Ringstad v Allianz Australia Insurance Limited
[2023] NSWPICMP 202
•10 May 2023
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Ringstad v Allianz Australia Insurance Limited [2023] NSWPICMP 202 |
| CLAIMANT: | David Ringstad |
INSURER: | Allianz Australia Insurance Ltd |
| REVIEW Panel | |
| PRINCIPAL MEMBER: | John Harris |
| MEDICAL ASSESSOR: | Geoffrey Stubbs |
| MEDICAL ASSESSOR: | Geoffrey Curtin |
| DATE OF DECISION: | 10 May 2023 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act2017; the claimant suffered injury when his motorbike collided with the insured vehicle; the claimant suffered various injuries and severe laceration to the right arm; the dispute related to whether the injury was a threshold injury; claimant re-examined; discussion of interpretation of threshold injury with reference to skin injury; Dhupar v AAI Ltd applied; examination showed claimant suffered ongoing loss of sensation to the medial antebrachial cutaneous nerve injury; that skin injury found to be a non-threshold injury; other injuries found to be threshold injuries; Held – claimant suffered an injury to a nerve; finding made that claimant suffered a non-threshold injury. |
| DETERMINATIONS MADE: | Medical Assessment – Threshold injury Review Panel Assessment of Threshold Injury The Review Panel revokes the certificate dated 24 November 2022 and issues a replacement certificate that the motor accident caused a non-threshold injury to the right arm involving an injury to the medial antebrachial cutaneous nerve. |
REASONS
BACKGROUND
Mr David Ringstad (the claimant) suffered injury in a motor accident on 14 November 2021 (the motor accident) whilst riding a motor bike which collided with the insured vehicle.[1]
[1] Claimant’s bundle, p 10.
The claimant alleges that the motor accident caused the following injuries:[2]
(a) Injury to the right arm – degloving and 30cm laceration from elbow to proximal wrist, scarring.
(b) Injury to the right shoulder – proliferative tendinopathy.
(c) Injury to the right elbow – soft tissue irritation/dysfunction with signs of pain neurogenic origin/brachial plexus/radicular throughout right upper limb from cervical spine to hand.
(d) Injury to the thoracic spine – soft tissue.
(e) Injury to lumbar spine – soft tissue.
[2] Claimant’s bundle, p 1.
The insurer is liable to pay to Mr Ringstad any damages and/or statutory compensation entitlements under the Motor Accident Injuries Act 2017 (the MAI Act) for the motor accident.
The issue presently in dispute is whether Mr Ringstad’s injury is classified as a “threshold injury” within the meaning of the MAI Act.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter including whether “the injury caused by the motor accident is a threshold injury for the purposes of the Act”.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor[3] and, pursuant to s 7.26 of the MAI Act, on review by a review panel.
[3] Section 7.20 of the MAI Act.
Whether a person has only suffered threshold injuries as a result of a motor vehicle accident affects the entitlement to both statutory benefits and damages.
Statutory benefits by way of loss of earnings and treatment and care expenses cease after 26 weeks[4] if “the person’s only injuries resulting from the motor accident were threshold injuries”.[5] An injured person otherwise cannot recover damages under the MAI Act if the “only injuries resulting from the motor accident were threshold injuries”.[6]
[4] For motor accidents occurring prior to 1 April 2023.
[5] Sections 3.11 and 3.28 of the MAI Act.
[6] Section 4.4 of the MAI Act.
MEDICAL ASSESSMENT
The medical dispute was referred to Medical Assessor Page who issued a Medical Assessment Certificate dated 24 November 2022 (the medical assessment). Medical Assessor Page concluded that Mr Ringstad sustained injuries were a minor injury within the meaning of the MAI Act.
