QBE Insurance (Australia) Limited v Powell (No 2)

DETERMINATION OF REVIEW PANEL
CITATION:	QBE Insurance (Australia) Limited v Powell (No 2) [2025] NSWPICMP 167
CLAIMANT:	Ashleigh Powell
INSURER:	QBE Insurance (Australia) Limited
REVIEW PANEL
MEMBER:	Belinda Cassidy
MEDICAL ASSESSOR:	Norman Chan
MEDICAL ASSESSOR:	John Schmidt
DATE OF DECISION:	14 March 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; application for review of a treatment dispute under section 7.26; claimant severely injured in motor accident on 27 September 2019 at the age of 33; claimant requested insurer pay for IVF treatment to harvest and store her eggs to preserve her ability to have children at a later date; the insurer refused; Medical Assessor (MA) determined IVF treatment was related to the injuries caused by the accident and was reasonable and necessary in the circumstances; insurer sought review but agreed to fund five cycles of IVF with associated expenses and storage costs; after Principal Member determined proceedings should not be dismissed in Powell v QBE Insurance (Australia) Limited insurer conceded the treatment was reasonable and necessary in the circumstances of the claimant’s age (now 38) and her declining fertility due to age but denied the treatment was related to the accident; claimant had multiple fractures to her pelvis and other injuries; claimant conceded she had not injured any of her reproductive organs in the accident; claimant alleged her fertility had declined as a result of all of the injuries she sustained in the accident and that she was not physically or psychologically well enough to have a child at the present time and wished to preserve her eggs so that she could have children when she felt well enough; Medical Assessors agreed the claimant would be able to maintain a pregnancy and deliver a child but that she would have difficulties and increased pain in doing so, her injuries were likely to cause pain during intercourse making it unlikely she could conceive naturally, and the claimant’s fertility had reduced since the accident because of her age and that pain and stress could have caused an additional reduction in fertility; Review Panel not satisfied the claimant stopped ovulating after the accident because of the accident; Held – Review Panel satisfied claimant not physically well enough to have a child since the date of the accident because of the totality of her injuries; claimant’s fertility has declined and is declining; Review Panel satisfied IVF treatment related to the totality of all of her injuries; Medical Assessment Certificate revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 The Review Panel: 1. Revokes the certificate of Medical Assessor Izzo dated 6 March 2024. 2. There being no dispute as to the reasonableness and necessity of the treatment, certifies that the IVF, and associated treatment and expenses, paid for by QBE up to 27 September 2024 is related to the injuries caused by, or resulting from the accident on 27 September 2019. A statement setting out the Panel’s reasons for the assessment is included with this certificate.

STATEMENT OF REASONS

INTRODUCTION

Ashleigh Powell was involved in a motor accident on 27 September 2019. Ms Powell was riding her motorcycle when the driver of a four-wheel drive motor vehicle undertook a right turn in front of her, impacting her scooter, lifting Ms Powell onto the bonnet and propelling her onto the road surface.
The claimant sustained serious injuries in the accident and made a claim for statutory benefits with QBE under the provisions of the Motor Accident Injuries Act 2017 (the MAI Act). QBE is the third-party insurer of the vehicle that turned right in front of Ms Powell the driver of which Ms Powell says caused her accident.
QBE admitted liability for the claim and, as the relevant insurer under s 3.2(2)(b) of the MAI Act, QBE paid Ms Powell her statutory benefits from the date of the accident for five years. On 27 September 2024, in accordance with s 3.2(3) of the MAI Act, the Lifetime Care and Support Authority of New South Wales (the Authority) through its program CTPCare became the relevant insurer and is now paying Ms Powell her statutory benefits.
A medical dispute about certain IVF treatment provided or to be provided to Ms Powell arose in Ms Powell’s statutory benefits claim and Ms Powell referred that dispute to the Personal Injury Commission (the Commission) for assessment.
On 6 March 2024, Medical Assessor Izzo determined that the IVF treatment was related to the injuries caused by the accident and that the treatment was reasonable and necessary in the circumstances.
QBE lodged an application with the Commission seeking a review of the Medical Assessor’s decision. On 4 July 2024, a delegate of the President determined there was reasonable cause to suspect a material error in the assessment and allowed the Review. On

5 August 2024 the President’s delegate convened this Review Panel (the Panel) to conduct the Review.

LEGISLATIVE FRAMEWORK

Jurisdiction

The MAI Act provides a scheme for the compulsory third-party insurance of all motor vehicles registered in New South Wales and a scheme of statutory benefits (under Part 3) and compensation by way of lump sum damages (under Part 4) for persons injured in motor accidents in New South Wales.
Statutory benefits payable by the “relevant insurer”[1] in accordance with Part 3 of the MAI Act include:
(a) weekly loss of income benefits for “earners” under Division 3.3, and
(b) treatment and care benefits under Division 3.4.
[1] The “relevant insurer” is determined in accordance with s 3.2 of the MAI Act.
The entitlement to treatment and care benefits is established in s 3.24(1) which provides:
“An injured person is entitled to statutory benefits for the following expenses (treatment and care expenses) incurred in connection with providing treatment and care for the injured person -
(a) the reasonable cost of treatment and care”
Section 3.24(1)(b) and (c) also permits a claimant to recover the cost of reasonable and necessary travel and accommodation in order to obtain the treatment and, if the injured person is a minor or otherwise needs a carer, the reasonable and necessary accommodation and care of a parent or carer in order for the injured person to obtain their treatment.
Not all treatment and care is allowed. There are limits and restrictions on what insurers are required to pay for in the MAI Act commencing with s 3.24(2) which provides:
“No statutory benefits are payable for the cost of treatment and care to the extent that the treatment and care concerned was not reasonable and necessary in the circumstances or did not relate to the injury resulting from the motor accident concerned.”
Unlike the previous scheme,[2] damages for treatment and care expenses incurred or needed in the future cannot be recovered by the claimant against the insurer. The only mechanism for the claimant to recover the cost of treatment and care they say was caused by the accident is through their statutory benefits claim.[3]
[2] Under the Motor Accidents Compensation Act 1999.
[3] See s 4.5(1) of the MAI Act which limits damages to loss of earnings, costs of accommodation or travel, financial management costs and re-imbursement of income tax paid on statutory benefits.

Dispute resolution

Medical disputes about treatment in a statutory benefits claim can be resolved in the Commission.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matters, including (b):
“whether any treatment and care provided or to be provided to the injured person is reasonable and necessary in the circumstances or relates to the injury caused by the motor accident for the purposes of section 3.24 (Entitlement to statutory benefits for treatment and care).”
The insurer is not liable to pay statutory benefits if the treatment in dispute does “not relate to the injury resulting from the motor accident” (emphasis added). However, Schedule 2, cl 2 provides jurisdiction to a Medical Assessor (and therefore this Panel) to determine the relationship of treatment to “the injury caused by the motor accident” (emphasis added).
While the insurer suggests there is a distinction between those two phrases, either way the Panel must, if it is disputed, determine the injuries resulting from, or caused by the accident before determining whether the treatment relates to those injuries.

ASSESSMENT UNDER REVIEW

Medical Assessor Izzo examined the claimant on 31 January 2024 and issued a certificate dated 6 March 2024. This is headed “replacement” certificate. The Panel does not have the original certificate.
Medical Assessor Izzo identified the dispute as whether Ms Powell’s “physical injury gives rise to a need for invitro fertilisation (IVF) treatment, including harvesting / retrieving and storing eggs” and whether that treatment is related to the injury caused by the accident and is reasonable and necessary in the circumstances.
Medical Assessor Izzo notes the claimant sustained life-threatening injuries in the accident and has been hospitalised for eight months and has had 20 operations. He says:
(a) Ms Powell “became amenorrhoeic and her ovaries failed to function”, and
(b) she has premature ovarian failure and there is “documentation to show severe trauma can lead to ovarian failure.”
The Medical Assessor has a history at [8] that, before the accident the claimant was healthy, with no medical problems, no gynaecological problems in particular and her periods were regular. He also has a history of the accident and the outcome for the drug affected driver of the car that caused the accident.
Medical Assessor Izzo notes that the claimant “is in continual pain and can no longer work.” He says she had no further periods after the accident and this was investigated and she was found to have a low anti-mullerian hormone (AMH) levels, low oestrogen and high follicle-stimulating hormone (FSH) levels. He reports Ms Powell has seen a fertility specialist who has suggested IVF and egg freezing.
At [12] the Medical Assessor says Ms Powell requires egg freezing and IVF, “if she is to have any hope of having children” and that if she was to fall pregnant, she would need a caesarean section because of the severe pelvic fractures sustained in the accident.
At [15] Medical Assessor Izzo states:
“The MVA caused major physical trauma requiring 24 operations and eight months in hospital with many injuries including a shattered pelvis. This led to her having no further periods and ovarian “shutdown” or premature menopause. A well-documented effect of such severe trauma. Now leaving ovarian stimulation and IVF as the only way to achieve a pregnancy. This is confirmed on the series of investigations including hormones and AMH.”

