Gerling v AAI Limited t/as GIO

DETERMINATION OF REVIEW PANEL
CITATION:	Gerling v AAI Limited t/as GIO [2022] NSWPICMP 213
CLAIMANT:	Jennifer Gerling
INSURER:	AAI Limited t/as GIO
REVIEW PANEL:	Principal Member John Harris Dr Shane Moloney Dr Geoffrey Stubbs
DATE OF DECISION:	12 May 2022
CATCHWORDS:	MOTOR ACCIDENTS- The claimant was involved in a motor accident in 2017; the Panel had determined in an earlier dispute (Gerling (No 1)) that the claimant injured her low back resulting in surgery; the parties had referred 24 treatment and care disputes, 22 of which related to claims for future treatment; the Panel had previously determined that the recency of the low back surgery meant that the condition had not stabilised and that the future treatment could not be determined at this stage; the claimant sought to “rephrase” the future treatment disputes and have the Panel determine these as past treatment disputes; Held- that application was opposed and rejected by the Panel as the amendment would create procedural unfairness; any amendment would cause further delay as the affected party would be entitled to adduce further evidence; the Panel determined the past dispute for domestic assistance making orders specifying varying degrees of assistance over the past four years; the amount of assistance was reduced due to previous findings that the claimant did not injure her shoulders or knees in the subject accident, and these were contributing to the loss; the claimant’s condition had improved substantially following surgery and an order made for modest assistance (3 hours per week) since that time based on the need to restrict heavy lifting such as cleaning and shopping.
DETERMINATIONS MADE:	The Review Panel revokes the certificate of Medical Assessor Cameron dated 10 July 2021 and issues the following certificate. - The injuries to the cervical spine and lumbar spine gave rise to a need for domestic assistance from 23 November 2017 to 28 March 2022 and this assistance is causatively related to the injury sustained in the motor accident. - The following assistance caused by the motor accident from 23 November 2017 to 28 March 2022 is reasonable and necessary in relation to the injuries sustained in the motor accident: (a) 23 November 2017 – 14 December 2017 – 15 hours per week; (b) 15 December 2017 to 15 November 2021 (except the period following knee surgery in March 2021 for a period of eight weeks) – 7 hours per week; (c) 16 November 2021 to 13 January 2022 – 20 hours per week; and (d) 14 January 2022 to 28 March 2022 – 3 hours per week. The balance of the medical dispute is stood over in accordance with our reasons in AAI Ltdv Gerling [2022] NSWPICMP 67 at [172].

REASONS

BACKGROUND

Ms Gerling (the claimant) suffered injuries to the cervical and lumbar spines in a motor accident on 23 November 2017. The insurer insurers the liability of the at fault vehicle under the provisions of the Motor Accidents Compensation Act 1999 (the MAC Act).
A Further Amended Referral dated 15 June 2021 listed four distinct medical assessments, they are:
-   Permanent impairment of the Urinary system (assessment 1);
-   Permanent impairment and Treatment dispute of two surgical procedures of the cervical spine and lumbar spine (assessment 2);
-   Twenty-four treatment disputes of physical injuries (assessment 3), and
-   Permanent impairment and eight treatment disputes of the psychological injury (assessment 4)
This Panel was constituted to hear together the medical dispute described as assessment 2 (the treatment dispute of the proposed surgical procedures for the cervical and lumbar spines) and assessment 3.[1]
[1] See Direction dated 15 December 2021 issued in both R-M10433482/21 and R-M10464504/21.
In AAI Ltdv Gerling[2] the Panel made findings of the nature of the injuries sustained in the motor accident and held that the lumbar spine fusion was causatively related to the motor accident and reasonable and necessary in the circumstances. We then concluded:
“172. Ms Gerling has undergone extensive lumbar spine surgery on 15 November 2021 which we have found is causally related to the motor accident. We are unable to assess that part of the various treatment and care disputes which requires answers post the assessment undertaken by both Medical Assessors. In the expert view of the Medical Assessors on the Panel and endorsed by the Panel, Ms Gerling’s lumbar spine condition will not settle until 12 to 18 months following the lumbar spine surgery. We also note the improvement since the operation and hopefully Ms Gerling can continue to reduce the dangerous levels of narcotic medication that were being consumed prior to the operation.
173. In relation to the treatment and care disputes from the date of the accident to the date of assessment, which we will treat as the date of these Reasons, the parties are directed to file and serve submissions separately addressing each past treatment and care dispute and separately addressing the issue of “reasonable and necessary in the circumstances” and whether the treatment is causally related to the motor accident. As these reasons show, the issues are not the same.
174. We understand that the remaining two “past” treatment disputes relate to the amount of domestic assistance and rehabilitation treatment (exercise physiology, physiotherapy, hydrotherapy). The claimant is required to clarify this in her submissions.
175. The parties’ submissions are to be based on the findings of injury which have been made in these Reasons, that is injury to the cervical spine and the lumbar spine which has not resolved and required surgery, and the findings that the right shoulder and knees were not injured. The other soft tissue injuries (such as the calves, shin and thigh) have resolved within a short period.
176. The claimant is to file and serve submissions by close of business 7 April 2022. The submissions are to specify the evidence in support of the claim for past treatment by page reference to the bundle of documents already filed in the matter.
177. The respondent is to file and serve submissions by close of business 14 April 2022 on the same basis.
178. Neither party has leave to file updated further evidence.”
[2] [2022] NSWPICMP 67 (Gerling (No 1))
Those reasons meant that further submissions were required in light of the Panel’s findings on injury, particularly the finding of lumbar spine injury resulting in the lumbar fusion.
The timetable for providing further submissions was subsequently extended in accordance with the parties’ joint request.
These are the balance of our reasons constituted as the Panel in both matters.

