Davidson v Allianz Australia Insurance Limited
[2022] NSWPICMP 501
•1 December 2022
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Davidson v Allianz Australia Insurance Limited [2022] NSWPICMP 501 |
| CLAIMANT: | Kymberley Davidson |
INSURER: | Allianz Insurance Australia Limted |
| REVIEW Panel | |
| MEMBER: | Alexander Bolton |
| MEDICAL ASSESSOR: | Michael Couch |
| MEDICAL ASSESSOR: | Paul Curtin |
| DATE OF DECISION: | 1 December 2022 |
CATCHWORDS: | MOTOR ACCIDENTS – Claimant was injured on 13 June 2018; impact between two cars when the insured car turned right across the car in which the claimant was travelling; claimant suffered a fractured ankle and soft tissue injuries to her foot as well as scarring to her foot; decision of Medical Assessor reviewed; claimant has ongoing difficulties with her ankle which limits her ability to walk and stand; consideration of whether an articular or intra-articular fracture occurred; Held – finding by the Panel that the fracture of the talus did not involve an articulating surface; Whole Person Impairment (WPI) of right ankle assessed at 4% and scarring assessed at 2% equating to a total of 6% WPI. |
| DETERMINATIONS MADE: | The Panel revokes the certificate of Medical Assessor McGrath dated 5 June 2021. The Panel determines that the following injuries were caused by the motor accident: · right ankle – open talus fracture and ligament tears caused by the accident, and · right foot – soft tissue injuries caused by the accident. The injuries caused by the motor accident have a total whole person impairment of 6%. |
STATEMENT OF REASONS
INTRODUCTION
Kymberley Davidson (the claimant) was injured in a motor vehicle accident on 13 June 2018.
The insurer admitted liability on 22 May 2020.
The claimant was referred to Medical Assessor McGrath for assessment of her whole person impairment (WPI). Medical Assessor McGrath issued a certificate on 5 June 2021.
The following injuries were referred to the Medical Assessor for assessment:
a. ankle – the degree of permanent impairment of the injured person that has resulted from the right ankle – open talus fracture and ligament tears caused by the accident;
b. foot – the degree of permanent impairment of the injured person that has resulted from the right foot – soft tissue injuries caused by the accident, and
c. skin – scarring – the degree of permanent impairment of the injured person that has resulted from the right ankle scarring.
Medical Assessor McGrath found a 5% WPI for the right foot and ankle and 3% WPI for skin/scarring giving a combined total assessment of 8% WPI.
The present dispute between the parties is whether the degree of permanent impairment as a result of the injury caused by the accident is greater than 10%.
The review
The claimant made an application for review of the assessment of Medical Assessor McGrath dated 5 June 2021. The claimant submitted that the Medical Assessor;
a. failed to properly categorise the claimant’s injury;
b. failed to consider or address all relevant material, especially the report of Dr Frank Machart dated 31 July 2020;
c. failed to provide reasons or a path of reasoning as to the categorisation of the claimant’s injuries;
d. failed to provide reasons for a path of reasoning as to why or why not the report of Dr Machart was not factored into the assessment, and
e. failed to provide sufficient reasons.
On 30 July 2021 the President’s delegate referred the medical assessment of the Medical Assessor to the Panel as she was satisfied that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in this application.
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a decision maker. A ‘new decisionmaker’ is defined in cl 14A(1) of Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new provisions apply. The new review provisions provide at s 7.26(5) of the Motor Accidents Injuries Act 2017 (the MAI Act) that a review panel consists of two medical assessors and a member assigned to the Motor Accidents Division of the Personal Injury Commission (the Commission).
Part 5 of the PIC Act enables the Commission to make rules with respect to practice and procedure for the Commission including proceedings before a panel reviewing a decision of a Medical Assessor – see s 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts the proceedings and may determine the proceeding solely based on the written application.
The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned – see s 7.26(6) of the MAI Act.
The Panel issued a direction to the parties requesting the provision of respective bundles. The parties complied with this direction.
There had been a dispute about whether or not the report of Dr Machart could be relied upon by the claimant in evidence. Ultimately, on 17 June 2022, the insurer confirmed that it took no objection about this and the report could be relied upon by the claimant.