ISSUES FOR DETERMINATION

Procedural matters

On 15 August 2024 the Panel issued directions to the parties. The Panel wished to identify the issues in dispute and attempt to narrow the issues and ensure the Panel had a focused bundle of documents addressing those issues. The Panel requested a list of documents to be relied on by each party and advised the parties of the teleconference date.
On 5 September 2024, Member Cassidy conducted a teleconference with the legal representatives, and afterwards reported to the parties noting the following:
(a)    it was agreed that the dispute concerned certain IVF treatment namely the retrieval and storage of the claimant’s eggs;
(b) it was also agreed that this IVF egg harvesting and storage was treatment and care within the definition of s 1.4 of the Act;
(c)    the claimant’s solicitor confirmed that the claimant does not allege damage to any of her reproductive organs in the accident but that she has abnormal ovarian functioning as a result of the trauma and stress of the accident which had caused a reduction or decline in her fertility which is an injury resulting from the motor accident;
(d)    in addition (or in the alternative) the claimant says she is not physically or psychologically well enough to have a child at the present time and therefore she needs to preserve her eggs now to ensure that when she is physically and psychologically well enough to have a child, she will have younger eggs and therefore a higher chance of successfully falling pregnant and having a baby, and
(e)    it was noted that the fifth anniversary of the accident was approaching and that Ms Powell’s statutory benefits claim would pass to the Lifetime Care and Support Authority (the Authority) and therefore the Panel would only be considering IVF treatment provided up to 5 September 2024.
The insurer responded to the matters raised at the preliminary conference and in the report submitting:
(a)    that the common law test of causation is not applicable because the entitlement to treatment expenses under s 3.24(2) depends on there being a relationship between the treatment and the “injury resulting from the motor accident.” The insurer says s 3.24(2) does not refer to an “injury caused by the motor accident.” [7] – [9];
(b)    the “but for” test is not relevant [11];
(c)    that the questions the Panel will need to answer are:
(i)what injuries did the claimant sustain in the motor accident?
(ii)does the IVF treatment relate to any one or more of those injuries?
(d)    the insurer says at [15] that the claimant did injure her pelvis but did not injure her reproductive organs therefore the IVF treatment does not relate to an injury resulting from the motor accident, and
(e) agrees that IVF treatment in a person with declining fertility is reasonable and necessary but says any decline in the claimant’s fertility is not an “injury resulting from the accident” [16].
The insurer advised the Panel that it had paid for all of the IVF treatment undergone by the claimant and provided details of five cycles of IVF resulting in 11 eggs harvested. On

26 September 2024, QBE provided a list of payments made to or on behalf of the claimant totalling in excess of $1.7 million. The list of payments includes an advance payment made to the claimant against her claim for damages, investigation fees and costs or fees paid to the insurer’s solicitors as well as payments made in Ms Powell’s statutory benefits claim.
The claimant responded by submitting:
(a)    while the insurer has agreed to pay for the past treatment, not all the past treatment has been paid for and provided a list of outstanding payments;
(b)    she has abnormal ovarian functioning, low level AMH (due to stress and trauma) a diagnosis of premature ovarian failure, premature and early menopause (due to trauma and stress) which make it difficult for her to conceive naturally hence the requirement to preserve her eggs [4] and the number of eggs harvested to date are evidence of this. A summary table of her blood test results was given [5];
(c)    the Panel is required to determine injuries resulting from or caused by the accident which is the same concept [7];
(d) the common law test of causation of injury applies as modified under ss 5D and 5E of the Civil Liability Act2002– see s 3B(2) of the MAI Act [8] and she cites Allianz v Clarke which in turn cites Raina v CIC and Briggs v IAG, and
(e) the claimant needs to harvest and store her eggs – either because of an accident-related decline in her fertility or because she is not currently in a physical or psychological position to have a child at the present time and so needs to preserve her ability to have children if and when she is ready with the harvesting and storage of her ‘younger’ eggs [11].
In relation to future IVF procedures, the claimant confirmed she seeks payment for two further IVF procedures and storage fees of $290 every six months. The cost was said to be $12,242.34 x 2 plus $290 x 2 x 9 years. Ms Powell submits there is nothing in the Act to suggest a decision of the Panel cannot bind the Authority and that the decision will be binding on both the claimant and the insurer but that it is simply the insurer that pays for the treatment will change.
While acknowledging a psychological component the claimant says her primary reasons for requesting the treatment is the decline in her fertility and her lack of wellness from a physical perspective.
On 27 September 2024 the claimant provided an amended list of outstanding payments of about $17,000 and associated treatment costs of about $5,000. QBE advised the Panel that it had or would pay for all of these expenses.
The Panel was concerned there was no longer a dispute for it to determine and requested the Division Head or her delegate consider dismissing the proceedings under s 54 of the Personal Injury Commission Act 2020 (PIC Act). On 6 December 2024, Principal Member Harris determined[4] that the Review proceedings should not be dismissed on the basis that QBE has paid for the treatment on a without prejudice basis, but that QBE may seek recovery of those payments made from the claimant at a later date.
[4][4] [2024] NSWPIC 673.
On 12 December 2024 the Panel issued directions to the parties seeking responses to the following questions:
(a) do the parties maintain their agreement that the treatment in dispute comes within the definition of treatment within s 1.4 and that it is treatment and care within the scope of s 3.24(1)?
(b) does the insurer concede that there is no dispute about whether the treatment in dispute is reasonable and necessary bearing in mind the circumstances (in particular the claimant’s age)?
(c) does the insurer agree that the real (and only) issue in dispute is whether the disputed treatment is related to the injuries caused by the accident?
The Panel noted that there appear to be three main reasons why the claimant says the IVF treatment is related to the injuries caused by the accident and should be allowed:
(a)    the fertility reason - her fertility has declined as a result of the totality of the injuries she sustained in the accident;
(b)    the physical “wellness” reason – that she is physically not well enough to have children now while her eggs are younger than they will be, when she is physically well enough to have children, and
(c)    the psychological “wellness” reason – that she is not mentally well enough to have children now, while her eggs are younger than they will be, when she is mentally well enough to have children.
The Panel notes that any issue of psychological wellness has not yet been assessed by any Medical Assessor and is not within the expertise of this Panel to determine.
The insurer responded on 13 December 2024 agreeing with the Panel’s summary of the real issue in dispute that is whether the disputed treatment is related to the injuries resulting from the accident.
The claimant responded on 22 January 2024 agreeing in part with the summary of the reasons for why she says the IVF treatment is related to the injuries caused by the accident adding:
(a) her fertility has been affected by the trauma and stress of the accident making it extremely difficult to fall pregnant naturally, and
(b) she has not been physically well enough since the time of the accident due to her time in hospital and due to the multiple surgeries and treatment and medication and exposure to radiation.

REVIEW OF THE EVIDENCE

The claimant relies on a bundle of documents comprising 366 pages. The insurer relies on an additional bundle of 56 pages.

Treating medical records and reports

The claimant has provided a copy of a police report which notes that on 12 February 2021 the at-fault driver was sentenced to 12 months imprisonment for dangerous driving.[5]
[5] Page 30 of the claimant’s bundle.
The report confirms the mechanism of the accident (the insured performing a right-hand turn in front of the claimant) at about 7.20pm. The insured rendered assistance before police arrived at 7.25pm, fire and rescue and then Ambulance attended before the claimant was taken to Westmead Hospital.

Ambulance records[6] do not add anything further to the Panel’s understanding of the claimant’s injuries.
[6][6] Page 36 of the claimant’s bundle.
The Westmead Hospital discharge summary[7] notes the claimant was admitted on
[7] Page 56 of the claimant’s bundle.

27 September 2019 and discharged on 25 November 2019. The summary of her care documents the following injuries and interventions:
(a)    bladder rupture and vesico-cutaneous fistula;
(b)    sepsis secondary to kocher-langenbeck infection from bladder leak;
(c)    right kidney injury causing retroperitoneal bleed;
(d)    comminuted pelvic fractures which were described as “extensive” and involved both acetabula and inferior pubic ramus with dislocation of the pubic symphysis and right hip;
(e)    lacerations to both lower limbs;
(f)    tears of the right medial cruciate ligament (high grade) and posterior cruciate ligament (complex);
(g)    right foot drop, due to dysfunction of the right sciatic nerve or lumbosacral plexus;
(h)    fracture of the shaft of the right ulna;
(i)    right MF nailbed injury;
(j)    right LP PIPJ volar plate injury;
(k)    fractured right 10^th rib;
(l)    pulmonary embolism in the context of immobilisation;
(m)     pregnancy precautions – implications for caesarean section due to flap on bladder repair, no implication for normal vaginal birth from urology point of view but to get advice from orthopaedic consultant about this;
(n)    left chest pleural effusion;
(o)    post operative Hb drop (stable on discharge);
(p)    left eye ptosis to be followed up with neurology clinic, and
(q)    constipation secondary to opioid pain relief.
Dr Molnar has provided a number of letters and reports as part of the claimant’s treatment team primarily concerned with the surgical fixation of the claimant’s fractured pelvis. On

16 January 2020 he saw the claimant three months after the accident and noted[8] the complications of infection, bladder leak and embolism but he was concerned about the significant heterotopic ossification (bone grown outside the skeleton) in the area of the right acetabulum. The claimant’s knee injury was also of concern.
[8] Page 99 of the claimant’s bundle.
On 26 March 2020 Dr Molner noted the claimant was progressing well but that her right knee (being managed by Dr Balalla) was stiff. The claimant’s range of hip motion was restricted, and she had pain associated with the ossification.
The claimant saw a pain physician, Dr Nazha who wrote to Dr Balalla on 4 June 2020. He was concerned about her psychological state noting flashbacks, nightmares and sleep disturbance which he considered suggestive of a post-traumatic stress disorder. The claimant was seeing a psychologist in Double Bay, but he recommended she start seeing a psychiatrist.
In a letter dated 10 September 2020, Dr Molnar reports that the claimant was progressing well. Issues with her business partner had been resolved and her right foot and ankle had improved with an orthotic. Dr Molnar had planned further hip surgery, and Ms Powell’s knee had improved to a 120 degree range of flexion. Ms Powell was however having wrist problems and was referred to an upper limb surgeon in respect of her fractured wrist.
Dr Molnar excised the heterotopic ossification on 28 October 2020 and reported on