THE REMAINING MEDICAL DISPUTES (ASSESSMENT 3)

Assessment 3 particularises 24 treatment and care disputes, 12 of which relate to whether treatment relates to injury caused by the motor accident and 12 relate to whether the same treatment is “reasonable and necessary in the circumstances”. Accordingly, each of the 12 treatments has two issues, one relating to causation and the other relating to reasonable and necessary in the circumstances.
Of the 12 types of treatment and care disputes, only domestic assistance is for the period from the date of the motor accident to the date of the assessment. The other eleven treatment disputes are specified as being from the date of assessment for various periods up to 35 years.[3]
[3] Indeed these treatment disputes are staggered so that a particularly treatment dispute requires a response as to whether future treatment is required for 0, 1, 2, 3, 4, 5, 10, 15, 25 or 34 years.
On 10 July 2021 Medical Assessor Cameron issued a certificate pertaining to assessment 3 when he concluded that none of the various listed treatments or care were either reasonable and necessary or caused by the motor accident.
The claimant sought a review of the certificate issued by Medical Assessor Cameron. On 9 December 2021 the Delegate of the President determined that there was reasonable cause to suspect that the medical assessment of Medical Assessor Cameron was incorrect in a material respect.
The parties were then required to provide supplementary submissions addressing the issues in assessment 3 in the context of the findings of injury set out in Gerling (No 1).
As the Panel made clear in Gerling (No 1), we were only deciding the past treatment and care disputes because the claimant had recently undergone surgery and her condition was not stabilised.[4]
[4] Gerling (No 1) at [173] – [174].

THE REDRAFTING OF THE ISSUES IN ASSESSMENT 3

In its extensive supplementary submissions dated 14 April 2022, the claimant’s legal practitioner reframed the period for the 24 treatment disputes to cover the period from the date of the accident to the date of assessment (28 March 2022). The claimant’s legal practitioner asserted that they were “re-framed so they accord with the direction of the Review Panel”.[5]
[5] Claimant’s submissions dated 14 April 2022, [1.14].
Paragraph 174 of the reasons in Gerling (No 1) were clear and gave no leave for the claimant to “reframe” the dispute. We previously stated that we understood that there were two past treatment disputes. No leave was given to the claimant to reframe all future disputes.[6]
[6] Gerling (No 1) at [174], set out at [4] herein
The Panel then issued the following direction to the parties (further direction):
“The Panel has received the claimant’s further written submissions which purport to rephrase the period of the “Assessment 3” dispute in the Further Amended Referral dated 15 June 2021. The Panel did not give leave for this to occur.
On review of the Further Amended Referral, the only “past” disputes referred to Medical Assessor Cameron (Assessment 3) are those specified in 1 and 2 and these do not relate to injury to the lumbar spine and/or the cervical spine.
The Panel is not inclined to amend the dates in the Further Amended Referral although it is inclined to assess those specified in 1 and 2 based on the injuries to the cervical spine and lumbar spine.
The Panel directs the Insurer to advise the Panel by close of business 29 April 2022 whether it:
(a) consents to the past disputes (1 and 2) being determined on the basis of injury to cervical and lumbar spines;
(b) consents to the other 22 disputes being reworded to refer to the period between the date of the motor accident and the date of assessment.”

