Kotb v AAI Limited t/as GIO

DETERMINATION OF REVIEW PANEL

CITATION:

Kotb v AAI Limited t/as GIO [2023] NSWPICMP 310

CLAIMANT:

Mustafa Kotb

INSURER:

AAI Ltd t/as GIO

REVIEW Panel

PRINCIPAL MEMBER:

John Harris

MEDICAL ASSESSOR:

Michael Couch

MEDICAL ASSESSOR:

Neil Berry

DATE OF DECISION:

30 June 2023

CATCHWORDS:

MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; the claimant suffered injury on 10 October 2020 in a rear-end collision; the dispute related to the assessment of threshold injury and treatment and care; claimant re-examined; original review submissions limited to threshold dispute; claimant argued that all matters reviewed; no contrary response from insurer; review is of medical assessment (section 7.26(1)) and a new assessment of all matters (section 7.26(6)); Meeuwissen v Boden referred to; Panel reviewed all medical assessment disputes; significant pre-existing history of right knee, right shoulder and lumbar spine pain; no plausible medical explanation why motor accident caused or aggravated right knee condition; subsequent falls causing further injuries to arms due to right knee instability not caused by motor accident; deterioration of shoulder pathology from 2012 to 2021 explicable by normal ageing process associated with significant pathology and inflammatory arthritis; findings made that claimant suffered threshold injuries; findings made on treatment disputes noting distinction between “reasonable and necessary” and causation; Held – assessment of threshold injury confirmed; treatment and care certificates revoked. 

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 confirms the certificate dated 8 November 2022 that the claimant suffered threshold injuries.

Medical Assessment –Treatment and Care

Review Panel Assessment of Treatment and Care and 
Replacement Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017

The Review Panel revokes the certificate dated 8 November 2022 and issues a new certificate determining that:

·        the following treatment and care:

·        ten sessions of cleaning and lawn mowing;

·        referral to Professor George Murrell;

·        referral to Dr Ian Hargreaves, hand and wrist surgeon;

·        MRI scan of the shoulders;

·        MRI scans of the hands and wrists;

·        X-ray and ultrasound of both shoulders, and

·        provision of a TENS machine.

IS REASONABLE AND NECESSARY in the circumstances.

The following treatment and care:

·        ten sessions of cleaning and lawn mowing;

·        referral to Dr Ian Hargreaves, hand and wrist surgeon;

·        MRI scans of the hands and wrists;

·        MRI scans of the shoulders.

·        X-ray and ultrasound of both shoulders, and

·        provision of a TENS machine.

DOES NOT RELATE TO THE INJURY CAUSED BY THE MOTOR ACCIDENT.

The following treatment and care:

·        referral to Professor Murrell

RELATES TO THE INJURY CAUSED BY THE MOTOR ACCIDENT.

REASONS

BACKGROUND

1. Mr Mustafa Kotb (the claimant) sustained injury in a motor accident on 10 October 2020 when the insured driver caused a rear-end collision (the motor accident).[1] 

   [1] This is only a brief and non-exhaustive summary of the motor accident.

2. The insurer is liable to pay to Mr Kotb any damages and/or statutory compensation entitlements…