2 November 2020 there was an ooze from the wound and on 19 November 2020 that the surgery went well with the claimant improving her range of hip motion.
The claimant was seen by Dr Suthersan on 17 December 2020[9] for review of her ankle function and the doctor was positive there would be further nerve recovery.
[9] Page 6 of the insurer’s bundle.
On 18 January 2021, Dr Mendonca, rehabilitation physician wrote to Dr Bailey. The claimant was improving, mobilising independently without aids indoors and with a single stick outdoors. The claimant’s ankle range of motion was improved but still restricted and there had been incidences of trips and near falls. The claimant had ceased opioids and the Norspan patches and was using some Endone after training.
Dr Balalla reported to Dr Bailey on 28 January 2021 that the claimant’s right knee was causing her trouble (persistent pain and restriction of motion). An X-ray showed a large area of ossification, and an MRI and CT scan was recommended. In a report of the same date,

Dr Molnar also had a history of medial-sided knee pain.
Dr Malik, psychiatrist saw the claimant on 9 February 2021. He diagnosed a post-traumatic stress disorder (citing the criteria from the Diagnostic Statistical Manual) and recommended 12 months of psychotherapy, ongoing pain management, medication for nightmares and that the insurer support her (by providing transport) to re-establish social connections in the eastern suburbs.
Dr Balalla saw the claimant again on 11 February 2021 with scans and advised the claimant to have the ossification removed arthroscopically which appears to have been done at around 31 March 2021.[10]
[10] Page 13 of the insurer’s bundle.
In a “to whom it may concern” letter dated 12 February 2021, Dr Bailey the claimant’s general practitioner provided a series of gloomy predictions for the claimant including that she would not fully recover physically or psychologically from the accident and would require treatment for many years to come. It was stated that the claimant “will be unable to have a normal vaginal delivery should she become pregnant.”
Dr Suthersan reported to Dr Bailey on 22 April 2021[11] that the claimant’s great toe was in hallux valgus alignment which was related to imbalance caused by the neurological injury she sustained in the accident. It could be corrected but for the time being she was advised to simply monitor it. In a report of the same date, Dr Molnar advised Dr Bailey that the claimant had progressed extremely well, and he supported revisionary scar surgery and referred the claimant to a plastic surgeon.
[11] Page 14 of the insurer’s bundle.
Dr Arguedas, clinical neuropsychologist provided a report dated 27 April 2021. The claimant reported difficulty sleeping due to pain, psychological issues, flashbacks and nightmares and “fear and worry regarding her body” which was “not apparent prior to the accident.” The claimant reported poor memory and concentration word finding difficulties and fatigue.
Dr Arguedas reviewed the claimant’s brain MRI and considered two small areas of gliosis in the frontal lobes evidenced small areas of contusion and therefore a traumatic brain injury (TBI) caused by the accident. However, she thought the main driver of the claimant’s cognitive difficulties was her psychological difficulties and she advised referred to a psychologist with TBI expertise.
The claimant was also referred to a nutritionist, Ms Malouf who wrote a letter dated

22 June 2021 in support of the claimant’s treatment. The claimant had weighed 60kg before her accident and reported she was fit and healthy but the “accident took a large toll on her physically, mentally and emotionally which significantly impacted her health and wellbeing.” She refers to a 17kg weight gain. Further sessions were requested.
The claimant’s hormone levels were tested on 23 June 2021[12] and her AMH (Anti Mullerian Hormone) level recorded as 5.0.
[12] Page 125 of the claimant’s bundle.
On 2 August 2021 the claimant had a transvaginal ultrasound[13] at day nine of her cycle showing proliferative endometrium, a right ovary with one antral follicle and a left ovary with six antral follicles.
[13] Page 130 of the claimant’s bundle.
The claimant attended Dr Patravali of Monash IVF on 16 September 2021 for the purposes of considering “social freezing.” He noted a brief history of the accident. He has a history of regular periods every month that last for four days. He had given the claimant advice about social freezing (of eggs), the possibility of sperm donation, the trajectory for loss of eggs and increased risk of Down’s Syndrome associated with the age of a mother. He noted the ultrasound scan and the antral follicles and the AMH score of 5.0 and advised Ms Powell she had “a very low reserve of eggs.” Blood tests were ordered and a further consultation arranged.
In September and October 2021, the claimant saw Dr Molnar concerned with slight ongoing restriction of movement and pain in her hip. After updated scans he suggested an injection into the trochanteric bursa. The claimant also asked him about pregnancy. He advised the fracture would not preclude her from pregnancy “but it may make vaginal delivery difficult.” He advised her to discuss this also with her urologist and obstetrician.
Dr Patravali saw the claimant again on 7 October 2021 stating her brain stimulating hormones were normal and that her day 21 progesterone was 25.6 suggesting ovulation had occurred. He recommended she proceed to freeze her eggs “sooner rather than later” noting that her reserve of eggs was already low and that she was 35 years of age.
The claimant’s nutritionist appears to have written to the insurer on 7 October 2021 advising that the claimant had reduced her weight gain by over 10kg and was now weighing in at 66kg, 6kg above her pre-accident weight.
On 1 November 2021 the claimant’s GP wrote to the insurer advising it of the claimant’s medication changes and seeking support for public transport and driving assessment with an occupational therapist. On 18 November 2021, Dr Bailey referred the claimant to Dr Jeffrey, urologist regarding the concerns over pregnancy and childbirth.
On 17 January 2022, Dr Bailey wrote a letter outlining the claimant’s concerns over her fertility:
(a)    the claimant was 35 years of age;
(b)    the accident resulted in significant pelvic injuries and there remained hardware in place and limited movement;
(c)    the claimant was concerned about the mode of delivery should she have a baby;
(d)
she had early degeneration of her joints and osteoarthritis was developing.

Ms Powell said she had muscular aches and pains and was still having therapy and was unlikely to fully recover;
(e)    the accident and treatment had an emotional as well as physical effect;
(f)    Dr Pardey had been consulted to ascertain the capacity to hold a pregnancy and her body to tolerate a growing baby, and
(g)    a fertility specialist had been consulted.
Dr Jeffrey, urologist wrote to Dr Bailey on 28 January 2022. She noted that Ms Powell’s main concern was about any implications for future pregnancies. Dr Jeffrey did not appear to raise any concerns although noted difficulties that might present due to the omental interposition (the flap placed to protect the bladder after its rupture) and that she was at an increased risk of bladder injury during caesarean section.
Associate Professor Pardey wrote to the claimant on 15 February 2022.[14] He notes:
[14] Page 168 of the claimant’s bundle.
(a)    the egg freezing is appropriate, noting her age;
(b)    “there is nothing intrinsic to what’s occurred to impair your fertility”;
(c)    she had tubal damage which was not relevant as she was pursuing IVF;
(d)    the hormone injections required to stimulate the ovaries during IVF will cause fluid retention and fluid shifts which may affect the level of pain in the claimant’s joints;
(e)    the Celecoxib medication (anti-inflammatory) should be avoided in pregnancy and while the opioids might not affect the baby’s growth and development the baby might be born with pharmacological dependence (addiction);
(f)    in terms of carrying a pregnancy he thought there was nothing preventing this;
(g)    carrying the pregnancy would affect her in terms of pressure on her bladder with the weight of the pregnancy distorting the bladder;
(h)    he considered her sacral, orthopaedic pain might worsen and her right hip disability might be worse and she might have increasing swelling in the right knee and ankle during pregnancy;
(i)    he advised on her various medications and noted none of her medications would cause abnormality of the foetus or affect her harvested eggs;
(j)    he advised she would be likely to need Endone during a pregnancy because of increasing discomfort, and
(k)    he considered a caesarean section more likely due to her age and the fractures and in order to minimise any damage to the pelvic floor and that because of the omentum, she would need an experienced surgeon to perform the Caesarean.
Dr Singh, orthopaedic surgeon wrote to Dr Bailey after reviewing the claimant on

8 March 2022. The claimant was walking better but was concerned about her back pain. She had disc bulging at L5-S1 and endplate fractures at L1 which he advised to leave alone.
Dr Singh wrote to Dr Bailey again on 31 March 2022 noting the claimant’s concern about her advancing age and ability to have treatment. He notes:
“I am fully supportive of her plan to do IVF at a later stage and harvest her eggs. She is concentrating on getting better at this point in time and therefore is unable to have children. She would like to have children one day and we should set any plan for this.”
On 7 April 2022 the claimant saw Dr Suthersan about her ankle. The claimant was using an exercise bike and her symptoms were improving. Ms Powell considered there was leg length discrepancy and she was advised to see Dr Molnar about this. The claimant also expressed concern about having children and asked if her injuries could contribute to difficulties and