The insurer filed submissions almost simultaneously with the Panel’s further direction. The insurer submitted that “the claimant had unnecessarily expanded the scope of the disputes”[7] and otherwise provided submissions addressing the two past disputes.
[7] Insurer’s submissions, [15].
In a supplementary submission filed on 29 April 2022 the insurer accepted that the past disputes should be determined based on the injuries to the cervical and lumbar spines but otherwise did not consent to the other 22 disputes being reworded to change the nature of the disputes from the date of assessment and ongoing to the period from the date of the motor accident to the date of the assessment.
There is no basis to reword the medical disputes as the claimant has attempted in its recent submissions. An amendment to the medical disputes would create procedural unfairness and involve further delay because an adversely affected party would be entitled to file further evidence. This matter has already utilised extensive resources of the Commission. Otherwise, the wording of the 22 disputes in Assessment 3 of the Further Amended Referral clearly specify that they relate to the period from the date of assessment into the future.
The Panel’s reasons in Gerling (No 1) provided that we will not presently determine the future disputes because Ms Gerling’s post-surgical condition will not stabilise for a period of some 12 or more months following the surgery.

LEGAL PRINCIPLES

The legal principles of causation are set out in Gerling (No 1). The claimant must establish that there is a material contribution between the motor accident and the need for treatment.[8]
[8] Gerling (No 1) at [149].
The legal test of whether treatment is “reasonable and necessary in the circumstances” is also discussed in Gerling (No 1).[9] It is unnecessary to repeat these principles as we are determining the medical disputes together and our findings in Gerling (No 1) form part of our findings in the present decision.

MEDICAL DISPUTE PERTAINING TO PAST DOMESTIC ASSISTANCE

[9] Gerling (No 1) at [156] – [161].

Insurer’s submissions

The insurer referred to the opinion expressed by Medical Assessor Cameron that no assistance was causally related and not reasonable and necessary and the opinion of Mr Miszczuk in a report dated 29 June 2021.
It was noted that Medical Assessor Cameron held that “the physical injures she sustained in the subject accident would not restrict domestic function”. Mr Miszczuk accepted that Ms Gerling required domestic assistance for seven hours for a period of 2.86 weeks from 25 November 2017 to 14 December 2017.
The insurer accepted that “limited assistance due to the lower back pain was causally related to the accident” but that the domestic assistance is not reasonable and necessary.

