Insurance Australia Limited t/as NRMA Insurance v Kirkpinar
[2024] NSWPICMP 258
•26 April 2024
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Insurance Australia Limited t/as NRMA Insurance v Kirkpinar [2024] NSWPICMP 258 |
| CLAIMANT: | Musa Kirkpinar |
| INSURER: | NRMA |
| REVIEW PANEL | |
| MEMBER: | Hugh Macken |
| MEDICAL ASSESSOR: | Michael Couch |
| MEDICAL ASSESSOR: | Drew Dixon |
| DATE OF DECISION: | 26 April 2024 |
| CATCHWORDS: | MOTOR ACCIDENTS – Review of medical assessment; total hip replacement; documented pre-existing symptomatic permanent impairment; left sided hemiplegia; pre-existing medical condition; bicyclist hit by car; significant pre-accident medical history; method of assessment; restricted range of motion; Held –Panel revokes the certificate of Medical Assessor Alan Home; non-accident-related impairment. |
| DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION 1. The Panel revokes the Certificate of Medical Assessor Alan Home dated 12 April 2023. The claimant has suffered a physical injury being an injury to his lumbar spine giving rise to an impairment of 5%. The claimant suffered a total hip replacement of his left hip giving rise to a current whole person impairment of 20%. A deduction of 10% WPI is made because of documented pre-existing symptomatic permanent impairment, leaving a net impairment of 10% caused by the accident. The claimant suffered a soft tissue injury to the cervical spine giving rise to a whole person impairment of 0%. The claimant’s whole person impairment of 15% is greater than 10% whole person impairment. |
STATEMENT OF REASONS
INTRODUCTION
Musa Kirkpinar (the claimant) is a 59-year-old man who was injured in a motor vehicle accident on 16 July 2011 when the bicycle he was riding was struck from behind by the insured’s vehicle. The claimant requested the insurer concede that the physical injuries he sustained exceed the 10% whole person impairment (WPI) threshold established by the legislation. The insurer declined to make this concession. The claimant then sought an assessment of WPI which was the subject of final assessment by Medical Assessor Home dated 12 April 2023 which found that the claimant had sustained a WPI of 20%. In particular the claimant underwent a left hip replacement as a consequence of the injuries sustained in the motor vehicle accident. This decision was the subject of a determination of an application for a review of a medical assessment by the President’s delegate Rachael Brittliff dated
14 June 2023. This certificate determined that there was a reasonable cause to suspect that the medical assessment was incorrect in a material respect. In issue was whether Medical Assessor Home adequately considered whether the surgery required by the claimant would have been required regardless of the injury sustained in the accident. The matter was then forwarded to this Review Panel.
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission).
Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application.
The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
STATUTORY PROVISIONS/GUIDELINES
The determination of a threshold injury constitutes a medical assessment matter pursuant to Schedule 2, cl 2 of the Motor Accident Injuries Act 2017 (MAI Act).
A medical assessment matter is determined in in accordance with Division 7.5 of the MAI Act by a Medical Assessor.
The applicant insurer has sought a review of a certificate of Medical Assessor Home and submits that the medical material does not support a finding that the claimant sustained a WPI threshold injury.
The Panel conferred on 6 September 2023 and considered that the primary issue of contention between the parties is whether or not the motor vehicle accident caused or hastened the need for the left hip replacement which the claimant has undergone. It was also noted that an assessment of this was made more complicated by an unrelated disability consequent to a stroke which left the claimant with hemiplegia. It was determined that the claimant had needed to be examined and this was scheduled for 30 October 2023 at the Commission’s rooms by Medical Assessor Couch.
At that assessment it was noted that the claimant has had a further stroke in late 2022 (since Medical Assessor Home’s examination) which left him with left sided hemiplegia and an impaired memory. The assessment took place over a period of approximately 70 minutes. The claimant attended with his elder brother, Muharred Kirkpinar.
The Panel considered all the material contained in the application and reply which were before Medical Assessor Home together with the material which was accepted by the President’s delegate but not considered by Medical Assessor Home. These documents included:
(a) further submissions;
(b) NSW Ambulance records;
(c) Dr David Pugh clinical notes;
(d) City West Medical Centre clinical records;
(e) Dr Ameer Ibrahim clinical records;
(f) Dr Velibor Todorovic clinical records, and
(g) Mr Maher report dated 27 April 2019.
