Insurance Australia Limited t/as NRMA Insurance v Omid
[2025] NSWPICMP 624
•20 August 2025
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Insurance Australia Limited t/as NRMA Insurance v Omid [2025] NSWPICMP 624 |
| CLAIMANT: | Wana Omid |
| INSURER: | Insurance Australia Limited t/as NRMA Insurance |
| REVIEW PANEL | |
| MEMBER: | Hugh Macken |
| MEDICAL ASSESSOR: | Shane Moloney |
| MEDICAL ASSESSOR: | Mohammed Assem |
| DATE OF DECISION: | 20 August 2025 |
| CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of medical assessment; whole person impairment (WPI); medical dispute; fracture of the pelvis; neurological examination; scarring assessment; soft tissue injury to lumbar spine; acetabular fracture; no displacement of right hip; Held – medical certificate revoked; 7% WPI. |
| DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Review Panel Assessment – Threshold Injury Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Nigel Minogue dated 2. The following injuries caused by the motor vehicle accident give rise to a permanent impairment of 7% whole person impairment (WPI) and is not greater than 10% WPI: · lumbar spine – soft tissue injury 5% WPI, and · right hip – acetabular fracture 2% WPI. |
REASONS
BACKGROUND
Wana Omid (the claimant) is a 28-year-old person who was injured in a motor vehicle accident on 26 July 2022. The claimant sustained significant fractures as a result of the motor vehicle accident. The parties agreed that the claimant’s injuries ought to be considered a non-threshold injury. The claimant sought a concession from the insurer that the injuries left the claimant with a whole person impairment (WPI) of in excess of 10%. After a review, the insurer declined to make this concession and thereafter the claimant lodged an application for assessment for WPI with the Personal Injury Commission (Commission). The claimant was examined by Medical Assessor Christopher Canaris on 7 January 2025 who, in a certificate of the same date, determined that the claimant sustained psychological injuries of 20%. The insurer has sought a review of this Medical Certificate which has been accepted. The matter is yet to be referred to a Medical Review Panel.
The claimant was examined by Medical Assessor Nigel Menogue on 14 January 2025 who, in a certificate dated 5 February 2025, determined that the claimant sustained injuries caused by the motor accident which give rise to an impairment of 12% WPI.
The insurer has sought a review of this determination and, in a certificate dated
5 February 2025, President’s delegate Kenneth Ho decided that there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect. Thereafter this matter was referred to this Medical Panel.
STATUTORY PROVISIONS/GUIDELINES
Section 57 of the Motor Accidents Compensation Act 1999 (MAC Act) defines a “medical dispute” as a disagreement or issue to which Part 3.4 of the MAC Act applies.
Section 58 and s 60 of the MAC Act together with cls 1.5-1.7 of the Guidelines set out the procedures for referral to one or more Medical Assessors and the principles to be applied at such assessments.
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 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.
PRE-ACCIDENT HISTORY
Ms Omid was born in Australia and completed high school here. She had various attempts to complete university courses and had been enrolled to do a liberal arts and science degree at Sydney University which is now deferred. In 2019 she started work at a Kennel and cattery as a kennel attendant. She had been working there virtually full-time for the three years before the accident.
The claimant currently lives alone.
HISTORY OF THE MOTOR ACCIDENT
Ms Omid was driving her car when she was T-boned on the driver side by a car coming from the right. She was wearing a seatbelt at the time and airbags were deployed. She thinks that she may have had a brief loss of consciousness at the time and remembers getting helped out of the car by a passerby. She was taken by ambulance to Royal North Shore Hospital.
HISTORY OF SYMPTOMS AND TREATMENT FOLLOWING THE MOTOR ACCIDENT
Ms Omid attended the medical suites of the Commission on 23 July 2025. She was unaccompanied.
At Royal North Shore Hospital, radiological studies showed a fracture of the pelvis and was initially treated by traction and a week after the accident there was a surgical procedure with an open reduction and internal fixation of the right acetabular fractures with plates and screws. There was a second surgical procedure when a screw was inserted to stabilise a displaced fracture of the right sacroiliac joint. The treating orthopaedic surgeon, Dr Isaacs followed her up in outpatients. At the time of admission, there was also a laceration to the right scalp which was treated with staples.
Ms Omid states that she had right hip pain at that time. She was referred to rehabilitation and was initially using crutches. Physiotherapy was also undertaken by three different physiotherapists. Another orthopaedic surgeon, Dr Hibberd was consulted, and she was then referred to a pain specialist Dr Mir who organised bone scans and further MRIs. Ms Omid states that she has had increased pain in the right leg which radiates down the leg which has become more intense in the last year. Nerve block has been approved but not undertaken at present.
There have been no further injuries sustained since the subject accident.
CURRENT SYMPTOMS
Ms Omid has right sided low back pain which in the last six months is now radiated to the left as well. She has the right lateral hip pain which radiates down the posterior leg to the level of the calf and right groin discomfort. She considers that this pain has increased since August 2024 and attributes this to a long staircase of 40 steps where she was living at that time.
She is able to drive okay and walks her dog.
