Insurance Australia Limited t/as NRMA Insurance v Quigley
[2025] NSWPICMP 3
•6 January 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Insurance Australia Limited t/as NRMA Insurance v Quigley [2025] NSWPICMP 3 |
CLAIMANT: | Beau Quigley |
INSURER: | NRMA |
REVIEW PANEL | |
MEMBER: | Hugh Macken |
MEDICAL ASSESSOR: | Michael McGlynn |
MEDICAL ASSESSOR: | Sophia Lahz |
DATE OF DECISION: | 6 January 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Review of medical assessment; whole person impairment; assessment of head and brain injury; combined certificate; complicated pre-accident medical history; traumatic brain injury; fractured left scapula; brain scan abnormality; clinical dementia rating; Held – Medical Assessment Certificate revoked. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT Certificate issued under s 7.23(1) of the Motor Accident injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Ian Cameron dated · the injuries caused by the motor accident give rise to a permanent impairment of 8% and IS NOT GREATER THAN 10%. |
STATEMENT OF REASONS
INTRODUCTION
Beau Quigley (the claimant) is a 21-year-old man who was injured in a motorcycle accident on 28 September 2020. Following the accident, it was determined that the claimant sustained a non-threshold injury and, following the insurer’s declining to concede the claimant’s injuries exceed 10% whole person impairment (WPI) threshold, the matter was referred to the Personal Injury Commission (Commission) for the assessment of WPI.
The claimant has suffered a number of injuries including scarring, head and brain injury as well as an injury to his left shoulder and lumbar spine.
The claimant was assessed by Medical Assessor Geoffrey (Paul) Curtin who, in a Certificate dated 19 April 2024, determined the claimant had sustained a WPI of 4%. This was made up of a finding on 2% WPI consequent on the scarring sustained by the claimant and 2% WPI consequent on the nerve injury to the claimant’s left lower leg. This was described as the scarring of the left ankle associated with dysaesthesia in the distribution of the lateral sural cutaneous nerve. This figure, when combined with the certificate of Medical Assessor Ian Cameron dated 24 April 2024 which assessed WPI as 7%, gave rise to a combined certificate certifying WPI of 11%.
The insurer sought a review of this determination primarily on the basis that the lower left leg nerve damage was not a matter which was referred to the Medical Assessor and accordingly not a matter which ought to be assessed.
In a Certificate dated 19 April 2024, the President’s delegate Melinda Drew, determined that there is a reasonable cause to suspect the medical assessment was incorrect in a material respect. Accordingly, the matter was referred to the Medical Panel.
The Panel convened on 31 September 2024 and determined that it was appropriate to re-examine the claimant in respect to the injuries. The Panel is of the view that the injuries sustained by the claimant include a nerve injury to the claimant’s lower left leg and it is the Panel’s view that this injury ought also be assessed in determining WPI.
Directions were issued to the parties that they are to provide any further material or submissions that they wish to make in respect to the Panel’s assessment of the claimant’s nerve injury – left lower leg prior to the re-examination of the claimant.
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.
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.
Sections 58 and 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.
The claimant was examined at the Commission’s rooms on 27 November 2024 by Medical Assessor Sophia Lahz and Medical Assessor Michael McGlynn. He attended with his mother, Katherine Quigley for the assessment.
Medical Assessors permitted his mother participate in the assessment although explained that they needed to obtain the information from Mr Quigley. However, they would ask her questions at their discretion during the assessment. It is common practice to obtain history from close relatives/partners regarding the effects of traumatic brain injury.
History
The claimant is aged 21 and right-handed. By way of background, there had been a normal birth and delivery and he achieved milestones of walking and crawling early although speech was slower to develop. He was found to have dyslexia at age 6 and later given a diagnosis of ADHD at age 10. In year 3, he participated in a special (Redfern) reading programme using green paper which was helpful. He remained in a mainstream school although he always struggled with reading/writing tasks, doing better with numbers.
