Dulalia v QBE Insurance (Australia) Limited

DETERMINATION OF REVIEW PANEL
CITATION:	Dulalia v QBE Insurance (Australia) Limited [2025] NSWPICMP 116
CLAIMANT:	Jeremias Del Mundo Dulalia
INSURER:	QBE Insurance (Australia) Limited
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	Margaret Gibson
MEDICAL ASSESSOR:	Sophia Lahz
DATE OF DECISION:	25 February 2025
CATCHWORDS:	MOTOR ACCIDENTS – Review of certificate and reasons of Medical Assessor dated 1 April 2024 who assessed a whole person impairment (WPI) of 4% for soft tissue injuries to the claimants hand, cervical spine, lumbar spine, left knee, left foot, left shoulder, and right shoulder; claimant injured in an accident on 15 November 2011; delayed reporting of up to three years of some injuries by the claimant to his treating practitioners including ACL injury; claimant underwent an MRI scan of his left knee in September 2015 which revealed a complete rupture of the ACL; Review Panel not satisfied that it was reasonable to suspect that the claimant would take four years to complain about an ACL injury when this would be expected to give immediate and acute pain upon occurrence; Held – Review Panel assessed the claimant’s WPI at 0%; Medical Assessment Certificate revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Panel revokes the certificate of Medical Assessor Cameron of 1 April 2024. 2. The Panel assesses the claimant's whole person impairment at 0%.

STATEMENT OF REASONS

INTRODUCTION

This is an application by the claimant for review of a certificate and reasons of Medical Assessor Cameron (the Medical Assessor) dated 1 April 2024.
The Medical Assessor found the following injuries caused by the accident gave rise to a permanent impairment of 4%:
(a)    head – soft tissue injury;
(b)    cervical spine – soft tissue injury;
(c)    lumbar spine – soft tissue injury;
(d)    left shoulder – soft tissue injury, and
(e)    right shoulder – soft tissue injury.
The following injuries were referred by the Personal Injury Commission (Commission) for assessment of whole person impairment (WPI):
(a)    injury to head - memory loss, chronic headaches, intermittent dizziness fatigue;
(b)    injury to cervical spine - loss of range of movement;
(c)    injury to lumbar spine - with symptoms of radiculopathy and pins and needles;
(d)    injury to left shoulder - rotator cuff tendon strain;
(e)    injury to right shoulder - consequential injury;
(f)    injury to right hand - right little finger deformity;
(g)    injury to left knee- requiring anterior cruciate ligament (ACL) reconstruction, and
(h)    injury to left foot - chronic dorsal left foot pain, soft tissue and impact injury.
The Panel has conducted a review of all injuries referred to the Medical Assessor for assessment of permanent impairment.

Bundles of documents

The parties have each presented their respective bundles of documents upon which they rely. The Panel have read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel or a Panel Member has not read it, in much the same manner as parties not referring to or not specifically relying on a document in their own bundle and submissions.
The Panel is not required to “analyse every piece of information from every opinion contained in a document with which he [it] was provided” – see Farr v Insurance Australia Limited t/as NRMA Insurance Ltd [2014] NSWSC 1435 at [46]. The Panel is to come to its own conclusion and to take its own history.

The accident

The claimant was involved in the accident on 15 November 2011, over 13 years ago. The claimant was driving a Suzuki Swift sedan when he slowed his car to allow a child to cross a pedestrian crossing. A Holden Commodore driving behind him failed to stop and collided with the rear of the claimant’s car. The claimant has provided a statement declared on

8 October 2019 saying:
“As a result of the impact, I was jolted back and forward hitting my forehead and face against the steering wheel and then my head and neck jolted backwards and forwards in a whiplash motion causing the back of my head to hit the top of my head against the inside roof of my car.
I recall blacking out for a short time immediately after the accident. When I regained consciousness (about 15-20 minutes after impact) I recall that I was being transported by ambulance to a regional hospital nearby.”
The claimant was discharged from hospital on the evening of the accident date.