The examination findings of the Medical Assessor were:[7]
“He has a longitudinal scar running from the lateral side of his right elbow along the ulnar border of his forearm to the lower forearm that is 15 centimetres long. It is well healed with a faint scar and there is no keloid or hypertrophy of the scar. The scar is non-tender. He has no sensory changes around the scar. He has equal circumference of his right forearm compared to the left, and there appears to be no underlying muscle or other structures involved with the laceration. He has normal power and function of his right wrist and hand with strong grip strength. He had no sensory changes in his right hand and there was no evidence of median or ulnar nerve changes.
The ulnar nerve was irritable on the medial side of the right elbow, but the left ulnar nerve was also irritable at the elbow.
He had full range of movement of his right shoulder, right elbow and right wrist and hand equal to the left.”
[7] Insurer’s bundle, p 39.
The Medical Assessor concluded that there was no evidence of any significant underlying injuries such as muscle or tendon tear or nerve damage.[8]
[8] Insurer’s bundle, p 42.
AMENDMENTS TO MINOR INJURY
The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2023 with various amendments commencing on 1 April 2023. From 1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.
The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
The original Medical Assessment Certificate was issued when the relevant term was “minor injury” which, because of the amendment, is now described as a threshold injury.
Accordingly, an injury which does not fall within the definition of a threshold injury (“a non-threshold injury”) means that a claimant has an entitlement to claim damages and, subject to other exclusions, receive statutory entitlements beyond either the 26 week or 52-week limitation period.
THE REVIEW
The application for referral of the medical assessment to a Review Panel was made by
Mr Ringstad within 28 days after the parties were issued with the original certificate for the medical assessment for which the review is sought.The President’s delegate referred the medical assessment to the Review Panel (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.[9]
[9] Section 7.26(5) of the MAI Act; claimant’s bundle, p 4.
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of Schedule 1 of the PIC Act. As the medical assessment the subject of the review was made on or after 1 March 2021, the new
review provisions apply.The review provisions provide[10] that a Review Panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
[10] Section 7.26(5A) of the MAI Act.
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 Medical Assessor.[11]
[11] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the 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.[12]
[12] Rule 128 of the PIC Rules.
The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[13]
[13] Section 7.26(6) of the MAI Act.
The Panel provided the parties with a copy of the decision of Dhupar v AAI Ltd.[14] We also advised that we would examine for any injury “to any nerves or a complete or partial rupture of tensons, ligaments, menisci or cartilage” and invited the parties to file any further submissions.
[14] [2023] NSWPICMP 99 (Dhupar).
The Panel did not receive a response to this Direction from either party.
LEGISLATION
A threshold injury is defined in s 1.6 of the MAI Act and includes a “soft tissue injury” or a “minor psychological or psychiatric injury”. Within these reasons we have referred to either a soft tissue injury or threshold injury interchangeably, although the latter is a wider concept as it also includes a minor psychological or psychiatric injury.
Section 1.6(2) of the Act defines a soft tissue injury to mean:
“[A]n injury to tissue that connects, supports or surrounds other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia, fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.”
Section 1.6 provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury or a minor psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the Regulations) further defines minor injury to include “an injury to the spinal nerve root that manifests in neurological signs (other than radiculopathy)” and an acute stress disorder and an adjustment disorder.
Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by the motor accident is a threshold injury for the purposes of the Act. Version 9.1 of the Guidelines applies to motor accidents occurring on or after 1 April 2023. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:
“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a minor psychological or psychiatric injury caused by the motor accident.
5.4 Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a)a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b)a review of all relevant records available at the assessment
(c)a comprehensive description of the injured person’s current symptoms
(d)a careful and thorough physical and/or psychological examination
(e)diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
Clauses 5.7 to 5.9 of the Guidelines relate to whether an injury to a spinal nerve root in the context of neurological symptoms is classified as a threshold injury. An injury resulting in radiculopathy will not be classified as a threshold injury.
Clause 5.7 of the Guidelines provides:
“In assessing whether an injury to the neck or spine is a soft tissue injury, an assessment of whether or not radiculopathy is present is essential.”
