Repaja v Insurance Australia Limited t/as NRMA Insurance
[2023] NSWPICMP 233
•31 May 2023
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Repaja v Insurance Australia Limited t/as NRMA Insurance [2023] NSWPICMP 233 |
| CLAIMANT: | Andja Repaja |
| INSURER: | Insurance Australia Ltd t/as NRMA |
| REVIEW Panel | |
| PRINCIPAL MEMBER: | John Harris |
| MEDICAL ASSESSOR: | Drew Dixon |
| MEDICAL ASSESSOR: | Margaret Gibson |
| DATE OF DECISION: | 31 May 2023 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; the claimant was a front seat passenger who suffered injury on 25 November 2017 when the insured vehicle T-Boned the claimant’s vehicle on the passenger side; assessment of permanent impairment; claimant re-examined; delayed onset of complaint of left hip pain is relevant but not determinative on injury: AAI Ltd v McGiffen referred to; findings on MRI scan consistent with direct trauma from airbag deployment to left side of body; no pre-existing or other factors to explain left hip symptoms which were first reported two months after accident; examination findings for neck and back showed diagnosis related estimate (DRE) Category I; assessment of left shoulder and left hip combined at 8%; Held – original assessment revoked; finding made that claimant was below the threshold for permanent impairment. |
| DETERMINATIONS MADE: | Medical Assessment – Permanent Impairment WHETHER THE DEGREE OF permanent impairment OF THE INJURED PERSON AS A RESULT OF THE INJURY CAUSED BY THE MOTOR ACCIDENT IS GREATER THAN 10% THE ASSESSMENT MADE BY THE REVIEW PANEL UNDER S 7.23(1) OF THE MOTOR ACCIDENT INJURIES ACT 2017 IS AS FOLLOWS: The Panel revokes the certificate dated 20 October 2022 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a whole person impairment NOT GREATER THAN 10%: · cervical spine; · lumbar spine; · left shoulder, and · left hip. |
REASONS
BACKGROUND
On 25 November 2018 Mrs Andja Repaja (the claimant) was a front seat passenger which was T-boned by the insured vehicle on the passenger side resulting in airbag deployment.[1]
[1] Claimant’s bundle, p 8.
Insurance Australia Limited (the insurer) insured the owner and/or driver of the motor vehicle for liability to pay to Mrs Repaja any damages and/or statutory benefits under the Motor Accident Injuries Act 2017 (the MAI Act).
The issue in dispute is whether Mrs Repaja’s “degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%”. This constitutes a medical dispute within the meaning of the MAI Act.[2]
[2] See Division 7.5 and Schedule 2 clause 2 of the MAI Act.
The following injuries were referred for assessment:
· cervical spine;
· lumbar spine;
· left shoulder, and
· left hip.
Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be made in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines are issued pursuant to s 10.2 of the MAI Act. The Guidelines adopt the fourth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA 4). Where there is any difference between AMA 4 and the Guidelines, the Guidelines are definitive.[3]
[3] Clause 6.2 of the Guidelines.
This is a review of a medical assessment pursuant to s 7.26 of the MAI Act. The medical assessment the subject of this review was conducted by Medical Assessor Rapaport and dated 20 October 2022 (the medical assessment).[4] The Medical Assessor assessed the degree of permanent impairment at 0%. The details of that assessment are set out later in these Reasons.
THE REVIEW
[4] Insurer’s bundle, p 3.
The application for referral of a medical assessment to a Review Panel (the Panel) was made by the claimant within 28 days after the parties were issued with the original certificate for the medical assessment for which the review is sought.[5]
[5] Section 7.26(10) of the MAI Act.
The President referred the medical assessment to the Panel as they were satisfied that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application.[6]
[6] Section 7.26(5) of the MAI Act; claimant’s bundle, page 303.
Pursuant to s 7.26(5A) of the MAI Act and Schedule 1, cl 14F(2) of the Personal Injury Commission Act 2020 (the PIC Act), the Panel consists of two Medical Assessors and a Member of the Motor Accidents Division of the Personal Injury Commission (the Commission).
Part 5 of the PIC Act enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Merit Reviewer or a Medical Assessor.[7]
[7] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[8]
[8] Rule 128 of the PIC Rules.
The review is by way of new assessment of all matters with which the medical assessment is concerned.[9]
[9] Section 7.26(6) of the MAI Act.
