Insurance Australia Limited t/as NRMA Insurance v BON
[2025] NSWPICMP 69
•6 February 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Insurance Australia Limited t/as NRMA Insurance v BON [2025] NSWPICMP 69 |
CLAIMANT: | BON |
INSURER: | Insurance Australia Limited t/as NRMA Insurance |
REVIEW PANEL | |
MEMBER: | Susan McTegg |
MEDICAL ASSESSOR: | John Carter |
MEDICAL ASSESSOR: | Margaret Gibson |
DATE OF DECISION: | 6 February 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; review of Medical Assessment Certificate (MAC); the claimant suffered injury in a motor accident on 10 November 2016; the dispute related to the assessment of whole person impairment (WPI) of the abdomen, and anterior caecal perforation requiring surgery; Medical Assessor (MA) found no colonic impairment but found claimant had symptoms consistent with anterior cutaneous nerve entrapment over T10 to L1 distribution of the anterior abdomen which he assessed under tables 11 and 13 of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides) which relate to upper extremity functions; Held – on examination claimant denied any abdominal pains or sensory symptoms over the abdomen; no findings to suggest neuropathy of any anterior cutaneous nerves over the abdomen and no impairment of activities of daily living; anterior caecal perforation assessed under table 3 of the AMA 4 Guides; no signs and symptoms of colonic disease; no limitation of activities of daily living as a result of injury; MAC revoked; claimant sustained 0% WPI as a result of anterior caecal perforation requiring surgery. |
DETERMINATIONS MADE: | Review Panel Certificate issued under Part 3.4 of the Motor Accidents Compensation Act 1999 following a review under s 63 as to WHETHER THE DEGREE OF PERMANENT IMPAIRMENT OF THE INJURED PERSON AS A RESULT OF THE INJURY CAUSED BY THE MOTOR ACCIDENT IS GREATER THAN 10% 1. The Review Panel revokes the certificate of Medical Assessor Garvey dated 27 June 2024 and issues a new certificate determining that the following injuries were caused by the motor accident and give rise to a whole person impairment that is not greater than 10% and is 0%: · abdomen – anterior caecal perforation requiring surgery. |
STATEMENT OF REASONS
INTRODUCTION
On 10 November 2016 when she was 8 years old the claimant BON was a passenger in a vehicle driven by her mother in wet weather when the vehicle slid to the other side of the road and down an embankment before colliding with a tree (the accident).
NRMA Insurance Australia Limited trading as NRMA Insurance (the insurer) is the relevant insurer with liability to pay any damages to [BON] under the Motor Accidents Compensation Act 1999 (MAC Act).
This dispute is in relation to whether the degree of permanent impairment sustained by the claimant as a result of the injury caused by the accident is greater than 10%. This constitutes a medical dispute within the meaning of the MAC Act.[1]
[1] Sections 57 and 58 of the MAC Act.
This dispute in relation to the abdominal injury was referred to Medical Assessor Garvey.
DOCUMENTATION BEFORE THE REVIEW PANEL
On 14 October 2024 the solicitor for the insurer uploaded a bundle of documents indexed and paginated from pages 1 to 1889 (insurer’s documents).
On 28 October 2024 the solicitor for the claimant uploaded a bundle of documents indexed and paginated from pages 1 to 18 (claimant’s documents).
The Panel notes that there are extensive medical records addressing the claimant’s physical and psychological injuries. The Panel has read the entirety of the medical records but only proposes to reference those records which are relevant to the dispute to be determined by the Panel.
RELEVANT LEGAL AUTHORITY
Permanent impairment dispute
The Motor Accident Permanent Impairment Guidelines (the Guidelines) were issued pursuant to s 44(1)(c) for the assessment of permanent impairment. The Guidelines are based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are effective from 1 June 2018 and relate to motor vehicle accidents that occurred between 5 October 1999 and
30 November 2017. The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.[2]
[2] Clause 1.2 of the Guidelines.
Causation of injury is addressed in the Guidelines:
“1.5 An assessment of the degree of permanent impairment is a medical assessment matter under Section 58 (1)(d) of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person’s impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues.
1.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows: ‘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:
1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2.The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.’
This, therefore, involves a medical decision and a non-medical informed judgement.
1.7 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.”
MEDICAL ASSESSMENT UNDER REVIEW
Medical Assessor Garvey issued a certificate dated 27 June 2024.[3] The following injuries were referred for assessment:
· abdomen – anterior caecal perforation requiring surgery.
[3] Insurer’s documents p 13.
