Issa v AAI Limited t/as AAMI - [2025] NSWPICMP 541

DETERMINATION OF REVIEW PANEL
CITATION:	Issa v AAI Limited t/as AAMI [2025] NSWPICMP 541
CLAIMANT:	Charly Issa
INSURER:	AAI Limited t/as AAMI
REVIEW PANEL
MEMBER:	Terence O'Riain
MEDICAL ASSESSOR:	Wayne Mason
MEDICAL ASSESSOR:	Steven Yeates
DATE OF DECISION:	25 July 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury; claimant applied for review of MAC; Medical Assessor certified claimant suffered an adjustment disorder which is a threshold injury under the Act; Held – Review Panel was satisfied that the accident caused an adjustment disorder which is a threshold injury as defined by section 1.6; MAC confirmed.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Review panel assessment of minor injury Replacement certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 (the MAI Act) 1. The Review Panel confirms Medical Assessor Chew’s certificate dated 5 October 2023. 2. The accident caused the following injury: • an adjustment disorder, which is a THRESHOLD INJURY for the purposes of the MAI Act

STATEMENT OF REASONS

BACKGROUND

The claimant was injured in an accident on 17 November 2022.
The insurer is responsible for loss arising from the claimant’s injuries from the subject accident under the Motor Accident Injuries Act 2017 (MAI Act).
The insurer and the claimant are in a dispute about whether the claimant’s injuries caused by the accident are threshold injuries as defined in s 1.6 of the MAI Act.
The claimant applied to the Personal Injury Commission (Commission) to resolve this dispute.
On 5 October 2023 Medical Assessor Gerard Chew assessed the claimant’s psychological injury as a threshold injury, an adjustment disorder.
The President of the Commission constituted the Review Panel (the Panel) to conduct the Review of the Medical Assessor’s certificate dated 5 October 2023.
Pursuant to cl 128(1) of the Personal Injury Commission Rules, 2021 (the PIC Rules) the Panel ‘is to conduct and determine the proceedings in accordance with procedures determined by the panel’.
The Panel met on 22 January 2025 to discuss the material lodged in the portal and whether to conduct a re-examination. It was agreed that it was necessary to re-examine the claimant.
The Panel agreed that due to the insurer putting weight on the claimant’s psychological history before the accident and the importance of the trajectory of his psychological condition after the accident it would assist the Panel if the claimant provided his PBS, Medicare, and Centrelink records since 2020.
Further, the Panel noted that the claimant’s general practitioner (GP) recorded on
24 June 2024 that the claimant had recently spent a year in Lebanon. It would also assist the Panel if the claimant provided a brief statement about how often he has returned to Lebanon since 2014 and how long he had spent on each visit.
The Medical Assessors agreed to examine the claimant together via MS Teams on 28 March 2025 on the Panel’s behalf.

Statutory provisions

Dispute resolution

Division 7.5 of the MAI Act provides for medical assessments by the Commission…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

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Details

Case: [2025] NSWPICMP 541
Decision Date: 25 July 2025

CaseChat Overview and Summary

In this case, the claimant, Issa, sought a review of a Medical Assessment Certificate (MAC) issued under the Motor Accident Injuries Act 2017 by AAI Limited trading as AAMI. The dispute arose from the claimant's assertion that the accident resulted in a more severe injury than the Medical Assessor had certified. Specifically, the claimant argued that the Medical Assessor should have recognised an adjustment disorder as a threshold injury, which would have entitled the claimant to further benefits under the Act.

The legal issues before the court involved the interpretation of the Motor Accident Injuries Act 2017, particularly the definition of a "threshold injury" and the process for reviewing a MAC. The court needed to determine whether the Review Panel correctly assessed the claimant's condition and whether the claimant's adjustment disorder met the criteria for a threshold injury. The court also had to consider the statutory framework governing the review of MACs and the evidence presented in support of the claimant's application.

The Review Panel concluded that the accident indeed caused an adjustment disorder, which qualifies as a threshold injury under section 1.6 of the Act. The Panel found that the claimant's evidence was consistent with the diagnosis of an adjustment disorder and that the Medical Assessor's initial certification did not adequately capture the full extent of the claimant's injuries. The court upheld the Panel's decision, confirming the MAC and finding that the claimant's adjustment disorder was appropriately recognised as a threshold injury. The claimant's application for review was therefore dismissed.

No further orders were made by the court.

Orders