The claimant’s submissions
The claimant says that the Medical Assessor categorised the claimant’s right ankle injury as an “open talus fracture and ligament tears”. The claimant says that in determining permanent impairment of the ankle and foot injury, Medical Assessor McGrath said:
“Ankle and foot impairment is based upon her current loss of range of motion. She does not satisfy the criteria for entries under T64 p86 of AMA 4. Bony angulation or ligament instability was not established”.
The Medical Assessor assessed the ankle and foot injury as 5% WPI.
The claimant in her submissions relies on a report of Dr Machart dated 31 July 2020. The Panel notes that the claimant was initially precluded from relying on this report. However, the insurer has consented to the report of Dr Machart forming part of the claimant’s evidence.
The claimant says that there should be reliance on this report for a WPI assessment saying “Irregularity on the subtalar joint does not rate. Ankle joint is best analogy. Ankle intra-articular fracture with displacement rates at 8%. The subtalar joint is similar and close by analogy. This is appropriate. 8% WPI.” The claimant submits that this assessment is in accordance with Table 64, page 86 of the American Medical Association’s Guides to the Evaluation of Permanent Impairment Fourth Edition (AMA 4).
The claimant also relies on an MRI report of the right foot and ankle of 16 November 2018. This reported:
“posterior talus/posterior malleolar fracture with step in articulating surface and fissuring to articular cartilage and associated bony oedema.… Full thickness tear and deltoid ligament partial tear”.
The claimant submits that the assessor made reference to this MRI report but only stating “There was a step in the articulating surface”. The claimant submits that the assessor did not make any further reference to the damage to the articular surface.
The claimant further says that the Medical Assessor failed to provide a pathway of reasoning about how he came to categorise and diagnose the claimant’s injuries and why he disagreed with Dr Machart.
The accident
The claimant was injured on 13 June 2018 when driving a car which was collided into by the insured car which turned across her path.
Liability has been admitted by the insurer.
The insurer’s submissions
The insurer submitted that having regard to the ankle conditions listed in Table 64, the claimant’s fracture could either be diagnosed as extra articular or intra-articular but not both. The insurer further submitted that the Medical Assessor’s reference to bony angulation not being established meant that the Medical Assessor considered the claimant’s fracture to be extra articular and not intra-articular.
In response to the claimant’s submission that the Medical Assessor did not refer to the report of Dr Machart, insurer says that the assessor referred to his report at page 5 of his reasons and noted that Dr Machart assessed impairment based upon analogy
The insurer says that the Medical Assessor specifically addressed Dr Machart’s method of assessing impairment. Insurer says that the assessor simply did not agree with it and arrived at a different conclusion.
The insurer addressed the claimant’s assertion that the Medical Assessor erred in not assessing the claimant’s ankle impairment, basis of a diagnosis of an intra-articular fracture with displacement, in accordance with Table 64 in the AMA 4 guides. The insurer referred to paragraph 6.69 of the Motor Accident Guidelines which states;
“Assessment of the lower extremity involves a physical evaluation that can use a variety of methods. In general, the method that most specifically addresses the impairment should be used.”
The insurer also refers to s 3.2I of the AMA 4 guides at page 84 which says:
“Some impairment estimates are assigned more appropriately on the basis of a diagnosis than on the basis of findings on physical examination… The evaluating physician must determine whether diagnostic or examination criteria best describes the impairment of specific patient. The physician, in general, should decide which estimate best describes the situation and should use only one approach for each anatomic part.”
The insurer says that it was open to the Medical Assessor to assess the claimant’s impairment using the range of motion method.
The insurer says that consistent with other treating evidence, the Medical Assessor diagnosed the claimant’s ankle injury as an open talus fracture and ligament tears and then provided the following reasons for his impairment assessment at page 7:
“Ankle and foot impairment is based upon her current loss of range of motion. She does not satisfy the criteria for entries under table 64 page 86 of AMA 4. Bony angulation or ligament instability was not established.”
The insurer submits that having regard to the claimant’s report symptoms, the material considered by the Medical Assessor and the Medical Assessor’s clinical examination findings, in particular the mild restrictions in range of motion found at the ankle, the Medical Assessor correctly reached the conclusion that the range of motion method most specifically addressed best described the claimant’s right ankle impairment. This is particularly in circumstances where the Medical Assessor specifically found that the claimant did not satisfy the criteria for a diagnostic based impairment assessment under Table 64 of the AMA 4 guides.