STATUTORY PROVISIONS
The provisions of the Civil Liability Act 2002 (the CL Act) apply to the MAI Act in determining issues of causation. Particularly ss 5D and 5E of the CL Act.[10] In Raina v CIC Allianz Insurance Ltd[11] Campbell J stated:
“One may accept that a review panel is engaged in a process of dispute resolution by expert assessment of medical issues arising under the Act. However, the questions arise in a legal context and it is incumbent upon the panel, medical practitioners they may be, to correctly apply the law including the law of causation in the exercise of their powers. This includes the provisions of Division 3 of Part 1A of the Civil Liability Act 2002(NSW), ss5D and 5E: see s 3B(2)(a) of that Act. Although it may be expected that questions about the appropriate scope of liability will arise but rarely.”
[10] See s 3B(2) of the Civil Liability Act 2002.
[11] [2021] NSWSC 13 (Raina) at [65].
Further, clauses 6.5 to 6.7 of the Guidelines refer to causation of both injury and whether the degree of permanent impairment is caused by injury.
Clause 6.7 of the Guidelines provides:
“There is no simple common test of causation that is applicable in all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.”
ASSESSMENT UNDER REVIEW
The Medical Assessor found that the motor accident caused soft tissue injuries to the left shoulder, cervical and lumbar spine and enthesopathy of the left hip.
The Medical Assessor found that the soft tissue injuries to the left shoulder, cervical and lumbar spine had resolved. In relation to the left hip injury, the Medical Assessor found:
“The enthesopathy of the left hip was caused by the accident and was associated with some partial delamination of gluteal muscles that attach to the greater trochanter. The small area of partial tearing was in the Gluteus mimus muscle that is a very small adjunct to the Gluteus Maximus muscle that forms the bulk of the musculature that gives form to the buttock and abducts and extends the proximal femur where it articulates with the hip joint.
There was no antecedent history of left hip pain or enthesopathy of gluteal muscles and this must therefore be attributed to the motor accident.”
The Medical Assessor found no assessable impairment.
MATERIAL BEFORE THE REVIEW PANEL
The parties filed bundle of documents for the Panel’s consideration.
The claimant forwarded further clinical records by way of late Application. These documents were admitted even though they were served at such a late point in time without any proper explanation as to why the documents were not obtained earlier.
We note that the insurer did not have an opportunity to respond to the admission of these documents. We have admitted the documents as we have concluded that the claimant did not reach the threshold and the material otherwise did not impact on our ultimate findings.
Pre-existing conditions
The pre-accident records of the general practitioner (GP) do not refer to any relevant pre-existing condition.[12]
[12] Claimant’s bundle, pp 56-58; Insurer’s bundle, pp 147-149.
Medical records
The hospital emergency department discharge referral specified left shoulder, elbow and chest symptoms.[13]
[13] Claimant’s bundle, p 4.
On 27 November 2018, Dr Tomasevic, GP noted pain in the neck, mid and lower back, left shoulder, left upper limb, left lateral chest.[14] Significant bruising was noted in the left lower arm, left elbow and left lateral chest. The clinical notes of the GP refer to consistent complaints after that time.
[14] Claimant’s bundle, p 59.
The claim form dated 24 December 2018 refers to the motor accident and describes injuries to the neck, back, left shoulder, “left upper limp”, left knee and left chest.[15]
[15] Claimant’s bundle, p 8.
On 21 January 2019 Dr Giblin noted pain in the neck, left shoulder, mid thoracic and low back. Left knee pain was described as “settling”.[16] There was no reference to left hip pain.
[16] Claimant’s bundle, p 12.
However, an Allied health request for physiotherapy treatment dated 21 January 2019 completed by the GP referred to left facial, left shoulder, neck, thoracic, lumbar and left hip pain.[17]
[17] Claimant’s bundle, p 13.
Whole body bone scan dated 4 February 2019 noted pain in neck, thorax and both hips following the motor accident and showed degenerative arthritis at C4/5, T6/7, T8/9 and L5/S1. Uptake was noted in the left greater trochanter caused by bursitis, enthesitis or injury.[18]
[18] Claimant’s bundle, p 18.
The MRI scan of the cervical spine dated 21 February 2019 showed low grade disc bulges without neural impingement and no acute injury.[19] The MRI scan of the lumbar spine showed mild discovertebral changes throughout the spine with mild facet joint arthroplasty and no nerve root compression.
