Jarrar v AAI Limited t/as GIO
[2023] NSWPICMP 519
•13 October 2023
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Jarrar v AAI Limited t/as GIO [2023] NSWPICMP 519 |
| CLAIMANT: | Maysam Jarrar |
INSURER: | AAI Ltd t/as GIO |
| REVIEW PANEL | |
| PRINCIPAL MEMBER: | John Harris |
| MEDICAL ASSESSOR: | Margaret Gibson |
| MEDICAL ASSESSOR: | Ian Cameron |
| DATE OF DECISION: | 13 October 2023 |
| CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; dispute related to whether a physical injury was a threshold injury; claimant involved in a motor accident on 4 May 2021 in a rear end collision; claimant not re-examined as no utility due to right shoulder surgery; supraspinatus tear repaired at surgery; claimant established that right shoulder tear caused or aggravated by motor accident; medically plausible; contemporaneous clinical records showed right shoulder symptoms; continuous ongoing right shoulder symptoms resulting in surgery; reported improvement from surgery; decision consistent with treating surgeon opinion; observation that subsequent surgery did not result in injury being classified as non-threshold; Mandoukas v Allianz Australia Insurance Ltd applied; Held – medical assessment revoked; claimant assessed as suffered from non-threshold right shoulder injury. |
| DETERMINATIONS MADE: | Review Panel Assessment of Threshold Injury Replacement Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 The Review Panel revokes the certificate dated 22 May 2023 and certifies that the injury to the right shoulder is not a threshold injury. |
REASONS
BACKGROUND
Ms Maysam Jarrar (the claimant) suffered injury in a motor accident on 4 May 2021 when her vehicle was rear ended by the insured vehicle (the motor accident).[1]
[1] Claimant’s bundle, p 31.
The insurer is liable to pay to Ms Jarrar any damages and/or statutory compensation entitlements under the Motor Accident Injuries Act 2017 (the MAI Act) for the motor accident.
The issue presently in dispute is whether the injuries are classified as a “threshold injury” within the meaning of the MAI Act. Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter including whether “the injury caused by the motor accident is a threshold injury for the purposes of the Act”.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor[2] and, pursuant to s 7.26 of the MAI Act, on review by a review panel.
[2] Section 7.20 of the MAI Act.
Whether a person has only suffered threshold injuries as a result of a motor vehicle accident affects the entitlement to both statutory benefits and damages. For threshold injuries the entitlement to statutory benefits ceases after either 26 or 52 weeks, depending on the date of injury and the injured person cannot recover damages under the MAI Act if the “only injuries resulting from the motor accident were threshold injuries”.[3]
[3] Section 4.4 of the MAI Act.
STATUTORY AMENDMENT
The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on
28 November 2022 with various amendments commencing on 1 April 2023. From
1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
For motor accidents occurring on or after 1 April 2023, the entitlement to statutory benefits for a threshold injury have increased from 26 weeks to 52 weeks.
Accordingly, an injury which does not fall within the definition of a threshold injury (a non-threshold injury) means that a claimant has an entitlement to claim damages and, subject to other exclusions, receive statutory entitlements beyond either the 26 week or 52-week limitation period.
ORIGINAL MEDICAL ASSESSMENT
The medical dispute was referred to Medical Assessor McGrath who issued an amended medical assessment certificate dated 6 July 2023 (the medical assessment certificate).
Medical Assessor McGrath concluded that Ms Jarrar sustained soft tissue injuries to the cervical spine, right shoulder and chest which are threshold injuries for the purposes of the MAI Act. The Medical Assessor found that the motor accident did not cause injuries to the lumbar spine, right elbow and right wrist.
THE REVIEW
The application for referral of the medical assessment to a review panel was made by
Ms Jarrar within 28 days after the parties were issued with the medical assessment certificate.The President’s delegate referred the medical assessment to the Review Panel (the Panel) as they were satisfied that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application.[4]
[4] Section 7.26(5) of the MAI Act.
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 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 review provisions provide[5] that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
[5] Section 7.26(5A) of the MAI Act.
Part 5 of the PIC Act enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Medical Assessor.[6]
[6] Section 41(2) of the PIC Act.
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 proceedings solely based on the written application.[7]
[7] Rule 128 of the PIC Rules
The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[8]
[8] Section 7.26(6) of the MAI Act.
STATUTORY PROVISIONS
A threshold injury is defined in s 1.6 of the Act and includes a “soft tissue injury” or a “threshold psychological or psychiatric injury”. Section 1.6(2) of the Act defines a soft tissue injury to mean:
“[A]n injury to tissue that connects, supports or surrounds other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia, fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.”
