Greco v AAI Limited t/as GIO

DETERMINATION OF REVIEW PANEL
CITATION:	Greco v AAI Limited t/as GIO [2024] NSWPICMP 750
CLAIMANT:	Giuseppe Greco
INSURER:	AAI Limited trading as GIO
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	Alan Home
MEDICAL ASSESSOR:	Michael Couch
DATE OF DECISION:	1 November 2024
CATCHWORDS:	MOTOR ACCIDENTS – Review of certificate of Medical Assessor McGrath dated 10 December 2023; claimant injured in a rear-end collision on a country highway on 26 November 2021; assessment by the Medical Review Panel (Panel) of whether the claimant suffered a threshold injury to his lumbar spine and an annulus tear at the T12/L1 level; claimant did not have an MRI scan of his lumbar spine until 9 February 2022, shortly after he had suffered an assault by way of a push to his back in a shopping centre car park; no tear discovered; claimant had his next MRI scan on 23 June 2023 which demonstrated a posterior annulus tear at T12/L1; possibility that claimant may also have suffered an injury to his spine during course of lifting heavy materials at work; Held – a T12/L1 injury is a thoracic injury under the Motor Accident Guidelines; Panel was not satisfied that the claimant suffered a low thoracic disc lesion in the accident or an annulus tear at T12/L1; Panel satisfied that MRI scan findings of 9 February 2022 indicate that endplate irregularities at T10/11 and T12/L1 reflect a developmental condition being Scheuermann’s disease and an annulus fissure that exists in the area of developmental change is considered to be an incidental finding in this case; certificate of Medical Assessor McGrath affirmed.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION DETERMINATION 1. The Panel affirms the certificate of Medical Assessor McGrath dated 10 December 2023. 2. The Panel is not satisfied that the claimant suffered a T12/L1 posterior annular tear as a result of a motor vehicle accident on 26 November 2021 and that this was a non-threshold injury pursuant to the Motor Accident Injuries Act 2017. 3. The claimant has suffered a threshold injury as a consequence of the accident on 26 November 2021.

STATEMENT OF REASONS

INTRODUCTION

This is a review of the decision of Medical Assessor McGrath (the Medical Assessor) of
10 December 2023 about a threshold injury and not his first certificate of 24 April 2023.
The claimant makes an application for review of the certificate and reasons of Medical Assessor McGrath dated 10 December 2023. The claimant submitted that this application for review was made pursuant to s 63 (1) of the Motor Accidents Compensation Act 1999. However, the application for review is made pursuant to s 7.26 of the Motor Accident Injuries Act 2017 (the Act) with the accident having occurred on 26 November 2021.
Initially, there was a dispute between the claimant and the insurer about:
·        whether any treatment and care relates to an injury caused by the accident under Schedule 2, s 2(b) of the Act;
·        whether any treatment and care provided is reasonable and necessary in the circumstances under Schedule 2, s 2(b) of the Act, and
·        whether treatment or care provided to an injured person will improve the recovery of the injured person under Schedule 2, s 2(c) of the Act.
The Medical Assessor in his first certificate of 24 April 2023 concluded that the following treatment and care relates to the injuries caused by the motor accident. The proposed MRI taken to the claimant’s lumbar spine, as referred by the claimant’s general practitioner (GP), Dr Tang relates to the injury caused by the motor accident:
·        the request for a proposed consultation with pain specialist, Dr Russo as referred by the claimant’s GP relates to the injury caused by the motor accident;
·        the following treatment and care is reasonable and necessary in the circumstances;
·        the proposed MRI taken to the claimant’s lumbar spine, as referred by the claimant’s GP, is reasonable and necessary in the circumstances, and
·        the request for a proposed consultation with pain specialist, Dr Russo as referred by the claimant’s GP is reasonable and necessary in the circumstances.
The following treatment and care will improve recovery:
· the proposed MRI taken to the claimant’s lumbar spine, as referred by the claimant’s GP will improve the recovery of the injured person.
Subsequently, the claimant sought a decision about whether he had suffered a threshold injury under Schedule 2, s 2(e) of the Act.
The following injury was referred by the Personal Injury Commission (Commission) for assessment:
· lumbar spine - annular tears.
The Medical Assessor examined the claimant on 28 November 2023.
The Medical Assessor found the following injury caused by the accident:
· lumbar spine - non-specific soft tissue injury,
was a threshold injury for the purposes of the Act.

Amendment to legislation

The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2023 with various amendments commencing on 1 April 2023. From
1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.
The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
For motor accidents occurring on or after 1 April 2023, the entitlement to statutory benefits for a threshold injury have increased from 26 weeks to 52 weeks.
Accordingly, an injury which does not fall within the definition of a threshold injury (a non-threshold injury) means that a claimant has an entitlement to claim damages and, subject to other exclusions, receive statutory entitlements beyond either the 26-week or 52-week limitation period.

LEGISLATIVE BACKGROUND

Jurisdiction

The claimant’s claim is governed by the provisions of the Act. This legislation provides a scheme for the compulsory third-party insurance of all motor vehicles registered in New South Wales and a scheme of statutory benefits (under Part 3) and compensation by way of lump sum damages (under Part 4) for persons injured in motor accidents in New South Wales.
While almost all injured persons are entitled to some statutory benefits in accordance with Part 3 of the Act, there are some disentitling provisions and limits to the amount and extent of benefits available. One of which is that, under ss 3.11(1) and 3.28(1) of the Act, statutory benefits cease 26 weeks after the motor accident if the only injuries sustained by the injured person are “threshold” injuries. This is the case here because of the date of the accident.
It should also be noted that in a common law damages claim, no damages are recoverable if the claimant’s injuries are “threshold” injuries.
Pursuant to Schedule 2, cl 2 of the Act, various matters are declared to be a medical assessment matters, including (e) “whether the injury caused by the motor accident is a threshold injury for the purposes of the Act”.