He reported the claimant was now 16 years of age and a year 11 school student.
Medical Assessor Garvey noted the claimant was born with a “spastic colon” and had a tube inserted in her bowel on 13 October 2016 at Canberra Hospital.
Medical Assessor Garvey reported following the accident the claimant took off her seatbelt and felt a throbbing pain in her stomach. She was transported by ambulance to Bega Hospital where seatbelt burns across her lower stomach and around her neck were observed. She was sent home but that night flushed out her stoma in agony and was taken to hospital by her grandmother. Again, she was told there was nothing wrong and it was just swelling of the seatbelt. A third time the claimant realised her stoma was not flushing properly and she was taken back to hospital but again she was told that everything was fine. The claimant’s mother insisted she be taken to the Canberra Hospital by ambulance. She ultimately was taken to theatre for emergency surgery which started out as a keyhole procedure but was converted to a laparotomy because she was diagnosed with a split in the bowel and peritonitis.
Medical Assessor Garvey described the claimant’s present symptoms as stomach feels tight, bottom is sore, and she gets bad cramping pains about once a fortnight.
On examination Medical Assessor Garvey reported:
“Inspection: There was no cachexia, pallor of anaemia or jaundice. There was no clubbing of the fingers or liver palms. There were no spider naevi or stigmata of liver disease on the chest. There were no Caput Medusae (distended veins in chest or abdomen). The abdomen was symmetrical and flat in shape. There were no abdominal masses visible or discolouration. There was a caecal appendicostomy stoma with a Chait button plug. There was a 12 cm transverse lower abdominal incision which was well healed and a 4 cm infra umbilical laparoscopic port site incision and 2 other laparoscopic port site incisions, but no sinuses or other fistulas and the umbilicus was otherwise normal.
Palpation: There were no enlarged lymph glands palpable in the neck, axilla or groin regions. The supraclavicular fossae were normal, the external potential hernia orifices were closed, the femoral pulses were palpable. Light palpation was normal. Moderate palpation of the abdomen was normal in all quadrants. There was no muscular guarding and no rebound tenderness or crossed rebound tenderness. The liver was not palpable, nor was the spleen and the kidneys were not ballottable.
There were no abdominal masses palpable.
There was dysaesthesia in the distribution of the anterior cutaneous nerves from T10-L1 on each side
Percussion: The percussion note was resonant and there was no fluid thrill and no
shifting dullness.
Auscultation: On auscultation the bowel sounds were normal and there was no
aortic bruit and no gastric splash. Rectal examination was not performed. The
weight was 51.6 kg and height 162 cm (BMI 19.7). The waist circumference was 78
cm. I showed the Claimant the Bristol Stool Chart and she chose numbers 6 when she is flushing (‘Fluffy pieces with ragged edges, a mushy stool’) and 4 (‘Like a sausage or snake, smooth and soft’) when her motion is normal.”
Medical Assessor Garvey reported the claimant suffered from blunt seatbelt trauma to her caecostomy site and a laceration to her caecum which need to be repaired by a laparoscopic operation converted to an open operation followed by a successful outcome. He reported she had no signs and symptoms of colonic disease and no limitations of activities and no systemic functions and no sequalae after surgical procedure so she merited a 0% whole person impairment (WPI).
However, he found the claimant had anterior cutaneous neuralgia of the abdominal nerves from T10 to L1 caused by blunt abdominal trauma. He assessed the impairment for each nerve using Table 13 page 3/51 and Table 11, page 3/48 to rate unilateral sensory deficits for each nerve based on sensory loss or dysaesthesia based on severity as follows:
“Nerve T10: Moderate sensory impairment [60% sensory deficit of 3% WPI maximum] = 2% WPI
Nerve T11: Moderate sensory impairment [60% sensory deficit of 3% WPI maximum] = 2% WPI
Nerve T12: Moderate sensory impairment [60% sensory deficit of 3% WPI maximum] = 2% WPI
This calculates to be 8% WPI for each side = combined 16% WPI.”
Medical Assessor Garvey certified the following injuries were caused by the accident:
· lacerated caecum, and
· anterior cutaneous nerve syndrome from T10-L1 on each side.
He assessed a 16% WPI.
REVIEW PROCEDURE
An application for review of the medical assessment of Medical Assessor Garvey pursuant to s 63 of the MAC Act was lodged by the insurer on 9 August 2024 within 28 days of the date on which the certificate of Medical Assessor Garvey was made available to the parties.[4]
[4] Section 63(7) of the MAC Act.
