Rotella v AAI Ltd a/s AAMI - [2025] NSWPICMP 451

DETERMINATION OF REVIEW PANEL
CITATION:	Rotella v AAI Ltd a/s AAMI [2025] NSWPICMP 451
CLAIMANT:	Mario Rotella
INSURER:	AAI Ltd t/as as AAMI
REVIEW PANEL
MEMBER:	John Harris
MEDICAL ASSESSOR:	Shane Moloney
MEDICAL ASSESSOR:	Margaret Gibson
DATE OF DECISION:	11 April 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; accident in May 2017; minor rear end collision; chronic pre-existing cervical and lumbar spine symptoms; 40 distinct medical disputes on treatment and care before the Panel; absence of contemporaneous complaint and reference in claim form to lumbar injury; minor nature of accident; finding of no injury to the lumbar spine; Norrington v QBE Insurance (Australia) Ltd and Bugat v Fox referred to; complaint of increase in cervical spine symptoms within a week of motor accident; no pathological changes; physiotherapy over three months relieved condition; bilateral shoulder condition caused by neck injury; finding made that the accident caused a three months increase in cervical spine and shoulder symptoms; Held – Medical assessment revoked; findings made of reasonable and necessary and causation in respect of the 40 medical disputes.
DETERMINATIONS MADE:	1. The Review Panel revokes the certificate of Medical Assessor Shahzad dated 3 June 2024 and issues a new certificate determining that the following treatment and care for a period of three months: · general practitioner (GP) consultations monthly for the cervical spine and bilateral shoulders; · radiological scans for the cervical spine and shoulders; · pain killing medication for the cervical spine and shoulders, and · physiotherapy for the cervical spine and shoulders; is reasonable and necessary in the circumstances. 2. The following treatment and care for a period of three months: · GP consultations monthly for the cervical spine and bilateral shoulders; · radiological scans for the cervical spine and shoulders; · pain killing medication for the cervical spine and shoulders, and · physiotherapy for the cervical spine and shoulders; relates to the injury caused by the motor accident

REASONS

BACKGROUND

Mr Mario Rotella (the claimant) was involved in a motor accident on 26 May 2017. Mr Rotella was stationary in his motor vehicle when it was rear-ended by the insured vehicle.
The insurer is liable to pay Mr Rotella any damages under the Motor Accidents Compensation Act 1999 (the MAC Act).
There are multiple treatment medical disputes before the Panel. These disputes are set out later in these reasons.
A medical assessment matter is determined in accordance with Part 3.4 of the MAC Act. This means that the matter is determined at first instance by a Medical Assessor[1] and, pursuant to s 63 of the MAC Act, on review by a review panel.
[1] Section 60 of the MAC Act.
The medical disputes were referred to Medical Assessor Shahzad who issued a Medical Assessment Certificate dated 3 June 2024 (the Medical Assessment Certificate).[2] The Medical Assessor noted the development of tremors and other neurological abnormalities in mid-2023. The reasons on the motor accident causing any injuries were:[3]
“I note that the claimant had a long history…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

Continue reading Rotella v AAI Ltd a/s AAMI

Details

AGLC: Content removed [2025] NSWPICMP 451
Case: [2025] NSWPICMP 451
Decision Date: 11 April 2025

CaseChat Overview and Summary

Rotella, the appellant, was involved in a minor rear-end collision in May 2017 and subsequently brought a claim under the Motor Accidents Compensation Act 1999. The respondent, AAMI, disputed the claim, leading to a hearing before the Motor Accident Insurance Commission where 40 medical disputes were presented. The appellant alleged exacerbation of pre-existing cervical and lumbar spine symptoms, while the respondent contested the claims and sought to revoke the medical assessment made by the appellant's treating doctor.

The key legal issues before the court were whether the accident caused or exacerbated the appellant's lumbar spine and cervical spine symptoms, and if the treatment provided was reasonable and necessary. The court examined the evidence and expert opinions, considering the absence of a contemporaneous complaint about the lumbar injury and the minor nature of the accident. The court referenced previous cases, Norrington v QBE Insurance (Australia) Ltd and Bugat v Fox, to assist in its determination.

The court found that there was no injury to the lumbar spine, as the appellant had not complained of lumbar symptoms at the time of the accident and there was no reference to a lumbar injury in the claim form. However, the court did find that the appellant's cervical spine symptoms had worsened within a week of the accident, despite there being no pathological changes. The court considered the physiotherapy treatment provided, which relieved the appellant's condition over a three-month period, and found that the accident had caused a three-month increase in cervical spine and shoulder symptoms. The court revoked the medical assessment and made findings in respect of the 40 medical disputes, ruling that the treatment was reasonable and necessary and that the accident had caused the exacerbation of symptoms.

The court's final order was that the medical assessment was revoked, and findings were made in respect of the 40 medical disputes, with the determination that the accident caused a three-month increase in cervical spine and shoulder symptoms. The court did not make a finding of injury to the lumbar spine.

Orders