Radiculopathy is defined in cl 5.8 of the Guidelines as follows:
“Radiculopathy means the impairment caused by dysfunction of a spinal nerve root or nerve roots when two or more of the following clinical signs are found on examination when they are assessed in accordance with ‘Part 6 of the Motor Accident Guidelines: Permanent impairment’.
(a)loss or asymmetry of reflexes (see the definitions of clinical findings in Table 6.8 in these Guidelines)
(b)positive sciatic nerve root tension signs (see the definitions of clinical findings in Table 6.8 in these Guidelines)
(c)muscle atrophy and/or decreased limb circumference (see the definitions of clinical findings in Table 6.8 in these Guidelines)
(d)muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution
(e)reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.”
Neurological symptoms that do not meet the assessment criteria for radiculopathy means that the injury will be assessed as a minor injury.[15]
[15] Clause 5.9 of the Guidelines.
Sections 5D and 5E of the Civil Liability Act 2002 apply to the MAI Act.[16]
SUBMISSIONS
Claimant’s submissions dated 6 September 2022[17]
[16] See s 3B(2) of the Civil Liability Act 2002.
[17] Claimant’s bundle, p 1.
The claimant alleged that the motor accident caused various injuries evidenced by:
- certificate of capacity dated 23 November 2021;
- Application dated 24 November 2021;
- clinical notes of Coffs Harbour Health Campus;
- X-ray dated 14 November 2021, and
- report of Dr Jayne Schofield dated 14 December 2021.
The claimant submitted that he suffered a degloving injury where the “top layers of skin and tissue are ripped from the underlying muscle, connective tissue or bone”. This was not a minor injury within the meaning of the MAI Act.
Claimant’s submissions dated 12 December 2022[18]
[18] Claimant’s bundle, p 140.
These submissions were filed seeking a review of the Medical Certificate.
The claimant referred to the certificate of capacity dated 23 November 2021 and the Coffs Harbour Health Campus notes and submitted that the injury was “a complete or partial rupture of tendons, ligaments, menisci or cartilage” and fell outside the definition of minor injury.
Insurer’s submissions dated 26 September 2022[19]
[19] Insurer’s bundle, p 2.
The insurer noted that the claimant has describing the injury as “De-gloving” laceration of 30cm. It doubted the accuracy of that submission and referred to hospital notes including the emergency hospital notes and the record that there was “no obvious laceration to tendon”.
The insurer referred to two unrelated matters of which the relevance is highly doubtful.
The insurer submitted that any right shoulder injury came within the meaning of a minor injury and the X-rays of the right elbow was essentially normal.
The insurer submitted that there was no thoracic spine injury as there is an absence of information. In relation to the lumbar spine, the clinical notes of the general practitioner (GP) dated 23 November 2021 when the claimant advised of the motor accident, the additional history was:
“One week prior had hurt his back”.
The insurer noted that the Allied health recovery request dated 15 December 2021 also referred to previous lower back pain.
Insurer’s submissions dated 6 December 2022[20]
[20] Insurer’s bundle, p 43.
These submissions were filed opposing the application to review the assessment.
The insurer noted that the term “degloving” appears in the emergency note on 14 November 2022 but was not used by the surgeon. It also appears in the notes of Dr Sommerville dated 23 November 2021.
The insurer submitted that examination findings by the Medical Assessor and his diagnosis does not accord with a finding of “de-gloving” as the term is used by the claimant. The reasons clearly show the Medical Assessor came to the view that the laceration did not involve the deep structures such as tendons and nerves.
MATERIAL BEFORE THE REVIEW PANEL
Pre-accident medical records
In December 2018 the claimant reported low back pain.[21] The clinical note dated 23 November 2021 refers to the claimant hurting his back one week prior to the accident.[22] The Allied health recovery request dated 15 December 2021 refers to a past history of low back pain.