At age 10, the paediatrician started him on Ritalin SR because there was behavioural disturbance in the classroom in the context of academic difficulties. Mr Quigley was reluctant to take twice daily medication and further, the benefits of Ritalin were of relatively short duration, just 2-3 hours. Subsequently, the medication was changed to Dexamphetamine with longer duration of effect. His behaviour at school would typically remain reasonable until early afternoon when he could once again become distractible and sometimes get into trouble, due to some frustration with himself. The teachers would generally deal with these issues by assigning him various errands, given that whenever he was engaged/occupied his behaviour would improve.
I note the results of a psychometric assessment during school years indicating low premorbid intellectual function within the borderline range.
The claimant’s mother said that behavioural disturbance was confined to the school environment and that at home, there were no significant issues. She described his usual personality as kind, loyal and cheerful. He was always looking out for and trying to help his friends. He had a strong practical bent too and enjoyed being outdoors. He likes sports, such as basketball, football and boxing. He also enjoys motorbike riding and fishing.
His mother said that his memory and practical problem solving skills before motor accident were good.
In his last year at school Mr Quigley commenced a plumbing apprenticeship (unpaid) in which he had only to complete practical tasks (no theory or paperwork required). When he left school halfway through year 9 (because formal schooling was not for him), the apprenticeship did not convert to paid work because the employer needed a licensed plumber.
After leaving school, his father gave him work in a family business, a milk run in which he had to drive a MR truck to approximately 40 businesses four days per week. He had no problems learning how to drive the truck from a practical perspective although the written driving test was a challenge requiring significant rehearsal for him to pass it.
The claimant’s mother would prepare the run sheet for the work day. Mr Quigley was capable of following the sheet and completing the work tasks. He worked at night dropping milk to multiple cafes (approximately 40) around the southern and eastern suburbs, having to remember which keys were for where, and then to deactivate/reactivate the alarm and finally lock the door behind him. He reported that the milk crates were heavy up to 23 kg. He was able to complete all of these tasks independently and safely.
The claimant worked in the milk run for three years, right up until the time of the motor accident, and had been really enjoying this in addition to various hobbies listed above. He preferred working at night because he could then engage in his hobbies of an afternoon after sleeping through the morning.
At home, his mother said he was a “typical teenager” who did not complete many chores although he would sometimes mow the lawn, wash up and been able to keep his room tidy. Mr Quigley has always good enjoyed good relationships with his parents and two older sisters although being a quiet lad, he could sometimes be drowned out by his more talkative sisters.
Before the accident, Mr Quigley had numerous friends with whom he went fishing, did boxing and played sports. With respect to physical health, Mr Quigley reported back pain now and then although this never interfered with his activity levels.
The claimant sustained a right rotator cuff injury in 2019 from football, managed conservatively with attendant symptomatic improvement. Shoulder symptoms continued to catch him out sometimes with any injudicious activities although again these symptoms did not generally interfere with his activity levels. Mr Quigley has no history of left shoulder problems.
I asked Mr Quigley and his mother about the incident referred to by the insurer in November 2018 in which he reportedly came off a bike, hitting his head on grass, before complaining of nausea and dizziness. A CT brain scan at the time was reportedly satisfactory. However, neither his mother nor Mr Quigley could recall this incident.
In the documents which had been provided, I found a CT brain report dated 13 November 2018 with normal findings, which had been performed due to “concussion, nausea and dizziness”. Dr Zavras also refers to this incident in general practitioner (GP) records dated
13 November 2018 although there are no subsequent references to any lingering problems stemming from the 2018 incident which concern cognition, dizziness etc.
According to Mr Quigley and his mother, there is no history of previous traumatic brain injury and there have never been any hospitalisations aside from that following the subject motor accident and that occurring after a spider bite when he was aged 3. The only other injury which was reported is a laceration to the left hand when he picked up a glass (again several years ago).
The claimant has not smoked in 12 months and rarely consumes alcohol. When very young, he used recreational cannabis although since the motor accident, he has only used medicinal Cannabis (for headaches and shoulder pain) which he stopped taking, after losing his licence for testing positive to THC roadside. The claimant has required neither Dexamphetamine nor Ritalin since leaving school.
