Navarro v Allianz Australia Insurance Limited
[2025] NSWPICMP 800
•17 October 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Navarro v Allianz Australia Insurance Limited [2025] NSWPICMP 800 |
CLAIMANT: | Maria Navarro |
INSURER: | Allianz Australia Insurance Limited |
REVIEW PANEL | |
MEMBER: | Hugh Macken |
MEDICAL ASSESSOR: | Drew Dixon |
MEDICAL ASSESSOR: | David Gorman |
DATE OF DECISION: | 17 October 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of medical assessment; whole person impairment (WPI); soft tissue injury to lumbar sacral spine with aggravation of asymptomatic pre-existing chronic degenerative disease; soft tissue whiplash injury to the cervical spine with referred pain above shoulders; requirement to address WPI; diagnostic scans showed no clear abnormality; no muscle wasting and negative nerve stretching; no wasting and negative sciatic stretch testing; no evidence of radiculopathy nor any partial or complete rupture of ligaments; Held – the motor accident could not have caused the annular tears; they are degenerative in association with degenerative changes; pressure injury; restricted range of motion left shoulder; WPI 1%; medical assessment confirmed. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Review Panel Assessment – Threshold Injury Replacement Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel confirms the certificate of Medical Assessor Adam Rapaport dated ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT Certificate issued under s 7.23(1) of the Motor Accident injuries Act 2017 1. The following injuries caused by the motor accident give rise to a permanent impairment of 1% and IS NOT GREATER THAN 10%: · soft tissue injury to the lumbosacral spine with aggravation of asymptomatic pre-existing chronic degenerative disease at L4/5 and L5/S1 interverterbral discs, and · soft tissue whiplash injury to the cervical spine with referred pain to both shoulders. |
STATEMENT OF REASONS
INTRODUCTION
Maria Navarro (the claimant) is a 60-year-old woman who was injured in a motor vehicle accident on 5 May 2020. Following the accident the claimant lodged an application for Personal Injury Benefits and thereafter sought a concession from the insurer that her injuries are non-threshold injuries. Following a review the insurer declined to make this concession and consequently the claimant then lodged an application for Assessment of Threshold Injuries and Whole Person Impairment.
In a certificate dated 4 February 2025 Medical Assessor Canaris determined that the claimant has sustained non-threshold injuries. The claimant was examined by Medical Assessor Adam Rapport who, in a certificate dated 21 March 2025, determined that the claimant has sustained threshold injuries and accordingly no assessment of whole person impairment was required. The claimant sought a review of this determination and, a certificate dated 21 March 2025, President’s delegate Tajan Baba, decided that there is a reasonable cause to suspect that the medical assessment is incorrect in a material respect. The matter was then referred to this Medical Review Panel.
The Panel conveyed on 14 August 2025 and determined that it was appropriate that the claimant be examined specifically to address the claim for WPI which was not previously addressed.
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 the 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 new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission).
Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
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 matter solely based on the written application.
The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
The claimant attended the Commission medical suites at 1 Oxford Street Darlinghurst, and she was accompanied by a male friend Mr Eric Johanssen for support.
HISTORY
Pre-accident medical history and relevant personal details
The claimant is aged 61 years and works as a Registered Nurse part-time in the clinics of the Breast Cancer Institute at Westmead. She started there on 15 September 2025.
She worked full-time before the subject accident.
The claimant was born in Peru and she migrated to Australia in 1988. She worked as an assistant in nursing in aged care for some six years. She enrolled in a part-time nursing degree at University of Western Sydney over a five year period and graduated successfully with a nursing degree.
She started working as a registered nurse in the geriatric ward at Concord Hospital and then at Westmead Hospital in the surgical ward for six years.
In 2014 she moved to community nursing and was involved in the subject work-related motor vehicle accident on 5 May 2020 while she was on her way to work. She had problems finding duties which did not exacerbate her symptoms after the subject accident but eventually has started in the clinics as mentioned above.
She has had a cholecystectomy and uterine myomectomy.
She had a Workers Compensation claim for a fractured finger that required surgical reduction and internal fixation. It does not cause any ongoing problems.
History of the motor accident
On the early morning of 5 May 2020, Mrs, Navarro was driving to work in a Western Sydney Health Service company car when a car turning right from a driveway alongside and to her left, collided with the rear passenger door of her vehicle. She had described the accident as a ‘side swipe’ to the rear door. The claimant was wearing a seat belt. Air bags did not deploy.
She self-extricated from her car, exchanged details with the other driver and was able to drive her vehicle back to base that was located approximately 1km away.
After completing the incident form online, she began experiencing low back pain that radiated upwards towards her thoracic and cervical spine.
Her manager drove her to her home after she had completed the incident form.