[21] Insurer’s bundle, p 9.
[22] Insurer’s bundle, p 17.
Ambulance report
The ambulance report referred to a large laceration to the right forearm.[23]
[23] Claimant’s bundle, p 59.
Progress hospital notes on 14 November 201 referred to right elbow pain and laceration.[24] The emergency discharge note refers to the skin injury as:[25]
“Deep laceration to dorsal forearm, ulnar aspect just distal to elbow, 8cm gaping, further 2 cm superficial. Distally NV intact, good ROM and power in hand”.
[24] Claimant’s bundle, p 72.
[25] Claimant’s bundle, p 74.
The operation report from the Coffs Harbour Health Campus dated 15 November 2021 referred to a right forearm washout and closure which was contaminated and debrided.[26] Later notes on the wound exploration refer to the contamination of the wound arising from “large pieces of ? metal ? car pain work”[27] with the following comment:[28]
“Wound extends proximally up beside elbow joint, unable to see wound base
Wound extends down to extensor tendon: no obvious laceration to tendon, moving w finger extension
Impression: Contaminated deep laceration to dorsal forearm down to extensor tendon +/- ?underlying fracture.”
[26] Claimant’s bundle, p 65.
[27] Claimant’s bundle, p 74.
[28] Claimant’s bundle, p 74.
The X-ray of the elbow and humerus dated 15 November 2021 referred to a normal appearance except for a small focus of surgical emphysema.[29] Pain was noted “distal ulnar radium, elbow and shoulder”.
[29] Claimant’s bundle, p 90.
The certificate of capacity dated 24 November 2021 referred to a right arm laceration 30cm from elbow to wrist.[30] A further certificate dated 15 December 2021 noted that the claimant required further physiotherapy to regain full strength and that exercises to date had been focused on shoulder movement.[31]
[30] Claimant’s bundle, p 16.
[31] Claimant’s bundle, p 40.
On 14 December 2021 Dr Schofield noted on examination:[32]
“reduced power 4/5 thumb adduction
reduced power 3/5 elbow flexion
reduced power 3/5 for shoulder adduction and abduction
sensation grossly intact
wound healed, not infected”
[32] Claimant’s bundle, p 134.
An Allied health recovery request dated 21 December 2021 noted ongoing pain in the right shoulder and right arm with numbness in the ulnar distribution and sharp needling pain travelling up and down the arm.[33] At that time Dr Schofield noted the claimant felt pain up the forearm when he was holding something or shaking hands.[34]
[33] Claimant’s bundle, p 50.
[34] Claimant’s bundle, p 135.
On 12 January 2022 Dr Schofield noted arm “much improved, has been using it”.[35]
[35] Claimant’s bundle, p 136.
Claim form
Mr Ringstad completed a claim form dated 24 November 2021.[36] After describing the accident, the claimant stated that he suffered a “traumatic, deep and contaminated 30 cm laceration from right elbow to right wrist” other injuries to the back and right shoulder.
[36] Claimant’s bundle, p 5.
RE-EXAMINATION
The claimant was examined by Medical Assessor Curtin on 28 April 2023. The examination report is as follows:
“The re-examination was undertaken by Medical Assessor Curtin at his Westmead rooms on the 28 April 2023. Mr Ringstad was unaccompanied for the assessment.
History from the Claimant.
Mr Ringstad lives on the far north coast of New South Wales and has worked as a labourer for the Nambucca Shire Council for the past 20 years. He has enjoyed good general health in the past and there was no history of prior serious injury involving his right arm. He lives with his partner with whom he has four adult children, all of whom have left home.