There is occasional pain in the neck after any heavy lifting with a tightness feeling in the cervical spine. She does a minimum of cooking and cleaning and laundry at home and has not returned to work since the accident.
CURRENT TREATMENT
Present medication is Norgesic two tablets, four times a day about three to four times a week and she increases the dose after a walk. She takes an occasional Panadol and Seroquel at night.
Physiotherapy was ceased six months ago but she was told that this would restart after the nerve block was undertaken.
CLINICAL EXAMINATION
Ms Omid walked with a normal gait and sat comfortably during the interview. She states that she is right-handed. Her height was measured at 170 cm and weight of 60 kg. Apparently, she drove from Castle Hill to attend today’s examination.
Cervical spine
On testing range of movement, there was a full range of flexion/extension, side bending and rotation. On palpation and no guarding or spasm noted in the cervical musculature.
On neurological examination of the upper limbs, reflexes were brisk and equal with normal power were noted. No muscle wasting was apparent with the circumference of the upper arms 24 cm bilaterally (10 cm above the olecranon process) and in the upper forearms
22 cm bilaterally (5 cm below the process).
Lumbar spine
Ms Omid walked with a normal gait and was able to walk on her heels and toes and squat to 75% of expected range which was limited by low back pain. On testing range of movement, there was a full range of flexion, but extension was limited to 50% of expected range. Side bending was 80% of expected range bilaterally as was rotation. Straight leg raise when lying was 80° bilaterally with negative sciatic nerve root tension signs.
On neurological examination of the lower limbs, reflexes were brisk and equal bilaterally with normal power and no sensory changes were noted. No muscle wasting was apparent with the circumference of the lower thighs 34 cm bilaterally (10 cm above the superior patella pole) and at the maximum circumference of the calves 31 cm bilaterally. There was a full pain free range of movement of the knees.
Hips
| Hip Movements | Active ROM Measured RIGHT | Active ROM Measured LEFT |
| Flexion | 100°= 0% WPI | 110° |
| Extension | 20°= 0% WPI | 20° |
| Adduction | 20°= 0% WPI | 20° |
| Abduction | 40°= 0% WPI | 40° |
| Internal Rotation | 20°= 2% WPI | 40° |
| External Rotation | 40°= 0% WPI | 50° |
There was decreased sensation over the medial right thigh above the knee. Patrick’s test was negative bilaterally.
DISCUSSION
Scarring
There is a horizontal 8 cm scar in the suprapubic area which is barely visible in the pubic hair. There is a 2 cm well-healed lateral scar over the posterior gluteal region with no sutures and no colour changes. There is also a very faint 2 cm scar over the right lateral thigh.
Ms Omid also had a scar in the right occipital region posteriorly which had been stapled. This is contained within the hairline and is difficult to see.There were no trophic changes in any of the scars with no contour defect and no effect on any ADLs. Suture or staple marks were not visible and normal colour match with the surrounding skin. Ms Omid is able to locate the scars. Classification of best fit under the Temski chart is 0% WPI.
Cervical spine
There is no contemporaneous documentation of any injury sustained in the cervical spine due to the subject accident. On examination, there was a clinically normal cervical spine with an occasional comment of pain after heavy lifting. The Panel does not consider that Ms Omid sustained an injury to cervical spine in the subject accident. Medical Assessor Menogue came to the same conclusion.
Lumbar spine – soft tissue injury
With the significant fractures of the pelvis including the sacrum sustained in the subject accident, it would be expected that Ms Omid would have some pain in that region after the accident. On examination, there was decreased extension of the lumbar spine which is dysmetria. There were no signs of radiculopathy or non-verifiable radicular complaints in the lower limbs. The Panel accepts that Ms Omid sustained a soft tissue injury to the lumbar spine in the subject accident. Medical Assessor Menogue came to the same conclusion but did not note dysmetria. This gives a classification DRE category ll which is 5% WPI using table 72 of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition (AMA 4 Guides).
Right hip – acetabular fracture
The right hip was assessed using range of movement as there was an acetabular fracture sustained in the subject accident. The Panel has assessed this impairment as 2% WPI using table 40 of AMA 4 Guides for a decrease in internal rotation.
Fractured sacrum
This fracture sustained in the subject accident is assessed using the pelvis chart (page 131, AMA 4 Guides).
A CT scan of the pelvis on 26 July 2022 describes a “minimally displaced right sacral ala fracture extending into the anterior S1 foramina. No SI joint involvement.” The Royal North Shore Hospital discharge summary notes, “fracture through right sacral alar with widening of SIJ compared to contralat.” CT imaging dated 3 August 2022 describes a “fracture line extending through the right sacral ala into the anterior S1 foramina.”
Follow-up imaging, including an X-ray dated 14 August 2024 and a CT scan dated
9 December 2024, shows “a screw extending through the right sacroiliac joint” with no evidence of displacement, articular step, or subluxation post-operatively. There is no involvement of the SIJ joint surface noted in the radiology reports. After surgical fixation, she was classified as having a sacral fracture without displacement.Under the pelvis criteria (page 131, AMA 4 Guides), a sacral fracture without displacement or residual subluxation is assessed as 0% WPI.
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