Claimant’s submissions

The claimant asserts that immediately following impact, his car was pushed 47m past the point of the collision. The claimant says that this statement has not been challenged by the insurer.
The claimant says that his assertion of a contact injury to his left knee and foot is given some, albeit inferential, support from the records of Hawkesbury District Health Service. In this regard the claimant relies on the following notation:
“C/o pain in left hip posteriorly”
The claimant notes that the Medical Assessor found no association between injury to the left knee, left foot and right hand on the basis of:
(a)    a lack of contemporaneous evidence (page 7, paragraph 21);
(b)    the injuries being “medically implausible”, and
(c)    there were “other causes of these injuries” based on ‘evidence of the general practitioner (GP) records’.
The claimant submits that the Medical Assessor incorrectly approached the matter as if the contemporaneous recordings by doctors were the sole, or at least most important, factor in determining causation.
The claimant submits that he has explained two matters going to the question of contemporaneous evidence;
(a) first, his poor English, which the claimant submits ought to raise in the mind of a fair and objective observer the possibility that contemporaneous medical records, from the paramedics and hospital staff, may not fully account for all of the symptoms the claimant describes in his statement, and
(b) second, that he had experienced a loss of memory after the accident and was not of sufficiently sound mind to have explained all of his varied symptoms for the purposes of later compensation claims.
The claimant submits that the Medical Assessor’s observations were factually incorrect. In support of this the claimant refers to his affidavit [sic] which he says made specific reference to the various conditions of which he now claims as developing immediately after the accident.
In his submissions, the claimant accepts the fact of the chronology that he did not complain of his left knee, left foot and right ring finger to a medical treater for three years in the case of his knee and foot, and more still in relation to his ring finger, but the claimant submits that an injury is not made less real simply because it is not written about by a doctor.
The claimant says that the crucial error made by the Medical Assessor is found in paragraph 18, on page 6 of the certificate, with respect to Diagnosis and Reasons, where the Medical Assessor records:
“the general practitioner records show that there was a subsequent injury to the left knee and probably other body regions. These are probably subsequent sporting injuries”
The claimant submits that such a conclusion is contrary to the claimant’s evidence. The claimant says that the conclusion is contrary to the claimant’s denials to other doctors about therehaving been no injuries subsequent to the car accident and also to the Medical Assessor himself.
The claimant submits that the Medical Assessor has in effect concluded, based on unreasonable speculation, that the claimant had subsequent sporting accidents on no more evidence than the “fairly cryptic” records of Dr Tong, that read no more than as follows:
(a) on 22 March 2014, Dr Tong recorded an entry of “pain both knees for two months” and “loves playing basketball, can run, jog but painful with jumping”.
The claimant submits that nothing about this entry is necessarily determinative of a sporting injury – it merely records that the claimant can “run, jog” but found it “painful” when jumping. The claimant submits that the fact of there having been pain for two months, of itself, is not determinative of the fact that there had only been pain for two months – it is simply a record of what Dr Tong noted on that day about what was told to him.
The claimant submits that there is an obvious risk of central and fatal unfairness to a claimant if one reads GP’s records in a vacuum, does not enquire with or ask the claimant about their contents, and draws adverse conclusions from them.
The claimant submits that, returning to the single GP entry, it ought to be obvious why this entry alone cannot be the basis for an adverse credit/reliability finding and a reason to find subsequent sporting injuries. The claimant submits that it is possible that he had been in pain since 2011, but had effectively learnt to deal with his injuries while attempting to return to normal life, and that, consistent with an anterior cruciate ligament (ACL) tear, he was able to run and jog. The claimant submits that the GP record can be read in that manner and be entirely parsimonious with the ACL tear being from the car accident.
The claimant submits that, in the vein of a failure to give adequate reasons, if it is the Medical Assessors expert medical opinion that an ACL tear sustained in 2011 would have wholly precluded running or jogging thereafter and thus, it could not have been torn then if he reported running and jogging in 2014, then the Medical Assessor ought to have stated so. However, the claimant submits that such an opinion does not seem likely, since it is not unheard of for people with ACL injuries to function largely as normal when walking, jogging and running in certain conditions.
The claimant further submits that the Medical Assessor’s assertion that a “sporting injury” could “probably” account for other injuries makes little sense and makes even clearer the error. The claimant says that no such finding can be made on the evidence and suggests that the Medical Assessor was inclined towards speculating without basis.
The claimant submits that it should be noted that the Medical Assessor also appears to suggest that something determinative can be taken from the fact that the MRI report of 2015 of the left knee does not “note” the accident. The claimant says that this “conclusion” again suffers from a combination of:
(a)    assuming the medical record is a perfectly accurate transcription of what was said by the claimant to the doctor;
(b)    assuming therefore that the claimant did not in fact tell the doctor (who simply neglected to record it, did not hear the complaint, or did not regard it as sufficiently relevant to record it);
(c)    assuming the claimant ought to have both remembered and known of the relevance of the car crash to his need for an MRI in 2015 which the claimant says ignores the understood reality of the fallible human memory, and
(d)    assuming that, read together with the GP entry of Dr Tong, the claimant must have suffered a sporting injury.
The claimant refers to an MRI scan dated 15 December 2017 which the claimant says reports that his torn ACL appeared to be a “longstanding” injury. The claimant says that without more reasoning from the Medical Assessor, it is not obvious why this could not mean that the “longstanding injury” was from 2011 as opposed to 2014, or 2015.
The claimant submits that the following doctors accepted the causal relationship in the following ways:
(a) Dr Dias who, assessing on instructions from the claimant’s solicitors, accepted all injuries were causally related, and
(b) Dr Woo who, assessing on instructions from the insurer’s solicitors, accepted that the right little finger was related to the accident, but not the left knee.
The claimant says that Dr Woo’s conclusion rests on the same faulty use of the GP record; he concludes that “the GP notes [state] a left knee injury in 2015. There is no other documentation of this injury between 2011 and 2015.” The claimant says that this is, for the reasons set out above, a faulty misuse of the GP records.
The claimant submits that he made a very clear complaint of swelling and pain in his left knee within days of the accident and denies any other basis or cause for such an injury.
The claimant submits that it is appropriate that, given the Medical Assessor failed to conduct a permanent impairment assessment of the left knee, left foot and right hand/finger, then the claimant should be re-examined, and those impairments added to those found by the Medical Assessor in accordance with the Motor Accident Guidelines (the Guidelines).

Insurer’s submissions

The insurer summarised the claimant’s submissions as follows:
(a)     the Medical Assessor’s sole/predominate reliance on contemporaneous complaint evidence;
(b)     the Medical Assessor’s denial of procedural fairness and natural justice, and
(c)     the Medical Assessor’s failure to give adequate reasons for his causation findings.
The insurer refutes that the Medical Assessor solely or predominately relied upon only contemporaneous evidence in arriving at his decision. In support of this, the insurer refers to page 7 of Medical Assessors certificate, where the Medical Assessor noted that his determination of there being a lack of a causal nexus between the subject accident and the injuries to the right hand, left knee and left foot was also based on the contents of the GP records, which revealed evidence of other causes of these injuries. Under the “Summary of relevant documentation” heading on page 5 of the certificate, the Medical Assessor referred to the relevant consultation records from Campsie Family Medical Centre, in particular noting Dr Tong’s entry dated 22 March 2014, where it was mentioned that the claimant had been playing basketball and experiencing pain in his left knee for two months.
The insurer referred to the claimant’s submission that the Hawkesbury District Health Service clinical material provided support for the argument that he sustained a left knee and left foot injury in the subject accident as it was recorded that he complained of pain in the left hip posteriorly soon after the relevant incident. In response, the insurer submits that implying a causal relationship between the subject accident and injuries to the left knee and left foot based on the claimant’s reporting of pain in the left hip soon after the incident is far-fetched and fanciful. The insurer says that evidently, the left hip is a distinct bodily structure from the left knee and foot, and accordingly, the claimant’s submission that a causal relationship between the injuries to his left knee and left foot and the subject accident can be implied based on a record of him reporting left hip pain soon after the relevant incident, is clearly erroneous in the circumstances.
The insurer further submits that the conclusion of the claimant’s left knee injury not being caused by the subject accident is validated by the opinion of Dr Woo in his medico legal report dated 5 July 2023.
The insurer refers to the claimant’s submission that the claimant was denied procedural fairness and natural justice on the basis that the Medical Assessor had not put to him the conclusion that the GP records reveal a subsequent injury to the left knee and probably other body regions, which are likely subsequent sporting injuries. The insurer refutes this.
The insurer submits that the claimant was on notice that the records referred to evidence of a subsequent injury to the left knee that can be causally related to his participation in sporting activities. In particular, the insurer highlights the following GP consultation entries contained with the Campsie Family Medical Centre clinical records:
(a) 22 March 2014 – the claimant had been experiencing bilateral knee pain for two months with reference to him playing basketball, and
(b) 1 August 2015 – the claimant suffered a left knee twist injury when playing sports and experienced left knee pain upon full bending.
As such, the insurer submits that the Medical Assessor did not base his findings on information that was unknown to the claimant.
The insurer refers to the authority of Currie v Motor Accidents Authority of New South Wales [2013] NSWSC 83 and says that parties are entitled to an opportunity to respond to conclusions made by decision-makers that are not an obvious and natural evaluation of material. In this instance, the insurer says that the claimant cannot maintain that the conclusions of the Medical Assessor were not obvious and based on the natural evaluation of material.
The insurer submits that there is no reasonable cause to suspect the Medical Assessor denied the claimant procedural fairness and natural justice.

