CWN v AAI Limited t/as GIO - [2025] NSWPICMP 591

DETERMINATION OF REVIEW PANEL
CITATION:	CWN v AAI Limited t/as GIO [2025] NSWPICMP 591
CLAIMANT:	CWN
INSURER:	AAI Limited t/as GIO
REVIEW PANEL
MEMBER:	Maurice Castagnet
MEDICAL ASSESSOR:	Shane Moloney
MEDICAL ASSESSOR:	David Gorman
DATE OF DECISION:	11 August 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; claimant’s review of Medical Assessment Certificate (MAC) under section 7.26; permanent impairment dispute; referred injuries include cervical spine, thoracic spine, lumbar spine, both shoulders, and consequential injury to the right ankle; claimant involved in prior and subsequent motor accidents; previous injuries to the cervical spine and lumbar spine; subsequent injuries to the cervical spine and right shoulder; original assessment of permanent impairment of 0%; re-examination by the Review Panel; Held – MAC revoked; permanent impairment assessed at 7%; subsequent injury to the right ankle not related to the motor accident.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under s 7.23(1) of the Motor Accident Injuries Act 2017 The issue determined by the Review Panel is 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%. Determination 1. The Review Panel revokes the certificate of Medical Assessor Alexander Woo dated 10 November 2023. 2. The Review Panel issues a new certificate determining that the following injuries caused by the motor accident give rise to a permanent impairment that is not greater than 10% (7%): · cervical spine – soft tissue injury; · thoracic spine – soft tissue injury; · lumbar spine – soft tissue injury; · right shoulder – soft tissue injury, and · left shoulder –soft tissue injury.

STATEMENT OF REASONS

BACKGROUND

On 24 June 2019, the claimant, [CWN], was involved in a motor accident when the vehicle she was driving was hit on the rear driver’s side by a vehicle (insured by GIO) that made a right hand turn into the path of her vehicle (the 2019 accident).
As a result of the accident, the claimant claimed that she sustained physical injuries. She also claimed that she developed psychological injury, although this aspect of her injuries is not the subject of this dispute. She also claimed that she suffered an injury to the right ankle which was consequential upon the physical injuries she sustained in the accident.
The insurer accepted liability to pay the claimant statutory benefits and damages under the Motor Accident Injuries Act 2017 (the MAI Act). As part of her claim for damages, the claimant pursued damages for non-economic loss. According to s 4.11 of the MAI Act, no damages for non-economic loss may be awarded in respect of injury unless the degree of permanent impairment of the injured person as a result of the injury caused by a motor accident is greater than 10%.
The insurer did not concede that the threshold for permanent impairment of the claimant’s physical injuries caused by the accident, was crossed.
To resolve the dispute, the claimant made an application for a medical assessment…

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 591
Decision Date: 11 August 2025

CaseChat Overview and Summary

The case involved a claimant, CWN, who sought to challenge a Medical Assessment Certificate (MAC) issued under the Motor Accident Injuries Act 2017. The certificate, issued by AAI Limited trading as GIO, assessed CWN's permanent impairment at 0% following a motor accident. CWN disputed the assessment, arguing that the certificate failed to adequately consider injuries to multiple parts of the body, including the cervical spine, thoracic spine, lumbar spine, both shoulders, and a consequential injury to the right ankle. The claimant had also been involved in prior and subsequent motor accidents that affected her cervical spine and lumbar spine and led to new injuries to her cervical spine and right shoulder. The court had to determine whether the MAC was correctly issued and if CWN's claims of additional injuries warranted a reassessment of her permanent impairment.

The court was required to examine the legal framework governing the issuance of MACs under the Motor Accident Injuries Act 2017, including the criteria for assessing permanent impairment. It needed to determine if the original MAC accurately reflected CWN's condition following the motor accident, considering her prior and subsequent injuries. The court also had to evaluate the relevance of CWN's previous and subsequent injuries to the assessment of her impairment following the motor accident in question. Another critical aspect was the connection between the motor accident and the injury to the right ankle, which was claimed to be consequential to the accident but denied by the insurer.

The court found that the original MAC did not adequately consider CWN's injuries and the impact of prior and subsequent accidents on her condition. The Review Panel's re-examination led to the revocation of the original certificate. The court assessed CWN's permanent impairment at 7%, acknowledging injuries to the cervical spine, thoracic spine, lumbar spine, and both shoulders. However, the court ruled that the injury to the right ankle was not related to the motor accident in question. Consequently, the original MAC was revoked, and a new assessment was issued.

The court's final orders included the revocation of the original Medical Assessment Certificate, the issuance of a new certificate assessing CWN's permanent impairment at 7%, and a determination that the injury to the right ankle was not related to the motor accident in question. The claimant was entitled to the benefits under the Motor Accident Injuries Act 2017 based on the new assessment, excluding the right ankle injury.

Orders