On 16 September 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application referred the medical assessment to the Review Panel (the Panel).[5]
[5] Section 63(2B) of the MAC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[6]
[6] Rule 128 of the PIC Rules.
The review is by way of a new assessment of all matters with which the medical assessment is concerned.[7]
EVIDENCE BEFORE THE REVIEW PANEL
Ambulance report
[7] Section 63(3A) of the MAC Act.
The case description states:
“Single car MVA down an embankment, nil rollover. … Buk airbags deployed. Pt was sitting on the left back passenger seat. Seatbelt worn. Pt denies hitting her head. … Pt C/O C1 neck pain on palpation and general right-sided neck pain? from seatbelt. Nil other injuries on full secondary survey. Pt ambulating on scene. All vital signs within normal limits. Pt denies any nausea, dizziness, numbness of tingling. Mother states pt had recent surgery; abdominal drain insite. Pt states she felt something pull on drain. Denies pain around insertion area on palpation. Pt collared. Pt stable enroute.”[8]
Bega District Hospital
[8] Insurer’s documents p 45.
[BON] was assessed by Dr Tormey at Bega District Hospital on 10 November 2016 following the accident.[9] The discharge summary reports:
[9] Insurer’s documents p 244.
“Healthy 8yo female passenger in MVA.
…
Recent insertion of a right colonic access catheter to treat colonic dysmotility and resulting constipation with direct infusion of laxatives and water – doing well.
She was in a child seat in the rear of a vehicle driving by her mother when it skidded on a wet road, travelling backwards down an embankment striking a tree rear-first. No rollover. No LOC. She self-extracted and had some very mild right paravertebral pain in the neck. Well since.
Trauma survey:
Bright and well
No rest pain
Normal obs
Head, face, cervical spine, thoracolumbar spine uninjured
Torso, lung fields NAD
Abdomen – caecal catheter in situ, no displaced, no abdominal discomfort anywhere
Limbs, neuro NAD
Collar off – unrestricted, full painless ROM
No traumatic injuries identified or suspected. Home with review as needed.”
[BON] attended SERH on 2 December 2016. The history recorded by Dr Tormey was as follows:
“fall down 3 steps yesterday
Onto arms, legs and headstrike, no LOC
Continued to play at school
Mobilising well
Since yesterday, parents unable to flush caecal feeding tub
Worsening abdo pain to moderate
Nausea and vomiting, BNO for 5 days
No headache
No pain on mobilising.”[10]
[10] Insurer’s documents p 226.
A discharge summary dated 2 December 2016 reported [BON] presented with abdominal pain, vomiting and bowels not opening.[11] The appendicostomy tube was not flushing. She had a low grade temperature with leucocytes in her urine. She had a low grade fever and slight sinus tachycardia of 130. It was noted two months earlier she had undergone an appendectomy tube for chronic constipation. She was commenced on IV ampicillin, gentamicin and metronidazole and transferred to the Canberra Hospital under Dr Malecky for assessment of a blocked or displaced appendectomy tube.
Bega Valley Medical Practice
[11] Insurer’s documents p 219.
The first attendance at Bega Valley Medical Practice following the accident was a consultation with Dr Grace Daley on 1 December 2016 for the purposes of a mental health plan review.[12] Dr Daley reported the skin appeared normal around the stoma with catheter in situ in the right lower abdomen. Dr Daley observed an abrasion to the left forehead and also reported:
“Also today fell down a flight of stairs at school
- Hit her left forehead
- Thinks she tripped on the stairs
- Was with a friend of hers, on the way to the toilet
- Discussed also when mum was out of the room; no inconsistences in story, no concerns about non-accident injury”.
[12] Insurer’s documents p 1378.
On 2 December 2016 Dr Daley recorded “walk-in patient (cousin and mother here for consults)”.[13] On examination she reported the abdomen was not distended, soft but tender to light palpation and tender to percussion. Bowel sounds present, frequent and high-pitched. Stoma skins surface appeared clean, not infected. She recorded the following:
[13] Insurer’s documents p 1379.
“Well on Tuesday: appendicostomy was flushing well and bowels were opening every day.
Fell at school down stairs yesterday (Thursday), with bruises and abrasions to forehead and limbs.
Yesterday: unable to flush the appendicostomy catheter.
Bowels not open since Wednesday.
Vomiting and fever this morning, and poor appetite, and generalised abdominal pain overnight.
Febrile here in rooms.