Insurer’s submissions in reply to WPI application

The insurer submits the following:
(a) that the subject accident in 2011 did not cause or materially contribute any of the ongoing injuries claimed, noting the minor nature of the injuries identified by ambulance officers, hospital staff, and radiological imaging on the day of the accident, and
(b) that the significant absence of contemporaneous evidence since that time is relevant in supporting the fact that the accident did not contribute to any ongoing injuries.
It is the submission of the insurer that the claimant would have recovered from any minor injuries shortly following the accident. The insurer submits that the claimant’s significant delay in attributing his medical conditions to the subject accident is highly suggestive that the ongoing complaints are not causally related to the accident.
The insurer relies on the ambulance report dated 15 November 2011 which states that the claimant had slight bruising to the left eyebrow and complained of muscular pain. The claimant was reported to be oriented and mobile, his pain assessment was 1/10, and he denied loss of consciousness. There were no complaints of any left knee or right finger symptoms in either the ambulance records or the hospital records.
The insurer says that there is otherwise no further medical evidence which refers to the subject accident until March 2017, five years and four months following the accident.
The insurer submits that in the time between the subject accident and the next reference to the accident in the medical evidence, the following treatment is apparent on the records:
(a)    Consultation on 29 September 2015 at Campsie Family Medical Centre in which the claimant noted left knee pain due to a ‘left knee injury’. There was no mention of the subject accident.
(b)    An X-ray of the left knee dated 22 August 2015 states a clinical history of ‘left knee pain’ but does not mention the subject accident. The finding of that X-ray, as follows, shows a moderate joint effusion (which was more than three years following the accident):
“The main knee joint and patellofemoral joint space are preserved. There is a moderate knee joint effusion. No fracture or bone lesion is identified.”
(c)    Consultation on 2 October 2015 at Campsie Family Medical Centre for ‘knee injury’.
(d)    Consultation on 29 August 2016 at Campsie Family Medical Centre noting that the claimant had been experiencing dizziness for one week. The insurer says that there was no mention of the subject accident.
The insurer submits that the claimant’s efforts to pursue compulsory third party (CTP) compensation appear to begin on 4 March 2017 when the claimant consulted with Dr Bhatt at Rosehill Family Medical Centre and reported right knee pain and memory issues since the accident.
The insurer referred to a further consultation on 7 December 2017 with Dr Amirthanandan when the claimant reported that he had been experiencing intermittent headaches and vertigo, and knee pain, since the accident. He also reported that the 5^th right finger was ‘broken/deformed’ in the subject accident. The insurer says that there is no record of this. At the same time, the claimant also complained of left foot pain.

The insurer submits that in total, there were five available consultations at Rosehill Family Medical Practice until the cessation of records, however no objective diagnosis for any injuries was ever provided.
The insurer submits that the claimant subsequently consulted with Dr Bui at MyHealth Medical Parramatta. Those clinical records demonstrate the following three consultations to the date of records of 26 September 2017;
(a)     12 March 2017 - the claimant reported the car accident in 2011, complaining of pain in the central neck, right hand, and lateral left knee. The claimant reported that he never filed a CTP claim as he did not know of the availability for this.

Dr Bui provided the claimant with a claim form.
(b)     9 March 2017 - the claimant reported left knee pain. On examination, Dr Bui found no midline tenderness to the neck, with mild paravertebral tenderness. On the right hand, the doctor found decreased sensation to all finger on pinprick with bony swelling of the fifth digit. The claimant’s back was tender at T2 on palpation, with mild tenderness at L5. It was stated that the claimant’s knee was unremarkable save for a small effusion and mild patellar crepitus.
(c)     9 April 20170- the results of an MRI scan were discussed, which demonstrated a full thickness tear. The claimant said all there was no other accident or injury which could have caused the tear.
A further MRI dated 15 December 2017 confirmed a full-thickness ACL tear.
Since the insurer’s reply submissions were lodged on 22 March 2023, the claimant provided an updated list of injuries for referral to the Commission for assessment of WPI.
The following injuries listed by the claimant had not previously been alleged as accident related, and not included by the claimant:
(a)     Injury to cervical spine: loss of range of movement.
(b)     Injury to lumbar spine: with symptoms of radiculopathy and pins and needles.
(c)     Injury to left shoulder: rotator cuff tendon strain.
(d)     Injury to right shoulder: consequential injury.
In respect to the additional injuries, the insurer relies on the report of Dr Woo, orthopaedic surgeon, dated 25 July 2023 who found 0% WPI in respect of those additional injuries alleged by the claimant.
Specifically, the insurer submits that the available evidence determines that the injuries do not attract impairment above 0%, and any greater ongoing WPI is unrelated to the subject accident.