Threshold injury

A threshold injury is defined in s 1.6 of the Act as a “soft tissue injury” and a “threshold psychological or psychiatric injury”. Section 1.6(2) of the Act defines a soft tissue injury to mean:
“[A]n injury to tissue that connects, supports or surrounds other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia, fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.”
In summary, if a person injured in a car accident has soft tissue injuries only then, unless one of those soft tissue injuries falls within the excluding clause of s 1.6(4) the injured person’s statutory benefits cease in accordance with ss 3.11 and 3.28. If a person injured in a car accident has an injury to a structure (such as a bone) or an injury to an organ, that injury will not be a non-threshold injury.
Section 1.6(4) provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury or a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) further defines threshold injury to include “an injury to the spinal nerve root that manifests in neurological signs (other than radiculopathy)” and an acute stress disorder and an adjustment disorder (in terms of psychiatric or psychological injuries).
Section 1.6(5) says that the Motor Accident Guidelines (the Guidelines) may provide for the assessment of whether or not an injury is a threshold injury. Relevantly to the matters in issue in the claimant’s claim, cls 5.7 to 5.9 of the Guidelines are headed “soft tissue assessment – injury to a spinal nerve root” and cl 5.7 provides:
“In assessing whether an injury to the neck or spine is a soft tissue injury, an assessment of whether or not radiculopathy is present is essential.”
Clause 5.8 defines radiculopathy and adopts the method of assessment provided for in the whole person impairment chapter of Part 6 of the Guidelines. Clause 5.9 then provides:
“Where the neurological symptoms associated with the injured person’s injury of the neck or spine do not meet the assessment criteria for radiculopathy, the injury will be assessed as a threshold injury.”
Clauses 5.10 to 5.12 are not relevant to the matter before the Panel as they deal with psychological or psychiatric injuries.

Method of assessment

Part 5 of the Guidelines contain the procedure for assessing whether an injury resulting from the motor accident is a “threshold injury” for the purposes of the Act. In respect of the medical assessment of whether an injury is a threshold injury or not, the Guidelines relevantly provide:
“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.5   Diagnostic imaging is not considered necessary to assess threshold injury.
5.5    A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6    The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b) a review of all relevant records available at the assessment
(c) a comprehensive description of the injured person’s current symptoms
(d) a careful and thorough physical and/or psychological examination
(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”

Does the claimant have radiculopathy?

Radiculopathy is a medical term used by treating doctors, medico-legal examiners and Medical Assessors alike. Radiculopathy is used within the Guidelines in both the assessment of whole person impairment (to distinguish between categories II and III) and in threshold injury assessments.
In Chapter 5 of the Guidelines, the heading “Soft issue assessment – injury to a spinal nerve root” appears above the definition of radiculopathy in cl 5.6 as follows:
“Radiculopathy means the impairment caused by dysfunction of a spinal nerve root or nerve roots when two or more of the following clinical signs are found on examination ...
(a) loss or asymmetry of reflexes (see the definitions of clinical findings in Table 6.8 in these Guidelines)
(b) positive sciatic nerve root tension signs (see the definitions of clinical findings in Table 6.8 in these Guidelines)
(c) muscle atrophy and/or decreased limb circumference (see the definitions of clinical findings in Table 6.8 in these Guidelines)
(d) muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution
(e) reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.”
For the claimant’s injury to fall outside the definition of threshold injury in s 1.6, he would need to have two of the above signs. Pain is not one of the five signs of radiculopathy which might indicate an injury to a spinal nerve root.

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 fact that evidence is not referred to in these reasons does not mean it has been overlooked and nor is it required that each piece of evidence be mentioned (WAEE v Minister for Immigration and Citizenship (2003) 75 ALO 630 at [46]).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 has come to its own conclusion and has taken its own history.

The accident

The accident occurred on 26 November 2021. The claimant was slowing down for a road obstruction when he was hit from the rear. The claimant was aware of the impending impact and attempted to get out of the way by moving his foot from the brake to the accelerator pedal. Police attended the site of the accident. The local ambulance was engaged in other call outs. The car which the claimant was driving was drivable and he travelled a short distance home. An ambulance later attended his home and took him to the local hospital.
A photograph of the claimant’s car apparently taken immediately following the accident, follows;

[IMAGE UNABLE TO RENDER]