The claimant confirmed his involvement in the subject accident on 28 September 2020 of which he has no recollection. He had been on a motorbike (wearing helmet, track pants and jumper) with a friend riding beside him. He remembers that they had taken off from green traffic lights, with his next memory being that of waking up in SVH several hours later. He has been told that his motorbike T-boned a car which had been turning right across his path.
The claimant has vague recollections of the hospital. He was only admitted for a few hours and was discharged the following day. His mother said she saw him at the accident scene at which time there was bleeding from a head wound. She observed that he had been mumbling and incoherent, not apparently recognising his parents. Four hours later, she visited him at hospital at which stage he was still somewhat confused to place, thinking he was at POWH. However, by this stage his mental state had improved in that he now recognised his mother. Mr Quigley also remembers telling an elderly female hospital patient (in an adjacent bed) incorrectly that she was at Prince of Wales Hospital. His mother said that his mental state quickly improved over the next few hours such that he became lucid.
At hospital, a brain CT scan had been unremarkable. Mr Quigley was found to have suffered a left scapular fracture which was non-operatively managed in a sling for six weeks. Of note, there were multiple skin wounds including a large right parietal scalp laceration, a left shoulder graze, and lacerations to both left ankle and left knee. The claimant was referred to the Plastics service and had to return for dressings several days later.
Post-accident
He was discharged home the day after the motor accident to care of his family. Subsequently, around two weeks later, the claimant underwent skin grafting of the head, left knee and ankle, with left thigh donor site. This committed him to many weeks of dressings after hospital discharge.
The claimant was puzzled when I asked about the referred lower back injury. He told me that lower back symptoms are no different from before the motor accident and he does not believe the lower back was injured in the motor accident.
On being discharged, there was a period during which the claimant was depressed/miserable, distraught and overwhelmed by what had happened. He was also contending with multiple painful skin wounds/need for regular dressings.
From the time of the accident, Mr Quigley developed right-sided headaches emanating from the right parietal scar. Headaches would typically also involve the bifrontal regions, becoming sufficiently severe and frequent for him to seek medical advice. The doctor prescribed various medications such as Amitriptyline which were unhelpful and unfortunately caused side effects, and were later ceased.
In the finish, Mr Quigley opted to take medicinal Cannabis which he found helpful for headaches and left shoulder pain. The latter proved quite helpful although the treatment was quickly stopped (as already noted) after he lost his licence due to a positive drug test. He regained his licence earlier this year and remains abstinent from Cannabis and for that matter all medications aside from Ventolin for asthma.
In May 2021 (several months post 2020 subject motor accident), due to ongoing headaches, the doctor organised a brain MRI showing evidence of previous bleeding consistent with diffuse axonal injury. Mr Quigley did not require referral to a brain injury rehabilitation service although he was advised to avoid contact sports. His mother thought he may have undergone a brief cognitive assessment via his lawyers although she did not know the results.
Currently, there are no real cognitive concerns. Memory seems OK and Mr Quigley’s practical problem solving is unchanged compared with pre-injury. Social relationships (discussed further below) are also maintained. There have been no instances of verbal/physical aggression and Mr Quigley’s personality remains similar to that pre-injury i.e. loyal and kind to others.
The claimant was reportedly unemployed for around 12 months during which period mood was low, and there had been frequent frustration. Headaches continued as did left shoulder pain. Since the accident, he has also complained of sleep disturbance both difficulty falling asleep and difficulty staying asleep.
The claimant eventually found employment through the relative of a friend which involved standing at a conveyor belt whilst sorting out rubbish. He said the job stirred up left shoulder pain and the duties were also very boring. He disliked the role intensely and only stayed in the job for several months before resigning.
Examination
He has complained of left shoulder pain since the accident which makes it difficult for him to drive manual vehicles so he only drives automatic vehicles now.
Ongoing, there are headaches around 3-4 times per week typically of moderate intensity with throbbing character. Duration varies from 1-3 hours and they tend to be worse later in the day when he is tired or else after activity. Earlier, Mr Quigley would vomit during the headache although that aspect has ceased. Sometimes he can stay up and about when there is headache, whereas there are occasions when headache is severe, and he must lie down. He is no longer receiving any treatment for headaches. “I’m accustomed to them…I just get on with it…”.