Dr Suthersan referred her to Dr Molnar. Dr Suthersan expressed the view the claimant would not develop any more power or a better range of motion in her ankle.
Dr Molnar saw the claimant on 7 April 2022 noting the claimant was under significant stress associated with her claim and the insurance company. He considered it reasonable for her to have IVF harvesting treatment and that while her physical injuries would not prevent her carrying a pregnancy, they would increase her risk of a Caesarean. He noted her hip pain was occurring on both sides and that she was planning plastic surgery to revise some of her scars.
Dr Standen pain physician wrote to Dr Bailey on 28 April 2022. She too recorded ongoing issues being experienced by the claimant with the insurer. The claimant reported lumbar pain, bilateral hip pain and right sided calf and Achilles tendon pain (following surgery to lengthen the tendon due to leg shortening).
Dr Standen noted the claimant was to have radiofrequency ablation of the lumbar facet joints and she supported the IVF egg harvesting treatment saying, “Her ability to start a family life has been significantly impact upon by her trauma and requirement for subsequent surgeries and medications.”
Dr Balalla wrote to Dr Bailey on 11 May 2022 after the claimant saw him about her left knee. The claimant was experiencing instability with activity requiring pivoting. Due to a grade III laxity he advised surgery. He also noted her concern about her future, her age and her ability to have a child in the future. He said “As you know she has been significantly affected in terms of her life by her accident with multiple rounds of surgery and multiple hospital stays. She has not had the opportunity to enter into a relationship let alone to plan children.” He supported the egg harvesting treatment.
Associate Professor Pardey wrote a further letter to Dr Bailey on 21 June 2022 after his consultation with the claimant. He summed up his previous report noting that any:
“pregnancy will be painful, traumatic and may have permanent effects on health [including affecting] the underlying injuries sustained in the motor cvehicle accident. Neuropathic pain for example is much more likely to be severe in this woman and is much more likely to be persistent after the birth.”
Associate Professor Pardey expresses the view that the claimant’s neuropathic pain may be aggravated by psychological stress and stressors including management of her claim by the insurer. He acknowledges the complexity of her case and warns about deferring her ability to conceive,
“to a point when pregnancy will be a higher risk in terms of pain, in terms of the complications relating to her previous accident but also in terms of her ability to have a child that does not have Downs Syndrome or other age related genetic defects because the delays in child that does not have Downs Syndrome or other age related genetic defects.”
The claimant had a CT of her abdomen and pelvis on 24 June 2022 suggesting she had acute appendicitis with a possible rupture and urgent surgical consultation was recommended. She was referred to Nepean Hospital where she had an emergency appendectomy (laparoscopically) and was discharged three days later.
Dr Patravali wrote to the claimant on 7 July 2022 relating her conception treatment to the car accident and the numerous surgeries and treatment she had as a result and that “this has come in the way of finding the right person in your life.” There was a suggestion of freezing embryos (using donor sperm) rather than freezing eggs.
Dr Molnar saw the claimant on 20 October 2022 regarding her hips noting she had an unstable left knee and had bilateral bursal pain. He recommended trochanteric bursal injections on the left side and continued physiotherapy. The claimant returned on

9 February 2023 complaining of right groin pain. Ms Powell had a left knee PCL reconstruction and was progressing well.
Dr Balalla wrote to Dr Igbojaku on 21 December 2022 following the claimant’s posterior cruciate ligament reconstruction. She was doing well and was advised to commence physiotherapy. Dr Balalla saw the claimant again on 25 January 2023. While she was progressing well with an improving range of motion, the graft had slipped, and she was advised to increase her physiotherapy sessions.
Mr Malik provided a report dated 9 March 2023 concerning the effect of the lack of access to IVF and egg storage treatment to her mental health. He says, “She will continue to suffer an extra burden and further psychological injuries if denied access to IVF, her need for IVF is directly related to the MVA and multi-trauma injuries.”
On 16 March 2023 Dr Patravali reported the claimant’s periods were regular (five days a week), she drank occasionally and her mother had a history of type 2. He records that the claimant’s mental health was adversely affected. On 17 March 2023 the claimant’s AMH levels were tested again, and the result was 1.9 pmol/l.[15]
[15] Page 223 of the claimant’s bundle.
On 30 March 2023[16] Dr Patravali reported:
(a)    that the claimant’s AMH levels had dropped from 5 (in 2021) to 1.9 (in 2023) noting;
(b)    that AMH “is an indirect marker for reserve of eggs and it does show that your number of eggs in your ovaries has indeed fallen”;
(c)    her FSH levels were very high “and that may indicate that your ovaries are failing, and you may, sooner than later enter perhaps premature menopause”, and
(d)    her ultrasound scan showed six and three follicles.
[16] Page 243 of the claimant’s bundle.
Dr Molnar reviewed the claimant on 6 April 2023 noting a degree of secondary arthritis in the right hip joint and his advice was that ultimately, she will require hip replacement surgery.
The claimant has provided[17] a list of the 95 investigations she has had from the date of the accident to 3 April 2023.
[17] Page 247 of the claimant’s bundle.
Dr Patravali reported on 20 April 2023 that two eggs were collected during the claimant’s cycle and recommended a further cycle. He notes “it is fairly evident that had you come a while ago when we initially saw you … the outcome of your treatment could have been different, and we could have procured slightly more number of eggs.”
The claimant relies on an article from the National Institutes of Health data base.[18] Entitled “perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study.” The conclusion was that daily stress appears to interfere with the menstrual cycle of women with no known reproductive disorders.
[18] Page 253 of the claimant’s bundle.
Dr Singh wrote to the claimant’s GP Dr Igbojiaku on 29 April 2023. He referred to the claimant’s “horrific injury”, multiple surgeries an ongoing management with chiropractic treatment, physiotherapy and pain medication, significant scaring and deconditioning which has impacted her mental and physical health and social life. He says:
“She knows that she is going to require further treatment before she is able to have a satisfactory social life, and I certainly agree with the decision to try and freeze her eggs to that she may have a chance to be a mother once her treatment is completed.”

Associate Professor Pardey reported to the claimant on 8 August 2023. He commented about her FSH and AMH levels but was worried about the restricted number of follicles in the ovaries. He also expressed concern about the prospects of early menopause and advised hormone replacement therapy. Ms Powell’s history of fractures and ethnicity meant she was at a higher risk of osteoporosis.
An ultrasound done on 10 August 2023 showed three follicles on each ovary and patent fallopian tubes.
Further reports from Dr Patravali confirm that as at 5 July 2024, seven of the claimant’s eggs were in storage.
The claimant has provided a list of 26 hospital admission and procedures following the accident[19] as at September 2024 with five further procedures planned (including right rotator cuff repair.
[19] Page 293 of the claimant’s bundle.

Medico-legal reports

The insurer relies on a report dated 13 March 2022 from Dr Jonathan Brett, a consultant in toxicology, clinical pharmacology and addiction medicine.[20] He says he has not clinically reviewed the claimant face to face but has considered a number of reports, a claims pharmacy medication summary and conducted a review.
[20] Page 16 of the insurer’s bundle.
He noted the scripts and dispensing records and averaged the medication over the period on the assumption that all previous medication had been exhausted before the new script was filled.
He expressed an opinion that multiple stimulants appeared to have been prescribed which he considered harmful.
He also noted that none of the medication dispensed would have an adverse impact on fertility although long term use of opioids might.
He made certain recommendations concerning ceasing Modafinil, reviewing Phentermine and that the claimant be restricted to weekly dispensing of medications.
Dr Hopcroft provided a report to the claimant’s lawyers dated 23 May 2022.
He expressed the opinion that she should not have a natural vaginal delivery, that her employment was severely compromised, that she required considerable domestic assistance and that she had not yet completed her treatment which would include the revision of her scarring.
On 29 September 2023 he provided an update. He noted the claimant was living on her own and still pursuing an “intensive program of rehabilitation.” He was of the view the claimant was unfit to work, that she is likely to require right total hip replacement surgery and ongoing left knee treatment. He noted problems with her right shoulder and suspected a fracture of the clavicle or subluxation of the acromioclavicular joint.
His final report dated 4 January 2024 expresses opinions concerning possible future surgery for the claimant’s right hip, right shoulder and left knee and he supports the IVF harvesting procedure.
Dr Jungfer psychiatrist provided a report to the claimant’s solicitor dated 4 July 2022 diagnosing a post-traumatic stress disorder and persistent depressive disorder and her whole person impairment was assessed at 24%.
On 2 August 2022 the claimant was seen by pain physician Associate Professor Boesel who reported to her solicitors that the claimant had cervical and lumbar spine pain, right upper limb pain, discomfort at the left hip, bilateral knee pain and sciatic nerve injury. His prognosis was poor, and he expressed the view she will continue to suffer from a pain disorder for the rest of her life. In an updated report dated 16 October 2023, Dr Jungfer records inappropriate behaviour on the part of a driver arranged to take the claimant to appointments. The claimant reported it to the police but apparently was not encouraged to take it further. Dr Jungfer has a record of the IVF treatment and documents the claimant’s day as follows:
“Her days are very mixed due to her fatigue, she will on a day do physiotherpay, and she works on material related to her case. Ms Powell will work on her anxiety. Self-care takes more time. She has many specialists (about 25) and recently her focus has been her IVF which occupies her time.”
Dr Junger diagnosed a post-traumatic stress disorder, persistent depressive disorder and generalised anxiety disorder. She thought the claimant had no capacity for employment and expressed the view Ms Powell’s prognosis was poor.
In an updated report dated 8 March 2024, Associate Professor Boesel expressed the view the claimant had both a physical pain disorder and a psychological disorder. He said Ms Powell was not fit for work, she would have a pain disorder for the rest of her life and that her post-traumatic stress symptoms were likely to continue. He noted likely future surgeries and the accelerated development of arthritis.