Claimant’s submissions

The claimant submits that the Medical Assessor has erred in his conclusion in relation to the “T12/ L1 lesion”. The claimant says that the history taken by Medical Assessor is that prior to the accident, the claimant, “…enjoyed attending a gymnasium three or four time per week and walking his dogs.” The claimant says that the history taken also states, “He does not report any previous spinal injuries or disability.”
The claimant submits that there is no history taken, or clinical notes referred to that suggests that the claimant had a pre-existing back condition.
The claimant says that the accident involved the claimant’s vehicle, a Mercedes Benz sedan being hit so hard from behind that the vehicle was written off. He complained of back pain and imaging was taken of his spine. The claimant says that an MRI revealed disc desiccation with a posterior annulus tear and low-grade disc bulge without neural impingement at the T12/L1 level.
The claimant referred to the Medical Assessor quoting from a report of the claimant’s GP,
Dr Kang, where he said;
“I confirm that the second Magnetic Resonance Imaging that he had recently in 23.6.2023 demonstrated posterior annulus tear at T12/:1 level which was not picked up on Magnetic Resonance Imaging done on 8.2.2022. I can suspect that his condition may have deteriorated over 18 months period which led to tear of the disc.”
Following on from this, the claimant says that the Medical Assessor wrote at page 6 of his certificate, “we would have to assume that a tear was present due to the MVA, but not visible by initial MRI.”
The claimant submits that noting the history taken, the medical opinion of Dr Kang, and the assumption the Medical Assessor made that the T12/L1 annular tear was due to the accident, he continued to state that he was unable to link the T12/ L1 to be causally related to the accident.
The claimant submits that the Medical Assessor should have disclosed a path of reasoning which would lead to a conclusion, based on the balance of probabilities that the annular tear at T12/L1 was caused by the motor vehicle accident, and therefore a non-threshold injury.
The claimant submits that the Medical Assessor has determined that on the issue of causation, despite the lack of pre-existing back injury history provided by the claimant, and his clinical notes, despite the seriousness of the impact from being to the claimant’s vehicle, despite his complaints of back pain, despite the opinion of Dr Kang, despite the MRI scan that confirms a T12/L1 annular tear, despite the Medical Assessors own assumption that the annular tear was due to the accident, that the Medical Assessor remained unable to link the T12/L1 lesion as causally related to the accident.
To this, the claimant submits that Medical Assessor was in error, particularly when the claimant submits that he failed to provide reasons for this opinion, and the reasoning for this opinion is not known.
The claimant submits that in the absence of such reasons, the Medical Assessor has clearly failed to take into account and engage with relevant medical documentation. The claimant says that the paucity of reasons provided indicates the Medical Assessor has failed to properly analyse or consider the evidence before him and given proper, genuine or realistic consideration of the T12/L1 injury.

Insurer’s submissions

The insurer noted that the claimant alleges that the Medical Assessor assumed the T12/L1 annular was present due to the accident but not visible on the initial MRI, however, has failed to provide his path of reasoning in concluding that the annular tear was not causally related to the accident.
The insurer says that the claimant has taken the following phrase from the Medical Assessor’s reasons out of context:
“We would have to assume that a tear was present due to the MVA, but not visible by initial MRI.”
To clarify the position, the insurer in its submissions repeated the entire paragraph as extracted below:
“One difficulty lies in the lack of correlation between this pathology and his symptoms and signs, which corresponds to an injury in the lower back. Independently a T12/L1 injury is to be regarded as a thoracic injury under the Guidelines. The other point of concern, is the report of progression of the annular fissure (tear) at T12/L1 overtime. This may be due to unrelated events or a natural progression, given the lesion was not observed in the original MRI. We would have to assume that a tear was present due to the MVA, but not visible by initial MRI” (insurers emphasis).
The insurer submits that, having reviewed all the material before him, the Medical Assessor assessed the claimant and articulated his reasoning. The insurer says that the Medical Assessor was unable to link the T12/L1 tear as causally related to the accident. Additionally, the insurer says that the Medical Assessor said that there were no historical inconsistencies, but rather an “anatomical inconsistency” in respect of the reported pain. The insurer says the claimant reported pain to the lower lumbar spine around L5/S1 with referral into the right groin, however the tear was in the lower thoracic/upper lumbar joint. The insurer says that the issue raised by the claimant is therefore one of semantics and does not establish an error on the part of the Medical Assessor.
The insurer has noted the accident occurred on 29 November 2021. The claimant then suffered an assault at a Woolworths store on 3 February 2022. Thereafter, on
9 February 2022 the claimant underwent an MRI scan of his lumbar spine which reported “disc space narrowing and diffuse bulge at the T12/L1 level”. On 14 February 2022 the claimant had a referral for a CT injection and by way of a history it was reported “low back pain – has been experiencing disabling low back pain over the last few weeks – this follows lifting heavy materials at work – no radicular symptoms – the pain interferes with work and her [sic] sleep”. The claimant then had an MRI scan of the lumbar spine on 23 June 2023 which reported a posterior annulus tear at T12/L1.

The insurer has provided its submissions with respect to the original threshold injury application.
The insurer submits that the annular tears of the lumbar spine are minor injuries (now known as threshold injuries).
The insurer referred to an MRI scan of the lumbar spine performed by Dr Carr on
9 February 2022. It also noted in the further MRI of the lumbar spine on 20 June 2023 where it was reported;
“Schmorl’s nodes at T11-12 and L1-2.
T12-L1 disc desiccation with a posterior annulus tear and low-grade disc bulge without neural impingement.”
The insurer referred to the claimant’s GP, Dr Kang reporting in a referral dated 6 July 2023;
“I confirm that the second Magnetic Resonance Imaging that he had recently in 23.6.2023 demonstrated posterior annulus tear at T12/L1 level which was not picked up on Magnetic Resonance Imaging done on 9.2.2022. I can suspect that his condition may have deteriorated over 18 months period which led to tear of the disc.”
The insurer refers to the clinical records of Ms Cooper, psychologist, and an entry dated
4 February 2022, where it was recorded the claimant was assaulted the day before at Woolworths when a security guard punched him in his back. Thereafter the claimant was referred for an MRI of his lumbar spine on 7 February 2022 after the assault at Woolworths.
The insurer submits the tear of the lumbar spine is not causally related to the subject accident, and says that at most, the claimant sustained a soft tissue injury of the lumbar spine.