History of symptoms and treatment following the motor accident
She subsequently contacted her general practitioner (GP) Dr Thaninayagham who prescribed Endone to alleviate her back pain. She recalls that she “couldn’t walk properly”.
She took two weeks off from work during which time she experienced left sided neck pain that radiated into the left shoulder and interscapular region.
Mrs Navarro underwent plain X-ray of the cervical and thoracic spine on 13 May 2020. At that time, she was taking Endone 5 mg four times daily. With neck movements she experienced pain that radiated from the left parietal skull to the tip of her tongue and also into the submandibular area.
She was commenced on physiotherapy in June 2020 with gentle massages to the neck and shoulders as well as ultrasonic treatment in addition to gentle muscle building exercises.
She returned to office based administrative duties. She was able to drive to work in her 2001 model Mazda MX5.
She saw the neurologist Dr Walker on 17 September 2020. He ordered imaging of her whole spine but noted that “A CT of her thoracic and lumbar spine have not shown any clear abnormalities”. The MRI of the full spine dated 23 September 2020 reported minor degenerative disc changes in the lumbar spine but with no neural compromise.
A subsequent review by Dr Walker on 29 September 2020 confirmed his view that there was no evidence of neural impingement or compromise and that her symptoms were musculoskeletal in origin.
The claimant’s first investigation of her left shoulder was an ultrasound examination on
28 November 2020, almost seven months post motor accident. It was not diagnostic of any fractures or rotator cuff tears. She underwent ultrasound guided steroid injection into the subacromial bursa on 14 December 2020.
In March 2022 an MRI examination of the cervical spine was noted to be a normal study and a bone scan performed on 10 March 2022 was unable to find any abnormality to account for the claimant’s spine pain.
The claimant had consulted orthopaedic surgeon Dr Daniel Biggs in March 2022 with left sided neck pain that radiated into the left upper extremity. No surgical intervention was proposed, and she was recommended to return to her chronic pain management consultant.
In 2023 she had an exacerbation of pain after physiotherapy. She said she had “burning pain from head to toe”. She recovered from this.
The claimant consulted Dr Alister Ramachandran, a pain specialist on 1 March 2022. He performed a left suprascapular nerve block and subsequently a radiofrequency ablation of that nerve with a Botox injection. She reported that this gave her some relief of the left shoulder pain.
She has subsequently seen Dr Despande, a new pain specialist, and again had the suprascapular nerve ablation and botox in December 2024. This again helped.
Details of any relevant injuries or conditions sustained since the motor accident
On 1 July 2024 while driving a loan car because her own car was being serviced, she suffered a ‘head on but low speed’ car accident involving another car. It was within the hospital campus. She had no ongoing symptoms.
Current symptoms
She has neck pain on upward gaze.
The “burning” and “pins and needles” has resolved although she tries to avoid repetitive movements.
She can now tolerate a bra and can hold her arms up to wash her hair. The left shoulder she says is definitely better.
She still has some low back pain but she describes it as “manageable”.
Current and proposed treatment
She sees the physiotherapist weekly. She continues with her regular psychology sessions.
She takes gabapentin 300mg nocte and Nuromol as required.
She has ceased fluoxetine and Lyrica.
EXAMINATION
She was a well looking women with a height of 148cm and a weight of 65.5kg.
Cervical spine
She had mildly restricted range of motion to ¾ normal in all planes. There was no muscle spasm or dysmetria.
She was tender over the left side of the neck and over the left trapezius.
The upper limbs had normal power, sensation and reflexes. There was no wasting and negative nerve stretch testing.
Thoracic spine
There was normal extension, flexion and rotation.
There was no tenderness or muscle spasm.
There were no radiating symptoms around the chest.
Lumbar spine
She had normal ranges of flexion and extension. She could reach 15cm below her knees. Lateral flexion to the left and right were also normal.
Lower limb power, sensation and reflexes were normal. There was no wasting and she had negative sciatic stretch tests.
Shoulders
There was restriction in left shoulder range of motion in association with tenderness over the left trapezius.
The range of motion is outlined in the table below.
| SHOULDER RANGE OF MOTION | Right (degrees) | Left (degrees) |
| Flexion | 180 | 160 |
| Extension | 50 | 50 |
| Abduction | 180 | 150 |
| Adduction | 50 | 50 |
| Internal rotation | 80 | 80 |
| External rotation | 90 | 90 |
Comments on consistency
She was cooperative and consistent.
Summary of relevant radiological and medical imaging and other investigations
X-ray cervical and thoracic spine dated 13 May 2020: No vertebral compression fracture or malalignment in the cervical spine. There was no vertebral compression fracture and disc heights were maintained in the thoracic spine.
CT Lumbar spine dated 12 May 2020: There are minor disc bulges at the two lowest levels of the lumbosacral spine with spondylosis and no evidence of neural compression.