Claimant’s submissions

The claimant referred to AAI Ltd v Phillips[10] that the test of causation was satisfied if there was a material contribution to the need for treatment.
[10] [2018] NSWSC 1710
The claimant referred to her employment pre-motor accident with Home Instead providing care to clients which included manual handling.[11] Dr Harrison opined that the claimant was unable to do this work.[12] If the claimant was unable to do this work, then she was similarly unable to do domestic chores. This inference is confirmed by various lay witnesses, particularly Mr Tony Gerling who detailed the arrangements obtaining a commercial cleaner, that he assisted the claimant, that professional assistance ceased in October 2019 and that as at November 2020 the claimant remained reliant on[13] her husband for assistance.
[11] Claimant’s bundle, page 1200.
[12] Claimant’s bundle, page 94.
[13] Claimant’s bundle, pages 1180-1182.
Procare assessed the claimant on 31 January 2018 and provided a report dated 7 February 2018. Michelle Ardinghi, rehabilitation consultant at Procare, in a report dated 7 May 2018 (CB 302) noted paid cleaning of 2 to 2.5 hours per week.[14] An amended care request dated 16 November 2018[15] covers the period from 10 December 2018 to 12 April 2019 and generally relates to the neck and back. The reference to right shoulder injury and radicular symptoms suggests neck injury rather than discrete injury to the right shoulder.
[14] Claimant’s bundle, page 302
[15] Claimant’s bundle, pages 296-299.
The clinical notes of the general practitioner post motor accident make it plain that the injuries to the neck and back were debilitating such as the clinical note on 6 February.[16]
[16] Claimant’s bundle, page 385.
The claimant accepted that it was not the case that the right shoulder was insignificant but that following the previous injury on 11 November 2017 the claimant maintained responsibility for domestic tasks[17] and the neck and low back were the cause of the need for domestic assistance.
[17] Claimant’s bundle, page 1180-1182.
On 12 March 2018 the general practitioner, in the referral to Dr Diwan, noted worsening back pain.[18] On 25 June 2018 Dr Diwan recommended an assessment at home for cleaning and occupation health assistance.[19] The claimant was initially consulted by Dr Kohan for lumbar spine in September 2018 and on 1 November 2018 was recommending pain management review.[20]
[18] Claimant’s bundle, page 273.
[19] Claimant’s bundle, pages 245- 247.
[20] Claimant’s bundle, page 238.
The pain management assessment was conducted on 6 December 2018 and noted consistent pain over the back, neck and right shoulder over the previous 12 months.[21] That course commenced on 11 April 2019 and the first phase was completed on 4 April 2019.[22] The claimant attended again on 9 January 2020 after feeling she had regressed.[23]
[21] Claimant’s bundle, page 282.
[22] Claimant’s bundle, page 276.
[23] Claimant’s bundle, page 275.
Complaints of back pain and associated disorders were made to Dr Boon in mid-2020. On 30 June 2020 Dr Kohan recommended surgery. The claimant presented at St George Hospital on 30 September 2020 with chronic low back pain and was discharged on 2 October 2020.[24] At that time it was noted that the claimant was having difficulties with activities of daily living.[25]
[24] Claimant’s bundle, page 320.
[25] Claimant’s bundle, page 321.
The claimant was assessed by Joanne Heathcote at her home on 16 October 2020. Back pain was noted as dominant.[26] After noting various restrictions, Ms Heathcote made various recommendations over various specified periods for personal care assistance and domestic assistance.[27]
[26] Claimant’s bundle, page 200.
[27] Claimant’s bundle, pages 217 – 220.
The claimant submitted that after 17 October 2020 until the date of surgery on 15 November 2021, she would have required a small amount of personal care and 7.25 hours of domestic assistance.[28]
[28] Claimant’s submissions, paragraph 2.31.4.
Following surgery, Ms Heathcote noted that the claimant would require intensive rehabilitation as prescribed by her treating specialists.[29] In a report dated 17 November 2020, Dr Kohan noted that post operatively the claimant will be in hospital for 3 – 5 days and require an eight-week recovery period at home.[30] Dr Boon also documented post-surgery treatment the claimant would require.[31]
[29] Claimant’s bundle, page 224.
[30] Claimant’s bundle, page 234.
[31] Claimant’s bundle, pages 256- 257.
The claimant submitted that this care and assistance post-surgery and for the following eight weeks was at least equivalent to the care and assistance provided upon her discharge from home after the motor accident in 2017.[32]
[32] Claimant’s submissions, paragraph 2.1.36
For the remainder of the period, from 16 January 2022 to the date of the assessment, a period of 8 weeks, the claimant required self-care and domestic assistance of between 2 hours and 4.7 hours and between 7.25 hours and 9.75 hours of domestic assistance. The claimant referred to the history provided to the Review Panel of the present situation where pain was reduced by 85% although she used a walking stick as a security measure.[33]
[33] Gerling (No 1) at [114].
The claimant emphasised our earlier findings referencing the continuous low back pain and it being the main complaint. The right knee was troublesome prior to the motor accident but did not require care. The right shoulder was such that the claimant resumed swimming by 20 November 2017.[34] In relation to the left knee there was no persuasive evidence that it declined to the extent that domestic assistance was required, and the claimant had arranged commercial domestic assistance immediately following the accident when the left knee was not a problem. The left knee was not a cause for Procare to recommend and for the insurer to fund domestic assistance in 2018 and into 2019.
[34] Claimant’s bundle, page 286.
The claimant accepts that there was a period following left knee surgery when the predominant cause for self-care and domestic assistance was the effects of the operation. A concession was made that this would last four weeks.
The claimant referred to the Initial Needs Assessment report dated 7 February 2018 where the factors impacting upon common and domestic tasks performed by the claimant before the accident[35] and the physical and other facts affecting the claimant which included back discomfort and bilateral shoulder discomfort. Ms Heathcote similarly referred to back, neck and right shoulder discomfort.
[35] Claimant’s bundle, pages 306 – 307.
The opinion of Mr Miszczuk is limited because he incorrectly and outside his expertise, opined that recovery occurred after ten weeks in keeping with soft tissue injuries. His opinion is in direct contrast with the opinion expressed by Procare dated 16 November 2018 when it recommended 2.5 hours of domestic assistance every second week.