Medical evidence

The Clinical notes from Western Plains Medical and Dental Centre in Dubbo detail a slip and fall on slippery carpet on 16 February 2021, diagnosed as a back strain. There are no other pre-accident records of low back pain.
Ambulance report dated 26 November 2021:
“C/T 29 YO MALE, FROM HOME, STATES BEING INVOLVED IN MVA, DROVE BACK HOME AND NOW
C/O PAIN. O/A PT STATES PAIN TO NECK, LOWER BACK AND CHEST. PT DESCRIBES PAIN
CONSISTENT WITH WHIPLASH AND SEATBELT LASH. NO GRIMACING OR INCREASED PAIN ON
PALPATION OF C-SPINE. PT C/O CHEST PAIN IN LINE WITH SEATBELT. O/E PT ALERT, ORIENTATED.”
Wellington Hospital emergency department notes:
“Triage Form WEL Entered On: 26/11/2021 17:59 AEDT
Performed On: 26/11/2021 17:
Triage WEL
Triage Presenting Information : MVA
Additional Presenting Information : BIBA reportedly involved in an MVA.
Driver of vehicle who was stationery, went to render assistance to another 2 x vehicle MVA, was still in vehicle with seat belt on, when was rear-ended by another vehicle at 1606 hours.
Self-extricated.
NSW Police Force attended, did not state required ambulance - drove home, then called ambulance.
Ambulant to ambulance stretcher.
No distress noted whatsoever.
Speaking in full sentences.
No head strike, no LOC, no amnesia.
Reports neck pain, chest pain, lower back pain.
Reports whip lash.
Ambulance have palpated C-spine - non tender.
Given paracetamol and ibuprofen with good effect.
On: 27/11/2021
‘Triage WEL
Triage Presenting Information : Review
Additional Presenting Information : Patient re-presented post MVA yesterday with L) Flank pain.
Patient states same pain as yesterday.
Nil distress.
Walked into ED’.”
The Clinical notes from Western Plains Medical and Dental Centre in Dubbo detail a presentation on 29 November 2021. Back pain after lifting at work for some weeks is recorded, however, the entry is confusing as it relates to a female and at other times a male patient and the age is wrong. The panel considers that this is entry may be an erroneous entry in the clinical record.
The Certificate of Capacity dated 27 January 2022 by Dr Tang details “mechanical low back pain with possible lumbosacral disc protrusion aggravation of PTSD depression and anxiety”.
A further entry from Western Plains Medical and Dental Centre on 11 February 2022 by
Dr Morakinyo states IDENTITY CONFIRMED. Acute disabling low back pain this follows a recent motor vehicular accident, no radicular symptoms. Explained modalities of back pain management including CT Guided epidural. Refer physiotherapy and Tramadol was prescribed.
Dr Carr, radiologist, provided the MRI lumbar spine report of 9 February 2022. He said that no lumbar disc protrusion was identified. Disc space narrowing and a diffuse disc bulge at T12/L1. Endplate irregularity noted at T10/11 and T12/L1 levels in a pattern suggesting possible old Scheuermann’s disease. Lumbar disc height and hydration is preserved. No annulus tear, focal disc protrusion, nerve root compression or canal stenosis is identified. There is mild lower lumbar posterior facet joint hypertrophy. There is no evidence of bone oedema or stress reaction.
Following the referral for a CT guided epidural corticosteroid lumbar spine injection on
14 February 2022, Dr Carr issued a report on 23 February 2022 following review of the MRI scan of 9 February 2022 which he said showed no lumbar disc protrusion, nerve root compression or canal stenosis. Dr Carr noted disc degeneration at the T12/L1 level. He said that there was no site suitable for spinal/epidural steroid injection identified.
The claimant’s GP, Dr Tang, referred him to Dr Russo, pain specialist, by referral of
9 May 2022. The Panel notes that there is no report from Dr Russo. It not known by the Panel if the claimant saw this specialist. This was the subject of another dispute determination which is not for the consideration of this Panel.
The Medical Assessor provided his certificate of 24 April 2023. This was in relation to whether treatment was reasonable and necessary. The Medical Assessor concluded that as a result of the accident the claimant sustained a soft tissue injury to the lumbar spine with continuing symptoms and disability. The Medical Assessor noted the MRI report of
9 February 2022 and the spinal injection procedure of 9 March 2022 which reported adverse lower leg symptoms following the procedure.
In this certificate, the Medical Assessor reported that the claimant did not have radiculopathy or any signs of nerve root involvement.
The Medical Assessor said that, at the time of his examination for this certificate, given the claimant’s clinical presentation and symptoms, it was justifiable to order an MRI scan of the lumbar spine.
In the certificate of the Medical Assessor of 10 December 2023, with respect to whether the claimant had suffered a threshold injury, he concluded that the accident caused a lumbar spine non-specific soft tissue injury which was a threshold injury.
The Medical Assessor noted that the claimant had an altercation with a security guard in a Woolworths carpark on 3 February 2022, after the accident. The claimant reported that he did not sustain any injury in this event. However, his lower back pain was said to have increased by the push.
Whilst the Medical Assessor considered the MRI report of 9 February 2022 and a further report of 20 June 2023, he did not specifically comment on the different reporting outcomes. With respect to the report of 20 June 2023 he noted as follows;
-12 and L1-2.
T12-L1 disc desiccation with a posterior annulus tear and low-grade disc bulge without neural impingement”
The Medical Assessor referred to Dr Kang reporting:
demonstrated posterior annulus tear at T12/L1 level which was not picked up on Magnetic Resonance Imaging done on 9.2.2022. I can suspect that his condition may have deteriorated over 18 months period which led to tear of the disc (Medical Assessors emphasis)”
The Medical Assessor did not discuss the different reporting outcomes of the MRI scan of
9 February 2022 and 20 June 2023 nor a consideration of causation of the accident resulting in the different reported outcome in the later MRI examination.