Section 1.6 provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury or a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the Regulations) further defines threshold injury to include “an injury to the spinal nerve root that manifests in neurological signs (other than radiculopathy)” and an acute stress disorder and an adjustment disorder.
Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the Act. The Guidelines contain the procedure for assessing whether an injury caused by the motor accident is a threshold injury for the purposes of the Act. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after
1 December 2017. In respect of the medical assessment of whether an injury is a minor injury, the Guidelines relevantly provide:“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.4 Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a)a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b)a review of all relevant records available at the assessment
(c)a comprehensive description of the injured person’s current symptoms
(d)a careful and thorough physical and/or psychological examination
(e)diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
Clause 5.7 to 5.9 of the Guidelines relate to whether an injury to a spinal nerve root in the context of neurological symptoms is classified as a threshold injury. An injury resulting in radiculopathy will not be classified as a threshold injury.
Clause 5.7 of the Guidelines provides:
“In assessing whether an injury to the neck or spine is a soft tissue injury, an assessment of whether or not radiculopathy is present is essential.”
Radiculopathy is defined in cl 5.8 of the Guidelines as follows:
“Radiculopathy means the impairment caused by dysfunction of a spinal nerve root or nerve roots when two or more of the following clinical signs are found on examination when they are assessed in accordance with ‘Part 6 of the Motor Accident Guidelines: Permanent impairment’.
(a)loss or asymmetry of reflexes (see the definitions of clinical findings in Table 6.8 in these Guidelines)
(b)positive sciatic nerve root tension signs (see the definitions of clinical findings in Table 6.8 in these Guidelines)
(c)muscle atrophy and/or decreased limb circumference (see the definitions of clinical findings in Table 6.8 in these Guidelines)
(d)muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution
(e)reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.”
Neurological symptoms that do not meet the assessment criteria for radiculopathy means that the injury will be assessed as a threshold injury.[9]
[9] Clause 5.9 of the Guidelines.
Sections 5D and 5E of the Civil Liability Act 2002 apply to the MAI Act.[10]
SUBMISSIONS
Claimant’s submissions dated 18 August 2022[11]
[10] See s 3B(2) of the Civil Liability Act 2002.
[11] Claimant’s bundle, p 1.
These submissions noted that the Medical Assessor had not considered an MRI scan dated 9 May 2022, a referral to Dr Drynan dated 11 May 2022 and a report of Dr Drynan dated
15 June 2022.
Insurer’s submissions dated 27 October 2021[12]
[12] Insurer’s bundle, p 19.
The insurer referred to the clinical note dated 10 September 2020 which referred to chronic neck pain for a period of between one and two years.
The insurer referred to:
(a) the MRI scan dated 29 June 2021 which showed no cord compression;
(b) the physiotherapist who diagnosed Grade II whiplash, and
(c) the bone scan which showed only minor uptake with no significant active facet joint arthritis.
The insurer submitted that the clinical notes do not report two or more signs of radiculopathy.
The various reports only establish a threshold injury for the cervical spine.
The clinical notes of the general practitioner (GP) refer to pre-accident back symptom on
11 June 2020, 1 April 2021 and 8 April 2021.The GP, physiotherapist and sports physician do not diagnose a low back injury caused by the motor accident. The insurer submitted that the motor accident did not cause a low back injury.
The insurer noted that the claimant had prior right shoulder pain requiring physiotherapy and the clinical entry dated 8 April 2021 noting pain for many years which was worsening.
The GP provided a diagnosis of right clavicle pain following the motor accident. An X-ray dated 6 May 2021 as normal. There were no subsequent records of right clavicle pain.
The claimant’s physiotherapist in September 2021 diagnosed mild tendinosis with underlying bursitis of the right shoulder. The MRI scan of the brachial plexus was reported as normal.
The MRI scan of the right shoulder dated 29 June 2021 showed mild insertional tendinosis of the mid supraspinatus tendon. In September 2021, the sports physician reported that the claimant’s right shoulder pain was likely from the supraspinatus tendinosis with subacromial bursitis.
The insurer submitted that tendinosis with subacromial bursitis is a threshold injury.
The insurer noted that the clinical records showed injury to the chest caused by the motor accident. The MRI scans dated 1 June 2021 and 29 June 2021 showed no abnormality. The CT scan dated 2 September 2021 could not identify any abnormality for the ongoing chest pain.
The insurer submitted that the clinical records only establish a threshold injury to the chest.