Findings

Ms Gerling suffered from back pain and, to a lesser extent, neck pain, which was causatively related to the motor accident. That the claimant was “pain focused” does not detract from the fact that there was a real need for assistance caused by the motor accident, and which was reasonable and necessary in the circumstances
The claimant referred to the histories recorded by treating specialists who noted worsening back pain ultimately resulting in a lumbar fusion.[36] These histories, which we accept as accurate, support the need and causative link between domestic assistance and the motor accident. In addition, the clinical notes of the general practitioner refer to ongoing and debilitating back pain.[37]
[36] See [31] – [33] herein.
[37] See for example 20.2.18 (Claimant’s bundle, page 389); 14.5.18 (Claimant’s bundle, page 408).
This conclusion is otherwise consistent with the claimant’s attendance at St George Hospital on three occasions in 2020 for problems either directly or indirectly related to back pain.[38]
[38] Claimant’s submissions, [2.1.24] – [2.1.27].
Whilst we accept that Ms Gerling suffers from a pain syndrome, this does not detract from her need for domestic assistance if the condition is causatively related to the motor accident and the extent of the need for treatment is reasonable and necessary in the circumstances.
We accept that part of the need for domestic assistance related to the unrelated shoulder problem. The claimant’s submissions attempted to downplay this aspect by suggesting in part that the right shoulder was referred pain from the neck and was causatively related to the motor accident. We do not agree with this submission.
The claimant also submitted that there was no need for assistance prior to the motor accident from the right shoulder or bilateral knee condition. However, the right shoulder was injured less than two weeks before the motor accident and Ms Gerling was then having treatment. Although it was recorded that swimming had recommenced three days before the motor accident,[39] this does not otherwise detract from Ms Gerling’s consistent complaints of right shoulder problems following the motor accident.[40] The right shoulder is recorded as being an ongoing source of discomfort and Ms Heathcote noted it as “constant anterior right shoulder pain”[41] and appears to consider that disability iin her overall assessment. Ms Heathcote has also considered difficulties from the deterioration of function of the left knee and ongoing symptoms in the right knee.
[39] Claimant’s bundle, page 286.
[40] See for example reference by Ms Heathcote to right shoulder injections, claimant’s bundle, page 218.
[41] Claimant’s bundle, page 192.
The claimant otherwise conceded that it “is not the claimant’s case that injury to the right shoulder was insignificant”.[42]
[42] Claimant’s submissions, para 2.1.15.
In these circumstances, the need assessed by Ms Heathcote must be discounted because of the injuries unrelated to the motor accident, specifically the right shoulder and bilateral knee condition.
The insurer relied on the opinion of Medical Assessor Cameron whose decision is being reviewed. The Medical Assessor determined that the claimant suffered soft tissue injuries which would not be expected to cause limitations for domestic assistance. He otherwise applied an incorrect test for reasonable and necessary as he equated this with the test on causation. The observation that domestic assistance “is appropriate for people with serious injuries (multiple fractures, spinal cord injury, severe traumatic brain injury)” otherwise does not represent an accurate statement of legal principle.
The insurer relied on the opinion expressed by Mr Miszczuk, occupational therapist, in his report dated 30 July 2021.[43] Mr Miszczuk expressed the opinion and relied on other opinions that the need for assistance ceased by 14 December 2017.[44] There are also references in the report that a perception of disability does not support a need for assistance.[45] Similar observations were expressed by Medical Assessor Cameron.
[43] Insurer’s bundle, page 916.
[44] Insurer’s bundle, page 936.
[45] See for example Insurer’s bundle, page 963.
Mr Miszczuk referenced research and clinical guidelines (Annexure J of his report) in concluding that the nature of the injuries sustained should have resolved within set periods.
This opinion is inconsistent with our previous and present findings in these medical disputes of the back pain caused by the motor accident.
However, some of the additional domestic assistance relates to the right shoulder condition. We do not accept the claimant’s submission that the right shoulder pain was referred from the neck. The observations of restricted shoulder movement are recorded by various medical practitioners and, in our view, pertain to shoulder issues rather than referred pain.[46]
[46] See report of Ms Heathcote (claimant’s bundle, pages 209-210); Records of general practitioner dated 14/5/18 (claimant’s bundle, page 407).
For these reasons the claimant has satisfied the requisite causal relationship between the motor accident and the need for domestic assistance. However, we note that a portion of the claim relates to unrelated problems particularly with the right shoulder and to a lesser extent with the bilateral knee condition.