Review of pre-accident medical records
In 1993, Royal Prince Alfred Hospital (RPAH) notes describe facial fractures from an assault.
In January 2001, RPAH emergency admission after being found unconscious with head injury. Initial GCS recorded as 7-8.
In December 2008, RPAH documents detail a left-sided hemiplegia due to an acute right internal carotid artery occlusion on 17 December 2008. Initially planned long saphenous graft bypass was abandoned because of technical/anatomical problems, and carotid endarterectomy performed. Complicated by partial seizures-treated with anticonvulsant. He had several months inpatient rehabilitation at Balmain Hospital, and was able to return to live alone, with assistance. He was walking without a stick.
In May 2009, RPAH physiotherapist noted that there was difficulty using left upper limb, including playing bass guitar.
On 5 May 2009, RPAH neurology registrar Dr Delcourt found slight incoordination and weakness in left hand and preserved sensation.
On 7 December 2010, Dr Delcourt, neurology registrar documented dexterity problems in the left hand and complaints of headache. There was some residual stiffness in the left leg although his gait was steady with good cadence.
On 11 February 2011, RPAH rehabilitation specialist A/Prof Aggarwal noted that the claimant walked with a spastic left leg gait. There was marked bradykinesia of fine finger movements. On 9 March 2011- A/Prof Aggarwal recorded left hip pain for the last three months, sharp and shooting when he walks with throbbing sensation when seated. Occasional pain in the left leg posteriorly to the big toe and some numbness and a burning sensation. There was no complaint of back pain. X-ray had shown minimal degenerative changes in the left hip. At examination, good left hip motion although abduction was recorded at 20° and flexion at 80°. Power of hip flexion was normal. There was mild tenderness about the lateral left hip. There was further imaging requested to exclude lumbar spine pathology. He prescribed Mobic, with Panadol Osteo if needed.
On 1 March 2011, Dr Sam Lyer GP: “Getting pain in his left hip for a few months……”
On 2 March 2011, Dr Iyer: “X-ray of the pelvis and hips reports bilateral hip degenerative changes. More severe in the left where there is focal marked joint space narrowing. There are osteophytes bilaterally and suchondral cysts….”
On 10 June 2011, David Pugh physiotherapist described presentation for physiotherapy with worsening left hip pain from February 2011, impairing his efforts in the gym and keeping him away at night. There was an obvious loss of passive range of motion. The examination recorded by Mr Pugh revealed absolute loss of internal rotation when measured with the hip at 90 flexion, with positive labral signs and pain with compression. MRI scans showed wide-spread deterioration. He had been advised that he was not an ideal candidate for total hip replacement at this stage as his motor control still has the capacity to improve.
On 14 June 2011, Dr Ibrahim sports physician, one month before the motor vehicle accident, details recent increasing pain in the left hip radiating to the groin. The examinee walked with an antalgic gait. There was measured flexion of the hip to 90°, -10° of internal rotation and 30° of external rotation, similar to the right side. He was given an ultrasound-guided injection of steroid and local anaesthetic.
Review of post-accident medical records
The ambulance report of 16 July 2011 documents an accident between a car and a push-bike. Patient on a push-bike complaining of pain in lower back, abrasions and swellings, lower right leg, quite agitated. Patient reported a previous stroke 2-5 years before with left-sided defects. It appears he was struck on his right lower leg. Patient guessed speed of car as 50-60kmph.
The RPAH record of 16 July 2011 details the patient was knocked off his bike, denied loss of consciousness, complaining of pain in the right leg and pelvis. The detailed admission summary documents that Mr Kirkpinar is 47-year-old gentleman brought into RPAH by ambulance following a collision cycling with a car travelling at low speed. The patient reported being hit by the car and falling to the ground. Pain in the lower lumbar spine on the left, also pain in the right lower limb posteriorly. Cervical spine was cleared. There was normal range of motion of the cervical spine. There was no tenderness in the lumbar spine to palpation. There was administration of analgesia.