Medical examination

The claimant was medically examined on 6 August 2024 by Medical Assessor Home and Medical Assessor Couch. Since that time, the Panel had been awaiting further documentation which it requested from the claimant, for example, any CCTV surveillance video of the assault at Woolworths. This has taken some time to pursue and ultimately, it appears that it is not available. The Panel did not proceed to finalise its medical examination report until it was satisfied that no further evidence would be produced.
The medical examination report follows;
“Mr Greco was accompanied to the assessment by his partner, Mr Matthew McKay. The history was obtained directly from the claimant.
BACKGROUND
Mr Greco states that he has no past history of back pain. He confirms a history of psychiatric disorders, for which he remains under the care of a psychiatrist.
At the time of the accident, he had commenced a practical placement in order to obtain work as a nursing assistant.
He was born in Italy and immigrated to Australia in 2005.
DETAILS OF MOTOR ACCIDENT
Mr Greco states that he was involved in a motor vehicle accident on 26 November 2021. He was coming home from a work placement experience when the accident occurred. He said that he became aware of an obstruction, due to a traffic crash ahead. He was slowing his Mercedes sedan when his vehicle was struck from behind by a utility vehicle at speed. He recalls rear end damage. His partner Matthew was sitting by his side and he had another male friend in the rear.
He recalls that following the impact, he was able to alight from the vehicle. Police attended the scene. After discussion with the police, his male friend drove him to his home in Wellington. From there, he was taken by ambulance to the local Wellington Hospital in Bindawalla. There he was assessed and recalls that he received an analgesic injection. He was discharged home to the care of his general practitioner.
TREATMENT
Subsequently, he attended Dr Morakinyo in Dubbo. He was referred for physical therapy. He was prescribed analgesic and anti-inflammatory medications. He confirms that he attended the Wellington Hospital on several occasions over the next three months due to persisting lower back pain.
Due to persisting lower back pain, he underwent MRI scans of the lumbar spine, performed on 9 February 2022. He underwent an epidural injection to the lower back on 9 March 2022, but this caused him to experience lower limb paraesthesia and increased back pain for two or three days, with the additional symptoms thereafter settling. During the post injection period, he attended the Wellington Hospital emergency department on two occasions.
Thereafter, he received further treatment with physical therapy. This ceased after approximately six months. He was given home exercises. There has been no other treatment.
He confirms that he underwent further MRI scans of the lumbar spine in June 2023.
He reports the current use of Endone 5mg to 10mg daily. He also takes paracetamol and Clonazepam. He applies heat packs to his back on a regular basis.
CURRENT SYMPTOMS
Mr Greco reports symptoms of midline lower back pain. He indicates the lower lumbar region as the maximum site of pain. The pain extends laterally out towards the right hip and frequently radiates anteriorly into the right groin.
He describes further pain in the left anterior chest wall.
He reports intermittent pain shooting down the right leg extending to the posterior and lateral aspect of the right calf. There is occasional further radiation of pain to the foot and the right hallux. He describes exacerbation of leg pain with prolonged sitting, standing and walking.
FUNCTIONAL CAPACITY AND REPORTED TOLERANCES
He reports a sitting tolerance of up to an hour, a driving tolerance of 30 minutes and a walking tolerance of 20 minutes, all limited by back pain. Stair climbing exacerbates his back pain.
He is independent for activities of self-care but his partner helps him to dress in underwear and socks. He wears slip on shoes.
He limits lifting to a few kilograms.
SOCIAL HISTORY
He lives with his partner in a house in Wellington, New South Wales.
He smokes up to 12 cigarettes daily.
He helps out with light bench height domestic chores including most of the cooking, loading of the dishwasher and bench-height cleaning. His partner performs the laundry tasks and the heavier domestic chores.
He denies current active hobbies.
VOCATIONAL HISTORY
He did not pursue work as a nurse or paramedic after the subject accident.
PHYSICAL EXAMINATION
On examination, the claimant is a 32 year old standing 176cm and weighing 120kg.
Thoracolumbar spine
On examination of the thoracolumbar spine, there is normal spinal curvature. There is no muscle spasm. Lumbar flexion was performed to 3/4 normal range, there is smooth lumbar deflexion back to an erect posture Extension is also performed to 3/4 normal range, lateral flexion is performed to the right to 3/4 normal range and on the left to 1/2 normal range. There is pain in the lateral chest wall declared during extreme lateral flexion.
Straight leg raise is performed to 70° on the right and 80° on the left. Lasegue’s sign is positive on the right.
The neurological examination of the lower extremities reveals normal myotomal power in all muscle groups. There is normal sensibility throughout the lower extremities. The deep tendon reflexes are symmetrically preserved. There is no local muscle wasting in the right lower extremity. The circumference of the right thigh is 2cm larger than the left and the calf is 1cm larger than the left, consistent with right leg dominance.
Tenderness is elicited to palpation overlying the lowest two lumbar segments.
DIAGNOSIS AND CAUSATION
The claimant suffered an injury to the lumbar spine in a rear-end motor vehicle crash. There is early documentation of lower back pain in the medical record. The claimant’s diagnostic imaging demonstrates no disc abnormality in the lower lumbar regions corresponding with his level of pain.
The Panel note an L4/5 epidural was performed which caused temporary aggravation of his existing lower back pain.
The claimant reports referred symptoms to the right calf and foot, roughly corresponding to an L5 dermatomal pattern.
However, the clinical signs required for a diagnosis of radiculopathy in accordance with Clause 5.8 of the SIRA Guidelines are not met.
The Panel found the following clinical sign:
·    positive sciatic nerve root tension signs
The panel found no evidence of the following clinical signs:
·    loss or asymmetry of reflexes
·    muscle atrophy and/or decreased limb circumference.
·    muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution
·    reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.
The Panel concludes that that there are non-verifiable radicular complaints in the right lower extremity.
The Panel has carefully considered the imaging findings.
The medical Panel Members reviewed the MRI scan imaging findings of 9 February 2022.
The finding of endplate irregularities at T10/11 and T12/L1 reflect a developmental condition, Scheuermann’s disease. This is a developmental abnormality found in many asymptomatic individuals.
Whilst the precise cause of Scheuermann’s disease is not known, it appears to develop during the growth phase in adolescence due to discordant vertebral endplate mineralization and ossification during growth. This refers to a problem with the processes by which bones harden and form. These bone development issues lead to the alteration of their shape and may resulting in abnormal curvature of the spine or local lesions called Schmorl’s nodes.
These nodes are areas where the disc between each vertebra pushes through the bone at the bottom and the top of the vertebra.
Scheumman’s disease most commonly affects the lower thoracic and upper lumbar vertebrae. It is diagnosed when three intervertebral segments demonstrate end plate and intervertebral disc changes, as in this case. It is usually asymptomatic, as in this case.
The disc bulge documented at T12/L1 on the lumbar MRI scan imaging of 9 February 2022 is considered to be part of the Scheuermann’s disease, which extends over the segments above and below the T12/L1 segment.
The medical Panel Members reviewed the further lumbar MRI scan findings of 23 June 2023.
The Schmorl’s nodes at T11/12 and L1/2 and a low grade disc bulge with posterior annulus fissure at T12/L1 are, as for the previous imaging, considered to be features of Scheuermann’s disease.
There is an evident typographic error in the Lumus report of 23 June 2023, which refers to ‘low grade despite this’, should read ‘low grade disc bulge’.
An annulus fissure that exists in an area of developmental change is considered to be an incidental finding in this case.
The Panel find that the claimant’s complaints of low back pain, which are localised to the lowest two lumbar segments (L4/5 and L5/S1), do not correspond to the level of the imaging findings (T11 to L1) on the MRI scans.
The claimant does not report symptoms at the thoracolumbar junction.
The Panel concludes that the imaging findings at T12/L1 have not arisen as a consequence of the subject motor vehicle accident.
At the level of the claimant’s symptoms in the lower lumbar region, there is no structural abnormality on imaging.
The Panel is satisfied the injuries meet the definition of soft tissue injuries.
There is no evidence of injuries to the nerves, complete or partial rupture of tendons, ligaments, menisci or cartilage.
Further, there are insufficient findings of lumbar radiculopathy to satisfy the criteria in Clause 5.8 of the motor accident guidelines.
The Panel acknowledges the reasoning in David v Allianz Australia Ltd (2021) NSWPICMP 227 at (84)-(104), that radiculopathy can be present at any time to establish that the injury is not threshold for the purposes of the Act. However, the Panel is not satisfied that any time after the accident there were two a more clinical signs of radiculopathy being found on examination.
The Panel has found that there is insufficient medical evidence that the injury is not a threshold injury for the purposes of the Act from the time of the accident up to the time of the assessment.
Therefore, the Panel find that the claimant did suffer a threshold injury to the lumbar spine.
The Panel finds that the following injury caused by the motor accident:
·    Lumbar spine – soft tissue injury to the lumbar spine, non-verifiable radicular complaints in right lower extremity
is a threshold injury for the purposes of the Act.”
The Panel adopts the medical findings and report of Medical Assessor Home and Medical Assessor Couch.