We have considered the lay evidence which establishes a level of care provided gratuitously by family and friends. This evidence has been considered on the issue of causation and on the question on the extent of the need. However, whilst the evidence establishes extensive assistance provided, the claimant must establish the more demanding test that the need must be both “reasonable and necessary”.[47]
[47] This test is discussed in Gerling (No 1) at [156] – [161].
In keeping with these observations, the claim for up to 42 hours per week in the initial period is excessive, not necessary and to some extend unrelated to the motor accident. In the initial three week period, noting the extensive assistance provided, we assess the need causatively related to the accident at 15 hours per week.
We do not accept Ms Heathcote’s opinion that in the period from 15 December 2017 to 9 October 2019 there was a need for personal assistance of 5.4 hours per week which satisfies the test of “reasonable and necessary”. We do not accept that the cervical and lumbar spine injuries caused a need for assistance with showering and grooming. There was probably some personal assistance required which we assess at 2 hours per week.
In the same period there would have been a need for domestic assistance from heavier tasks. We accept that the injuries affected or prevented the claimant’s ability to clean, shop and to some extent cook. We assess this loss at 5 hours per week.
We do not accept that the need increased following the withdrawal of commercial assistance. In our view the need was the same although part of the service was undertaken gratuitously. This need continued in circumstances where the lumbar spine condition deteriorated until the surgery was undertaken in late 2021.
Accordingly, we assess the need from 15 December 2017 to 15 November 2021 at seven hours per week.
We accept that the surgery required Ms Gerling to rest for a period of eight weeks. During this period the claimant required substantial assistance, both in her personal needs and for assistance around the home.
The claimant submitted that the type of assistance for this period was consistent with the period post motor accident and claimed in the order of 42 hours per week. We do not accept that figure post motor accident. However, we accept in the eight-week recovery period following surgery that there was a substantial need including personal care assistance which we have averaged over the period and assess at 20 hours per week. We accept that the need would have been greater over the first part of the eight-week period and lesser as the claimant’s recovery progressed.
Following the recovery from a successful back operation, the claimant has significantly improved. The Panel is comprised of the two Medical Assessors who recently examined Ms Gerling. Our views of Ms Gerling’s present need are partly based on that clinical examination which showed a distinct improvement from previous reporting. The claimant otherwise accepted that there was a significant improvement and Dr Kohan reported a reduction in medication usage during this period.[48]
[48] Claimant’s submissions, [2.6.8].
In our view the neck condition does not contribute to the ongoing need for assistance. We otherwise do not accept that from 14 January 2022 the claimant has established a need for personal assistance such as grooming. We accept that there is a need for the heavier aspects of domestic assistance such as cleaning, cooking and shopping which is assessed at three hours per week. Heavier types of lifting and bending associated with cleaning and aspects of shopping would make the lumbar spine condition susceptible to aggravation and should be avoided.
The claimant submitted that this need was exemplified by the fact that someone drove Ms Gerling to the appointment and the ongoing use of a walking stick. Whilst that factual assertion is correct, we do not accept that the claimant’s present condition requires either the need for a driver and/or the use of a walking stick and establishes the “necessary” part of the test.
Finally, we note that the claimant conceded that the knee operation undertaken in March 2021 meant that no assistance was causatively related for a period of four weeks post-surgery.[49] Accepting the concession, the knee surgery was substantial and meant that the claimant was largely incapacitated for a period. In the absence of direct evidence, using the Panel’s medical expertise, we assess that the recovery period was probably in the nature of eight weeks give the significant knee surgery.

CONCLUSION
[49] Claimant’s submissions, [2.1.47]

The certificate issued by Medical Assessor Cameron is revoked. A replacement certificiate is issued at the commencement of these Reasons. As we previously noted, the claimant can seek to relist the matter for the determination of the future claims in accordance with our previous reasons. That further delay does not mean that the parties cannot attempt to resolve the overall dispute rather than continuing to seek Review Panel determinations on a number of medical issues.

[2022] NSWPICMP 213

12 May 2022