Isaac v AAI Limited t/as GIO

DETERMINATION OF REVIEW PANEL

CITATION:

Isaac v AAI Limited t/as GIO [2023] NSWPICMP 676

CLAIMANT:

Christine Isaac

INSURER:

AAI Limited trading as GIO

REVIEW PANEL

MEMBER:

Alexander Bolton

MEDICAL ASSESSOR:

Ian Cameron

MEDICAL ASSESSOR:

Trudy Rebbeck

DATE OF DECISION:

15 December 2023

CATCHWORDS:

MOTOR ACCIDENTS –  Review of certificate and reasons of Medical Assessor (MA) Truskett dated 21 June 2021; treatment and care dispute; the MA found that the treatment and care needs of the claimant did not relate to the injury caused by the accident and are not reasonable and necessary in the circumstances; body areas for review included cervical spine, thoracic spine right and left shoulders, right arm, right and left knees right and left legs; claimant involved in an accident on 25 March 2017 and transported to hospital by ambulance; Panel reviewed causation and found that the claimant did suffer a soft tissue injury to her neck as a consequence of the accident however the Panel was not satisfied the claimants other injuries work as a consequence of the accident on an ongoing basis; Held – the Panel found that if the claimant had a course of up to 10 physiotherapy in relation to her physical injuries and this would assist; the Panel determined that the claimant would have needed to 2 hours of care per week with a gratuitous basis to the date of assessment but thereafter, assistance is not appropriate.

DETERMINATIONS MADE:  

CERTIFICATE OF DETERMINATION

DETERMINATION

1.     The Panel revokes the decision of Medical Assessor Truskett dated 21 June 2021.

2.     The Panel determines that the claimant should undergo a course of 10 sessions of physiotherapy over 6-12 months.

3.     The Panel determines that the claimant needed two hours of domestic assistance per week from the date of the accident to the date of this assessment but no assistance thereafter.

4.     The Panel determines the following;

(a)   Domestic assistance – causation – whether the physical injuries give rise to a need for domestic assistance from the date of the subject motor vehicle accident to the date of the Medical Assessor’s assessment is causally related to the injury sustained in the subject accident. Yes.

(b)   Domestic assistance – reasonable and necessary – whether 0-7 hours per week of domestic assistance in relation to the physical injuries from the date of the subject motor vehicle accident to the date of the Medical Assessor’s assessment is reasonable and necessary in relation to the injury sustained in the subject. No, limited to two hours per week from date of accident to date of this certificate.

(c)   Domestic assistance – causation – whether the physical injuries give rise to a need for domestic assistance from the date of the Medical Assessor’s assessment and until the remainder of the claimant’s life expectancy (next 33 years) is causally related to the injury sustained in the subject accident. No.

(d)   Domestic assistance – reasonable and necessary – whether 0-4 hours per week of domestic assistance in relation to the physical injuries from the…