Causation

The accident occurred on 29 November 2021. The claimant then suffered an assault at a Woolworths store on 3 February 2022. Thereafter, on 9 February 2022 the claimant underwent an MRI scan of his lumbar spine which reported “disc space narrowing and diffuse bulge at the T12/L1 level”.
On 14 February 2022 the claimant had a referral for a CT injection and by way of a history it was reported “low back pain – has been experiencing disabling low back pain over the last few weeks – this follows lifting heavy materials at work – no radicular symptoms – the pain interferes with work and her [sic] sleep”. The claimant then had an MRI scan of the lumbar spine on 23 June 2023 which reported a posterior annulus tear at T12/L1.
From the imaging findings it is apparent that the claimant had underlying developmental and degenerative changes in the low thoracic spine. An annulus fissure would not be unusual in these circumstances. The fact that one MRI scan did not show a fissure or tear and second scan did, is not a marker of trauma. Given the time that passed, and the underlying developmental and degenerative change in the low thoracic spine it is more than likely to reflect a progression of the underlying degenerative change. The fact also that he did not declare or complain of pain in that spinal area since the accident, reflects that it is a progressive degenerative change, rather than a sequalae of trauma.
The Panel refers to the clinical records of Ms Cooper, psychologist. In an entry dated
4 February 2022, it was recorded the claimant was assaulted the day before at Woolworths where a security guard punched him in his back. Five days later, the claimant was referred for an MRI of the lumbar spine on 9 February 2022, after the assault at Woolworths.