For the insurer, Dr Shatwell considered that Dr Machart had utilised an incorrect diagnostic table in assessing WPI. In any event, Dr Shatwell was of the opinion that the claimant’s fracture was undisplaced and extra articular and on this basis expressed the view that the range of motion method of measurement still stood is the best way of assessing the claimant’s impairment. This opinion is contained within the supplementary report of Dr Shatwell dated 9 October 2020.
The insurer submits that there has been no failure by the Medical Assessor to properly categorise the claimant’s injuries.
The insurer submits that it is evident from the Medical Assessor’s reasons in his opinion differed to that of Dr Machart because the assessor found that the claimant’s injury did not satisfy the criteria for entries under Table 64 whereas Dr Machart did.
The insurer also submits that it is clear from the Medical Assessor’s certificate that the Medical Assessor’s reasons for the claimant’s injuries not satisfying the criteria under Table 64 in the guides were because bony angulation or ligament instability was not established.
The insurer submits that having regard to the ankle conditions listed in Table 64, the claimant’s fracture could either be diagnosed as extra articular or intra-articular but not both. Accordingly, the insurer submits that it follows that the Medical Assessor’s reference to bony angulation not being established means that the Medical Assessor considered the claimant’s fracture to be extra articular and not intra-articular.
The insurer also points out that the report of Dr Shatwell, obtained by it, considered that Dr Machart had utilised an incorrect diagnostic table in assessing WPI and that, in any event, the claimant’s fracture was undisplaced and extra articular such that the range of motion method still stood as the best way of assessing the claimant’s impairment.
In summary, the insurer submits that the Medical Assessor simply arrived at a different conclusion from that of the claimant’s qualified expert.
The insurer has provided in its bundle of documents 87 pages of medical records from Minchinbury Hospital but has made no reference to these notes within its submissions
Consideration of the report of Dr Machart for the claimant
With respect to the right ankle, Dr Machart said that on examination there was diminished movement which he measured with a goniometer at;
a. extension 10°;
b. flexion 40°;
c. eversion 10°, and
d. inversion 20°.
There was full movement in the opposite asymptomatic ankle.
Dr Machart said that the accident caused trauma to the right subtalar joint, intra-articular, which led to inflammation injury and stiffness. At the time of examination, Dr Machart said that symptoms had not resolved completely.
Consideration of reports of Dr Shatwell for the insurer
Dr Shatwell provided a report for the insurer of 20 July 2020.
Dr Shatwell was given a history of the accident by the claimant that she was proceeding in the outer lane of two towards a traffic light controlled intersection and had a green light in her favour. The driver travelling in the opposite direction ran a red light and turned across Ms Davidson’s car causing a collision between the driver side front wing ofthe claimant’s car and the passenger side front wing of the insured vehicle. Airbags were deployed. The claimant sustained a laceration to the outer side of her right ankle.
There was no damage to the perineal tendons which ran just behind the laceration. There was no damage to the articular surfaces of the subtalar joint.
The claimant was reported to have remained in Blacktown Hospital for about two weeks before she was transferred to Mount Druitt Hospital for a further two weeks convalescence. She was then transferred to Minchinbury Hospital for a further three weeks to mobilise properly for being allowed home.
Dr Shatwell considered that Dr Machart had utilised an incorrect diagnostic table in assessing WPI. In any event, Dr Shatwell was of the opinion that the claimant’s fracture was undisplaced and extra articular and on this basis expressed the view that the range of motion method of measurement still stood as the best way of assessing the claimant’s impairment. This opinion is contained within the supplementary report of Dr Shatwell dated 9 October 2020.
For a WPI assessment Dr Shatwell relied on Tables 42 and 43 on page 78 of the AMA 4 guides for ankle and hindfoot impairments. Table 42 with respect to the claimant prescribed a mild WPI of the ankle which gave a 3% WPI assessment. Table 43 prescribed a mild WPI of the hindfoot, giving a 1% WPI assessment. On the combined values chart, taking a 3% WPI and a 1% WPI this gave a 4% total WPI on Dr Shatwell’s assessment.
Dr Shatwell provided a further supplementary report of 9 October 2020. This report went to the method of range of motion assessment adopted.