Sleep disturbance continues with increased sleep latency and ease of waking up throughout the night. He feels tired during the day after receiving approximately 4-5 hours of sleep each night. He reported that he does not use screens late at night and he does not know why he has problems sleeping. He said he lies on his back and stares at the ceiling for long periods. He denied ruminations about the motor accident, nor are there any nightmares. He said that he is not particularly distressed or preoccupied with thoughts of the accident although discussions about it can sometimes cause him anxiety. Mr Quigley also mentioned that he dislikes the large head scar and ensures the barber “fixes things” so the scar is covered. He said he generally goes to bed at 9.00pm and generally up just a few hours later.
Unfortunately, Mr Quigley was unable to resume the milk run after the motor accident due to inability for heavy lifting due to persistent left shoulder pain.
Mr Quigley did see an orthopaedic specialist about the left shoulder (Dr Sher). Dr Sher’s letter dated 3 March 2023 refers to an ache around the left shoulder blade with internal rotation being the most restricted movement. Dr Sher also referred to scapular dyskinesia associated with a posterior instability pattern. Dr Sher recommended an MRI and suggested that Mr Quigley would benefit from postural training. The subsequent shoulder MRI did not demonstrate any structural joint problems (with plain X-ray taken on 1 March 2023 also being unremarkable). Consequently, the doctor recommended specialised physiotherapy to improve the shoulder biomechanics of which Mr Quigley attended approximately eight sessions. The latter were helpful (he completed various band exercises) although unfortunately, he could not afford to continue the treatment.
About eight months ago, Mr Quigley found employment (through his father) driving delivery trucks for Botany Access. He had to upgrade his truck licence from an MR to HR. Fortunately the written test from his earlier MR licence remained valid, and he only had to complete the practical test which found very straightforward. With his current work role, he works the day shift which he does not like as much as working nights because he now has less time to engage in hobbies.
He said too that the pay in his current job is less than the milk run although he is pleased to have work. His mother said that whilst unemployed, his mood had been low and he had been frustrated by physical inactivity and lack of daily routine. He is currently working 40-50 hours per week and coping with the necessary deliveries because there is no heavy lifting required of him. The employer is reportedly satisfied with his services.
Current status
The claimant remains somewhat moody and irritable especially if he has not slept well. His mother said that his mood and energy levels closely paralleled the amount of sleep he received the night before. The claimant said too that he remained frustrated by loss of sporting hobbies and inability to complete the milk run (due to left shoulder pain). Unfortunately, he had to stop football too (also due to left shoulder pain, risk of reinjury to the head), basketball (left shoulder pain), motorbike riding (left shoulder pain) and boxing (again risk of head reinjury and left shoulder pain). He did engage in a single boxing session although the activity caused significant left shoulder pain.
However, on the positive side, the claimant has maintained good interpersonal relationships with family and friends. He still goes to dinner and out fishing with friends. He has a relatively new girlfriend of three months standing with whom things are going well. He stays over at her place sometimes. They go for dinner, take boat trips and walk the dogs together.
The claimant is independent with all PADLS (personal care) and does not require prompting to maintain personal hygiene.
The claimant is independent with managing his finances. He has relatively few bills, only his mobile phone bill. He pays his parents for utilities although he lives at home rent free. He is very good at saving and actually rather miserly. He is also astute to scams and potential rip offs. He is presently saving up for a holiday to Western Australia.
There have been no epileptic seizures. The claimant does not report any changes in hearing, dizziness, smell or taste. He has gained 25 kg since the accident due to reduced physical activity. He does not report any issues with either mobility or balance. Mr Quigley takes no prescription medications now.
At the left shoulder, he complains of frequent activity-related “muscular” pain over the left medial scapular border and sometimes the interscapular region. The pain is worse with heavy lifting and if e.g. any throwing/tossing movements of the left arm and with overhead activities, mostly at end range. At night, he reports difficulties lying comfortably on the left shoulder. Sometimes, shoulder pain can be quite severe and he is observed walking around whilst cradling the left arm.