Urine sample collected at rooms: positive for nitrites and leucs
?Bowel obstruction or UTI
Need to go to ED for further evaluation and possibly rehydration.”
Dr Daley referred the claimant to SERH.[14] On 5 December 2026 Dr Daley was advised the claimant was taken to the Canberra Hospital and had a bowel perforation.
[14] Insurer’s documents p 1757.
In her clinical record of 15 September 2017 Dr Daley stated the claimant was not seen at her practice regarding the motor vehicle accident.
Canberra Hospital
The claimant presented to the Emergency Department on 26 October 2016 with concern that her recent appendicostomy had retracted inward.[15] The claimant was reviews by the paediatric surgery team who felt the stoma looked healthy and normal. The claimant and her grandmother were reassured that what was retracted was probably the balloon which was then in the bowel lumen as it should be. Otherwise, it was considered the appendicostomy was working well and the stoma site was well healed.
[15] Insurer’s documents p 1555.
On 2 November 2016 [BON] was seen in the Paediatric Surgical Outpatient Clinic following the laparoscopic appendicostomy done on 14 October 2016.[16] It was reported that she was doing really well with 200ml of washout daily via the appendicostomy.
[16] Insurer’s documents p 1556.
[BON] was admitted to the Canberra Hospital on 3 December 2016 and was discharged on 15 December 2016.[17] The presenting history was reported as follows:
“[BON] presented with abdominal pain, dysuria, and fevers in the context of a recent fall 2 days prior and having been in a low vehicle MVA 3 weeks prior. Initially [BON] was seen in Bega District Hospital and her appendicostomy was unable to be flushed.”
[17] Insurer’s documents p 516, 1559 and 1573.
The appendicostomy was unable to be flushed. Perforation of the caecum was confirmed by methylene blue dye via appendicostomy and repaired surgically at laparoscopy-laparotomy on
3 December 2016.
Canberra health services paediatric registrar
In a report dated 9 January 2019 Dr Douglas Greet, Paediatrics Registrar noted the following background history:
· chronic constipation;
· appendicostomy formed 2016, and
· low-speed car accident resulting in perforated cecum 2016, treated with laparotomy and oversew of cecal perforation.[18]
[18] Insurer’s documents p 988.
He was reporting in the context of [BON] relocating to Queensland. He reported since the 2016 surgery [BON] had been well although she had had issues with infections of her stoma site as well as problems with mucous leakage from the stoma site, although this was largely resolved. Dr Greer reported [BON] was managing her own Chait, flushing daily with no soiling. He reported she occasionally needed to do a double dose on weekends to completely wash out. He reported she had a soft non-tender abdomen.
Radiological and medical imaging
Abdominal X-ray, 2 December 2016:[19]
“Small air-fluid levels in loops of small bowel without abnormal dilatation, non-specific appearance. Prominent faecal material within the sigmoid colon but no abnormal colonic dilatation.”
[19] Insurer’s documents p 231.
Abdominal ultrasound, 2 December 2016:[20]
“Findings: No free peritoneal fluid or pelvic collections detected. The tube insertion in the right iliac fossa is noted and there is pain in this region. However, no fluid collection visible. There is a balloon related the tubing in the right iliac fossa which appears to be contained within bowel. This examination cannot determine whether or not the tube is functioning. …
The kidneys appear normal. There is no hydronephrosis. The gallbladder and biliary tree also appear normal.
Comment: No abnormality related to the appendicostomy detected.”
[20] Insurer’s documents p 232.
X-ray abdomen, 30 August 2017:[21]
“Clinical notes: Linogram required, to check patency of appendicostomy tube.
Report: The control film shows coiled catheter tubing over the right lower quadrant. Contrast has been instilled into the tubing on the subsequent X-ray filling the right sided large bowel, suggesting tube patency. No evidence of the contrast material into the peritoneal cavity.”
[21] Claimant’s documents p 13.
Ultrasound abdominal wall, 15 August 2024:[22]
“No fluid collection identified in the anterior abdominal wall.”
Medico legal reports
[22] Insurer’s documents p 1478.
Dr John McKee, surgeon
Dr McKee assessed the claimant at the request of the insurer and provided a report dated
29 April 2019.[23][23] Insurer’s documents p 23.
He noted a caecal catheter had been in situ since 13 October 2016 to provide right colonic access to treat colonic dysmotility and resulting chronic constipation since birth.[24] He noted following the accident on 10 November 2016 [BON], then aged 8 years had complained about very mild right paravertebral neck pain. He noted an Ambulance Officer reported the “patient states she felt something pull on her abdominal drain” although she “denies pain around the insertion area on palpation”. On examination in the Emergency Department the abdominal examination revealed the caecal catheter had not been displaced and there was no abdominal discomfort. No significant injuries were suspected and she was discharged home.