[19] Claimant’s bundle, p 19.
On 27 February 2019 Dr Giblin noted intermittent neck pain, persistent low back pain and left hip pain due to gluteal enthesopathy.[20] On 16 April 2019 Dr Giblin noted no improvement and recommended a left sided gluteal tendon injection.[21]
[20] Claimant’s bundle, p 21.
[21] Claimant’s bundle, p 28.
On 15 May 2019 Dr Giblin noted that the left hip injection only provided partial relief. Pain was in the lateral hip area. An MRI scan was recommended to clarify the pathology.[22]
[22] Claimant’s bundle, p 36.
The MRI scan of the left hip dated 21 May 2019[23] showed gluteus medius and minimus tendinosis with a possible intrasubstance gluteus minimus tear and trochanteric bursitis.
[23] Claimant’s bundle, p176.
Ms Marilie Birkett, physiotherapist noted in May 2020 that there had been minimal relief of pain in the left hip “for quite some time”.[24]
[24] Claimant’s bundle, p 122.
Dr Michael Walsh, orthopaedic surgeon, provided a report dated 20 July 2020.[25] The doctor stated:
“A recent MRI scan of her left hip reveals some wear and separation of the gluteus minimus with a development of an enthesophyte in relation to this. She also has some delamination in the structure of the medius tendon but no separation. The hip joint is reasonably well preserved.
Andja’s pain is almost certainly coming from her gluteal tendinopathy and I think she would be suitable for a hip tendon reconstruction.”
[25] Claimant’s bundle, p 37.
Dr Bassel Hassan, neurologist provided a report dated 6 January 2021.[26] The doctor opined that the claimant was suffering from “non-specific musculoskeletal pain including cervical paraspinal muscular pain rather than any issue neurological issue”.
[26] Claimant’s bundle, p 133.
An MRI scan of the lumbar spine dated 16 March 2022 showed multilevel degenerative changes with no significant spinal canal stenosis. Diffuse bulging was noted at L4/5 which contacted but did not compress the left L5 nerve root with possible impingement on the right.[27]
[27] Claimant’s late Application, p 42.
An MRI scan of the left shoulder dated 3 May 2022 showed bursal inflammation, mild AC joint arthroplasty and no cuff or labral tear.[28]
[28] Claimant’s bundle, p 267.
In a report dated 16 June 2022, Dr Guirgis opined that the claimant suffered post-traumatic mechanical derangement of the cervical and lumbar spine, subacromial impingement of the left shoulder, greater trochanter pain syndrome in the left hip, and left knee symptoms.[29]
[29] Claimant’s late Application, p 39.
Qualified opinions
Dr John Davis was qualified by the claimant and provided a report dated
13 October 2020.[30] The doctor opined that the motor accident caused injury to the cervical discs with likely impingement, aggravation of lumbar spine degenerative changes, left shoulder impingement and left gluteal enthesopathy. Impairment was not stabilised due to proposed surgical intervention.[30] Claimant’s bundle, p 38.
In a subsequent report dated 1 March 2021 Dr Davis assessed separate impairments of 5% for the lumbar spine, cervical spine and the left hip and assessed the left shoulder impairment at 7%.[31]
[31] Claimant’s bundle, p 51.
Dr Frank Machart, orthopaedic surgeon, was qualified by the insurer and provided a report dated 8 December 2020.[32] The doctor noted that the pattern of widespread injuries was inconsistent with contemporaneous evidence of injury as reported in the hospital notes and not supported by any evidence of structural derangement.
[32] Insurer’s bundle, p 49.
Dr Machart opined that the soft tissue injury occurred two years previously and was now healed. There was an element of psychological impact which was complicating the self-reporting of physical symptoms.
Statement
The claimant’s daughter provided a statement dated 28 April 2021.[33] She stated that at the hospital her mother was “confused” complaining of pain to her neck and left side of her body.
[33] Claimant’s bundle, p 232.
SUBMISSIONS
Claimant’s submissions dated 16 November 2022[34]
[34] Claimant’s bundle, p 335.
These submissions were filed seeking a review of the medical assessment.
The claimant referred to an updated scan of the lumbar spine dated 16 March 2022 which suggested possible impingement on the right L5 nerve root. This suggested a deterioration of the pathology which contradicted the finding of a resolution of symptoms.