As noted, Mr Quigley does not complain of any lower back pain due to the motor accident.
Examination findings
On examination, he was a pleasant young man who related well to the examiner. He presented in a very straightforward manner. Height was 180 cm and weight 103 kg. I noted that he is a tall young man with moderate adiposity. Gait was unremarkable and Romberg’s test was negative. Cranial nerve examination was unremarkable though smell was not formally assessed. There were full movements in all directions at the neck, middle back and lower back without tenderness, muscle spasm or guarding. There were no non-verifiable upper or else lower limb radicular complaints and no dysmetria.
There were no neurological abnormalities in the upper or else lower limbs with respect to sensation, muscle atrophy, power or reflexes. There was normal upper and lower limb coordination (finger nose, heel shin testing and rapid alternating movements). Active shoulder movements were measured with a goniometer and repeated three times to check for consistency. At the right shoulder, there were 170 degrees of flexion, 170 degrees of abduction, 80 degrees each of IR and ER, 50 degrees of adduction and 50 degrees of extension.
At the left shoulder, there was mild muscle atrophy about the left scapula. There was nearly full bilateral elevation (abduction 160 degrees 1% upper extremity impairment (UEI), flexion 160 degrees 1% UEI) i.e. 10 degrees loss of abduction and flexion compared with the uninjured right side, with extension of 50 degrees, internal and external rotation each 80 degrees and adduction 50 degrees, not attracting WPI according to the specific figures and tables of AMA4.
There was also mild left scapular winging on protraction (pushing with outstretched arm against the wall) indicates mild long thoracic nerve dysfunction. The long thoracic nerve supplying the serratus anterior muscle which inserts to the medial border of the scapula may be injured with trauma to the shoulder girdle. The nerve has a long and superficial course along the length of the serratus anterior predisposing it to injury when the shoulder girdle is injured (e.g. as with scapular fracture).
On the MoCA, Mr Quigley scored 23/30 (similar to the findings of Ian Cameron) with mild difficulty on cube drawing, language (repetition and verbal fluency), abstraction, and recall. These difficulties were likely pre-existing, given his academic difficulties for reading and writing preceding the motor accident.
Impairment assessment
The claimant has sustained a mild complicated traumatic brain injury in the subject 2020 motor accident with MRI brain imaging abnormalities noted in May 2021. (The MRI brain performed on 20 May 2021 was eventually arranged by the GP to investigate his complaints of persistent headaches). There was medically verifiable diminution of GCS 14 at the accident scene.
The MRI brain formal radiology report dated 20 May 2021 refers to multiple cortical and sulcal foci of susceptibility effect with old blood products in the left frontal and parietal lobes in a parafalcine location. The old blood products were reportedly consistent with the advent of diffuse axonal injury and I agree that such changes have resulted from a mild complicated traumatic brain injury incurred in the subject motor accident.
I do not accept the insurer’s submission that the abovementioned brain scan abnormalities demonstrated on the 2021 MRI brain scan were caused by the incident in November 2018
(when he reportedly fell from a bike, hitting his head on grass).
I say this for the following reasons:
· he was not hospitalized afterwards, and
· CT brain scan at the time was normal (CT brain is much less sensitive for findings of diffuse axonal injury than MRI). Whilst he complained of dizziness and nausea, there was no cognitive change reported, and there were also no ongoing symptomatic complaints stemming from the 2018 incident per the GP records. The 2018 incident was therefore minor and there was full recovery afterwards.
In the subject 2020 accident, on the other hand:
· there was a very substantial blow to the head with resultant large right parietal laceration requiring a skin graft, and
· there was altered level of consciousness immediately post MVA with GCS 14/15 and confusion.
Paragraph 6.164 on page 113 of the Motor Accident Guidelines (MAG) states that for an assessment of mental status impairment and emotional/behavioural impairment there should be significant impact to the head or cerebral insult, or that the motor accident involved a high velocity vehicle impact, and one or more significant medically verified abnormalities such as abnormal initial post injury GCS or post-traumatic amnesia or brain imaging abnormality.
