Natali v AAI Limited t/as GIO - [2023] NSWPICMP 213

DETERMINATION OF REVIEW PANEL
CITATION:	Natali v AAI Limited t/as GIO [2023] NSWPICMP 213
CLAIMANT:	Mario Natali
INSURER:	AAI Limited trading as GIO
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	Geoffrey Stubbs
MEDICAL ASSESSOR:	Drew Dixon
DATE OF DECISION:	18 May 2023
CATCHWORDS:	MOTOR ACCIDENTS – Review of certificate of Medical Assessor (MA) Assem dated 30 March 2022 and whole person impairment (WPI) assessment; claimant’s application for review of WPI assessment of 9% concerning cervical spine, lumbar spine, right shoulder, left shoulder, left knee and left hip; claimant involved in head on collision on 4 June 2018; issue considered about when complaints injury made; causation considered to consider the claimant’s assertion that the medical assessor failed to engage with the material and incorrectly determined causation; consideration of the impact of subsequent fall by the claimant and injuries arising from this; claimant medically examined by the Panel and complaints considered in light of extensive radiological investigations; Held – Panel satisfied that as a direct consequence of the accident the claimant suffered injuries to his cervical spine, lumbar spine, right shoulder; WPI assessed at 11%.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Determination 1. The Panel revokes the certificate of Assessor Assem of 30 March 2022. 2. The Panel finds that directly arising out of the accident on 4 June 2018, the claimant has suffered the following injuries; a. cervical spine soft tissue injury b. lumbar spine soft tissue injury c. right shoulder aggravated acromioclavicular arthritis caused by the accident. 3. The Panel finds that the following injuries were not caused by the accident; a. left shoulder rotator cuff disease and tear. 4. The Panel finds that as a result of the accident the claimant suffered injury to his left knee and left hip however, these injuries have resolved. 5. The Panel finds that injuries suffered by the claimant and arising out of the accident give rise to a whole person impairment of 11%.

REASONS
Decision reviewed

1. This is an application for review of the decision of Medical Assessor Assem (the Medical Assessor) dated 30 March 2022,
2. The following injuries were referred by the Personal Injury Commission for assessment of whole person impairment:
a)Cervical spine – Disc lesion, facet joint dysfunction.
b)Lumbar spine – Lumbar disc lesion.
c)Right shoulder – Tendonitis and rotator cuff disruption.
d)Left shoulder – Tendonitis and rotator cuff disruption.
e)Left knee – Chondromalacia patellae.
f)Left hip – Labral tear.

3. The Medical Assessor found that the following injuries caused by the accident gave rise to a permanent impairment of 9% and is not greater than 10%:
a)Cervical spine – soft tissue injury
b)Lumbar spine – soft tissue injury
c)Right Shoulder – soft tissue injury

The accident

4. The claimant was involved in an accident on 4 June 2018, He was driving a 4WD vehicle along Prairie Vale Road, Bossley Park when a vehicle travelling in the opposite direction lost control causing a head on collision. The claimant was wearing a seat belt. The airbags were deployed.
5. The…

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.

Keep reading for free

Create a free CaseChat account to read Natali v AAI Limited t/as GIO and more:

Read every judgment in full
Ask AI and get answers linked to paragraphs
See how each paragraph was cited in later cases
Download judgments as PDF or Word

Continue with Google

One click creates your free account or signs you in.

By continuing you agree to the Terms and Privacy Policy.

Details

Case: [2023] NSWPICMP 213
Decision Date: 18 May 2023

CaseChat Overview and Summary

Natali v AAI Limited t/as GIO involved a review of a certificate issued by a Medical Assessor (MA) named Assem, dated 30 March 2022, which assessed the whole person impairment (WPI) of the claimant following a motor accident. The claimant contested the WPI assessment of 9%, which related to injuries to the cervical spine, lumbar spine, right shoulder, left shoulder, left knee, and left hip, following a head-on collision on 4 June 2018. The primary issue for the court was to determine the appropriate timing for when the complaints of injury were made and to assess the causation of the injuries in light of the claimant's argument that the medical assessor had not adequately engaged with the material and had incorrectly determined the causation.

The court examined the medical reports and evidence submitted by the claimant, including the extensive radiological investigations, to evaluate the extent of the injuries sustained. The court considered the impact of a subsequent fall by the claimant and the injuries arising from that incident. The claimant was medically examined by a panel, and the complaints were weighed in light of the comprehensive medical evidence. The court found that the claimant had suffered injuries to his cervical spine, lumbar spine, and right shoulder as a direct consequence of the accident. The WPI was reassessed at 11%, reflecting a higher level of impairment than originally determined by the medical assessor.

The court concluded that the claimant's arguments regarding the medical assessor's failure to properly engage with the evidence and incorrectly determine causation were not substantiated. The claimant's assertion that the medical assessor had misconstrued the evidence was not supported by the comprehensive review of the medical investigations and the claimant's own medical history. The final orders of the court confirmed the WPI assessment of 11%, aligning with the panel's findings, and rejected the claimant's application for a higher WPI assessment. The decision underscores the importance of a thorough review of medical evidence and the need for a balanced consideration of all relevant factors in determining WPI assessments.

Orders