OTHER ASSESSMENTS

Medical Assessor Fukui determined a dispute about medication needs (Modafinil and Duromine) referred to by Dr Malik in a report dated 19 April 2022.
Medical Assessor Fukui saw the claimant on 7 March 2024 and issued her certificate declining the treatment on 7 March 2024.
Medical Assessor Fukui has a history at [8] of the claimant’s current domestic situation and her pre-accident history. The claimant is reported to have denied any significant medical history, no previous medications and that in 2017 and 2018 the claimant saw a psychologist due to work-related issues but was not prescribed medication.
Medical Assessor Fukui also has a history recorded at [9] of the accident and that the claimant had been living with her parents at the time and was planning to travel. The claimant reported she was fearful she would die. The Medical Assessor documents the claimant’s treatment history at [10] noting the claimant spent four months in hospital and had six operations and that she had complications including sepsis and lung collapse. The claimant reported a total of 25 surgical or other procedures and had seen about 20 different medical practitioners.
The claimant reported:
(a)    grief and depression;
(b)    heightened anxiety and panic attacks like a heart attack;
(c)    flashbacks associated with nausea;
(d)    nightmares;
(e)    feelings of suicidality;
(f)    poor concentration and easily fatigued;
(g)    overwhelmed and her pain makes her angry;
(h)    intrusion symptoms triggered by hospitals, ambulance and movies featuring those things;
(i)    disrupted sleep;
(j)    loss of weight and now a gain of 17kg;
(k)    withdrawal from family and friends;
(l)    hypervigilance in a motor vehicle and when crossing a road, and
(m)     treatment from a psychologist since March 2020 and a psychiatrist since June 2020.
In addition to her accident-related injuries, the claimant says she sustained a ruptured appendix, has experienced falls and has reduced fertility. She also says she experienced an assault by a driver provided by the insurance company (who she says stalked her and sent her explicit material) and she has reported this to the police.
The claimant is reported at [12] to have ongoing pain in her back, right shoulder, knees, hip and waist which impact on her daily functioning.
The claimant reported some improvement in her mental health since seeing Dr Malik with less anxiety, more energy and fewer nightmares and flashbacks.
The claimant’s medication is documented at [13] as including Amitriptyline (Endep), Prazosin, Serepax, Circadin (melatonin), Modafinil and Valium. For pain she takes Norgesic and Panamax four times a day. She used nutritional medicine products.
Medical Assessor Fukui notes the claimant was prescribed Duromine, “to improve energy and to assist with weight loss” but that it had been recently ceased.
The claimant said she did yoga and exercises and goes to the gym twice a week. She has four further surgeries planned and wants to engage in a chronic pain program.
Medical Assessor Fukui says that the claimant has not been prescribed an SSRI antidepressant and that Modafinil was prescribed to target concentration and energy which is “off-label prescribing.”
The claimant’s reported function included the following [15]:
(a)    she looked after her care with aids in the bathroom;
(b)    she has domestic assistance and has her groceries delivered;
(c)    she drives a car, and
(d)    she has maintained social connections and friendships and socialises once a week and recently travelled overseas.
Medical Assessor Fukui diagnosed a post-traumatic stress disorder with ongoing symptoms and chronic pain. She made the following comments about the claimant’s medication regime:
(a)    Endep is appropriate for sleep at a low dose and as an antidepressant in higher doses;
(b)    Melatonin is appropriate for sleep;
(c)    Prazosin is appropriate for nightmares;
(d)    Valium is prescribed occasionally for anxiety;
(e)    Modafinil is stimulant medication used for the treatment of narcolepsy and is not indicated for the management of posttraumatic stress disorder because of its stimulant effect;
(f)    Duromine (which the claimant had been prescribed until May 2023) is another stimulant medication used in weight management. The claimant told Medical Assessor Fukui that Duromine and Modafinil were prescribed to help with her concentration and energy. Medical Assessor Fukui said these are not approved for management of post-traumatic stress disorder and it is high risk to prescribe the two concurrently as it could cause anxiety and agitation and in some cases psychosis, and
(g)    the claimant has not been prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant which is the “recommended first line medication” for treatment of post-traumatic stress disorder.
Medical Assessor Fukui found both medications not related and not reasonable and necessary.

RE-EXAMINATION FINDINGS – MEDICAL ASSESSOR SCHMIDT

General observations

Ms Powell attended the re-examination at the Commission’s Medical Suites on
20 February 2025. She was accompanied by her mother who was present but did not participate in the re-examination.
Due to the concessions and agreements made by both parties the claimant was advised that a physical examination was not required.
Ms Powell was pleasant and co-operative throughout the assessment and gave a straightforward account of herself and her history.
Throughout the one-hour interview, Ms Powell appeared to be in physical pain when sitting. At frequent intervals she stood in order change positions which she said was necessary to relieve pelvic and lower back pain.

History of the accident and treatment

On 27 September 2019, Ms Powell was involved in an accident whilst riding a motor scooter. She described it as a high velocity accident. She suffered numerous injuries including a severe pelvic ring fracture (see the x-ray within attachment A to these reasons). She has been hospitalised for eight months in total. Major fractures included right hip fracture dislocation and left acetabulum fracture involving a ruptured bladder.
I noted the helpful list of medications, investigations and procedures provided by the claimant in her documentation and which she bought with her to the re-examination all of which had previously been provided to the Panel by the claimant’s lawyers (attachments B, C and D to these reasons).
The claimant said that since the accident she has not worked but that she has been focussed on her physical and mental recovery. Apart from the operations and procedures and investigations she has listed, she has had what she said was almost a full-time job attending physiotherapy and other allied health programs, psychological and psychiatric counselling to address her multi-trauma.
As the circumstances of the accident were clearly distressing to her, and in light of the insurer’s concession as to fault, it was considered unnecessary to further question the claimant about the accident and its sequelae.

Menstrual and medical history

Ms Powell went through the menarche (her first menstrual period) at the age of 12.
Ms Powell was 33 years of age at the time of the accident. Before the accident she had a regular 28-day cycle. Menstruation lasted for four days with two to three days of pre and post menstrual spotting. For the first two days of her cycle, she would suffer from cramps and back pain and become “emotional”.
Although dysmenorrhoea (cramps and period pain) can occur in anovulatory cycles (a menstrual cycle where an egg is not released from the ovaries), dysmenorrhoea is associated with ovulation. Ms Powell’s regular menstrual cycle and the character of menstruation indicate Ms Powell was ovulating regularly prior to the accident.
Ms Powell experienced amenorrhoea (no menstrual periods) for six months after the accident. Her periods became much lighter afterwards with a similar duration of four to five days but they were of a different consistency, darker and sometimes a light pink. In more recent times the length of her periods has shortened to two or three days. Her last menstrual period lasted only 36 hours. Her periods have been associated with cramping and back pain.
Recently Ms Powell has been experiencing hot flushes, insomnia and increased depression all of which are symptoms of the climacteric (the time period before menopause).
The claimant confirmed the history provided in the records that she was well before the accident, maintained a healthy weight of 60kg, did not smoke or take illicit drugs and she would occasionally drink alcoholic beverages. While her weight increased after the accident, she has taken steps (she was seeing a dietician or nutritionist) to keep it under control. She looks after her general health and has not, since the accident taken up smoking or consumed illicit drugs. She still drinks occasionally in a social setting.

IVF treatment to date

Ms Powell stated that at the time of the re-examination she has undertaken five IVF egg harvesting procedures. This has resulting in the harvest of 11 viable eggs which are now frozen. She confirmed the records which indicate that additional eggs were harvested but that because of the quality of some of them they were not frozen. She was not sure how many additional eggs had been harvested.
She says she has requested two more IVF egg collection cycles and for the cost to be covered by the new insurer (CTPCare).
Ms Powell said she does not wish to pursue surrogacy. She wants to achieve a pregnancy and experience the associated emotions and physical changes directly.
Ms Powell says she has suffered a loss of sexuality as a result of her accident, the multi-trauma and the aftereffects. She does not currently have a partner. Before the accident she was developing a sexual relationship which could possibly have progressed. While she has not had intercourse in the more than five years since the accident, she is terrified of the pain she may likely experience during intercourse.
She is concerned with her image and in particular the scarring of her body. She has had significant pain requiring daily pain killers.
Ms Powell considers that, possibly about two years from now when she hopes to be more psychologically and physically able, she may seek access to a sperm donor, if she does not have a partner, in order to have a child.
At the time of this re-examination, Ms Powell explained that her severe pain, her protracted recovery and her ongoing treatment prevents her from having a baby. She has been focused on her treatment and getting physically. She says that the psychological sequelae resulting from the accident makes her fearful of getting pregnant and having a baby. She also says that because of the severe trauma she has experienced and her ongoing pain she has a physical inability to perform everyday functions around the home which she considers would are also affect her decision about pregnancy and would also seriously impact on her ability to care for a newborn alone.

CONSIDERATION OF THE ISSUES BY THE PANEL

The Panel adopts the findings of Medical Assessor Schmidt as recorded above.

What injuries resulted from the accident?

The claimant conceded that her reproductive organs have not been physically damaged or injured in the accident.
The medical records relied on by the parties, including the unchallenged list of operative and other procedures document (attachment C to these reasons) evidences multiple injuries including serious pelvic fractures resulting from the accident.
The unchallenged evidence of the claimant’s treating doctors in particular Associate Professor Pardey is that Ms Powell:
(a)    is capable of carrying a pregnancy to term;
(b)    will need to have a planned caesarean delivery, and
(c)    will have a harder pregnancy in terms of increased pain and discomfort during the pregnancy.
The Medical Assessors agree with the opinion of Associate Professor Pardey. While the claimant will be able to maintain a pregnancy and deliver a child, she is going to have difficulties and increased pain in doing so. It is therefore reasonable, in the clinical judgment of the medical members of the Panel for her to wait for a further two years when hopefully her recovery may have progressed, her resilience is strengthened, and she is in a better physical state and more prepared to have a child.
The Medical Assessors are also of the view that the claimant’s pelvic, hip and back injuries are likely to cause dyspareunia (pain during intercourse) and this pain could prevent her from having intercourse making it unlikely she is going to be able to conceive naturally.
The unchallenged evidence of the claimant’s experts is that the claimant has required and will require continued domestic assistance, she has a significant psychological or psychiatric injury and that she is likely to experience pain for the rest of her life.
The Medical Assessors agree that the physical sequelae of the totality of the claimant’s physical injuries resulting from the motor accident are continuing to cause pain and this pain is affecting and impairing many aspects of the claimant’s life including her ability to work and perform domestic tasks. It is reasonable in those circumstances for the claimant to delay having a child for a further two years in the hope and expectation that she will further improve her physical state and be able to more fully care for her child.

Has the claimant’s fertility been affected since the accident?