Dr Shatwell said that he used the range of motion method as he considered this appropriate for the injury. He said that the “fracture” of the posterior tubercle of the talus was a non-articular fracture just outside the tibiotalar and subtalar joints. The doctor said that there was no sign of damage to talar dome or body of the talus.
Dr Shatwell said that the ankle joint appeared anatomic on the CT scan of 15 August 2018. Further, he said that the MRI scan of the right foot and ankle of 16 November 2018 showed a minor disruption of the cortex in the region of the posterior tubercle of the talus which is an undisplaced fracture.
Dr Shatwell measured;
a. extension at 0°;
b. flexion at 30° (on both ankles);
c. eversion at 0° (both ankles), and
d. inversion at 10°.
Dr Shatwell referred to the report of Dr Machart where he considered that the irregularity of the subtalar joint had no correlation in the diagnosis based estimate in Table 64 on pages 85 and 86 of the AMA 4 guides. Dr Shatwell said that Dr Machart used, on this basis, the ankle joint as an analogous joint. Dr Shatwell said that Dr Machart used an 8% WPI assessment for an intra articular fracture of the ankle with displacement which in his opinion was not appropriate.
Dr Shatwell said that Table 64 on page 86 provided a suitable heading under hindfoot where an intra articular fracture with displacement of the hindfoot is a 6% WPI impairment. Dr Shatwell said though that in his opinion neither of these estimates was satisfactory as the fracture was undisplaced and extra articular.
Dr Shatwell calculated a 5% impairment in his report in July 2020 based upon range of motion.
Dr Machart recorded 20% impairment based upon analogy.
Certificate of Medical Assessor McGrath
The Medical Assessor said that in this accident the claimant sustained a fracture to the lateral and posterior aspects of the talus bone and also the lateral malleolus. This was associated with significant tendon and ligament soft tissue injuries, including the medial aspect of the ankle. She received surgical care followed by rehabilitation with a good functional outcome.
The Medical Assessor diagnosed;
a. ankle - open talus fracture and ligament tears;
b. foot - soft tissue, and
c. skin Scarring.
Permanent impairment was assessed as follows:
| Body Part or System | AMA4 Guides/ Guidelines References (chapter/ page/table) | Permanent (YES/NO) | Current %WPI* | %WPI* from pre-existing OR subsequent causes | %WPI* due to motor accident | |
| 1 | Right foot and ankle | MA PIG p16-22 AMA4 Chap3.2 | yes | 5% | 0% | 5% |
| 2 | Skin Scarrig | MAPIG p57-59 T18 TEMSKI AMA4 T2 p280 | yes | 3% | 0% | 3% |
Re-Examination of the Claimant – Panel Examination
The claimant was examined by Medical Assessor Curtin on 11 March 2022. The report of Medical Assessor Curtin is adopted by the Panel and follows.
A physical examination of the claimant took place by Medical Assessor Curtin . His findings follow.
1. The claimant’s medical history, where it differs from previous records
The history is largely unchanged. Ms Davidson was the driver of a small car involved in a collision with another vehicle on the 13 June 2018 .The other vehicle was approaching from the opposite direction and carried out a right-hand turn in front of Ms Davidson’s car, a manoeuvre which resulted in a collision.
Ms Davidson sustained a wound to her right ankle and was taken by ambulance to Blacktown Hospital where she was admitted. The following day she underwent surgery for a debridement, washout and closure of a penetrating wound to the right ankle. Subsequent imaging revealed that she had sustained a fracture of the postero- medial talus together with injury to the deltoid and anterior talofibular ligaments on the lateral aspect of the ankle. These injuries were managed conservatively. She was discharged from hospital after one week but then spent an additional six weeks in hospital (first at Mount Druitt hospital and then Minchinbury hospital) for rehabilitation. She was eventually able to resume work in a part-time capacity four months after the injury.
Current symptoms
Ms Davidson says that the right ankle still causes her some difficulty. The ankle becomes sore after standing or walking for about 30 minutes. She experiences some difficulty walking on uneven ground or managing inclines. When negotiating stairs she prefers to hold a rail if one is available. With regard to her footwear, Ms Davidson that she likes to wear soft joggers which she finds completely comfortable. She says that she does not possess any shoes or boots, and it is therefore uncertain whether the scarring on her ankle would present a problem in restricting her footwear. She has not noticed undue swelling of her right ankle. She is aware of the scar on the side of the ankle which is still somewhat tender to touch. She applies sorboline cream regularly to the scarred area.