Medical evidence

The claimant was seen by Dr Lee, orthopaedic surgeon, who provided a report of

14 April 2020.
At the time of examination, the claimant complained of pain in his neck, left shoulder and left knee. Dr Lee said that the pain radiated to his head but he did not identify whether this was pain from neck or left shoulder or both.
Dr Lim referred to an X-ray of the left knee dated 17 November 2018 showing screws and staples due to previous ACL reconstruction.
Regarding the claimant’s injuries, Dr Lee said that the claimant:
“was injured in a motor vehicle accident on 15 November 2011. He did not lodge a claim because he was unfamiliar with the Australian system. His car was hit from behind by another vehicle causing him to hit the steering wheel and knock his knee. He injured his neck, left shoulder and left knee. He had knee reconstruction in the left knee. He has not seen a specialist or therapist to assess his problems. He also hit his head against the steering wheel suffering from concussion.”
Dr Lee assessed WPI for the claimant’s cervical spine, lumbosacral spine, left and right shoulders, right little finger and left knee at a total of 19%. Dr Lee did not consider nor did he discuss the issue of causation arising from the accident in 2011 and his treatment several years later without prior complaint.
The claimant was also reviewed by Dr Costa, occupational physician, who provided a report of 12 February 2021.
Dr Costa considered that the claimant’s condition was consistent with and reasonably attributable to the history of an injury arising out of the accident as he was asymptomatic and coping with all activities of daily living. However, no comment was made by Dr Costa about the gap in time from the date of the accident until he first sought treatment and attributable to in that regard.
Dr Dias, occupational physician, provided a report of 15 August 2023. Dr Dias noted that following the accident, the claimant was “transported from the accident site to the Hawkesbury District Hospital Emergency Department”. There, the claimant was noted to have severe pain in his cervical spine region, and bruising to his right eyebrow region. He underwent a CT scan of his brain and cervical spine at the hospital, which did not reveal any acute pathology. He was subsequently monitored and given analgesia before being discharged home on the night of 15 November 2011.
The claimant informed Dr Dias that following his discharge from Hawkesbury Hospital Emergency Department, he did not subsequently seek medical attention in the weeks and months following the subject accident despite experiencing ongoing pain in his neck, back, left shoulder, right little finger, left knee, and left foot. He recalls that he tried to continue on with his work duties and day-to-day activities and would manage his symptomatology with analgesia and anti-inflammatory tablets. His symptoms persisted, and he eventually consulted a GP in relation to his left knee condition in around March 2014, Dr Kenneth Tong, and was referred for X-rays of his right and left knees on 29 March 2014.
He subsequently underwent an MRI scan of his left knee on 30 September 2015 after consulting another GP, Dr Thomas Springer, and the MRI scan, performed on

30 September 2015 revealed a complete rupture of the ACL, a grade 2 injury of the medial collateral ligament, and disruption of the posterolateral corner stabilisers.
The claimant stated that he struggled to cope with the demands of his employment, after the subject accident, and ceased working for almost 18 months, between early 2012 and mid-2013 which he said was due to his injuries. He recalled that he had shut down his business, due to his injuries.
Dr Dias said that the claimant;
“did not have any documented pre-existing injuries or conditions affecting his head, neck, lower back, shoulders, hands, knees or feet prior to the subject motor vehicle accident of 15 November 2011. He was pain free and asymptomatic in all of these regions prior to the subject accident.”
Dr Dias said that as a result of the subject accident, the claimant sustained an acute concussive closed head injury, and acute whiplash related soft tissue injury to his cervical spine, acute soft tissue injuries to his lower back, left shoulder and left foot, and acute impaction injury to his left knee resulting in a full thickness ACL rupture, and an acute extensor tendon injury to his right little finger DIP joint resulting in a chronic right little finger mallet finger. Dr Dias said that the claimant had suffered with ongoing symptomatology in his various injured regions over the course of the past 12 years. He also developed a consequential injury to his right shoulder over the course of the past five to six years due to prolonged overcompensation for his left shoulder condition and continued to suffer with ongoing right shoulder pain, stiffness and discomfort at the present time.
Dr Dias said that in his opinion, the causal chain stemming from the subject accident to the claimant’s current diagnosed conditions remained unbroken. In his opinion, all of the claimant’s symptoms, disabilities and impairments with respect to his head, neck, lower back, shoulders, right little finger, left knee and left foot conditions remain entirely causally attributable to his involvement in the subject accident of 15 November 2011.
Dr Dias provided a total WPI assessment of 32%.

Panel medical examination

The claimant was examined by Medical Assessor Gibson and Medical Assessor Lahz on