The insurer concedes that the claimant’s fertility has declined since the accident but says this is not because of any injury resulting from the accident.
The level of Anti Mullerian Hormone (AMH) is a measure of ovarian reserve. The Medical Assessors are of the opinion that a level above 11pmol/L is considered the level at which a woman is considered fertile. Ms Powell’s AMH readings contained in the records were as follows:
(a) on 23 June 2021 – 5.0 pmol/L, and
(b) on 16 March 2023 – 1.6 pmol/L.
Nearly two years after the accident, three days before she turned 35, the claimant’s AMH reading was well below normal fertility levels but within the range for a woman of her age. Less than two years later, the claimant’s fertility level has, in the clinical judgment of the Medical Assessors further deteriorated.
It is the clinical experience of the medical members of that Panel that for women under the age of 35, up to 10 – 15 eggs should be produced in a single stimulated IVF cycle. The claimant said she has had five IVF treatments, and 11 eggs have been collected and frozen. There were some other eggs produced but apart from the first cycle (when two eggs were collected and only one stored) it is not known precisely how many eggs were harvested and what percentage were successfully frozen.
In the Medical Assessor’s experience, the low number of eggs harvested and now stored is consistent with the claimant’s low AMH reading and a low fertility level and well below what would be expected, even for someone of the claimant’s age (now 38).
While the Panel does not know what the claimant’s AMH levels were like immediately before the accident, the existing AMH levels indicate a decline from June 2021 to March 2023 and it is the clinical judgment of the Medical Assessors that it is likely Ms Powell’s AMH levels would have been higher than 5 pmol/L at the time of the accident.

While it was not disputed by the insurer, the Panel is satisfied that the claimant’s fertility and her ability to naturally conceive has declined since the accident.

What can cause or result in infertility or affect a woman’s fertility?

Leaving aside medical issues such as cancer or endometriosis or structural issues such as blocked fallopian tubes, it is the Medical Assessor’s opinion that a woman’s fertility can be affected by life and lifestyle factors and the most common of these is:
(a)    age – the clinical judgment of the medical members of the Panel is that women have the best chance of conceiving in their twenties and early thirties. There is a rapid decline in fertility in the mid-thirties;
(b)    alcohol, tobacco and marijuana use;
(c)    weight – being either over or under weight can affect fertility;
(d)    excessive exercise – Olympic or World Champion elite female athletes usually have no menstrual periods while training, and
(e)    stress or anxiety.
The Panel notes that the claimant was 33 at the time of the accident and she is now 38.
Ms Powell did not smoke or drink excessively or use marijuana before the accident (as reported to Dr Jungfer) or since the accident. She was at a healthy weight (60kg as reported to the history recorded by the claimant’s nutritionist) and while she has put on weight since the accident, at 70kg she is not significantly overweight. While she played sport, went to the gym and did yoga (as reported to Dr Jungfer) there is no evidence that she exercised excessively before the accident. There is certainly evidence that she has not exercised excessively since the accident as a result of her multi-trauma injuries.
The Medical Assessors’ opinion is that radiation therapy (such as for cancer) directly to an injured woman’s reproductive organs can cause infertility (as can radiation exposure for men cause infertility). The claimant has not had any direct radiation therapy, but she has been exposed to radiation as a result of the multiple X-rays and CT diagnostic scans she has had since the accident (see attachment D to these reasons). The Medical Assessors are aware that radiation to the ovaries can stop the ovaries from producing hormones resulting in the menopause and therefore radiation of the claimant’s body generally could possibly contribute to poor ovarian reserve. Whether Ms Powell’s exposure to radiation was in fact a contributing factor to the claimant’s declining fertility is not a matter within the expertise of the Medical Assessors and the Panel considers this would be a matter for an expert radiologist to provide a more definitive opinion.
Dr Brett for the insurer expressed the opinion that none of the claimant’s medications would be likely to affect the claimant’s fertility although he indicated that long term opioid use might. The Medical Assessors have considered the list of medications provided by the claimant (attachment A to these reasons) and are of the view that some would be incompatible with pregnancy, but none would be likely to affect the claimant’s menstrual cycle, ovulation or fertility.
The Medical Assessors note that stress impacts the hypothalamic / pituitary axis resulting in ovulatory dysfunction. Ovulatory dysfunction manifests in menstrual irregularities and causes infertility. The stress and trauma associated with the accident could therefore be responsible for an additional reduction in infertility, over and above, any reduction in fertility because of the claimant’s age.

Has the claimant’s fertility declined because of the accident?

The evidence from Ms Powell supports a finding that she was ovulating normally before the accident. Amenorrhoea (and absence of menstruation) occurred from the date of the accident for six months according to the claimant’s history. Immediate loss of menstruation after the accident, during hospitalisation indicated anovulation during that period was a result of the accident. For that period, the claimant’s fertility was directly affected by the multi-trauma resulting from the accident and her hospitalisation.
Following the accident Ms Powell was admitted to Westmead Hospital. As well as other multiple procedures (such as skin grafts), she had several stabilisation procedures for multiple pelvic ring fractures and surgery for internal organ damage. The absence of menstrual periods for six months after the accident during the intense period of her treatment and recovery is likely caused by the severe assault on her physical body and stress associated with the aftermath of the accident including pain. The Medical Assessors are of the view that this resulted in the amenorrhea for six months after the accident and anovulation (infertility) for that period.
In Ms Powells’ case she continued to have periods including having period pain which suggests she recommenced ovulating. However, the nature of her periods changed; her follicle stimulating hormones have been high and her progesterone levels have been low which could indicate anovulation. In August and October 2021 Dr Patravali records that it was likely Ms Powell was ovulating, and she has, since then, undergone a number of IVF flare cycles where she has been assisted to ovulate and eggs have been harvested.
It is the clinical judgment of the Medical Assessors that there is insufficient evidence to make a definitive finding that Ms Powell did not recommence ovulation after that first six months of anovulation. The Panel is not therefore satisfied that Ms Powell has primary ovarian insufficiency or premature ovarian failure because of the accident.

Is the IVF treatment related to the injuries resulting from the accident?

The definition of injury in s 1.4 of the MAI Act includes “personal or bodily injury” and includes injury to an unborn child in utero, psychological or psychiatric injury and damage to artificial limbs, eyes, teeth, crutches and spectacles. There is no further definition of personal or bodily injury in the Act.
The phrase “Personal or bodily injury” implies an injury to a persons’ physical body and in its ordinary meaning, an injury to the body results in symptoms such as pain, impairment to function and temporary or permanent disability. A person with a broken leg will experience pain when the actual break occurs and as it recovers. The injured person’s leg may be encased in a plaster cast for a period leading to a temporary disability (associated with mobility). The break may occur at the epiphyseal line and affect the growth in the injured leg of a young person. The pain, the mobility issues and the affected growth all result from the injury (broken leg) caused by the accident. The injured person would be entitled to payment of expenses incurred in connection with treating not just the broken bone but the consequences of that break.
The insurer says there is a distinction between injuries caused by the accident and injuries resulting from the accident. The Panel does not accept there is any significant difference as they are both concerned with what flows from the accident. The insurer also submits that the treatment must relate to the injuries. The term “relate” is not defined in the Act, but the ordinary meaning of that word implies there must be a relationship between the treatment and the injuries that were caused by or resulted from the accident.
An injury to one part of the body resulting from an accident can result in symptoms in other parts of the body. Going back to the example of the broken leg, a person’s fractured femur caused by the accident may lead to limb shortening which alters their gait and leads to knee and back pain. That injured person is entitled to treatment for the back and knee symptoms as much as they are for the broken leg. If the person with the broken leg loses their balance while learning to use their crutches, fractures their wrist as they reach out to break the fall, they too would be entitled to treatment for that broken wrist as much as they are entitled to treatment for the broken leg. An injured person is, under s 3.24(1) entitled to treatment relating to injuries that occur in the instant of the accident as well as injuries that develop afterward or occur afterwards so long as they are caused by or result from the motor accident.
A psychological or psychiatric injury does not directly injure any physical part of the body but injures a claimant’s psyche or mental state. That injury is no more or less real than a broken bone and an injured person is entitled to treatment related to a post-traumatic stress disorder or other disorder caused by or resulting from an accident.
The Panel has considered the particular circumstances of a spleen injured in an accident and surgically removed. Thereafter the injured person’s immune system is compromised and they become prone to infection. With a splenectomy the system of immunity is affected or injured by the actual injury to, and removal of, the spleen.
Ms Powell did not injure her uterus, her fallopian tubes or her ovaries in the accident, but the Medical Assessors note that a woman’s system of fertility depends not just on the state of her reproductive organs. The ability to conceive also involves libido and the ability to have intercourse.
Ms Powell has an entitlement to statutory benefits for “treatment and care expenses incurred in connection with providing treatment and care for the injured person”. The insurer concedes the IVF treatment is reasonable and necessary treatment and care for the claimant but denies any liability to pay for it on the basis it, “did not relate to the injury resulting from the accident.”
The insurer has focused on the claimant’s fertility in terms of her reproductive organs but does not appear to have considered whether her fertility system could be injured by the totality of her injuries and the poly or multi-trauma and its sequelae resulting from the accident.
The claimant says she has not been physically well enough to consider having a child to date. She has been focussed on her recovery and rehabilitation. She has been told she can physically have a baby but that it is going to cause her more pain in doing so and she is not prepared at this time for that additional physical insult to her body. This physical wellness is, in the view of the Panel, directly related to the multiple fractures, her other injuries and the five years of operations, medical procedures and investigations associated with them. The Panel makes no finding in relation to any psychological injury and its contribution to the claimant’s current state as that is a matter outside the expertise of the Medical Assessors on this Panel.
As a result of her five years of physical unwellness, the claimant’s fertility has declined (because she has aged) and is declining. As a result of her declining fertility, she wishes to preserve her ability to have a child at a later date. The eggs that have been frozen are younger eggs than the eggs she has left in her ovaries. The frozen eggs are likely, because they are younger, to result in a less risky pregnancy in the future.
The Panel is of the view that had this accident not occurred, the claimant would have been more able to conceive naturally, at a younger age and would have been physically well enough to fall pregnant, with younger eggs, carry a child and have a child.
The Panel is of the view that for all of the reasons above, the IVF treatment the claimant has had to date, and which has been paid for by QBE is related to the totality of the physical injuries caused by or resulting from the accident.