The MRI scans were not available for review, only the report from Dr Kang. Based upon this report, he had an annular tear at the T12/L1 level which is regarded as a non-threshold injury under the Guidelines if there is a causal link.
One difficulty lies in the lack of correlation between this pathology and his symptoms and signs, which corresponds to an injury in the lower back.
Independently a T12/L1 injury is to be regarded as a thoracic injury under the Guidelines.
The other point of concern, is the report of progression of the annular fissure (tear) at T12/L1 over time. This is considered to be due to unrelated events or a natural progression, given the lesion was not observed in the original MRI. The Panel does not find that the claimant suffered a thoracic spine injury. The Panel does not find that the claimant suffered a low thoracic disc lesion in the accident, or that the later finding of an annulus tear at T12/L1 was caused by the motor vehicle accident.

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.

83.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 the accident involving the claimant, in which he was the driver, he suffered a rear end collision. It was sudden, and most likely might have been with some degree of force. A photograph of the car in which he was travelling evidences clear damage and, according to his submissions, was written off for insurance purposes. On the observations of the Panel, the damage was indicative of a significant impact.
Campbell J in Owen v Motor Accidents Authority (NSW),[7] adopted Justice Johnson's approach with a caution touching upon the CLA:
"Given that the task of the Medical Review Panel in determining the causation question is not solely a medical determination within the expertise of the assessor's constituting the Panel, the position has, with respect, been aptly put by Johnson J in Ackling at p 500 [87] that the Assessors will derive practical assistance from this part of the Permanent Impairment Guidelines. But it is well to emphasise that the question to be assessed is one of legal causation involving mixed questions of fact and law arising principally from the law of negligence as modified by Civil Liability Act 2002, s 5D. (See s 3B(2)) of the Civil Liability Act (the CLA)."[8]
[7] [2012] 61 MVR 245; [2012] NSWSC 650.
[8] At [27].
In Kinchela v Insurance Australia Group Ltd t/as NRMA Insurance [2021] NSWSC 804 Justice Walton set aside the decision of a Medical Review Panel. The issues determined in Kinchela involved applying the definition of “minor injury” (now referred to as threshold injury”) and involved 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.’
[65] In McGiffen, the Court of Appeal held at [64] – [65]:
‘[64] The question that the review panel was required to address was not simply whether there was any contemporaneous evidence of complaint about an injury to the lumbar thoracic spine. It included whether Mr McGiffen’s lumbar thoracic spinal injury was causally related to the ‘gait derangement’, itself caused by the accident. That is, was the accident a contributing cause of a lumbar thoracic spinal injury by reason of the gait derangement caused by the accident.
[65] In deciding causation solely on the basis of the existence or otherwise of contemporaneous evidence of complaint of injury to the thoracic spine the review panel only partially addressed the question posed by s 58(1)(d)(of the Motor Accidents Compensation Act). For that reason, the decision recorded in the panel’s certificate must be treated as a purported and not real exercise of its statutory function under s 58(1)(d), leaving that function unexercised, and the Authority and the panel liable to the relief granted by the primary judge for jurisdictional error.’
[40] The second defendant failed to apply the correct test of causation as set out in the relevant Guidelines informed by s 5D of the Civil Liability Act 2002 (NSW) and the common law. As result, the second defendant failed to apply the appropriate legal test in order to discharge its jurisdictional function.”
In Briggs v IAG Limited trading as NRMA Insurance [2022] NSWSC 372, Wright J, regarding causation and the issues to be addressed, said;
“67 The second ground of review concerned the second review panel’s approach to the issue of causation. It was submitted that the panel applied an erroneous test in relation to causation and thus failed to exercise its jurisdiction.
68 As to whether the motor vehicle accident trauma was a cause of a ‘left posterolateral annular tear’ with ‘mild disc desiccation’ shown on Mr Brigg’s MRI test results, the second review panel concluded that causation had not been established because:
(1) ‘[a]t present, causation cannot be determined by medical imaging, unless there are sequential studies, either side of a motor vehicle accident and within a short time period’, and Mr Briggs only had post-accident MRI results;