13 December 2024. Their report follows,
Medical Assessment of Mr J Dulalia by Assessors Margaret Gibson and Sophia Lahz at St Leonards Rooms 13/12/24
Mr Dulalia attended punctually and is aged 48 and right-handed. He said he caught the train from home in Western Sydney.
The assessment was assisted by a telephone Tagalog interpreter Ms Maria Louisa Merjer ASZ72S. However, Mr Dulalia indicated that he preferred to communicate in English for the majority of the interview and would use the interpreter if experiencing difficulties with either comprehension or expression. The assessors encouraged him to do so.
The purpose of the assessment (medical assessment of injuries from the subject 2011 motor accident) was explained and he asked the Assessors what he should do if he could not remember something (citing poor memory). We asked him to simply do his best and let us know what he could recall.
He was born in the Philippines and told the Assessors that he came to Australia in either 2006 or 2007 in order to marry a woman also from the Philippines but who was also an Australian citizen.
He told the Assessors that he is currently living at Doonside in a unit with friends. He is single although he has a son aged around 6. He mentioned that a former partner was making it difficult for him to see his son and that his son does not live nearby.
He is not working and has not worked for some time. He is receiving a Centrelink benefit. He said that he is now a permanent resident and has a Medicare card although he could not tell the assessors when these privileges were granted.
He said he “kept breaking the diamonds”. (He is a diamond setter who previously had his own business which he said he could not continue after the motor accident.) He initially said he could not remember when he last worked although it was subsequently mentioned that he had a series of jobs (some part time, others full time) post MVA from which he had been terminated due to poor performance, most recently in 2020. He said that before the subject 2011 motor accident, employers had liked him although the accident put a stop to that.
We asked him why/how he was actually damaging the gem stones at work. He showed us the right little finger mallet (DIP) deformity and said that his fingers applied the wrong forces, and also that frequent severe headaches made it difficult for him to concentrate on the job at hand.
The Assessors enquired about his health preceding the motor accident and were informed that he had been perfectly well. On specific enquiry, he denied any musculoskeletal problems affecting neck, back, knees, shoulders or hands before the 2011 motor accident.
He reported to be an ex-smoker who stopped two years ago, having smoked 2-3 cigarettes daily. He said he consumed alcohol occasionally and he denied any use of illicit substances. In youth, he did use Cannabis though he has not partaken for years.
Before the accident, he said he was a very good chess player both “speed” and “long game”.
He showed us a container of ginger/tea/chili oil which he was applying to painful body parts. We asked about his medications and he produced his Webster pack containing Neurontin, Allopurinol, Pantoprazole, Endep, Osteomol and Escitalopram.
He confirmed his involvement in the subject accident during November 2011. He said he was driving (restrained by seatbelt) whilst doing a delivery in his former partner’s car when his vehicle was rear-ended. He had some difficulty providing details amid complaints of poor memory although he eventually confirmed that he had been on a roundabout and had slowed down when he saw a child walking on the road. He remembers the impact and said that immediately afterwards he was in “shock” and lost consciousness. Subsequently, he told the assessors that he felt his brain “moving inside his head”.
The Assessors asked him if any part of his body had struck inside the cabin in the accident. However, he said he did not remember.
It was put to Mr Dulalia that the ambulance report makes no reference to any loss of consciousness at the scene of the accident. He then said that he had been asked if he had “blacked out”. He explained that in the Philippines, the term “blackout” only refers to a power outage so he had responded in the negative, not having understood the question from the ambulance officers given his English was poor.
Through the interpreter, he then stated to the assessors: “My eyes were closed, my mind was not working and I was asleep mentally”.
It was mentioned to Mr Dulalia that the ambulance officers noted he was fully alert and oriented (GCS 15/15).
The ambulance took Mr Dulalia to hospital where he remained for only a few hours before discharge home. He said on specific enquiry that he did not remember the treatment received/events at hospital. He said that at that stage, he was not worried about himself. He was much more worried about the state of the car. He then commented that no one worries about cars involved in accidents in the Philippines because people are impoverished and there is no car insurance.
The Medical Assessors discussed with him the contents of the hospital records i.e. that the only complaints noted in records were a graze about the eye and neck pain. He responded that he did not remember what had happened although he then spontaneously commented that he recalls the hospital calling a taxi in which he then travelled home.
The Medical Assessors asked him if he were able to walk and look after himself immediately after the accident. He replied that his former partner immediately “kicked him out of home” because (he said) the accident caused damage to her car. Subsequently, he told the assessors he was compelled to live in his car for two weeks. He then said that he went to stay with a friend.
The Medical Assessors tried to obtain the bigger picture of his living arrangements over the last 14 years although he could not provide any coherent account. The Medical Assessors remain uncertain as to how stable his present living arrangements are or were.
After the accident, Mr Dulalia said there was pain all over the body, particularly the head and left knee, left shoulder and lower back.
The Medical Assessors asked him when he initially consulted a doctor after the 2011 accident. It was put to him that the earliest record noted was in August 2013. In reply, Mr Dulalia said that it was expensive to see a doctor in the Philippines and from a cultural perspective, self-healing was generally encouraged. He added it had been expensive to see a doctor in Australia and he had really wanted to cure himself. He said he took the “cheapest” medication for symptomatic relief which was Nurofen and he took many tablets daily for months.
He said he felt “stronger” with regular intake of Nurofen and he felt OK. As time went by he said that he continued with his efforts to get better.
He could not provide any coherent account of when he started consulting a GP. The content of the 2013-2015 GP records were discussed with him, highlighting that he had reportedly been playing basketball, running, jogging and able to jump although he had also been reporting knee pain. Mr Dulalia denied running and jogging although acknowledged that he was playing basketball, he said on medical advice. The doctor had been encouraging him to walk regularly and play sport, as part of the self-healing process referred to above.
He said he continued the walking and sporting activities until a scan showed the torn ligament (ACL) in the left knee. He said that he had continued the walking and sports activities despite knee pain, having not realised the damage from the 2011 motor accident. He did not accept the suggestion that he injured the left knee during sporting activities circa 2015 when he had been playing sports with resultant weight bearing twisting injury.
He said that after the accident, he became very depressed due to widespread pain of the neck, back, left shoulder, later right shoulder and left knee and did not know what he should do.
He said that he started seeing a psychologist who said that he should meet friends and become less socially isolated.
He has been attending the Rose Hill Family Medical Centre in 2017. He produced a letter from the doctor which he read to the assessors. This details a “complex medical history” inclusive of chronic pain since the motor accident 2011, with chronic post traumatic headache and a diagnosis of PTSD. He had seen a neurologist Dr Schwarz who made the abovementioned diagnoses. He was receiving psychological interventions including CBT. He said the letter also referred to neck and left shoulder pain and left-sided body pain secondary to central sensitisation for which he had seen several pain specialists. He had attended the Westmead Pain Clinic (where he said) he was once again advised to walk and play sport. However, he continued to struggle to manage the chronic pain. The letter he said contained references to polypharmacy for depression and insomnia. The letter also referred to him being let go from work in 2020 due to poor concentration and reduced fine motor skills. Further, there had been a relationship break up. He was seeing various allied health professionals for mood changes and emotional dysregulation, reduced motivation, sleep disturbance and poor concentration.
The Medical Assessors asked him about the review he attended with the brain injury service at Westmead although he said he did not recall this. (Essentially, he could not provide a coherent account of interventions at either the pain clinic or else the brain injury service.)
In 2018 (he could not remember the year) he underwent surgery to the left knee for repair of the ACL although he said the knee pain was no better after the operation.
He still sees a psychologist, he thought monthly and he said there had been recent physiotherapy treating multiple body parts “all of the body”. He said most recently that the physiotherapist has said he needs surgery on the right shoulder. He told the assessors that he had to lie on the right shoulder due to severe left shoulder pain from the accident, with this resulting in injury to the right shoulder as well.
The main ongoing treatment is medication for pain and mental health, and psychology sessions.
Current Symptoms and Function
There are widespread aches and pains involving the head, neck, both shoulders, left knee, lower back and left foot which he ascribes to the 2011 motor accident.
He said his aches and pains were generally much worse in Winter.
He complains of constant bifrontal and left-sided headache (pointing toward the ear and neck as well) with intermittent “sudden” exacerbations. He likened the headache to an “icecream” headache which he said was “killing him”.
Mr Dulalia complains of pain in the left side of the head and neck spreading toward the trapezius. He indicated numbness too in the ulnar forearm associated with an “electricity” sensation in all fingers.
He said both shoulders (in a line with the neck) were painful and that he could no longer raise his arms overhead. He was asked for how long this had been the case and he replied “a couple of years”.
He indicated pain and sensitivity around the right little finger DIP, the site of a mallet finger flexion deformity.
He complains of lumbosacral (low back pain) with spread of symptoms to the left anterodistal thigh and posterior as well as medial knee. He reported numbness in the leg at the above locations although he said too that he sometimes felt as though he were being hit by a hammer.
He said on specific enquiry that the left knee does not feel stable and that he had in fact fallen over whilst carrying his young son.
At the left foot, he complains of intermittent pain especially in cold weather between the second and third toes.
He said too that he often burped and this happened several times during the interview for which he did apologise.
He does drive but only short distances most often to medical appointments. He said too that due to his injuries he cannot cook, clean or do any shopping. He has a clothes hanger for the laundry, he does as much as he can at home and friends are helping him.
No imaging was brought to the assessment.
Examination