The insurer noted that there was no contemporaneous record of right elbow injury. In September 2021 there was an initial report of right elbow pain which had progressed into synovitis. There was otherwise no record of right elbow symptoms. The insurer accordingly submitted that any right elbow injury was a threshold injury.
The insurer submitted that there was no record of any right wrist injury, and this was not caused by the motor accident.
MATERIAL BEFORE THE REVIEW PANEL
Pre-accident medical records
In July 2018 there were complaints of generalised body aches and pain including in the neck.[13]
[13] Claimant’s bundle, p 127.
In April 2019 the claimant was reported as having physiotherapy for neck pain.[14] The clinical entry on 8 April 2021 states:
“multiple tender points through back and shoulder and thigh
Has been teher [sic] since many years
Now worsening”
The GP then diagnosed fibromyalgia and referred the claimant to a rheumatologist.
[14] Claimant’s bundle, p 112.
On 10 September 2020 Dr Mariam Ghufran, GP recorded a recent flare up of neck pain which had been “on and off for last 1-2 years”.[15]
[15] Claimant’s bundle, p 86.
A clinical note of Dr Mariam Ghufran, GP dated 1 April 2021 noted recent onset of low back pain[16] with a normal neurological examination.
[16] Claimant’s bundle, p 80.
An X-ray of the thoracic spine and lumbar spine dated 9 April 2021 was normal.[17]
[17] Insurer’s bundle, p 71.
Post-accident medical records
The clinical note of the GP dated 5 May 2021 noted pain in the neck and right clavicular area with mild numbness in the right arm.[18] On 6 May 2021 the GP noted more neck, right shoulder and arm pain.[19]
[18] Insurer’s bundle, p 35.
[19] Insurer’s bundle, p 36.
Certificate of capacity dated 5 May 2021, 21 May 2021, 28 May 2021 and 3 August 2021 referred to neck, right shoulder and right clavicular pain.[20]
[20] Claimant’s bundle, pp 36 - 47.
An X-ray of the right clavicle dated 6 May 2021 showed no abnormality.[21]
[21] Insurer’s bundle, p 70.
A claim form dated 12 May 2021[22] referred to the motor accident causing clavicle, neck and shoulder pain with radiation down the arm to the wrist and “lower right lat and lower back pain”.
[22] Claimant’s bundle, p 29.
On 28 May 2021 the GP noted worsening neck, right shoulder and thoracic pain.[23] Elbow pain is also referenced in the clinical notes in early June 2021.
[23] Insurer’s bundle, p 38.
An MRI scan of the right brachial plexus dated 1 June 2021 was normal.[24] An ultrasound of the right chest wall dated 1 June 2021 demonstrated no abnormality.[25]
[24] Insurer’s bundle, p 67.
[25] Insurer’s bundle, p 69.
The claimant underwent an MRI scan of the right shoulder, chest and cervical spine on
29 June 2021.[26] The cervical spine and chest wall scans were essentially normal. The right shoulder scan showed mild insertional tendinosis of the mid supraspinatus tendon with no evidence of a discrete tear.[26] Insurer’s bundle, p 32.
A referral to the physiotherapist from the GP dated 1 July 2021 noted neck and right shoulder pain following a whiplash injury.[27]
[27] Insurer’s bundle, p 31.
An Allied health recovery request for physiotherapy dated 1 July 2021 referred to neck and right shoulder symptoms.[28]
[28] Insurer’s bundle, p 74.
In a report dated 20 July 2021 the GP referred to the motor accident causing a “whiplash injury with severe neck, shoulder and elbow pain no progressing to synovitis and emotional trauma”.[29]
[29] Insurer’s bundle, p 26.
Associate Professor Paoloni, sports physician, provided a report dated 7 September 2021.[30] The doctor diagnosed that the motor accident caused “right shoulder pain that appears to be from supraspinatus tendinosis with subacromial bursitis”, with possible cervical facet nerve conduction studies of the upper limbs in December 2021 were reported as being within normal limits arthropathy. Subsequent reports provided the same diagnosis.
[30] Insurer’s bundle, p 28.
A bone scan dated 21 September 2021 was reported as normal for the cervical spine, thoracic spine and shoulders with minor active arthritic change in the acromioclavicular joints bilaterally.[31]
[31] Claimant’s bundle, p 272.
An ultrasound of the right shoulder dated 2 November 2021[32] showed intact rotator cuff tendons.
[32] Claimant’s bundle, p 256.
Nerve conduction studies of the upper limbs in December 2021 were reported as being within normal limits.[33]
[33] Claimant’s bundle, p 260.