Given the presence of substantial blow to the head with large, deep scalp laceration, altered GCS (14) and subsequent MRI brain imaging abnormalities with susceptibility artifact from haemosiderin (old blood product) deposition, he meets the criteria for occurrence of traumatic brain injury.
No AWPTAS (abbreviated post-traumatic amnesia scale) was completed at hospital after the subject 2020 accident although this was a medical omission. Given the serious soft tissue injury to the scalp with large, deep laceration and the altered GCS (14/15), abbreviated PTA testing should have been undertaken. Therefore, there was no formal measurement undertaken of PTA duration.
The DAI (diffuse axonal injury) changes noted on the post motor vehicle accident scan (May 2021) were significant and have certainly arisen from the subject 2020 accident associated with a substantial blow to the head causing scalp laceration large and deep enough to require a skin graft, and not the trivial cycling incident occurring in late 2018.
Persons such as Mr Quigley with specific learning difficulties/borderline intellectual abilities are particularly susceptible to decompensation after traumatic brain injury. He will continue to experience problems with mood, irritability and sleep which will fluctuate according to life events. He will cope less well in the future with life adversity due to the mild complicated traumatic brain injury sustained in the subject motor accident 2020.
Of note, there was no ratable WPI for brain injury preceding the subject motor accident. Whilst Mr Quigley’s pre-injury intellectual abilities were borderline per psychometric assessments, these difficulties were counterbalanced by an easy going personality and a strong practical bent so that he functioned independently and very satisfactorily with respect to social and vocational activities (as confirmed by the detailed history I have taken from
Mr Quigley and his mother). Therefore, there is no pre-existing behavioural/emotional/cognitive impairment for which deduction should be made.
Mr Quigley suffers from headaches since the motor accident although headache is not a ratable impairment per AMA4/MAG. He is eligible for WPI assessment for cerebral impairment per MAG due to the brain injury sustained in the subject motor accident.
On the CDR (Clinical Dementia Rating), there is score of 0 for Memory, he is fully oriented O=0, he solves everyday problems and handles financial problems well (Judgment and problem solving=0), he is independent in his job (the reason for job change was physical due to left shoulder pain not brain injury) Community Affairs=0, life at home is maintained (sporting hobbies have been affected by the left shoulder pain, concerns around further brain injury, although not by the effects of brain injury itself) Home and Hobbies=0 and he is fully capable of personal care Personal Care=0, not requiring any prompting. Thus CDR=0=0% WPI for “mental and integrative status”.
As noted, Mr Quigley is affected by mild emotional/impairments (frustration, mood fluctuations) due to brain injury for which a rating of 6% WPI is appropriate per Table 3, page 142 AMA4 “Emotional and behavioural impairments”. He experiences frustration, irritability, and sleep disturbance in the context of mild complicated traumatic brain injury all of which continue to adversely affect his quality of life.
He incurred a left scapular fracture with loss of terminal upper limb elevation (abduction/flexion) giving 2% UEI or else 1% WPI (Table 3, page 20). Of note there was also mild scapular winging observed at my examination indicative of mild serratus anterior dysfunction from long thoracic nerve injury. The long thoracic nerve runs the length of the serratus anterior which it supplies, having a long and superficial course predisposing it to injury. As noted, the nerve can be injured in the event of scapular fracture.
According to Table 15 AMA4 page 54, there is a maximum 15% UEI for long thoracic nerve dysfunction. There is mild scapular winging (Table 12, page 49 AMA4) i.e. 25% for grade 4/5 strength, of 15% UEI= 4% UEI (post rounding). MAG directs that the larger impairment value is chosen when there are competing WPI methodologies such as range of motion and nerve injury i.e. 4% UEI = 2% WPI.
He has not incurred any lower back injury in the motor accident.
Conclusions
The Panel has determined the claimant has sustained a WPI of 6% as a consequence of the brain injury and 2% WPI for the left shoulder, giving rise to a WPI of 8%.
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