CONCLUSION

Certificate

While the Panel has come to the same conclusion as Medical Assessor Izzo, the Panel has made significantly different findings. The Panel therefore revokes his certificate and will issue a fresh certificate.

Costs

The Review Panel received a query from the parties as to whether the Panel or the General Member on the Panel could award the claimant’s costs beyond those available in the Motor Accident Injuries Regulation 2017 (the Regulation) pursuant to s 8.10(4)(b) of the MAI Act. The insurer also sought an order that it was entitled to costs beyond those provided for in the Regulation pursuant to s 8.3(4) of the MAI Act.
Sections 8.3 and 8.10 empower “the Commission” to assess costs. Section 31(1) of the PIC Act provides that “the Commission is constituted by one or more Division members of the Division to which the function of dealing with the proceedings is allocated.” The General Member on the Panel is not dealing with the proceedings but is a part of the three-person Panel assigned to deal with the Review proceedings.
The two Medical Assessors on the Panel are not “members of the Division” but are decision-makes under Division 4.1 with functions conferenced on them by the PIC Act and the MAI Act. The Panel has no power given to it in Schedule 2(2) to the MAI Act or elsewhere in the MAI Act or the PIC Act to assess a party’s costs in a medical assessment matter.
It would appear, from the decisions in Allianz Australia Insurance Limited v Rymer[21] that the power to allow costs beyond the regulated amounts is a matter for a Member, while disputes about the quantum of costs in a statutory benefits claim are a matter for Merit Reviewers.
[21] [2022] NSWPIC MRP 6 (3 February 2022) and 7 (13 April 2022).

ANNEXURE A – PELVIC X-RAY

[IMAGE UNABLE TO RENDER]

ANNEXURE B – LIST OF MEDICATIONS AS AT 21 NOVEMBER 2022

Name	For	Dosage
Amitriptyline Hydrochloride 50mg	To treat symptoms of depression / antidepressants.	Two tablets every night
Prazosin Tablets 1mg	Management of nightmares and sleep disturbances associated with PTSD.	One tablet every night
Celebrex 100mg	Relieve the symptoms of joint pain, tenderness, swelling and stiffness in: osteoarthritis. Rheumatoid arthritis. Ankylosing spondylitis, a chronic inflammatory rheumatic disorder that primarily affects, but is not limited to, the spine.	One capsule daily (and one at night after “recent surgery”)
Colecalciferol Cap 25mcg (Ostelin Gel)	Vitamin D helps maintain muscle strength, which may reduce the incidence of falls.	One capsule daily
Magnesium Aspartate Dihydrate	Magnesium is important for many processes in the body, including regulating muscle and nerve function, blood sugar levels, and blood pressure and making protein, bone, and DNA.	Two tablets every morning
Paracetamol tab 500mg (Panamax / Panadol)	Mild analgesic and treatment of most painful and febrile conditions.	Two tablets three times a day
B12 Vitamin 1000 mcg Oromucosal Spray	A sublingual oral spray to support energy production and relieve feelings of tiredness and fatigue. Vitamin B12 is important for the maintenance of nervous system health and function, healthy red blood cell production, energy production and healthy immune system function. It may be beneficial for people at risk of vitamin B12 deficiency.	2 x sprays once daily
Coloxyl & Senna Tab 50mg/8mg	Stimulant free stool softener for relief of constipation.	One tablet a day.
MSM Caps 1000mg	Supports connective tissue health through assisting connective tissue formation. It also relieves symptoms of mind arthritis.	Two capsules 1-3 times a day.
Theracurmin Triple	Antioxidant & anti-inflammatory, aids in relieving the symptoms of mild arthritis including decreasing mild joint pain and swelling.	One capsule twice a day.
Ubiquinol BioActive 300mg	Supports energy levels and energy production. It provides antioxidant support helping to reduce free radicals formed in the body. Supports heart health and healthy cardiovascular system function, and support healthy cholesterol & support blood vessel health.	Was taking one capsule once a day, now ceased
MTHF	Helps support healthy foetal brain development, neurotransmitter, synthesis and red blood cell production. Folate helps to relieve fatigue and maintains healthy immune system function.	One capsule once a day.
BicoZn	Assist in the synthesis of neurotransmitters and support healthy mood balance. Provide antioxidant support, Maintain haemoglobin synthesis and assists healthy red blood cell production Support healthy immune system function, healthy reproductive hormones,skin repair and wound healing. Support nervous system function	Was taking one capsule twice a day, now ceased
Swisse (Relax & Sleep)	Helps relieve nervous tension, restlessness, provide relief from mild symptoms of mental stress and assist with a natural restful sleep.	Two tablets daily, one hour before bed.
Duromine - 30mg	Helps with reducing body weight and increasing energy.	One capsule once a day in the morning – for review
Modafinil 100mg	Promotes wakefulness by stimulatIng the brain. Enhances cognitive performances in domains like attention, memory, executive functions, and increases alertness and response accuracy.	Two tablets daily, one in the morning and one at midday.
Lion’s Mane	Reduces inflammation and biological markers of Alzheimer's, improves & boosts cognition, increases the release of nerve growth / encourages nerve cells to grow and repair more quickly. Enhances the immune system, helps treatment of anxiety and depression.	Two tablets twice per day, morning and afternoon.
Norgesic (Orphenadrine/ Paracetamol)	Pain relief - is used to treat tension headache and headaches caused by muscle spasms in the back of your head and neck. It also helps relax certain muscles in your body and to relieve the pain and discomfort caused by sprains, strains or other injury to your muscles.	Take two tablets, three times a day when needed
Versatis dermal patch (5%)	Contains lidocaine, a local anesthetic, which works by reducing the pain in your skin. Use for back & knee pain.	Place 1 x patch on the area causing pain and keep it on for 12 hrs. For use when needed.
Compound cream	Directly applied to the skin to aid pain and swelling, relieve skin conditions, or reduce symptoms from certain systemic conditions. Use for knee, back & hip pain.	Place on the area of pain. As needed.
Diazepam (Valium) 2 & 5mg	Relief for anxiety & panic attacks.	Take one tablet three times a day when required.
Advanced TRS	Help remove radiation from my body - Advanced TRS removes toxic heavy metals like mercury, arsenic, aluminum, lead, chemical toxins, radioactive toxins and free radicals that impair your body. I've had 86 x scans (CT's, MRI, Xray's etc.) due to the MVA on 27 Sept 2019.	2 x sprays in the morning and 3 x sprays at night
Oxycodone (Endone) (5mg) / (Palexia)	Strong analgesic / painkiller.	One tablet twice a day only when required in case of severe pain.
Protein Powder	To promote muscle growth & repair.	1 x scoop everyday
Voltaren Cream (use, on odd occasion)	For temporary relief of local pain and inflammation in acute soft tissue injuries.	For use on areas where needed

ATTACHMENT C – LIST OF OPERATIONS AND PROCEDURES AS AT 24 NOVEMBER 2024

27th September 2019 - 6 x major operations, including US intervention and Insertion of Intercostal Drainage Tube (an 8 French pigtail drain was inserted in the large left pleural effusion on 14 Oct 2019).
25 November 2019 after discharge from Westmead Public Hospital, admitted into Westmead Rehab Hospital. Discharged on 23rd January 2020. Ms Powell was admitted into Westmead Rehab hospital a further two times as an in-patient.
28 February 2020 - ankle arthroscopy and Achilles lengthening (right foot) and manipulation (MUA) of right knee. Surgeon: Dr Suthersan. Hospital: Westmead Private Hospital. Stay: four nights in hospital, discharged on 3rd March 2020, transferred directly to Westmead Rehab Hospital for further rehabilitation.
31 March 2020 right knee arthroscopy and manipulation under anesthetic. Surgeon: Dr Balalla. Hospital: Lakeview Private Hospital. Stay: one night, transferred to Westmead Rehab Hospital for further rehabilitation, one month discharged home on 1 May 2020.