The Medical Assessors observed that he was slender man with wiry build. Weight was 74 kg. He appeared to sit comfortably during the interview.
The Medical Assessors observed an abrupt change in his demeanour on commencement of the physical examination. Whilst he appeared to sit comfortably during the interview, during the examination, he complained frequently of pain, supported painful body parts e.g. the left arm, visibly shook and at times had to sit down due to complaints of dizziness/nausea.
He was asked to do the best he could with all requested movements during the physical examination or else it would be difficult to use the observed ranges of motion to determine the WPI. He said he was doing his best although pain prevented him from doing many of the movements we were asking of him.
When removing his T-shirt he did not raise his arms beyond 30-40 degrees. When removing his trousers, he was observed to bend both knees to at least 110 degrees without apparent discomfort.
Gait was unremarkable although he complained of pain/weakness with walking on heels and walking on toes.
There was global restriction of the neck without asymmetry. There was no dysmetria, no spasm/guarding and no upper limb non-verifiable radicular complaints. The neck was non-tender although there was flinching when the left trapezius was even lightly palpated. There was no tenderness at the right trapezius. The shoulder joints were unremarkable.
He complained frequently of pain whilst moving the shoulders and the neck.
It was very difficult to assess shoulder movements due to pain complaints. He would lift his arms just a few degrees and then let them suddenly flop down whilst making unusual “jerky” movements making it a challenge to record measurements with the goniometer. The medical assessors did the best they could. Movements were repeated although he complained more and more of pain, complained of dizziness and said he felt he could vomit. Prior to this he had been holding onto some bookshelves with the left arm whilst being asked to move the right shoulder. He was invited to take a break, sit down and have some water. He declined the water although he sat down and held his head for a few minutes until he felt sufficiently recovered to continue.
At best, there were 30 degrees of shoulder abduction observed bilaterally, 40 degrees of right shoulder flexion, 35 degrees of left shoulder flexion and minimal bilateral shoulder extension. He stated he could not put his hands behind his head, nor reach the lower back with either hand due to damaged shoulders. Attempts were made to assess shoulder IR and ER in the plane of the body although even this was difficult due to frequent pain complaints and general disinclination for moving his arms in case of pain. The assessors concluded that nothing would be gained by continuing to attempt to measure active shoulder movements.
Upper limb reflexes were present and symmetrical. Strength testing was invalidated by pain complaints. The dominant right arm measured 29 cm compared with 28 for the left arm at corresponding levels. The dominant right forearm measured 27.5 cm compared with 27 cm for the left at corresponding levels. There was no wasting of the small muscles of the hands.
There was normal upper limb sensation aside from subjective reduction of light touch at the right posterior arm, not in a dermatomal distribution.
There was normal lumbar lordosis. Again, he required much encouragement to move given frequent pain complaints. Lower back movements were globally restricted without dysmetria. There were no lower limb non-verifiable radicular complaints. There was no muscle spasm or else guarding.
He was reluctant to lie down – he said that at home he can only lie down because he has special pillows.
There was no measurable calf wasting (37 cm at corresponding points) and no significant thigh wasting right 39 cm and left 38.5 cm. Lower limb reflexes were present and symmetrical. He could sit with each leg outstretched although he was originally reluctant to sit forward due to numbness of the left leg (i.e. negative SLR, sciatic stretch). The lower limb sensation was normal aside from reduced light touch at the left anteromedial thigh, not in a single dermatomal distribution. Lower limb strength testing was again invalidated by pain complaints higher up.
He pointed to an area at the top of the left foot between the second and third toes as being sore during cold weather.
There was full active range of motion at the ankles and hindfeet, not attracting any WPI according to the specific tables in AMA4. The knees moved 0-110 degrees without crepitus. There was tenderness at the left knee medial joint line. The knees were stable in the AP and ML planes.
Overall, he was generally found to move better when distracted by conversation.
Conclusions
The Medical Assessors determined that Mr Dulalia was a poor/unreliable historian unable to provide a coherent account of symptom development post-accident, treatment and social/living arrangements since the motor accident of 2011.
He gave the Medical Assessors to understand that he has many physical injuries and consequently very physically disabled due to the 2011 motor accident.
During the history, he often replied that he either did not know or else did not remember details requested of him.
The contents of the medical records were discussed with him, specifically those of the ambulance report, contemporaneous hospital records and GP records of 2013 and beyond. He was asked about the delay in reporting myriad symptoms/injuries to a doctor after the 2011 motor accident and provided various explanations about not knowing/understanding his rights and of being advised to self-heal via regular walking and sporting activities. However, the Panel found the situation as reported, not medically plausible.
Had he ruptured the left ACL at the time of the motor accident, this would certainly have been noted at hospital. There would have been gross swelling of the left knee and great difficulty walking, for which there was no evidence. The Medical Assessors found no evidence that he had sustained any kind of injury to the left knee. The GP records indicate that he likely ruptured the left ACL during sporting activities in August 2015 following which an MRI demonstrated acute traumatic findings.
The 2015 knee MRI shows a large joint effusion with synovitis, bony oedema the complete ACL rupture and various acute traumatic findings at the left knee involving the posterolateral corner structures, high signal changes in the conjoint tendon and upper lateral calf muscles, subchondral fracture of the lateral femoral condyle, and acute strain findings of both lateral ligaments. The reporting radiologist refers to “evidence of pivot shift injury with complete rupture of the ACL”. High signal changes are acute, consistent with oedema/inflammation. There was also a small subchondral fracture present of the lateral femoral condyle present, another acute finding
The 2017 MRI reportedly showed “long standing ACL rupture”.
The hospital records post 2011 motor accident refer only to neck pain, some pain in the posterior left hip and a small cut above his eyebrow. The subject accident is described as minor.
The Medical Assessors accept that he suffered a soft tissue injury of the neck which should have resolved within three months of the subject motor accident.
There is nothing in the contemporaneous records to confirm a soft tissue injury of the lower back. The Medical Assessors whilst noting that lack of contemporaneous evidence in medical records is not determinative of causation, considered the totality of the medical documentation and the findings on history and examination at Panel medical assessment, and have determined that they do not accept that he sustained a lower back injury in the motor accident.
The Medical Assessors also determined that Mr Dulalia has not suffered a traumatic brain (head) injury in the subject accident. GCS post 2011 motor accident was consistently 15/15. The hospital and ambulance records do not refer to any confusion/altered sensorium. A brain scan was normal. No PTA testing was undertaken because it was not medically necessary. He does not meet the criteria set out in paragraph 6.164 MAG for assessment of cerebral impairment due to brain injury.
Whilst he reports various cognitive problems particularly affecting memory, the cause of these is unclear to the Panel. However, it can definitively be said that the latter problems are not due to traumatic brain injury from the 2011 motor accident.
The Medical Assessors determined that the contemporaneous medical records (ambulance and hospital) do not refer to any shoulder symptoms. The mechanism of the (rear end) motor accident is also not one which would be anticipated to cause injury to either shoulder. From a clinical perspective, he pointed to the trapezial regions and said that the shoulder symptoms were contiguous with those in the neck. He also indicated that the left shoulder became problematic first and then the right shoulder due to having to now lie on this side not the left (due to the left sided pain). The Medical Assessors found the latter suggested mechanism of injury to the right shoulder not medically plausible. A shoulder does not become injured by lying on one’s side in bed.
The Medical Assessors also noted that the onset of shoulder complaints was very delayed after the 2011 motor accident, with no complaints being made until several years after the accident. The claimant was asked about the onset of various symptoms and said that the injuries such as the shoulders became more evident as time went on. The Medical Assessors found that this is not consistent with the usual natural history of soft tissue injuries which usually become symptomatic immediately/soon post trauma and then typically recover within a few months of an accident. Soft tissue injuries do not inexorably worsen with time.
The Medical Assessors also did not accept that the minor neck soft tissue injury sustained in the motor accident the reason for the gross restriction in active bilateral shoulder range of motion observed during their physical examination. There were no neurological abnormalities of spinal cord, nerve root, peripheral nerve capable of restricting shoulder movement. There was no muscle wasting and there was also no muscle guarding or spasm preventing the shoulders from normal
The Medical Assessors observed variable giving way at both shoulders associated with high level pain complaints at the neck/trapezial regions. The Medical Assessors determined that the claimant voluntarily restricted his shoulder movements in case of pain.
Regarding the right (little) mallet finger deformity the Medical Assessors found no evidence that this has been incurred in the motor accident. Again it would have been noted in the contemporaneous hospital records. A common cause of mallet finger is hyperextension from catching a ball during sport.
Essentially, the Medical Assessors found his presentation at interview and examination not credible. They were unable to explain his reported memory lapses on an organic basis and also found the observed limitations during the physical examination not consistent with his reported abilities for driving, taking public transport and personal care tasks. The discrepancy was brought to his attention although he could not provide a plausible response to account for this.
In summary, the Medical Assessors determined that the subject motor accident caused at most minor soft tissue injuries to the face and neck which would have long since resolved.
The claimant’s course has been complicated by a chronic pain syndrome, a condition whereby there are ongoing pain complaints beyond the usual time for tissue healing.
The claimant’s circumstances are obviously complex and there is also a psychological dimension about which the medical assessors are not qualified to comment further. Chronic pain is a complicated biopsychosocial phenomenon.
However, the medical assessors have determined that there is 0% WPI for the neck soft tissue injury complicated by chronic pain state, based on their clinical findings (Table 6.7 MAG), and no other injuries due to the subject 2011 motor accident that would attract WPI.

