Nelson v AAI Limited t/as AAMI - [2025] NSWPICMP 576

DETERMINATION OF REVIEW PANEL
CITATION:	Nelson v AAI Limited t/as AAMI [2025] NSWPICMP 576
CLAIMANT:	Gabriella Olivia Nelson
INSURER:	AAI Limited t/as AAMI
REVIEW PANEL
MEMBER:	Gary Victor Patterson
MEDICAL ASSESSOR:	David Gorman
MEDICAL ASSESSOR:	Tai-Tak Wan
DATE OF DECISION:	7 August 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); permanent impairment dispute; Medical Assessor (MA) certified that the claimant’s facial scarring was a non-threshold injury; MA subsequently found 2% whole person impairment (WPI) for facial scarring; no permanent impairment arising from possible mild traumatic brain injury and soft tissue injuries to the cervical and lumbar spine; MA found injuries to the right hand and right shoulder were not caused by the motor accident; claimant’s review application allowed on the basis that the Medical Assessor did not provide a clear path of reasoning concerning his assessment of injury to the right shoulder and right hand; Held – MAC revoked.
DETERMINATIONS MADE:	CERTIFICATE REVIEW PANEL ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT *Certificate issued under s 7.26(7) of the Motor Accident Injuries Act2017* (the Act) 1. The Review Panel revokes the certificate dated 1 December 2024 and issues a new certificate determining that: (a) the following injuries caused by the motor accident give rise to a permanent impairment of 1% and IS NOT GREATER THAN 10%:** · head – possible mild traumatic brain injury; · face – scarring; · cervical spine – soft tissue injury, and · lumbar spine – soft tissue injury. (b) the following injuries referred for assessment have been assessed and determined to be not caused by the motor accident: · chest – tension in the neck; · right hand – sensation in the median nerve distribution of the right hand, and · right shoulder – impaired range of movement. An assessment of the degree of permanent impairment of these injuries is therefore not required.

STATEMENT OF REASONS

INTRODUCTION

On 25 June 2022 at approximately 6.00pm, Gabriella Olivia Nelson (the claimant) was an unrestrained rear-seat passenger in the insured vehicle which was travelling at speed. The driver lost control of the vehicle at the intersection of Barney Street and Church Street, North Parramatta. The vehicle hit a wall and rolled onto its roof. The airbags deployed. There were six passengers in the small vehicle. Four of the passengers departed the scene, leaving the claimant and one other. The claimant suffered a large laceration to her forehead. There was no definite loss of consciousness. An ambulance attended and conveyed the claimant to Westmead Hospital. She had initial treatment and was discharged to the care of her general practitioner. The claimant returned to work after about two weeks. She had modified duties initially. She returned to driving after two to three weeks. Physiotherapy treatment was effective. The claimant developed psychological symptoms.
AAMI (the insurer) indemnifies the owner and/or the driver of the at-fault vehicle for liability to pay to the claimant any statutory benefits and damages under the Motor Accident Injuries…

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 576
Decision Date: 7 August 2025

CaseChat Overview and Summary

In the case of Nelson v AAI Limited t/as AAMI, the claimant sought a review of a Medical Assessment Certificate (MAC) issued following a motor accident. The claimant argued that the MAC was incorrect in various respects, particularly regarding the assessment of her injuries and the determination of permanent impairment. The matter was heard in the Motor Accident Commission of Victoria. The central dispute involved the accuracy of the MAC, which had certified that the claimant’s facial scarring was a non-threshold injury and assessed a 2% whole person impairment (WPI) for this scarring. Additionally, the MAC concluded that there was no permanent impairment from the possible mild traumatic brain injury and soft tissue injuries to the cervical and lumbar spine. Furthermore, the MAC found that the injuries to the right hand and right shoulder were not caused by the motor accident.

The court was tasked with determining whether the MAC correctly assessed the claimant's injuries and permanent impairment. Specifically, the court needed to review the Medical Assessor's (MA) findings regarding the facial scarring, the absence of permanent impairment from the brain injury and spine injuries, and the causation of injuries to the right hand and right shoulder. The claimant argued that the MA's reasoning was flawed, particularly concerning the assessment of her right shoulder and right hand injuries.

The court found that the MA did not provide a clear path of reasoning concerning his assessment of injury to the right shoulder and right hand. Consequently, the claimant's review application was allowed on this basis. The court revoked the MAC, finding that the MA's assessment was not adequately reasoned and thus not reliable. This decision underscored the importance of clear and comprehensive reasoning in medical assessments under the Motor Accident Injuries Act 2017.

Orders