2. Additional history since the original Medical Assessment Certificate was performed
None.
3. Findings on clinical examination.
Ms Davidson was a large and pleasant lady of 59 years . She was considerably overweight with a BMI of 49.5 (157 cm and 122 kg) placing her well within the morbidly obese range. She was able to walk easily without any walking aids. Her gait was consistent with the obesity and there was no obvious limp. With assistance for balance, she was able to stand on her toes without discomfort.
Neither ankle was particularly swollen, the circum-malleolar girth on the right side were 27 cm and 25 cm on the left. There was no evidence of calf wasting on the right side (maximum circumference: right 46 cm, left 47 cm). There was some residual stiffness of the right ankle due to reduction in dorsi flexion and hindfoot inversion (see chart below). Normal movement of the toes was present .On the lateral aspect of the ankle there was a transverse scar extending for 40 x 3 mm. The scar was depressed and somewhat adherent to deeper tissues, and the central part of the scar was thickened and slightly tender to deep palpation. There were no obvious suture marks and no clear colour contrast with the surrounding skin. There was no evidence of any significant sensory loss associated with the scarring.
| Ankle | Right | Left | |
| dorsiflex (knee extended/knee flexed | >10°+ | 10° | 20° |
| plantarflex | >20°+ | 30° | 35° |
| inversion | >20°+ | 20° | 25° |
| eversion | >10°+ | 15° | 15° |
4. Results of any additional investigations since the original Medical Assessment Certificate
There have been no additional investigations.
5. Comments on Whole Person Impairment
Assessor McGrath has found 5% WPI due to reduced range of movement at the ankle and hindfoot. It is not completely clear how this figure was reached. The Motor Accident Guidelines Paragraph 6.85 states that tables 40 to 45 page 78 AMA 4 are used to assess range of motion of the lower extremities. Where there is loss of motion in more than one direction/axis of the same joint only the most severe deficit is rated…. only deficits arising from separate tables can be combined. Following this direction, the measurements detailed by assessor McGrath can only reach a total of 4% WPI., which is the same impairment found as a result of this examination, and also in the report dated 02/07/2020 of A/Prof Michael Shatwell.
With regard to ankle movements, the Assessor finds 10° of dorsi flexion and 20° plantarflexion both of which could be responsible for 3% WPI according to Table 42 on page 78 of AMA 4 . Only one of these measurements however can be used to find impairment. Similarly, hindfoot impairments are assessed on Table 43 and the Certificate findings of 20° for inversion and 10° for eversion would both attract rating of 1% WPI, but only one of these can be used.
The report of Dr Frank Machart dated 19 October 2020 raises the possibility that the ankle impairment might more properly be based on a “Diagnosis Based Estimate” rather than the loss of ankle/hindfoot movements. Dr Machart suggests that because irregularity on the subtalar joint does not rate in Table 64 of AMA4, that an estimate of 8% WPI would be appropriate because the subtalar joint is similar to the ankle joint and should therefore attract the same impairment rating.
Alternatively, Table 64 does allow for 6% WPI for an intra-articular fracture with displacement affecting the subtalar bone. The MRI dated 16 November 2018 does report “posterior talus/posterior malleolar fracture with step in articulating surface”. The MRI examination of 20 September 2018 reports that the “subtalar joint is unremarkable in appearance”. A CT scan also taken on the 20 September 2018 reports “no talar dome collapse or trans chondral fracture is seen” but does not specifically report on the subtalar joint.
The Certificate issued by Medical Assessor McGrath states that the ankle and foot impairment is based upon the current loss of range of motion and that “she does not satisfy the criteria for entries under T 64 of AMA 4”. The report of A/Prof Michael Shatwell (25 June 2020) provides the opinion that the MRI examination on 16 November 2018 shows a minor disruption of the cortex in the region of the posterior tubercle of the talus, which represents a non-articular fracture just outside the tibio-talar joint”. After consideration of these various opinions in conjunction with the physical findings presented by the claimant, the Panel is of the opinion that an estimate of ankle impairment based on a Diagnosis Based Estimate is not appropriate.