The Panel adopts the report and findings of Medical Assessor Gibson and Medical Assessor Lahz.

Causation

The Motor Accident Guidelines

The Guidelines identify the test for causation in cls 6.6 and 6.7.[1]
[1] Causation is defined in the Glossary at page 316 of the American Medical Association Guides 4th edition (AMA 4 Guides). It is in the same terms as Clause 6.6 of the Guidelines.
Clause 6.6 provides:
“Causation means that a physical, chemical or biologic 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:
(a) The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
(b) The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.”
Clause 6.7 provides:
“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.”

The authorities

In Ackling v QBE Insurance (Aust) Ltd,[2] Johnson J indicated that the task of a review panel in assessing whether an injury was caused by the relevant accident is "a practical one". His Honour also observed that a review panel will derive practical assistance from the Guidelines when undertaking the task of assessing causation.[3]
[2] [2009] 75 NSWLR 482; [2009] NSWSC 881.
[3] At [87]. Justice Johnson was then referring to the predecessors to clauses 6.5-6.7 of the Motor Accident Guidelines, being clauses 1.7-1.9 of the Permanent Impairment Guidelines.
Section 5D of the Civil Liability Act 2002 (CLA) also needs to be considered when assessing causation.

73.Section 5D of the CLA provides:
"General principles
(1) A determination that negligence caused particular harm comprises the following elements:
(a) that the negligence was a necessary condition of the occurrence of the harm ('factual causation), and
(b) that it is appropriate for the scope of the negligent person's liability to extend to the harm so caused ('scope of liability')."