On the 14/11/2021 around lunchtime, he decided to take his motorbike for a quick ride in the countryside, something he enjoyed to do a couple of times a week. He was having a leisurely trip and had just crossed a single lane bridge when he was involved in a collision with an oncoming car which had moved into his lane. He said that fortunately he was travelling fairly slowly when he and his bike crashed against the side of the car. He retained control of the handlebars and the bike stayed upright, but the right side of his body crashed heavily against the car. The bike stopped and he was able to step off it without falling on the ground. He then became aware that the side of his right forearm was bleeding heavily. He was wearing a helmet but no special protective clothing. He said that he was sore down his right side with multiple abrasions.
He was taken by ambulance to Coffs Harbour Hospital and was admitted overnight. The following day his right arm was repaired in the operating room and the operation report noted ‘a degloving injury right forearm… Laceration was gaping… 10 cm..fatty tissue, muscle of show’. Elsewhere it stated that the wound was gaping 8 cm. It appears that the wound did not penetrate deeper than superficial tissues, and after a washout and debridement, the wound was primarily closed with sutures. X-ray of the right forearm (15/11/21) reported ‘soft tissue laceration lateral to the proximal radius with no underlying bony injury’. He was then discharged home with his right arm in a sling and was followed up in the hospital for wound review and removal of sutures.
He said that his neck, right shoulder, arm and hip were very stiff and sore for weeks after the accident and that initially he needed his wife to help with showering and dressing. Because he has financial difficulties at time, he was very anxious to get back to work as soon as possible, but he said that because of the physical nature of his work, he was unable to work for three months, and it was about six months before he was back to full-time normal duties. During this recovery period, he said that his symptoms of stiffness and pain in the neck, back and hip completely recovered. He was not aware of any radicular symptoms. A physiotherapy AHHR dated 15/12/21 reported ongoing pain in the right shoulder and arm, some restrictions of shoulder movement and ‘right elbow soft tissue dysfunction’.
Current status.
Mr Ringstad reported some ongoing problems with his right arm. He said that his right arm was generally weaker than before, but fortunately, he was normally left-handed. He said that he can no longer completely straighten his right elbow, and this causes a problem when he tries to lift objects like a heavy bucket by its handle. He has also noticed that his right hand is often numb in the morning and that it will go numb while he is driving his car. He said that he has had some mental health issues as a result of the accident, but that he has been able to rely on a good family network for support. He is aware of some residual scarring on his right arm, but he said that the appearance of the scar doesn’t bother him. He admitted to some numbness in the skin adjacent to the scar.
Examination.
Mr Ringstad was a fit looking Caucasian man of 57 years. He was moderately overweight with a BMI of 29.3 (179 cm and 94 kg). He had a fair complexion, was heavily tanned and had a cheerful and pleasant manner. He was fully cooperative with the assessment and there was no evidence of abnormal pain behaviour.
Examination of the right upper limb revealed some minor restriction of movement of the right shoulder which lacked 20° of abduction and 15° of internal rotation compared with the left side. The right elbow lacked 28° of full extension, but there was full flexion, and full supination/pronation. There was mild restriction of wrist flexion compared with the left side although right wrist flexion remained within normal limits at 60°. There was otherwise no restriction of movement of the wrist, thumb and fingers of the right hand. There was no evidence of wasting of the right biceps or forearm. Provocation tests for carpal tunnel syndrome on the right side were negative, and there was no evidence of sensory loss or muscle wasting in the right hand. Maximum grip strength was 54 kg on the left and 28 kg on the right.
On the extensor surface of the right forearm, there was a noticeable, pale, flat scar extending for 17 cm from the elbow to the mid forearm. The scar was fine line, quite soft and pliable but there were noticeable suture marks. Immediately adjacent to the scar there were several other similar but much smaller linear scars. Sensory testing using a 40 g sharp point (Neuropen) indicated numbness along the length of the scar and also diminished sensation in an area of 16 x 5 cm surrounding the distal half of the scar. The scar was non-tender and not adherent to deeper structures. No tenderness or crepitus was noted in relation to the elbow joint.
Examination of the lumbar spine revealed a full range of symmetrical movement in all planes. Straight leg raising was unrestricted, brisk reflexes were present on both sides, and there was no evidence of sensory loss or of muscle atrophy or weakness.