[24] Clinical notes re admission 13 October 2016 – 18 October 2016 insurers documents p 722.
Dr McKee reported, according to the claimant’s mother, [BON] experienced abdominal pain following the accident. He noted she attended Dr Daley on 1 December 2016 in respect of a Mental Health Plan review. Dr Daley noted “she fell down a flight of stairs at school today, hitting her left forehead”.
On 2 December 2016 Dr Daley observed that on 29 November 2016 [BON] had been well and her appendicostomy had been flushing well and her bowels had been opening daily. There is a notation that she “fell at school downstairs yesterday” and that yesterday her mother had been unable to flush the appendicostomy catheter. She had been vomiting, she had been febrile with a poor appetite and had been complaining about generalised abdominal pain overnight. A urine sample was positive for nitrites and leucocytes. Dr Daley observed the abdomen had not been distended, it had been soft but tender to light palpation and high pitched. Dr Daley referred
[BON] to the South East Regional Hospital (SERH).Interestingly Dr McKee reported both the claimant’s mother and grandmother denied there had been an accidental fall at school. Ms Broughton, the claimant’s mother stated her daughter had been feeling unwell and dizzy and her friend accompanied her to the sick bay when on the second last of five steps she must have “fainted” and not actually fallen over. Her friend caught her and after calling out to the teacher [BON] was assessed in the sick bay. It was suggested there may have been some confusion with a cousin, Elijah who had had a fall resulting in a large forehead swelling and multiple abrasions.
Dr McKee reported at SERH Dr Tormey observed [BON] had been experiencing abdominal pain, vomiting and no bowel action “for one day after the fall” and that the “tube was not flushing”. The clinical history and findings were consistent with urinary tract infection and [BON] was transferred to the Canberra Hospital. The Hospital Discharge Summary reported “[BON] presented with abdominal pain, dysuria and fevers and in the context of a recent fall two days prior and having been in a low vehicle speed MVA three weeks prior”.
At the Canberra Hospital a perforation of the anterior aspect of the caecum adjacent to the ileocaecal junction was repaired and after a thorough peritoneal lavage the abdominal wall was closed. [BON] was discharged on 15 December 2016.
Dr McKee reported [BON] experienced daily abdominal discomfort mainly located about the stoma associated with clothes rubbing the Chait button. She undertook anterior colonic washouts on a daily basis and once a week a full “flush” is administered. [BON] was aware of intermittent faecal incontinence. She no longer experienced any frequency of micturition or dysuria and only rarely does she experience urinary incontinence.
Dr McKee found the accident caused an aggravation of the pre-existing constipation, resulting in a caecal perforation, but the aggravation had ceased.
Dr McKee found the claimant had no digestive system permanent impairment as a result of the accident related caecal perforation from which she had completely recovered. He concluded the ongoing daily colonic washouts are for the long-standing history of constipation prior to the accident. As colonic function had returned to its pre-accident level, there were no residual symptoms or signs resulting from the caecal perforation and the abdominal scar was asymptomatic he found no colonic impairment according to AMA 4, Table 3, page 241 of the AMA 4 Guides and assessed 0% WPI.
SUBMISSIONS
Insurer’s submissions
The insurer provided submissions dated 9 August 2024.[25]
[25] Insurer’s documents p 4.
The insurer submits Medical Assessor Garvey referred to the incorrect Tables in assessing WPI. It is noted that Medical Assessor Garvey referred to table 13, page 3/51 and table 11, page 3/48 for unilateral sensory deficits. The insurer submits this is incorrect where table 13 is related to upper extremity impairment due to injury to C5 to T1 and table 11 is for rating upper extremity functions.
Further, the insurer submits it is unclear how the Medical Assessor assessed 3% WPI noting that table 13 does not mention 3% for any sensory nerve deficits. It is also submitted it is unclear how he assessed the WPI to be 2% for nerve T10 to L1 totalling 8%.
The insurer also notes that in the Permanent Impairment Table Medical Assessor Garvey refers to table 68 on pages 3/88-3/89. This insurer submits this is incorrect and inconsistent with the assessment of WPI under tables 13 and 11. Table 68 is for impairments from peripheral nerve injuries and does not mention the anterior cutaneous nerve.