(2) ‘a delamination may not fall within the definition of a tear’; and

(3) ‘the defect may not be the source of his pain and disability’.
69 The substance of the reasoning was that since there could be no scientific certainty that the L4/5 left posterolateral annular tear with mild disc desiccation was caused by the accident based on medical imaging and there was a possibility that the injury was not a tear and may not have been what led to Mr Brigg’s pain and disability, causation had not been established.
70 This reasoning does not accord with the relevant legal test in relation to causation, which does not require scientific certainty. In Metro North Hospital and Health Service v Pierce[2018] NSWCA 11, the Court of Appeal said, in relation to causation in a similar context, as follows at [138] (White JA, Macfarlan and Payne JJA agreeing):
‘138 Whether the Hospital’s negligence in not responding to the induced seizures in a timely manner materially contributed to Ms Pierce’s worsened condition is not to be determined on the basis of scientific certainty, but on the balance of probabilities’.
73 The second review panel did not address the question of whether on the balance of probabilities the motor vehicle accident caused the annular tear even though there might be no scientific certainty. Furthermore, the second review panel’s reasoning did not reflect the approach to determining causation in cll 6.6 and 6.7 of the Guidelines, which in my view is consistent with the legal principles I have outlined.
74 The present case is not one where medical science established that there was no possible connexion between the motor accident and Mr Brigg’s relevant injuries. From the material available, the second review panel accepted that the motor accident in this case could have caused or contributed to Mr Brigg’s L4/5 left posterolateral annular tear. Indeed, the panel expressly accepted that:
‘the plaintiff was involved in relatively severe front-end collision. The medical and biomechanical literature supports the conclusion that spinal injuries with resulting pain and disability can arise from this type of trauma.’
75 This being so, it was necessary for the panel to consider whether the motor accident did cause or contribute to Mr Brigg’s condition. This required, not a consideration of material derived as a result of an internet search for “all past and recent high-quality research articles pertaining to MRI imaging of the lumbar spine, with a focus on injury, degeneration and pain”, but rather a consideration of the material referred to in cl 5.6 of the Guidelines, namely all the evidence available to the panel including all relevant findings derived from:
(1) a comprehensive, accurate history, including pre-accident history and pre-existing conditions;
(2) a review of all relevant records available at the assessment;
(3) a comprehensive description of the injured person’s current symptoms;
(4) a careful and thorough physical examination; and
(5) diagnostic tests available at the assessment, noting that imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.
76 In Mr Briggs’s case that would include, without attempting to be exhaustive:
(1) Mr Briggs’s age, circumstances and relevant medical history at the time of the motor accident, including whether there was any previous history of lumbar spine pain;
(2) the particular nature and extent of the accident and the forces that would have been operative on Mr Briggs as a result of the accident; and
(3) Mr Briggs’s circumstances and relevant medical history including the MRI results and results of other medical examinations and testing, after the motor accident.
77 In light of all that material and in accordance with cll 6.6 and 6.7 of the Guidelines, the panel should then have made ‘a non-medical informed judgment’ as to whether it was likely that the motor accident caused or contributed to Mr Briggs’s injury in question.”
Photographs of the car in which the claimant was travelling, probably taken a short time after the accident but not known to the Panel, show clear rear end body damage to the rear boot area of the car.
The Panel must consider whether, with the claimant’s complaints, the disability is causally related when there was little or no complaint about this area of disability for several months post-accident.
The Panel is mindful that a lack of reported lower back complaint should not preclude a conclusion that this condition arose from the accident.
Scientifically, there is a possibility that the accident could have caused an annular tear. The Panel must consider, did the accident contribute to the claimant suffering a T12/L1 posterior annular tear as a result of the accident and when no immediate complaint was made when in normal circumstances, an injury of this nature would be expected to bring about acute pain.
While the lack of contemporaneous complaint or record is not determinative, the reality is that there is essentially no evidence of immediate complaint about low back pain following the accident, before the Panel. There is nothing to confirm any immediate complaint or treatment of acute back pain.
The Panel must also ask itself in considering whether the accident contributed to the claimant’s physical injuries as referred to it by the Commission, whether the claimant’s condition arises because of contribution by the accident causing a T12/L1 posterior annular tear, and whether the accident materially contributed to that condition and need for treatment.
On the balance of probabilities, can it be said that the T12/L1 posterior annular tear, first identified in an MRI scan of the lumbar spine on 23 June 2023, was caused by the accident? The Panel is not satisfied that this is the case.
The MRI scan imaging findings of 9 February 2022 indicate that the endplate irregularities at T10/11 and T12/L1 reflect a developmental condition, Scheuermann’s disease which is found in many asymptomatic individuals.
The disc bulge documented at T12/L1 on the lumbar MRI scan imaging of 9 February 2022 is considered to be part of the Scheuermann’s disease, which extends over the segments above and below the T12/L1 segment.
As noted in the medical examination report, the medical Panel members reviewed the further lumbar MRI scan findings of 23 June 2023.The Schmorl’s nodes at T11/12 and L1/2 and a low grade disc bulge with posterior annulus fissure at T12/L1 are also considered to be features of Scheuermann’s disease.
An annulus fissure that exists in an area of developmental change is considered to be an incidental finding in this case.
The Panel find that the claimant’s complaints of low back pain, which are localised to the lowest two lumbar segments (L4/5 and L5/S1), do not correspond to the level of the imaging findings (T11 to L1) on the MRI scans.
The claimant does not report symptoms at the thoracolumbar junction.
The Panel concludes that the imaging findings at T12/L1 have not arisen as a consequence of the subject motor vehicle accident.
The Panel is satisfied that the accident could have caused a soft tissue injury to the lumbar spine. Despite the delay in documentation, and subsequent trauma in an assault, the Panel is satisfied that the claimant suffered a low back injury in the subject accident. This is a threshold injury.

CONCLUSION

This is a dispute between the claimant and the insurer about: whether the injury caused by the accident is a threshold injury under Schedule 2, s 2(e) of the Act.
The Panel is satisfied that the accident could have caused a soft tissue injury to the lumbar spine. The Panel is satisfied that the claimant suffered a low back injury in the subject accident. This is a threshold injury.

DETERMINATION

The Panel affirms the certificate of Medical Assessor McGrath dated 10 December 2023.
The Panel is not satisfied that the claimant suffered a T12/L1 posterior annular tear as a result of a motor vehicle accident on 26 November 2021 and that this was a non-threshold injury pursuant to the Act.
The claimant has suffered a threshold injury to the lumbar spine as a consequence of the accident on 26 November 2021.

[2024] NSWPICMP 750

1 November 2024