The Personal Injury Claim Form dated 15 August 2011 documents details of the motor vehicle accident with injuries listed as right leg including knee, left leg, left side of body, left shoulder, cervical spine and shock.
On 25 October 2011, RPAH neurologist Prof Anderson: “He had some setbacks to recovery, having been knocked off a pushbike by a car in July this year further injuring his hip and knee on the left side…….”
On 2 November 2011, Dr Ibrahim sports physician notes some mild pain in the left hip. He was given cortisone which helped him in June. Unfortunately, he was then hit by a car on a bike which set him back a bit. He still feels better than before the initial cortisone injection done in June. He was given a second injection of a Kenacort and local anaesthetic.
On 19 July 2011, the motor vehicle accident was recorded by Dr Iyer as follows:
“Was in a motor vehicle accident on 16 July. Was cycling when a car ran into him. No loss of consciousness. Seen at RPAH. Now complaining of pain in the dorsum of the left hand and wrist. Pain in the left elbow. Pain in front and both sides of the neck, left shoulder, left chest, lower back, left ankle and left shin. There is restricted motion at the shoulder and pain on rotation of the neck was recorded. The patient was prescribed Endone.”
On 26 July 2011, Dr Iyer documents a lot of pain in the right lower back spreading to the knee and on 2 August 2001, Dr Iyer reports pain in the left lower limb after the accident.
On 12 August 2011, Dr Iyer records complaints of pain in the left hip going down the left lower limb to the toes, pain with. He underwent an MRI scan of the left hip on 30 June and was awaiting to see Prof Anderson. Also waiting to see the Pain Clinic at RPAH. Taking Panadol Osteo. Left hip, left lower limb pain is recorded 19 September 2011. A lot of pain in the left groin and left lower back recorded 26 October 2011. It is documented that he did not have left groin and left lower back pain prior to the motor vehicle accident and pain was exacerbated by walking for 10 minutes.
On 2 August 2012, Dr Purcell, anaesthetic registrar at the Pain Management Centre detailed ongoing left hip pain and requiring a crutch to mobilise. There had been progression of degenerative changes in the left hip with full thickness cartilage loss on both sides of the joint anterolaterally and progression of subchondral sclerosis and oedema. Hip replacement was discussed. There is a recommendation for use of strong analgesia.
The report from A/Prof Aggarwal documents the history including pre-accident pain and imaging of the left hip, then the motor vehicle accident recorded July 2011. Since then, increasing left groin and hip pain, further MRI imaging in 2012 showing a progression of degenerative changes. At that stage he recommended that due to the significant progression of the left hip degeneration, that he would benefit from a total hip replacement.
Subsequent correspondence from treating practitioners document gradual worsening of left hip symptoms, leading to eventual total hip replacement (THR) in September 2016.
The Panel has carefully considered the various medicolegal reports, which were also reviewed in detail but Medical Assessor Home in his Certificate of 4 April 2023. The various opinions are noted, but do not significantly affect the Panel’s conclusions.
The Panel notes that Medical Assessor Long, in his Certificate of 5 May 2015 (much closer to the date of accident, and when Mr Kirkpinar’s memory was apparently satisfactory), accepted causation of an aggravation of pre-existing osteoarthritis of the left hip, although he failed to make a deduction for pre-existing impairment.
Pre-Accident medical history and relevant personal details
Mr Kirkpinar said that his family emigrated to Australia from Turkey when he was aged 6 years. He had grown up in Sydney. He attended primary school in Newtown and left high school after Year 10, having obtained his School Certificate. He said that school performance was “OK”. He vaguely recalled a fall in 2002 without remembering all the details. (Because of his obviously poor memory, I considered it appropriate to ask his brother a few questions – he said that he had been admitted to hospital but after this returned to work as a panel beater).
He completed his apprenticeship as a panel beater and had worked in this trade until having a stroke in 2008 (at the age of 44 years). He developed a left hemiparesis, subsequently underwent a carotid endarterectomy at RPAH and after rehabilitation made a generally good recovery, although he still had some weakness in the left leg and loss of dexterity in the left hand.