A referral from the GP to Dr Drynan dated 10 December 2021 noted persistent neck and right shoulder pain with swelling and numbness in lateral three digits since the motor accident.[34]
[34] Claimant’s bundle, p 262.
Dr David Drynan, surgeon provided an initial report dated 16 December 2021.[35] The doctor noted that injections into the subacromial space aimed at treating the tendinosis of the rotator cuff as well as subacromial bursitis did not work. The doctor stated:
“It is my impression of Maysam suffers from multiple issues regarding pain in her right upper limb, of which I’m not sure any other significant structural regarding a bone, muscle joints. Unfortunately Maysam has been suffering with this pain for seven months now and I believe she’s in today pain cycle. She has some alternate sensation that does not match any significant myotome dermatome, plexus [or] regional peripheral nerve distribution. Her pain appears to come and go as well as the functional improvement relapses depending on certain days. This all appears to be a non-mechanical driver of this condition.”
[35] Claimant’s bundle, p 277.
Dr Drynan expressed concern that the claimant may be falling into a chronic pain cycle and recommended ongoing physiotherapy and referral to a chronic pain specialist.
An MRI scan of the right shoulder dated 9 May 2022 showed:[36]
(a) trace SASD fluid;
(b) minimal intrasubstance long head biceps tendinosis, and
(c) Burford complex on the background of a sublabral foramen.
[36] Claimant’s bundle, p 247.
Dr Drynan provided a further report dated 16 May 2022.[37] The doctor noted no improvement following physiotherapy treatment. He did not recommend surgery for the Burford complex as shoulder “instability” was not the claimant’s primary concern.
[37] Claimant’s bundle, p 283.
Dr Drynan noted that the recent MRI scan confirmed partial thickness rotator cuff tears. He opined that there may be intra-articular issues and recommended an ultrasound guided injection to the glenohumeral joint to ascertain the source of the pain.
Dr Drynan provided a further report dated 15 June 2022.[38] The doctor noted long-standing shoulder pain in the context of the motor vehicle accident. Recent intra-articular steroid injection into the long head of biceps tear significantly improved the claimant’s pain.
[38] Claimant’s bundle, p 248.
Dr Drynan opined that the recent injection and improvement in pain confirmed that part of the shoulder pain is coming from the superior labral tear involving the biceps anchor.
Dr Drynan provided a further report dated 5 September 2022. The doctor noted that surgery had not approved and recommended a biceps tenodesis to improve pain in the anterior super aspect of the shoulder.[39]
[39] Claimant’s bundle, p 306.
Right shoulder arthroscopy, AC joint excision, subacromial decompression and rotator cuff debridement was undertaken in January 2023.[40] The operation report noted the following findings:[41]
[40] Claimant’s bundle, p 315.
[41] Claimant’s bundle, p 314.
“stable shoulder
Grade 1 anterior load and shift nil inferior or posterior
Glenoid - central interior defect - ? old traumatic or developmental
Buford complex
Labrum - rolling in unstable biceps anchor
SST - partial-thickness - more posterior
SSC – NAD
IS – NAD
Interval – tight and synovitic
subacromial space”
On 31 January 2023 Dr Drynan noted that lateral side neck and lateral shoulder pain had improved. On 1 March 2023 Dr Drynan noted ongoing improvement. In respect of causation, Dr Drynan opined:
“I anticipate she may have dislocated during the event and has some chondral changes that may demonstrate a dislocation at that time. Maysam had ongoing biceps tendinopathy and some impingement that may be due to her rotator cuff imbalance of power.”
In June 2023 Dr Drynan noted ongoing improvement with the claimant having no pain when recently travelling to a warmer climate.[42]
[42] Claimant’s bundle, p 319.
RE-EXAMINATION
The Panel did not re-examine the claimant. For the following reasons we have determined that the motor accident caused a non-threshold injury to the right shoulder. There is no utility in a further medical examination of the right shoulder given that there has been recent surgery with reported excellent recovery. As this is a non-threshold injury, any further examination is unnecessary.
FINDINGS
The review is a new assessment of all matters with which the medical assessment is concerned. The original medical assessment related to the injuries sustained in the motor accident were threshold or not threshold injuries as defined under the MAI Act.
The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[43] and Insurance Australia Ltd v Marsh.[44]
[43] [2021] NSWCA 287 at [40], [41] and [45].
[44] [2022] NSWCA 31 at [11], [21] and [64].
The Panel adopts the reasoning in David v Allianz Australia Ltd[45] that radiculopathy can be present at any time to establish that the injury is not a threshold injury for the purposes of the MAI Act.