Conclusions.
Although Mr Ringstad’s description of the accident suggests that some soft tissue injury to the spine could have occurred, there is no information regarding spinal injury in the ambulance record, hospital record, and the limited reports from his GP and physiotherapist.
He has some stiffness of his right shoulder and elbow, the precise cause of which is not clear. The laceration on his forearm extends over the lateral aspect of the elbow. The hospital notes state that an x-ray of the elbow and right humerus was carried out, but the brief x-ray report makes no mention of the elbow saying only that there was ‘no underlying bony injury’. Pain and stiffness of both joints are reported by his GP, Dr Schofield, and in the physiotherapist AHRR and there is a clear link of these injuries to the motor accident.
The operative description of the wound on his right forearm suggests that there was limited degloving of the skin and subcutaneous tissues resulting in some gaping of the wound. Such limited degloving is of no great consequence and does not by itself imply any injury to nerves, tendons, ligaments or cartilage. He does have however some loss of sensation which extends well beyond the margins of the scar itself and this indicates some injury to the medial antebrachial cutaneous nerve or one of its branches. The right arm laceration has therefore resulted in a non-minor injury.”
FINDINGS
The review is a new assessment of all matters with which the medical assessment is concerned. The original medical assessment related to the injuries sustained in the motor accident were minor or non-minor as defined under the MAI 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[37] and Insurance Australia Ltd v Marsh.[38]
[37] [2021] NSWCA 287 at [40], [41] and [45].
[38] [2022] NSWCA 31 at [11], [21] and [64].
We adopt the reasoning in Lynch v AAI Ltd[39] that the claimant bears the onus of proof in establishing that any injury is not a threshold injury for the purposes of the MAI Act.
[39] [2022] NSWPICMP 6 at [44]-[62].
The Panel adopts the examination report of Medical Assessor Curtin and adds the following reasons.
Skin/nerve injury
The parties were invited and failed to make any submissions on the accuracy of Dhupar which has now been applied by other Review Panels.[40] That decision only states what is evident from the clear wording of the definition of soft tissue injury, that is, an injury to nerves is excluded from the definition and is therefore not a threshold (previously minor) injury. There is no reason not to read the words other than in accordance with the plain language of the section.
[40] See Al-Samer v AAI Ltd [2023] NSWPICMP 115 and Sarwary v Allianz Australia Insurance Ltd [2023] NSWPICMP 125.
The insurer included two first instance decisions where a laceration in another part of the body was found to be a minor injury. Two matters can be discerned from those medical assessments. First, there was no legal analysis of the meaning of what constitutes a minor (now threshold) injury. Secondly, a finding of fact in one case has no legal consequence to a finding of fact in an entirely unrelated matter.[41]
[41] See Edwards v Noble [1971] HCA 54 at [14] per Barwick CJ.
Medical Assessor Curtin identified an injury to the medial antebrachial cutaneous nerve. The loss of sensation described by the claimant accords with the nature of the injury. The injury does not have to be “deep”, as the insurer submitted, to have caused that nerve injury. The nature of the laceration was otherwise consistent with injury to that nerve.
We otherwise note that Medical Assessor Curtin’s findings differ from Medical Assessor Page. We are required to form our own opinion. The evidence based on the nature of the laceration and Medical Assessor Curtin’s clinical findings is clear that there was an injury to the medial antebrachial cutaneous nerve.
For these further reasons we are satisfied that the motor accident caused a nerve injury which is not a threshold injury.
Other injuries
We are satisfied that the other injuries were threshold injuries as there is no evidence that the injuries were other than soft tissue injuries. This conclusion is based on the examination and the clinical records.
CONCLUSION
For these reasons the Panel concludes that the certificate issued by Medical Assessor Page is revoked. A replacement certificate is attached at the commencement of these Reasons.
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