The claimant referred to an absence of prior symptoms and consistent complaints since the motor accident. Reference was made to the opinion of Dr Davis that the claimant sustained disc damage in the motor accident.
The claimant submitted that the Medical Assessor failed to provide measurements of range of motion of both the cervical and lumbar spine and referenced previous assessments by treating health practitioners.
The claimant referred to the MRI scan of the left shoulder which showed subacromial bursal inflammation and mild AC joint arthroplasty. In relation to range of motion, the claimant submitted that the Medical Assessor failed to articulate whether there was a reasonable expectation that the injured joint would have had similar findings to the injured part before injury.
The claimant noted that the comments on minor injury were an irrelevant consideration in circumstances where the insurer had accepted otherwise.
In relation to the left hip, it was submitted that the Medical Assessor failed to engage with Dr Walsh’s opinion. The issue of minor injury was otherwise irrelevant. The Medical Assessor otherwise failed to provide proper measurements in relation to motion.
Insurer’s submissions dated 18 June 2021[35]
[35] Insurer’s bundle, p 14.
The insurer submitted it relied on the opinion of Dr Machart dated 8 December 2020 that the claimant had suffered a soft tissue injury to the left upper limb which had resolved.
In relation to the cervical spine there was no complaint at hospital of tenderness and had normal head rotation. The MRI scan of the cervical spine shows degenerative changes with no evidence of traumatic changes.
The insurer submitted that there was no injury to the cervical spine and otherwise no assessable impairment.
In relation to the lumbar spine there was no complaint of injury at hospital. The MRI scan of the lumbar spine shows degenerative changes with no evidence of traumatic changes. The insurer submitted that there was no injury to the lumbar spine and otherwise no assessable impairment.
The insurer noted that the claimant reported pain in the left shoulder at hospital and received treatment. It referred to inconsistent assessments of range of motion.
The insurer noted that the left hip was not mentioned at hospital or by Dr Giblin on
21 January 2019. The left hip was not mentioned until 27 February 2019. It submitted in the absence of contemporaneous evidence the left hip was not injured in the motor accident.
Insurer’s submissions dated 6 December 2022[36]
[36] Insurer’s bundle, p 24.
These submissions were filed opposing the application to review the medical assessment.
The insurer noted that neither MRI scan of the lumbar spine showed evidence of nerve root compression. Further the opinion of Dr Davis was old and the difference in opinion is otherwise not a basis for review.
The insurer submitted that there was no ambiguity with respect to the Medical Assessor’s findings of range of movement. Complaints of pain are not sufficient to establish impairment.
The insurer submitted that the finding that the range of motion was the same in both shoulders. As the right shoulder was not injured in the motor accident, it logically followed that any loss of motion was due to underlying degenerative changes.
In relation to the left hip, the findings by the Medical Assessor showed there was no ongoing impairment.
RE-EXAMINATION
Ms Repaja was examined by Medical Assessor Dixon. The examination report is as follows:
“The claimant was referred to the Medical Assessor, Dr Adam Rapaport for assessment of permanent impairment for injuries to the cervical spine, lumbar spine, left shoulder and left hip. After his assessment on 28 July 2022, his Certificate of 1 August 2022 noted the impairment disputes to be assessed were:
1. Mechanical injury to cervical spine discs with likely intermittent impingement;
2. Mechanical trauma to lumbar spine with aggravation of pre-existing degenerative change;
3. Subacromial/subdeltoid bursitis of the left shoulder with impingement;
4. Enthesopathy of the left hip.
The Applicant held the view that her injuries exceeded the threshold of 10% as a result of the motor vehicle accident on 25 November 2018. The Respondent submitted that the injuries sustained in the subject motor vehicle accident did not exceed the threshold of 10%.
The submissions filed were seeking review of the Medical Assessment, in particular referring to an updated scan of the lumbar spine on 16 March 2022 which suggested possible impingement of the right L5 nerve root. Reference was made to a much earlier report of Dr John Davis who felt there was discal injury in the subject motor vehicle accident and that the MRI scan of the left shoulder had shown subacromial bursitis and AC joint arthroplasty and that the claimant’s hip injury was associated with gluteal enthesopathy and that she had a cortisone injection arranged by Dr Mathew Giblin, after an MRI of the hip had shown intrasubstance gluteus medius and minimus tear and trochanteric bursitis. Two injections were performed without sustained benefit.