Mr Kirkpinar said that he had not managed to return to work since the 2008 stroke and had been in receipt of the Disability Support Pension (DSP). After recovering quite well from the stroke, Mr Kirkpinar became mobile and quite physically active, walking without a stick and regularly using a pushbike. He had also resumed driving a manual transmission car until becoming more disabled after a recent stroke (not apparently mentioned in the documents available to the panel) in late 2022. Since then, he had had more difficulty walking, having to use a stick, and his memory was a lot worse.
After Mr Kirkpinar’s arrival, it became obvious that his memory was much worse than when he had attended Medical Assessor Home in November 2022. On questioning, he could not remember the full chronology of his hip symptoms or any symptoms prior to the subject motor vehicle accident.
History of the motor accident
Although his memory was obviously very poor, Mr Kirkpinar did appear to remember the bicycle accident. He said that he had ridden his bike to a fruit shop in Stanmore Road to get some vegetables. He realised his had left his wallet at home and left to go and get it. He was riding on Stanmore Road (the main road) near the intersection with Holt Street. He saw a car coming out of the side road. He stated, “I made eye contact with the guy, he gave me the nod, I thought ‘sweet’, and I went to go…”.
He thought that another car travelling in the same direction on Stanmore Road had struck him-he was knocked off his bike but remained conscious. His bike was severely damaged and not repairable. He was taken by ambulance to RPAH where he was assessed, including imaging, and discharged home later that day.
History of symptoms and treatment following the motor accident
Mr Kirkpinar did recall being a lot worse with his mobility after being knocked off his bike, but because of his memory problems, could not give more specific details. I considered it appropriate to note the spontaneous comment from his brother that he had complained more about his hip after this accident. Mr Kirkpinar and his brother explained that he had sustained a further stroke around Christmas of 2022, again affecting his left side. Since then, his memory has been a lot worse. He is able to walk but with more difficulty and uses a stick now.
Current symptoms
When I asked Mr Kirkpinar what areas of his body he thought had been affected by the 2011 accident, he replied “my whole left side” including his left hip. He described current symptoms as follows:
“1. Left hip
He described pain, pointing to the left groin. He described pain as continuous (his brother confirmed that he does often complain of left hip pain). For the purpose of assessing his total hip replacement (THR) results, I went through Table 65 on Page 87 of AMA4 with Mr Kirkpinar. I made allowance in the scoring for the effect of his strokes.
He uses a stick outside, but not in his unit. He described moderate, occasional pain, and he can walk about six blocks. His one-bedroom unit is on one level and he only has to negotiate one step. He does need to use a handrail on stairs. He has some difficulty putting on shoes and socks, can sit for an hour in any sort of chair. Prior to his most recent stroke he was able to use public transport, although he no longer does so.2. Neck
I asked Mr Kirkpinar if he had any problems with his neck and he denied these (his brother confirmed that he had not heard Mr Kirkpinar complain of neck symptoms.)
3. Low back
Mr Kirkpinar described his low back as ‘uncomfortable but bearable’. On questioning, his brother said that he could not remember if he had complained about low back pain, and that he mainly complained about his left hip.
4. Right hip
On questioning, Mr Kirkpinar described his right hip as ‘pretty good but very uncomfortable because of what I’ve had on the left side’. On questioning, his brother said that he had not heard him complain about his right hip.”
Present activities
As noted above, Mr Kirkpinar had not worked since the stroke in 2008. He also told me that he had previously been a keen musician, playing in various pub bands. He is single and lives alone in a one-bedroom unit in Newtown. Carers come in daily. He eats pre-prepared meals which he heats in a microwave. He no longer leaves the unit much on his own. Mostly a carer accompanies him, although he can go out to buy a newspaper on his own. (He commented that prior to the most recent stroke, reading the newspaper and doing crosswords helped to keep his brain functioning – I understood that he can no longer manage crosswords since his most recent stroke.)
Current treatment
Because of his poor memory, Mr Kirkpinar could not detail all his medications to me. He thought that he was taking about four Paracetamol a day. (I understood from Mr Kirkpinar and his brother that he receives weekly medication in a Webster pack and that there are five or six different medications.)
