 reveals one result at 8.10pm at the Eastern Distributor at Woolloomooloo. This is inconsistent with his Statutory Declaration which suggests that he travelled on other toll roads ( ie the Harbour Bridge - Southbound) during his journey from his residence.
4.6 Dr Shin, Dr Nicholson and Dr Duckworth have opined that the claimant's injuries are consistent with a motorcycle accident. They were not asked to consider and have not provided opinion on whether the injuries could be consistent with a fall down stairs. The fact that the injuries could be consistent with a motor accident does not mean they cannot also be consistent with the fall down stairs.
4.8. The claimant did not receive any opiates prior to calling 000 such the effects of opiates cannot explain why the claimant provided a different mechanism of injury. If the claimant was suffering delirium secondary to his pain, it again reinforces the concerns highlighted by the insurer as to how the claimant was able to ride his motorcycle home for over 30 minutes whilst suffering such delirium.
4.10 Despite opining that concussion is a clinical diagnosis made on clinical judgement, the basis for Dr Shin's conclusion that the claimant sustained a potential head injury or concussion is not apparent. In GIO’s submission, noting Dr Shin’s reference to the diagnosis partly being made based on history it is likely based on the claimant’s subjective self-reports. It is not clear whether Dr Shin is privy to contemporaneous hospital records which suggests that there was no head strike and no loss of consciousness...”

REASONS

Whilst this is a reference to fault, there is no requirement contained within s 1.9 the accident is caused by the fault of the owner or driver. It is a requirement of s 1.9 of the Act, for the claimant to succeed in his argument, the injury results from the use or operation of the vehicle, and only, if the injury is a result of and is caused during one of the four circumstances listed at s 1.4 (a) to (d).
At the assessment conference, I stated to the claimant the insurer needs to be notified, not only if a person has been injured in a motor vehicle accident, but also must be informed as to where that accident took place. The insurer also needs to be informed as to why the accident occurred, are there any witnesses to the accident and is there any CCTV footage available.
I further informed him if the insurer is informed of the exact location of the accident, then with its resources, is it can conduct further inquiries which will enable them to understand the facts and circumstances surrounding the accident, and then make a determination about liability.
I also stated the ambulance report recorded a Glasgow coma scale GCS of 15/15. I informed him ambulance paramedics are trained to initially carry out several tests with an injured person. The claimant acknowledged this fact. Furthermore, the claimant on page 20 of the transcript, stated his general practitioner Dr Shin had in his possession copies of the documentation from the hospitals.
On page 29 of the transcript, he confirmed he discharged himself from the Royal North Shore Hospital, five days earlier than he should have, and as he was leaving, there was an argument with the hospital staff because of the fact he had reported he had injured himself falling downstairs, and the claimant said, “they were looking at me like this is not a fall downstairs job.” I put to him there was no record of this conversation in the hospital records, and he agreed there was no such record.
On page 65 of the transcript, he advised he was not able to report the accident to the police until 11 July 2024 as he stated, prior to that, he was bedridden for a period of six weeks.
On page 77 of the transcript, I questioned him regarding the entry in the clinical notes of the Heritage Medical Practice Wahroonga regarding an entry on 6 May 2024 which states, “confirmed discharge letter – having multiple rib fractures from serious MVA”. The note is recorded by Dr Valerie Tung. It was noted by me there was no reference in any of the statements of the claimant of this consultation. On page 79 of the transcript, I asked him why he consulted the medical practice on that date, and he advised it was a telehealth call.

Dr Shin was away, but he needed medication. I asked him the following question on page 79 of the transcript,
“Member ‘do you recall this conversation?’
Claimant ‘no, that is after the accident’.
Member ‘it is’,
Claimant ‘yeah, I don't remember, again I was popping pills like lollies, I don't know, and with this practice Member I would call up. I would use telehealth regularly and if there is no one there, I don't see her at all. She was probably just a ….’”
I further questioned him on page 81 of the transcript regarding he had no recollection of this conversation with Dr Tung. He replied “can’t remember when you're drugged out and just need to call up for medication”.
I also discussed the fact that on page 125 of the transcript, the records obtained from Telstra were of no assistance in determining the location of the claimant at the at the time of the alleged incident. I also determined the statement from the claimant’s wife, apart from the fact she confirmed the claimant arrived at their home severely injured and said he was in “a motorcycle accident” does not provide any assistance in determining such injuries were sustained in a motor vehicle accident as alleged by the claimant.
I further determined the reports from Dr Shin, Dr Nicholson and Dr Duckworth are flawed as there is no reference in any of their reports of having read the ambulance report, the clinical records of Hornsby District Hospital and the clinical records of Royal North Shore hospital. All of these records confirm, based upon interviews with the claimant, there was no head strike and no loss of consciousness. The claimant was not administered any form of pain medication before he initially reported to the ambulance paramedic that he injured himself by falling down a flight of stairs. The ambulance report and both hospital records provide confirmation the claimant whilst in pain, was always coherent.
I further note in both the records of Royal North Shore Hospital and Hornsby District Hospital the claimant has not provided details of his local medical officer (general practitioner). If these doctors had been provided with copies of the said records, then it would have been necessary for them to discuss the contents of the reports and provide reasons why they have formed their various opinions regarding the claimant’s presence of mind, in view of the information contained in the reports. I find it difficult to accept these doctors had the reports available to them and, also the fact they have made no reference in their reports as having access to this documentation.
I also note having reported to Dr Tung and on 6 May 2024 he sustained injuries in a motor vehicle accident, he subsequently had a telehealth conference with the Royal North Shore Hospital on 17 May 2024 in which it is recorded “56M 2/52 post left midshaft clavicle # after fall down 4 steps”. There is no explanation from the claimant as to why he did not advise the hospital on 17 May 2024 this recorded history was incorrect, when 11 days earlier he had provided a history to Dr Tung he had been involved in a serious motor vehicle accident.
In conclusion, I determine the various explanations provided by the claimant in support of his allegation he was injured in a motor vehicle accident are inconsistent and implausible. The reports provided by his treating doctors are flawed as they make no reference to the records of the NSW Ambulance and hospitals.
I therefore find the injury to the claimant has not resulted from a motor vehicle in this state. I determine the claimant is not entitled to statutory benefits pursuant to s 3.1 of the Act.
Since the claimant is self-represented, there will be no order as to costs.

[2025] NSWPIC 327

16 July 2025