The mechanism of injury was T-bone collision with the claimant’s vehicle on the left hand side, where she was a front seat passenger wearing a seat belt and the air bag deployed. She sustained injuries to her neck, left shoulder, left hip and lower back.
Examination
On examination on 23 May 2023 at my Hornsby rooms with an Interpreter, she presented in a straightforward manner and walked without limp.
On examination of the cervical spine there was symmetrical restriction of motion with flexion extension decreased by one third and lateral rotation decreased by one quarter bilaterally and lateral flexion decreased by one third bilaterally. There was mild tenderness of the left trapezius muscle extending up into the bottom of her scalp into the post auricular area on the left. There was no neurological deficit of either upper limb. Her reflexes were symmetrical, and power was grade 5 out of 5 and there were no objective sensory changes. There was no spasm in her cervical spine nor dysmetria. The facet joints were mildly tender on the left.
Chest expansion was 4cm out of 5cm with some left lateral pleuritic pain in this area.
On examination of her left shoulder there was decreased elevation with forward flexion 130 degrees, active abduction 110 degrees, extension 40 degrees, adduction 40 degrees, external rotation 80 degrees and internal rotation 70 degrees. Measurements were taken by a goniometer and the testing was repeated on three occasions which showed consistency.
Shoulder girdle power on the left was grade 4 out of 5 and there was tenderness of the trapezius muscle and posterior deltoid and supraspinatus muscle belly. There was mild drooping of the shoulder. There was tenderness of the axillary wall on the left where she had a bruise after the accident. Power was grade 4 out of 5.
There was a full range of motion of her right shoulder where power was grade 5 out of 5.
There was stiffness of her lumbar segment where flexion and extension were decreased by one third and lateral flexion decreased by one quarter bilaterally. There was tenderness at the L5 level in the midline. There was no erector spinae muscle spasm and no dysmetria. Her straight leg raise was 60 degrees on the left associated with pain at her lateral hip and 70 degrees on the right. There was no neurological deficit nor wasting with symmetrical reflexes and no sensory losses and muscle power was grade 5 out of 5.
Her gait was satisfactory as was toe walking. There was a mild limp on heel walking associated with left hip trochanteric pain and her squat test was satisfactory.
There was mild tenderness in the region of the trochanteric bursa. She had a full range of motion of her right hip with flexion 130 degrees, active abduction 35 degrees, adduction 30 degrees, extension 0 degrees, external rotation 35 degrees and internal rotation 30 degrees. Flexion was 120 degrees bilaterally. The same movements were found on the right.
Imaging Studies
Whole body bone scan with SPECT/CT of the lumbar spine on 4 February 2019 showed increased uptake at the left greater trochanter thought to be due to bursitis/enthesitis or injury. There was discovertebral degenerative arthritis at C4/5 and L5/S1 levels.
MRI of the cervical spine on 20 February 2019 showed no evidence of osseous traumatic injury. There were low grade disc bulges without neural impingement.
MRI of the lumbar spine on 20 February 2019 showed discovertebral changes throughout the entire lumbar spine with mild facet arthropathy and no nerve root compression was seen. The lumbar spine showed no nerve root or thecal sac compression but there was a combination of Modic type 2 as well as type 1 endplate changes with endplate oedema at L2/3 and L4 with minor Modic type 2 changes at L1/2 and at L2/3 a posterior annular tear with low grade disc bulge and at L3/4 a broad based disc bulge with mild facet joint arthropathy and at L4/5 broad based disc bulge with ligamentum flavum thickening and facet joint arthropathy with mild thecal sac compression but no definite nerve root compression with minimal disc bulge at L5/S1.
MRI of the left hip on 21 May 2019 showed tendonosis of the medius and minimus with intrasubstance gluteus medius and minimus tear and trochanteric bursitis.
MRI of the left shoulder on 3 May 2022 showed no rotator cuff or labral tear but there was mild AC joint arthropathy and subacromial bursitis.
In summary this claimant has had neck and back strain injuries in the subject motor vehicle accident together with contusion to her left shoulder and left hip.