The claimant submits that the assessor failed to properly categorise the claimant’s injury as being an intra-articular fracture with displacement. The panel agrees with the opinion of A/Prof Shatwell, an Orthopaedic surgeon who stated that the fracture of the talus did not involve an articulating surface. He reviewed both the CT scan (15/08/2018) and the MRI (16/09/2018) of the right foot and ankle, and concluded that there was “a minor disruption of the cortex in the region of the posterior tubercle of the talus which represents a non-articular fracture just outside the tibiotalar joint”. In a supplementary report dated 09/10/2020, A/Prof Shatwell expanded on this opinion, stating that the MRI showed “an undisplaced fracture which is not likely to cause problems in the future with the ankle or subtalar joints”
Three MRI studies of the right ankle were carried out. The first, on the 15/08/2018, was not included in the documentation, although the MRI dated 20/09/2018 makes reference to it. The MRI on the 20/9/18 date makes no reference to any step in an articular surface, merely stating that the “subtalar joint is unremarkable in appearance”. The panel was also influenced by the multiple letters from the treating Orthopaedic surgeon, Dr Bijoy Thomas over the period 26/7/2018 to 26/11/2018. Nowhere in these letters to Ms Davidson’s GP is there any mention that the ankle fracture was one that involved a step in an articular surface, clearly a matter that could compromise the long-term outlook for Ms Davidson. The MRI dated 16/11 2018 is the only document where there is a mention of “a small step in the posterior articulating surface of the subtalar joint”. In the four years that have elapsed since the injury there is no evidence that the reported step in the articular surface has resulted in any deterioration of the ankle joint, as Ms Davidson, who is extremely overweight, continues to walk comfortably without any discomfort.
Assessor McGrath had found 3% WPI due to scarring on the ankle and provides 8 TEMSKI criteria in support of this assessment. The Panel does not agree with two of these, namely that there is poor colour matching of AMA 4 of the scar, and that there is a minor effect on activities of daily life (ADL) in regard to footwear and chemical agents. A current photograph of the scar is attached. Ms Davidson did not make a complaint that she was unable to wear certain types of footwear on account of the injury to her ankle. Neither is there any record a similar complaint in the Impairment Certificate .She is a very large lady who finds it most comfortable to wear soft joggers on each foot. Similarly, Ms Davidson did not volunteer any history of sensitivity to chemical agents, and there is no detail regarding this claim in the Certificate.
It is the view of the Panel that an assessment of 2% WPI could be justified on the following basis with reference to the TEMSKI chart;
a)the claimant is conscious of the scar and is able to locate it easily
b)there is a visible contour defect and some adherence of the scar which is slightly tender
c)Ms Davidson applies treatment to the scar intermittently, but there is no significant colour contrast with surrounding skin, no suture marks,
d)negligible effect on any ADL, and
e)the scar itself is not usually visible with usual clothing.
Combining the impairments due to reduced range of ankle movement (4%) with that due to scarring (2%) arrives at the total of 6% WPI.
Apportionment
Pre-existing/Subsequent Impairment
Effects of Treatment
A Current % of permanent impairment 6%
B Pe-existing/subsequent % for permanent impairment 0%
C Adjustments % for effects of treatment 0%
Final % permanent impairment 6%
Causation
- Nil
- Nil
The claimant was involved in an a motor vehicle accident on 13 June 2018 at around 6.00pm. She was the driver of a small car. The insured car turned in front of her car. Her car was impacted on the front right section. Ambulance and police were in attendance and she was taken to Blacktown Hospital with a diagnosed fracture of the right ankle. She received surgery for her injury and was then transferred to a rehabilitation hospital and then to a private rehabilitation hospital. In total, she spent seven weeks in hospital.
The Panel has concluded that it would not be unreasonable for the claimant to suffer injury to her right foot and ankle as well as scarring as a direct consequence of this accident. In the particular circumstances of this accident, the Panel is satisfied that the injuries suffered by the claimant are causally related to the accident occurring on 13 June 2018.
Determination
The Panel revokes the certificate of Medical Assessor McGrath dated 5 June 2021.
The Panel determines that the following injuries were caused by the motor accident:
· right ankle – open talus fracture and ligament tears caused by the accident, and
· right foot – soft tissue injuries caused by the accident.
The injuries caused by the motor accident have a total WPI of 6%.
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