The insurer relies upon the report of Dr McKee dated 29 April 2023. He found no colonic impairment according to table 3, page 241 of the AMA 4 Guides and assessed 0% WPI. The insurer submits this is correct and is consistent with the findings of Medical Assessor Garvey who also found no signs and symptoms of colonic disease and no limitations of activities and no systemic functions and no sequalae therefore meriting 0% WPI under the AMA 4 Guides.
The insurer relies upon the report of Dr McKee who found the claimant had completely recovered from the caecal perforation. He considered the ongoing daily colonic washouts are for the long-standing history of constipation which occurred prior to the accident. Dr McKee also found on palpation of the abdomen no tenderness, no masses, no palpable faeces and no groin herniation. This is consistent with the findings of Medical Assessor Garvey who also found moderate palpation of the abdomen was normal in all quadrants and there was no rebound tenderness or cross rebound tenderness. The insurer submits it is unclear upon what basis Medical Assessor Garvey reached a diagnosis of anterior cutaneous nerve syndrome from T10 -L1 on each side.
Claimant’s submissions
The claimant provided undated submissions in response to the application for review.
The claimant submits Table 11 on page 48 and Table 13 on page 15 of the AMA 4 Guides are used to assess not only permanent impairment of the upper extremity but also pain or sensory deficit resulting from peripheral nerve disorders.
The claimant submits that the conclusion of Medical Assessor Garvey differed from that of
Dr McKee does not bespeak error.
MEDICAL EXAMINATION
[BON] was examined at the Personal Injury Commission’s medical suites at 1 Oxford Street, Darlinghurst by Medical Assessor Carter at 2.00pm on Tuesday 4 February 2025. She was accompanied by a chaperone, her grandmother. The reason for the re-examination was explained to her in detail.
The history of the motor vehicle accident was reviewed with her and was consistent with the history noted in the other documents. At the time of the accident, [BON] was wearing a lap seat belt over her right shoulder. The trauma from the accident resulted in a split bowel, and following successful surgery, she remained an inpatient until May 2017.
At the assessment by Medical Assessor Garvey on 25 June 2024, he noted that [BON] had symptoms consistent with anterior cutaneous nerve entrapment over T10 to L1 distribution of the anterior abdomen.
At the examination by Medical Assessor Carter on 4 February 2025, [BON] stated that she felt well and that she runs or walks for one hour most afternoons. Her stoma was functioning normally. She empties her bag once per day.
[BON] denied any abdominal pains or sensory symptoms such as dysaesthesia, paraesthesia or numbness over the abdomen, except for some tingling over the horizontal scar in the right iliac fossa.
Examination of the abdomen was unremarkable apart from a 10cm scar in the right lower abdomen above her stoma. There was no muscle guarding, and no abnormalities detected on palpation.
Light touch sensation over the abdomen was normal, as was her ability to differentiate between sharp and blunt touch.
Thus, there were no findings to suggest a neuropathy involving any of her anterior cutaneous nerves over the abdomen. There was no impairment of her ability to undertake activities of daily living.
PANEL FINDINGS
Diagnosis and causation
The claimant sustained injury to the abdomen, namely an anterior caecal perforation requiring surgery caused by the accident.
The Panel finds the claimant did not sustain anterior cutaneous nerve entrapment of the abdomen caused by the accident.
ASSESSMENT OF PERMANENT IMPAIRMENT
Colonic impairments are assessed under Table 3 on page 241 of the AMA 4 Guides. However, where [BON] has no signs and symptoms of colonic disease, no limitation of activities, no special diet or medication and no systematic manifestations or sequalae following the surgical procedure as a result of injury caused by the accident the Panel finds the claimant has sustained a 0% WPI for colonic impairment.
The Panel did not find any symptoms or signs of a neuropathy involving the abdominal wall, or any reduction in her activities of daily living. Where the Panel finds no anterior cutaneous neuralgia of the abdominal nerves there is no related assessable impairment.
CONCLUSION
The Panel revokes the certificate of Medical Assessor Garvey dated 27 June 2024 and issues a new certificate determining that the following injuries were caused by the motor accident and give rise to a WPI that is not greater than 10% and is 0%:
· abdomen – anterior caecal perforation requiring surgery.
DE-IDENTIFICATION
In my capacity as a Member of the Personal Injury Commission I direct the published decision be subject to de-identification pursuant to s 132 of the Personal Injury Commission Rules 2021 having regard to the safety, health and wellbeing of the claimant where she was a child at the time of the motor accident and where she is currently under the age of 18 years.
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