Her diagnoses are:1. Neck strain injury to the cervical spine with post traumatic stiffness without dysmetria or muscle spasm nor neural compression without radicular complaint;
2. Back strain injury with Modic changes and annular tear at L2/3 with minor disc bulges but no neural compression;
3. Contusion to left shoulder with post traumatic subacromial bursitis and post-traumatic stiffness with trapezial muscle and deltoid pain;
4. Mild trochanteric bursitis associated with a limp on heel walking.
Her impairment for her cervical spine is DRE I, 0% WPI.
That for her lumbar spine is DRE I, 0% WPI.
That for her left shoulder is from Pie Charts 38, 41 and 44, 8% UEI which equates to 5% WPI.
That for the trochanteric bursitis of the left hip is from Table 64, 3% WPI.
This gives a total of 8% WPI.
There were no symptomatic pre-existing conditions.
She has reached MMI.”
FINDINGS
The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[37] The Panel adopts the examination findings of Medical Assessor Dixon and adds the following further reasons.
[37] Section 7.26(6) of the Act.
The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[38] and Insurance Australia Ltd v Marsh.[39] This is particularly relevant where there are inconsistent opinions tendered by the parties. In these circumstances the clinical examination and objective evidence (such as scans) explain how and why we have reached a different conclusion from the previous contrasting views.
[38] [2021] NSWCA 287 at [40], [41] and [45].
[39] [2022] NSWCA 31 at [11], [21], [64].
We note that the cervical and lumbar spine were mentioned to the GP on
27 November 2018, that is only two days after the motor accident. That these body parts were not mentioned at hospital does not detract from the reporting of symptoms within a short period.The circumstances of the motor accident could and did cause soft tissue injury to the spine. Considering the absence of pre-existing symptoms and the short duration of onset of recorded complaint, we accept that these body parts were injured in the motor accident.
Further the fact that the neck and back was recorded as being injured only two days after the motor accident suggest that it was more likely than not that symptoms were present before the claimant presented to her GP. Again, this suggests that the delayed onset of symptoms was insignificant and otherwise medically consistent with being injured in the motor accident.
For the reasons articulated by Medical Assessor Dixon, whilst there were ongoing symptoms in the spine, the signs were insufficient to establish a DRE Category II rating and are assessed at DRE Category I.
The insurer correctly noted that there was an absence of early reference to the left hip although incorrectly submitted that the first reference was on 27 February 2019.
The left hip is mentioned by the GP in the referral for physiotherapy dated 21 January 2019, coincidentally the date when the claimant saw Dr Giblin when that body part was not referenced in his report.
The absence of record is relevant but not determinative of the question of causation: AAI Ltd v McGiffen.[40]
[40] [2016] NSWCA 229 at [64]-[66].
The circumstances of the motor accident were significant where the claimant was a front seat passenger and stuck by airbag deployment on her left side. There was no prior history of left hip symptoms.
Both the mechanism of the injury and the pathology shown on MRI scan are consistent with the motor accident whereby there was direct trauma to the left side of the body. Left sided trauma is otherwise evidenced by contemporaneous complaints of left shoulder symptoms at hospital and left sided symptoms by the GP two days later.
The absence of early recorded complaint of left hip injury tends to suggest against a finding of causation of injury to that body part. However, the absence of other causes including any pre-existing left hip condition and the mechanism of the motor accident are strong indicators supporting a finding of causation for the left hip.
The claimant’s daughter stated that the claimant was confused at hospital and was complaining of left sided pain. Complaints of left sided symptoms are consistent with the initial consultation note made by the GP. The claimant otherwise required an interpreter with Medical Assessor Dixon which may explain some confusion with communication with some medical practitioners.
The GP ultimately associated and accepted that the motor accident caused left hip injury when he included that body part in the physiotherapy referral.
For these reasons we are satisfied that the motor accident caused a left hip injury.
There was early report of left shoulder pain consistent with the mechanism of injury of trauma to the left side of the body. The pathology shown on the left shoulder MRI scan is entirely consistent with direct trauma. We otherwise note that Medical Assessor Dixon tested for and found consistency in loss of range of left shoulder movement and found normal right shoulder movement.
We are satisfied that the impairment is permanent because it is unlikely to change substantially with or without treatment and is not likely to remit despite medical treatment.
Pre-existing or subsequent injuries causing impairment
There is no basis to conclude that there should be a deduction for pre-existing or subsequent injury.
CONCLUSION
The certificate is revoked. The new certificate is attached at the commencement of these Reasons.
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