Physical examination
Mr Kirkpinar walked into the examination slowly with a very abnormal gait, using a stick in his right hand. He was wearing tracksuit pants and a top, socks and slip-on flat shoes. Height was 176cm and weight 96kg (I note that in November 2022, Medical Assessor Home weighed him at 115 kg).
He spoke good English with an Australian accent. He was cooperative throughout and appeared quite straightforward. Affect was apparently within normal limits and he made good effort and was cooperative throughout. There was no evidence of abnormal pain behaviours, self-limitation or inconsistency.
As noted above, detailed history taking was very much limited by his poor memory. He kept repeating “I do pretty well considering” and also several times said, “my memory is pretty good”. (However, his brother on several occasions confirmed there had been a big change in his memory since the most recent stroke around Christmas 2022.)
Mr Kirkpinar was able to sit in a normal office chair during our interview, could sit on the examination couch, lie supine for examination of his lower limbs, and then sit up again unaided. He told me that he was not wearing underpants under his tracksuit and I was able to examine his lower limbs satisfactorily with these on, rolling up the loose legs to above his knees.
Cervical spine
There was a slight tendency to forward protrusion of the head and neck (poke neck). He did not report any tenderness to palpation over the cervical spine. Active cervical spine flexion was full, whereas extension was about half of normal, with some tightness described rather than pain. Rotation was full to the right and two-thirds of normal to the left, which was again described as tight. Lateral flexion was one-third of normal to the right and half of normal to the left.
Thus, there was dysmetria of cervical spine movements. There was no muscle guarding or spasm and he was not describing non-verifiable radicular complaints in either upper limb. Examination of the upper limbs was consistent with his previous stroke but there was no specific evidence of cervical radiculopathy.
Lumbosacral spine
While standing and walking, Mr Kirkpinar had a forward stoop at the waist. On palpation he did not report any tenderness over the lumbosacral spine. On measuring AROM with him standing, there was dysmetria – flexion was almost full and able to reach fingertips to his knees, but he could not extend beyond the neutral position, complaining of low back pain when he tried.
Upper extremities
Mr Kirkpinar confirmed that he was right-handed. The right upper arm measured 36.5cm in circumference, the left 35.5cm, the right forearm 30.5cm and the left 30cm. The left biceps jerk was definitely brisk compared to the normal reflex on the right. Triceps and brachioradialis reflexes were normal and unremarkable on the right, but I could not obtain them on the left.
Proximal power in the left upper limb was quite good, grip strength was fair, but power of intrinsic muscles was definitely reduced. Tone was increased (spasticity) in the left upper limb and on finer movements the left hand was definitely slow and clumsy – all these changes are consistent with his previous left-sided strokes.
Lower extremities
The right (dominant) calf measured 37cm and the left 35cm. Straight-leg-raising was 40 degrees bilaterally. Knee jerks were normal and approximately symmetrical. The right ankle jerk was normal and the left pathologically brisk. The right plantar response was flexor and the left extensor. Power of all muscle groups in the right lower limb was normal (5/5). There was moderate weakness of all muscle groups in the left lower limb (4/5).
AROM of the hips was measured with the goniometer as follows:
Right Left Flexion 80° 90° Extension 0° 0° Abduction 30° 30° Adduction 20° 30° Internal Rotation 0° 30° External Rotation 30° 40°
I noted a 30cm long, pale, lateral scar over the left hip, and incidentally a 50cm long scar from above the right knee down to the ankle (from a previous vein graft donor site).
Rating the left THR from Table 65 of AMA4, based on my examination, I assessed 59 points from Table 65. There was no loss of points from Section D (deformity) based on my examination. Note that when assigning the points rating, I did make allowance for his left-sided stroke. From Section E (range of motion), there were 3 added points. This gives a total of 62 points which is very close to the assessment of rating of Assessor Home in November 2022 of 60 points. This places him firmly in the “fair” range, giving 20% WPI.
Panel conclusions
Assessment was made difficult by Mr Kirkpinar’s recent further stroke, and particularly very poor memory.
Assessment is also made more difficult by the 12 years that have elapsed between the date of accident and the Panel’s consideration of this matter.