There are two elements to address when assessing causation under s 5D(1):
"factual causation";[4] and
"scope of liability".[5]
[4] See s 5D(1)(a) of the CLA - this is the statutory restatement of the “but for” test (see Adeels Palace Pty Ltd v Moubarak [2009] 239 CLR 420; [2009] HCA 48 at [45]) i.e. but for the negligent act or omission, would the harm have occurred?
[5] See s 5D(1)(b) of the CLA. See Adeels Palace at 42; Wallace v Kam [2013] 250 CLR 375; [2013] HCA 19 at [12].
Assessing "factual causation" and "scope of liability" involves making value judgments.[6]
[6] There is a conflict between s 5D and the Guidelines. Section 5D requires the use of the “but for” test and the Guidelines state that while the “but for” test may be useful in some cases, it “is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes”.
In Kinchela v Insurance Australia Group Ltd t/as NRMA Insurance [2021] NSWSC 804 the issues involved applying the definition of “minor injury” (now referred to as “threshold injury”) and a question of causation in respect of an amputated toe.
The discussion in Kinchela concerning the correct principles to apply relating to causation follows:
“[38] The second defendant’s task was not to answer the question of whether there was any contemporaneous evidence, or corroborative evidence, to support an injury to the right 2nd toe, but whether the accident contributed to the right 2nd toe infection, avulsion of the nail and ultimate right 2nd toe amputation. By focussing only on whether there was a contemporaneous record of complaint in the clinical notes or the ambulance notes, the actual question it was required to consider was overlooked – did the motor vehicle accident materially contribute to the right 2nd toe amputation?
[39] The second defendant fell, therefore, into the type of error identified in Owen v Motor Accidents Authority of NSW(2012) 61 MVR 245; [2012] NSWSC 650 at [51]- [52]; Bugat v Fox(2014) 67 MVR 150; [2014] NSWSC 888 (“Bugat”); AAI Ltd t/as GIO v McGiffen(2016) 77 MVR 348; [2016] NSWCA 229 (“McGiffen”). The error identified is in treating the absence of a contemporaneous complaint or report of injury as determinative of the issue of causation. Associate Justice Harrison cited the decision in Bugat with approval in Briggs. Her Honour said at [64]-[65]:
[64] In Bugat, RS Hulme AJ held that the lack of contemporaneous evidence cannot be determinative of causation. His Honour stated at [31]-[32]:
‘[31] One of the pivotal questions for the panel was whether the injuries of which the plaintiff complained had been caused (or materially contributed to) by the motor accident she alleged. To that question the presence or absence of contemporaneous evidence of injury was relevant but not determinative in circumstances where there was other evidence, in particular the plaintiff’s claim form made but 15 days later, the remarks of Dr Hor in his report of 13 July 2011, and the plaintiff’s statements which the certificate discloses were made to the panel to the effect that at the time of the accident she suffered ‘pain in her neck going out to both shoulders’.
[32] While I accept that, as an administrative decision-maker, the panel’s reasons should not be subjected to ‘minute and detailed textual criticism in the hope of finding something on which to base an argument’ [Allianz Australia Insurance Ltd v Motor Accidents Authority (NSW) (2006) 47 MVR 46, [2006] NSWSC 1096 at [36]] in expressing themselves the way they have, the panel have clearly shown that they have regarded what they perceived as the absence of contemporaneous evidence as determinative on the issue of causation. In doing so they erred, the error being one apparent on the face of the record.”
The Panel must consider, whether the disability is causally related when there was little or no complaint about the areas of disability for at least three years post-accident.
The Panel must ask itself whether the accident contributed to the claimant’s physical injuries as referred to it by the Commission.
It is the finding of the Panel that the medical evidence does not support any causal link between the subject accident and the left ACL injury. There is no mention of knee symptoms in hospital or ambulance records. The claimant was reported by ambulance officers to have been walking around at the scene with no knee complaints listed.
The insurer submitted that even where the claimant seeks to allege that the subject accident resulted in some unresolved pathology that contributed to the occasioning of a tear, the medical evidence does not indicate that any such injury capable of having a more than negligible effect on the left knee tear was sustained in the subject accident. The Panel accepts that this is correct.
Upon examination by ambulance officers and hospital staff, the claimant’s symptoms related to any head injury was limited to slight bruising at the eyebrow. The CT scan on the day of the accident found no abnormalities.
The claimant reported loss of consciousness to hospital staff, but he reported that there was no loss of consciousness to ambulance officers.
Dr Woo accepted injuries to the cervical spine, lumbar spine, left shoulder, right shoulder and right little finger. Apart from the right little finger, these were all assessed at 0% WPI. The right little finger was assessed at 3% and therefore one can only assume that Dr Woo accepted that this was related to the accident, but he gave no consideration to that, noting there is no evidence of a specific injury.
Dr Bentivoglio merely said that one would have to say that his injuries are related to the accident but there was really no analysis about this.
It was not until an MRI scan was performed on 30 September 2015 that it was revealed that the claimant had a complete rupture of the anterior cruciate ligament, a grade 2 injury of the medial collateral ligament, and disruption of the posterolateral corner stabilisers. As was noted in the Medical Assessors report, the claimant had an ACL rupture and other traumatic findings at the left knee involving the posterolateral corner structures and strain findings of the lateral ligament. The reporting radiologist refers to “evidence of pivot shift injury with complete rupture of the ACL”. High signal changes and bony oedema are acute findings, consistent with recent injury. There was also a small subchondral fracture of the lateral femoral condyle present, another acute finding. The findings were not consistent with a chronic injury.
An MRI scan of 15 December 2017 confirmed a full thickness ACL tear which appeared then to be longstanding.
Dr Dias said that as a result of the accident, the claimant sustained an acute concussive closed head injury, and acute whiplash related soft tissue injury to his cervical spine, acute soft tissue injuries to his lower back, left shoulder and left foot, and acute impaction injury to his left knee resulting in a full thickness ACL rupture. He said that the injuries were all related from the accident of 15 November 2011 however, he provided no pathway for this conclusion. He also assessed the claimant as having a 32% WPI. In the opinion of the Panel, Dr Dias’ conclusions do not align with the other medical evidence and cannot be relied upon. He has not considered why the claimant was not immediately treated at hospital for an ACL rupture and why this was not investigated for at least three years after the accident and taking into account the possibility of sporting injuries having intervened.
The Panel is not satisfied that the accident and impact has had a more than negligible effect on the injuries suffered by the claimant.
When the claimant was medically examined, he was inconsistent with his demonstrated abilities. The Medical Assessors noted in the medical examination that the reported situation by the claimant was not medically plausible.
As was reported in the medical examination, had the claimant ruptured his ACL at the time of the accident, he would have had gross swelling of the left knee and would have found it extremely difficult to walk. Such a disability would have been noted at the hospital, but it was not.
The claimant has submitted that injury to his left foot and knee was supported by record in the hospital notes of a complaint of pain in his left hip posteriorly. The Panel does not accept this as a reasonable argument as it is not supported by any subsequent medical evidence.
The ambulance report noted that accident as being minor and the claimant’s complaints on treatment were only of neck pain, some pain in his left hip and a cut above his eyebrow. He was observed to be walking around after the accident unaided.
It is the finding of the Panel that the complaints of injury and disability by the claimant are not complaints arising from the accident. The complaints are not contemporaneous in time to the accident and are too remote to be attributed to the accident.

CONCLUSION

The Panel finds that the accident has caused minor soft tissue injuries to the claimant’s face and neck which would have long resolved.
The Panel assesses the claimant's WPI at 0%.

DETERMINATION

The Panel revokes the certificate of Medical Assessor Cameron dated 1 April 2024.
The Panel assesses the claimants WPI at 0%.

[2025] NSWPICMP 116

25 February 2025