CT thoracic spine dated 21 May 2020: There are no significant degenerative changes in the thoracic spine and no other abnormal findings.
MRI of the full spine dated 25 September 2020: There is minimal multilevel spondylosis of the lumbar spine including minimal bilateral foraminal narrowing from L3/4 to L5/S1 but without significant neural impingement identified. There is no significant foraminal narrowing or neural impingement identified in the cervical or thoracic spine. The spinal cord is of a normal contour and signal.
X-ray and ultrasound left shoulder dated 21 October 2021: Heterogeneous changes in the subscapularis of the left rotator cuff consistent with mild tendinosis. There is some thickening of the left subacromial/subdeltoid bursa.
X-ray left shoulder dated 1 March 2022: No abnormalities seen.
MRI imaging of the cervical spine dated 9 March 2022 reported by radiologist Dr Tushar Singh noted that it was a normal study.
MRI lumbar spine – 15 May 2023 – disc bulges at L2/3, L3/4, L4/5 and L5/S1 with bilateral facet joint arthrosis at this level; small right foraminal annular fissure.
DETERMINATIONS
Diagnosis, Causation and Reasons
Cervical spine – soft tissue “Whiplash” injury – no evidence of radiculopathy nor any partial or complete rupture of ligaments or fibrocartilage (disc). Soft tissue injury caused by the accident with cervical pain immediately after the accident.
Thoracic spine - soft tissue injury – no evidence of radiculopathy nor any partial or complete rupture of ligaments or fibrocartilage (disc). Soft tissue injury caused by the motor accident with some interscapular pain reported soon after the accident.
Lumbar spine - soft tissue injury – no evidence of radiculopathy nor any partial or complete rupture of ligaments or fibrocartilage (disc). Soft tissue injury caused by the motor accident with lumbar pain immediately after the accident. The motor accident was not of a type or of the severity to cause a disc injury in a seat belted driver. The motor accident could not have caused the annular tears described at L2/3 and L5/S1 – they are degenerative in association with other degenerative changes including facet arthrosis at the L5/S1 level. These degenerative changes are not unexpected in a 60 year old Registered Nurse.
Left shoulder – referred pain from the cervical spine – unlikely that the motor accident could have caused mild bursitis and tendinosis reported. The mild subscapular tendinosis of the left shoulder is likely to be a pre-existing degenerative condition.
Summary of injuries referred by the parties
The following injuries WERE caused by the motor accident:
(a) soft tissue injury to the lumbosacral spine;
(b) soft tissue “whiplash” injury to the cervical spine with referred pain to left shoulder, and
(c) soft tissue injury to the thoracic spine – resolved.
Threshold injury
The cervical spine soft tissue whiplash injury is a threshold injury because there is no nerve injury (radiculopathy) and there is no evidence of partial or complete rupture of ligaments or fibrocartilage (disc).
The lumbosacral soft tissue whiplash injury is a threshold injury because there is no nerve injury (radiculopathy) and there is no evidence of partial or complete rupture of ligaments or fibrocartilage (disc). The motor accident was not of a type or severity to cause a significant lumbar injury in a seat belted driver as discussed above. On balance it could not have caused the annular tears described at L2/3 and L5/S1. they are degenerative in association with other degenerative changes.
The thoracic spine is a threshold injury now resolved
The left shoulder is a threshold injury as there is no partial or complete rupture of ligaments, tendons or cartilage – the symptoms and restriction in movement of the left shoulder is referred from the cervical spine.
Permanent impairment
She has reached maximal medical improvement and her symptoms and signs have been stable for at least six months.
Looking at each referred injury in turn
Cervical spine – there are persisting symptoms with no radiculopathy and no dysmetria. She is DRE category I giving a WPI of 0% based on Table 73 on page 110 of the American Medical Association Guides to the Evaluation of Permanent Impairment, fouth edition (AMA 4 Guides).
Thoracic spine – the symptoms have resolved – no assessable impairment.
Lumbar spine - there are persisting symptoms with no radiculopathy and no dysmetria. She is DRE category I giving a WPI of 0% based on Table 72 on page 110 of the AMA 4 Guides.
Left shoulder – using the Nguyen principle, we can assess impairment based on restricted range of motion. One uses Figures 38, 41 and 44 on pages 43,44 and 45 of the AMA 4 Guides. The limitation in flexion gives 1% UEI (upper extremity impairment) and the limitation in abduction a 1% UEI. The total UEI is 2% which equates to a 1% WPI using Table 3 on page 20.
CONCLUSION – Threshold injury
The following injury is a threshold injury:
• soft tissue whiplash injury to the cervical spine with referred pain to the left shoulder;
• soft tissue injury to the lumbar spine, and
• soft tissue injury to the thoracic spine.
CONCLUSION
The injuries caused by the motor accident result in a WPI of 1%.
0
0
0