Having carefully considered all the information available, the Panel considers that, on the balance of probabilities, the accident on 16 July 2011, in which Mr Kirkpinar was knocked off his pushbike by a car, was a contributing cause, which was more than negligible, to aggravation of pre-existing osteoarthritis in his left hip. The Panel considers that this resulted in his needing THR earlier than would otherwise have been the case.
Rating of his left THR is “fair” (AMA 4 Tables 64 and 66), giving 20% WPI. Like Medical Assessor Home, the Panel considered whether there should be a deduction for pre-existing symptomatic impairment of the left hip (Motor Accident Guidelines 6.31-6.33). Medical Assessor Home had noted left hip flexion of 80 and abduction of 20 recorded at RPAH on
29 March 2011. Based on these he calculated a pre-existing WPI of 4%. (Referring to AMA4 Table 40, the Panel noted that flexion of 80-100, or abduction of 15-25 are in fact classified as “Mild” impairment (2% WPI). (Only one of these can be used-they are not additive)After extensive deliberation the Panel considered that 4% WPI was probably an inadequate deduction for pre-existing impairment of the left hip. Both medical members agreed that the most specific (and therefore desirable) method of assessment would be using AMA 4 Table 62, “Arthitis Impairments Based on Roentgenographically Determine Intervals”. The recommended imaging is standing weightbearing plain X-rays. These were not available before the accident, but MRI dated 1 July 2011 was reported:
“There is no bone marrow oedema pattern in the pelvis or proximal femora. There is no significant hip joint effusion. At the left hip joint, there is prominent elongation of the acetabular rim. There is degenerative fraying of the acetabular labrum. There is advanced full thickness peripheral cartilage wear over the acetabulum and also over the peripheral weight-bearing surface of the femoral head. There is early subchondral cystic change in the anterior and superior acetabular margin. There is marginal osteophytic bony spurring of the femoral head. At the left greater trochanter, the gluteal tendons are intact with no tear or significant enthesopathy and no trochanteric bursitis. There is a small joint effusion. At the right hip, there is similar acetabulum morphology with peripheral acetabular cartilage wear and subchondral cystic change in the acetabular rim. There is a tear at the base of the anterosuperior acetabular labrum from which there is arising a paralabral cyst, which is dissected outside the anterolateral capsule and extends superiorly adjacent to the anterior iliac crest. The paralabral cyst measures 4.5 cm x 2.2 cm.”
Based on this, the two medical members agreed that the most likely cartilage interval would have been 1mm, giving 10% WPI from Table 62. The above MRI findings do not suggest
0mm (zero) cartilage interval, which would give 20% WPI. Accordingly, the net impairment resulting from the subject accident and hastening of THR is 10%.
Findings in the lumbosacral spine are very similar to those of Medical Assessor Home, with quite marked dysmetria, assessed as DRE Lumbosacral Category II. The Panel assessed the claimant’s lumbosacral to be DRE Category II and giving rise to a WPI of 5%.
There was some restriction of AROM in the right hip, probably due to osteoarthritis-there was evidence of this on a bone scan. The Panel did not consider that there was sufficient evidence to attribute this to the accident.
There was dysmetria in the cervical spine, with loss of extension and rotation to the left (Medical Assessor Home had found no dysmetria). Although Medical Assessor Home obtained a history of constant right-sided neck pain in November 2022, on this occasion
Mr Kirkpinar denied pain, and his brother said that he had not heard him complain of neck symptoms. Interpretation of this history is made more difficult by the recent deterioration in his memory.If the Panel were to accept causation of a cervical spine injury (as did Medical Assessor Home), the injury would now be assessed as DRE category II, giving 5% WPI. However, given the absence of current reported symptoms, the Panel takes a conservative approach, and has not included this in the total impairment.
The Panel’s examination findings, determination of causation and determination WPI were different to the findings of Medical Assessor Home for the reasons mentioned above. Accordingly, the Panel is of the view that a new certificate ought to be issued in accordance with the Panel’s finding of a WPI of 15% consequent on the claimant’s left hip and lumbar spine injuries.
DETERMINATION
The Panel revokes the certificate of Medical Assessor Home dated 23 April 2023. The claimant has suffered physical injury being a soft tissue injury to his left hip and lumbar spine giving rise to a 15% WPI.
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