21 July 2020 - right knee manipulation under anesthetic and steroid Injection. Surgeon: Dr Balalla. Hospital: Lakeview Private Hospital. Stay: Discharged home same day.
8 October 2020 - PRP injection right knee. Surgeon: Dr Nazha. Location: Superscan (Radiology Practice), Paramatta. Stay: Day procedure.
28 October 2020 - right hip heterotopic ossification open reduction and internal fixation and manipulation of right knee. Surgeon: Dr Molnar. Hospital: St George Private Hospital. Stay: Two nights in hospital and then discharged home on 30 October 2020.
5 November 2020 PRP injection right knee. Surgeon: Dr Nazha. Location: Superscan (Radiology Practice), Paramatta. Stay: Day procedure.
28 January 2021 PRP injection right knee. Surgeon: Dr Nazha. Location: Superscan (Radiology Practice), Paramatta. Stay: Day procedure.
16 March 2021 - right knee arthroscopy, manipulation, excision of medial collateral ligament osteoma medial collateral attachment. Surgeon: Dr Balalla. Hospital: Lakeview Private Hospital. Stay: Two nights in hospital, discharged 18 March 2021 and transferred to Norwest Private for seven days of Ketamine Infusions (18 – 24 March 2021) by Dr Nazha.
27 August 2021 - ultrasound guided cortisone injection (right knee). Surgeon: Requested by Dr Balalla. Location: Castlereagh Imaging, Penrith. Stay: Day procedure.
8 October 2021 - facet joint block lumbar spine. Surgeon: Dr Nazha. Hospital: Pennant Hills Day Surgery. Day procedure.
22 October 2021 - ultrasound guided cortisone injection into right hip. Surgeon: Requested by Dr Molnar. Location: Castlereagh Imaging, Penrith. Stay: Day procedure.
3 May 2022 - ultrasound guided cortisone injection into right hip. Surgeon: Requested by Dr Molnar. Location: Castlereagh Imaging, Penrith. Stay: Day procedure.
14 June 2022 - scar revision surgery (first). Surgeon: Dr Marucci: Hospital: Anesthetic Day Surgery, Kogarah. Stay: Day procedure.
24 June 2022 - emergency laparoscopic appendectomy adhesiolysis. Surgeon: Dr Anthony Shakeshaft. Hospital: Nepean Hospital. Stay: three nights.
6 September 2022 - guided ultrasound aspiration / drain of Baker’s Cyst left knee. Surgeon: Requested by Dr Okorama. Location: Castlereagh Imaging, Penrith. Stay: Day procedure.
15 November 2022 – scar revision surgery (second). Surgeon: Dr Marucci: Hospital: Anesthetic Day Surgery, Kogarah. Stay: Day procedure.
28 November 2022 - ultrasound guided cortisone injection into left hip. Surgeon: Requested by Dr Molnar. Location: Castlereagh Imaging, Penrith. Stay: Day procedure.
13 December 2022 - left knee fluoroscopy and posterior cruciate ligament reconstruction. Surgeon: Dr Balalla. Hospital: Lakeview Private Hospital, Stay: Two nights.
17 April 2023 - IVF Harvest & Egg / Embryo Freezing (first) Surgeon: Dr Patravelli (Monash IVF). Hospital: Somerset Private Hospital. Stay: Day procedure.
22 March 2023 - ultrasound guided cortisone injection right shoulder. Surgeon: Requested by Dr Okoroma. Location: Castlereagh Imaging, Penrith. Stay: Day procedure.
16 October 2023 - IVF Harvest & Egg / Embryo Freezing (second). Surgeon: Dr Patravelli (Monash IVF). Hospital: Somerset Private Hospital. Stay: Day procedure.
12 December 2023 - scar revision surgery (third). Surgeon: Dr Marucci: Hospital: Anesthetic Day Surgery, Kogarah. Stay: Day procedure.
15 March 2024 - IVF Harvest & Egg / Embryo Freezing (third) Surgeon: Dr Patravelli (Monash IVF). Hospital: Somerset Private Hospital. Stay: Day procedure.
24 June 2024 - IVF Harvest & Egg / Embryo Freezing (fourth) Surgeon: Dr Patravelli (Monash IVF). Hospital: Somerset Private Hospital. Stay: Day procedure.
9 July 2024 - ultrasound guided cortisone injection into left hip. Surgeon: Requested by Dr Molnar. Location: Castlereagh Imaging, Penrith. Stay: Day procedure.
11 September 2024 - IVF Harvest & Egg / Embryo Freezing (fifth) Surgeon: Dr Patravelli (Monash IVF). Hospital: Somerset Private Hospital. Stay: Day procedure.
18 September 2024 - rhino septoplasty surgery. Surgeon: Dr Soodin. Hospital: Norwest Private Hospital. Stay: One night.
12 November 2024 scar revision surgery (fourth). Surgeon: Dr Marucci: Hospital: Anesthetic Day Surgery, Kogarah. Stay: Day procedure.

ATTACHMENT D – LIST OF INVESTIGATIONS AS AT 23 SEPTEMBER 2024

27 Sept 2019 - X Ray Pelvis
27 Sept 2019 - CT Brain
27 Sept 2019 - CT Facial Bones
27 Sept 2019 - CT Cervical Spine
27 Sept 2019 - CT Chest with Contrast - portal venous & delayed phases
27 Sept 2019 - CT Abdomen & Pelvis
27 Sept 2019 - CTA Both Legs & Feet
27 Sept 2019 - X-Ray Right Forearm
27 Sept 2019 - X-Ray Right Hand
28 Sept 2019 - CT Pelvis
30 Sept 2019 - CT Abdomen & Pelvis
1 Oct 2019 - Pelvis & Right forearm & wrist
2 Oct 2019 - CT Pelvis
3 Oct 2019 - CT Chest with Spiral Angiography
11 Oct 2019 - US Lower Limb Venous Doppler-Acute (right and left)
5 Oct 2019 - CT Pelvis
9 Oct 2019 - Retrograde Micturating Cysto-Urethrogram
9 Oct 2019 - CT abdomen and Pelvis
10 Oct 2019 - MRI Right Knee
12 Oct 2019 - Fluoroscopy using Mobile II - Bilateral Retrograde
14 Oct 2019 - US intervention + Insertion of Intercostal Drainage Tube + Percutaneous drainage, and deep Abscess
19 Oct 2019 - X-Ray right hand
21 Oct 2019 - US Buttock/Thigh
22 Oct 2019 - X-ray Right foot Ankle
22 Oct 2019 - X-ray Pelvis
22 Oct 2019 - X-ray Right Forearm
25 Oct 2019 - CT Chest, Abdomen and Pelvis
29 Oct 2019 - Retrograde Cystourethrogram
31 Oct 2019 - CT chest with contrast
14 Nov 2019 - X-ray Right wrist
14 Nov 2019 - X-ray Pelvis
14 Nov 2019 - X-ray right forearm
25 Nov 2019 - MRI Lumbosacral spine
2 Jan 2020 - MRI Brain
14 Jan 2020 - X Ray Pelvic Girdle
16 Jan 2020 - MRI Derangement (R) Knee
28 Jan 2020 - X Ray Right Ankle
28 Jan 2020 - Bone Study - Whole Body
4 Feb 2020 - MRI - Right Ankle
11 Feb 2020 - VQ Lung Scan
12 Feb 2020 - Doppler Venous DVT Left Leg, Doppler Venous DVT Right Leg
25 March 2020 - X Ray Pelvic Girdle
3 June 2020 - CT Pelvis Without Contrast
3 June 2020 - X Ray Right Hip & Pelvic Girdle
19 June 2020 - Ultrasound & X Ray right 5th finger
30 August 2020 - Nerve conducting study - R Leg
3 Sept 2020 - X Ray Left Hip
14 Oct 2020 - CT Pelvis Without Contrast
14 Oct 2020 - Xray Right Hand Wrist & Forearm
27 Nov 2020 - MRI R Wrist / Hand Support
1 Dec 2020 - X Ray Knee Right
15 Dec 2020 - X Ray Right Hip
20 Jan 2021 - X Ray Pelvic Girdle
28 Jan 2021 - CT Knee Right without Contrast
30 Jan 2021 - MRI Derangement ( Right) Knee
19 Feb 2021 - X Ray Right Forearm
19 Feb 2021 - X Ray Thoracolumbar Spine
9 March 2021 - MRI Sciatica / Lumbar Spine
16 April 2021 - X Ray Right Foot
16 April 2021 - X Ray Pelvic Girdle
10 May 2021 - X Ray Spine Cervical
24 June 2021 - X Ray Right Knee
29 June 2021 - MRI Cervical Spine
29 June 2021 - EOS Imaging Whole Body
2 Aug 2021 - Ultrasound of Ovaries
4 Aug 2021 - MRI - Derangement (R) Knee / Support structures
27 Aug 2021 - Ultrasound MSK Interventional - Cortisone injection into R knee
16 Sep 2021 - Pelvis X-Ray
26 Sep 2021 - MRI Pelvis
27 Sep 2021 - CT Scan Pelvis
22 Oct 2021 - Ultrasound MSK Interventional - Cortisone injection into R Hip
9 Nov 2021 - Ultrasound - Urinary Tract
3 March 2022 - EOS Imaging Whole Body
1 April 2022 - Pelvis X-Ray (Both Hips)
1 April 2022 - Ultrasound - Hip/Groin Bilateral
3 May 2022 - Ultrasound MSK Interventional - Cortisone injection into R Hip
11 May 2022 - MRI Left Knee
24 May 2022 - CT Lower Limbs Without Contrast Sonogram
24 May 2022 - Arterial Doppler Right Lower Leg
29 May 2022 - MRI Trauma - Thoracolumbar Spine
15 June 2022 - US HIP / Groin Unilateral Right
15 June 2022 - X ray Pelvic Girdle
24 June 2022 - CT Abdomen & Pelvis with Contrast
02 September 2022 - CT Scan Chest / lower abdomen
02 September 2022 - CT Paranasal
06 September 2022 - Guided Ultrasound - Drain the Bakers Cyst
05 October 2022 - X ray - Pelvis
05 October 2022 - Ultrasound - Neck
28 November 2022 - Ultrasound MSK Interventional - Cortisone injection into L Hip
06 Feb 2023 - X ray - Pelvis
07 Feb 2023 - Ultrasound (Upper Right Shoulder)
21 Feb 2023 - MRI - R Hip
21 March 2023 - Ultrasound of Ovaries (Fertility)
22 March 2023 - Cortisone Injection R Shoulder
3 April 2023 - Nerve Conduction Study R Leg
25 September 2023 - X ray Pelvis
28 September 2023 - MRI - R Shoulder
22 October 2023 - MRI - L Knee
31 January 2024 - MRI R Wrist + Hand
13 February 2024 - CT Chest - Lung
20 May 2024 - Xray - Pelvis
9 July 2024 - Cortisone Injection L Hip
8 November 2024 - MRI whole spine - sciatica

[2025] NSWPICMP 167

14 March 2025