[45] [2021] NSWPICMP 227 at [84] – [104].
We adopt the reasoning in Lynch v AAI Ltd[46] that the claimant bears the onus of proof in establishing that any injury is not a threshold injury for the purposes of the MAI Act. That conclusion is consistent with the observations in Briggs v IAG Ltd (No 2):[47]
“The second review panel did not address the question of whether on the balance of probabilities the motor vehicle accident caused the annular tear even though there might be no scientific certainty.”
[46] [2022] NSWPICMP 6 at [44] – [62].
[47] [2022] NSWSC 372 (Briggs (No 2)) at [73].
The body parts alleged to be injured are set out earlier in these Reasons.
Right shoulder
We note the reference to shoulder symptoms prior to the accident on 8 April 2021. However, the GP notes are in the context of fibromyalgia rather than to restriction of movement. The note does not identify the shoulder.
The insurer correctly noted that the GP record on the day after the accident did not refer to right shoulder pain but to “tenderness in right clavicle”. However, there was also reference to “mild numbness in right arm”.
On 6 May 2021, that is within two days of the motor accident, the GP noted “more neck and right arm with shoulder pain today”. It is medically plausible that there can be a delay in onset of symptoms from injury of two days. We do not believe that the absence of right shoulder compliant on the day after the motor accident as medically significant.
The medical records summarised earlier show a constant reporting of right shoulder symptoms which eventually led to surgery.
At surgery, Dr Drynan found a partial thickness tear of the “SST” which is shortform for the supraspinatus tendon. The Panel accepts the treating surgeon’s direct observation that there was partial tear of the right supraspinatus tendon.
The issue is whether the motor accident caused or aggravated the tear of the supraspinatus tendon.
On the balance of probabilities, we accept that the motor accident probably aggravated and extended the right supraspinatus tear. This finding is based on:
(a) the absence of prior right shoulder complaint save as to one mention of shoulder complaint before the accident and in circumstances that does not refer to restriction of movement but tenderness indicative of fibromyalgia;
(b) that it is medically plausible that there can be trauma imposed on the right shoulder through the seat belt in a rear accident on a driver. That conclusion is supported by the opinion provided by Dr Drynan;
(c) the continuity of complaints by the claimant from two days after the motor accident;
(d) that the treating surgeon opined that in June 2022 the source of the shoulder pain, and
(e) that the operation treated the right supraspinatus tear from which there is a clear report of substantial recovery. This suggests that the tear was a substantial cause of the reported shoulder pain.
This finding means that the right shoulder injury is not a threshold injury as defined in the MAI Act because the injury was a partial rupture of a tendon.
Other injuries
We accept that the claimant sustained a soft tissue injury to the cervical spine evidenced by the contemporaneous complaints, the nature of the motor accident and the claimant’s history. The nature of the motor accident was likely to have caused a whiplash injury to the cervical spine which explained the immediate complaints of neck pain.
The recorded histories show previous cervical spine problems.
The various scans, clinical findings and various medical opinion does not support a finding that the motor accident caused a traumatic injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage. It is medically plausible and likely given the nature of the symptoms that the motor accident aggravated the pre-existing degenerative changes in the cervical spine. That is a threshold injury as defined.
There are no recorded observations of two signs of radiculopathy as defined in cl 5.8 of the Guidelines. The clinical notes refer to radicular right arm pain. However, these are not signs of radiculopathy as defined because they are not described as relating to a specific dermatome and radicular pain is not a sign of radiculopathy.
For these reasons we conclude that Ms Jarrar has not satisfied, at any time, two clinical signs of radiculopathy pursuant to the Guidelines.
The claimant had low back pain immediately prior to the motor accident evidenced by the clinical notes and referral for an X-ray. The post-accident clinical notes do not support an aggravation of the low back condition caused by the motor accident.
Whilst it is unnecessary to decide in light of our findings on the right shoulder, the Panel doubts that the motor accident caused a low back injury.
The injury to the chest wall was clearly soft tissue as all relevant scans and examination showed no pathology relevant to showing a non-threshold injury.
Whilst it is unnecessary to decide, we also doubt that the motor accident caused injuries to the right wrist and elbow.
Other matter
We doubt that because the motor accident had caused the need for surgery which involved cutting of tissue, the injury is classified as a non-threshold injury: see the discussion in Mandoukas v Allianz Australia Insurance Ltd.[48]
[48] [2023] NSSC 1023 at [93].
CONCLUSION
For these reasons the Panel concludes that the certificate issued by Medical Assessor McGrath is revoked.
5
0