Salins v Insurance Australia Limited t/as NRMA Insurance
[2025] NSWPICMP 653
•29 August 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Salins v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 653 |
CLAIMANT: | Dolreich Salins |
INSURER: | Insurance Australia Limited t/as NRMA Insurance |
REVIEW PANEL | |
MEMBER: | Jeremy Lum |
MEDICAL ASSESSOR: | Michael Couch |
MEDICAL ASSESSOR: | Christopher Oates |
DATE OF DECISION: | 29 August 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; permanent impairment dispute; review of Medical Assessment Certificate (MAC); claimant was walking across a pedestrian crossing when he was hit by a car; original Medical Assessor assessed 9% whole person impairment (WPI) comprising of 5% right wrist, 2% right knee, and 2% right shoulder; Review Panel re-examination found loss of range of motion in the right wrist and right shoulder which amounted to 11% WPI; claimant sought assessment of injury not in original medical dispute; Mandoukos v Allianz Australia Insurance applied; Review Panel examination findings of injuries not referred for assessment recorded in annexure at end of Review Panel’s reasons; Held – MAC revoked; claimant’s injuries caused by the motor accident gave rise to 11% WPI which is greater than 10%. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Alexander Woo dated (a) The Review Panel certifies the following injuries were caused by the motor accident: · right wrist – soft tissue injury with triscaphe joint capsular tear, Grade 2 ligament sprain and triangular fibrocartilage complex tear; · scarring – right wrist and forearm at surgical site; · right shoulder – soft tissue injury, and · right knee – soft tissue injury. (b) The Review Panel finds that the above injuries result in a whole person impairment of 11% which IS greater than 10%. |
STATEMENT OF REASONS
BACKGROUND
Dolreich Salins (the claimant) was involved in a motor accident on 13 May 2021. He was walking across a pedestrian crossing when a car hit the side of his right knee, right hand and wrist. He fell onto the bonnet of the car and shouted at the driver to stop. The car did not immediately stop and pushed the claimant further along before coming to a complete stop.
A passer by called for an ambulance and paramedics diagnosed the injury to the hand/wrist to be soft tissue injury. Based on the paramedic’s assessment, the claimant opted not to go to hospital.
In September 2021, due to persistent symptoms, the claimant underwent an arthroscopic debridement and repair of his right wrist.
The claimant made a claim for personal injury benefits with NRMA (the insurer), the third-party insurer of the vehicle that he says caused the accident.
A medical dispute arose about whether the degree of the claimant’s whole person impairment (WPI) is greater than 10% WPI. This is important because if there is a dispute about the degree of a claimant’s WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor for determination.
[1] See Division 4.3 of the Motor Accident Injuries Act 2017 (MAI Act).
On 18 February 2025, Medical Assessor Alexander Woo assessed the claimant’s injuries as having a WPI of 9% which results in a WPI of not greater than 10%.
The claimant lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Woo’s assessment.
On 9 April 2025, a delegate of the President (Ms Stephanie Wigan) accepted the application for review and referred the matter to this Review Panel (the Panel) to conduct the Review proceedings.
MEDICAL ASSESSMENT UNDER REVIEW
Medical Assessor Woo was referred the following injuries for assessment:
· right wrist / right hand- Triscaphe joint capsular tear; Grade II sprain of the dorsal intercarpal ligament. Triangular fibrocartilage complex tear;
· scarring – right wrist and forearm at surgical site;
· right shoulder – mild traumatic subacromial bursitis with impingement, and
· right knee – musculoligamentous strain.
Medical Assessor Woo accepted that the above injuries were causally related to the motor accident of 13 May 2021.
The right wrist had a loss of range of motion and was assessed as 5% WPI.
The right knee had a normal range of motion. There was, however, tenderness and crepitus in the patellofemoral joint, in keeping with the history of contusion and MRI findings of chondral fissuring at the lateral facet of the patella. This was assessed as 2% WPI.
The right shoulder could not be assessed using range of motion, as the Medical Assessor observed voluntary guarding during clinical examination. There were MRI findings of subacromial/subdeltoid bursitis and it was determined that the appropriate impairment methodology was by joint swelling. Mild joint swelling was chosen which converts to 2% WPI.
As the claimant had arthroscopic debridement and repair of the triangular fibrocartilage complex of the right wrist, the associated surgical scarring was assessed at 0% WPI.
The claimant’s total combined WPI was assessed as 9% WPI.
SUBMISSIONS
Claimant’s submissions
The claimant says the Medical Assessor should have used range of motion in the assessment of the right shoulder. It was incorrect for the Medical Assessor to use another method of assessment in circumstances where the range of motion findings between the Medical Assessor and Dr Porteous are very similar.
The claimant otherwise submits that the evidence indicates that the claimant’s accident-related injuries has met the 10% threshold for an entitlement to non-economic loss damages.
Insurer’s submissions
The insurer says there is no error in the assessment of the right shoulder. It is submitted in circumstances where the Medical Assessor found voluntary guarding, it would be inappropriate to use range of motion as a valid method of assessment.
The insurer’s original reply submissions also addressed the alleged injuries to the right shoulder, right wrist (and associated scarring) and the right knee. These submissions are summarised below.
Right shoulder
It is submitted that the claimant’s general practitioner, Dr Komonen, found a full range of motion in the right shoulder in a clinical note entry dated 14 May 2021. What followed were consultations with Dr Komonen from 14 May 2021 through to 23 December 2023, a period of over two years, where there were no reports of right shoulder pain, injury or restricted range of motion.
The insurer further refers to the radiology including the ultrasound dated 18 May 2021 which identified no injuries or deformities. The whole-body scan and SPECT/CT dated
28 June 2021 showed no injury to the right shoulder.The insurer notes that there were pre-accident clinical note entries from the claimant’s physiotherapist, Mr Hany George who recorded right shoulder complaints in February 2020 with multiple entries in November 2020. These records were not available to either Dr Dixon or Dr Porteous. The insurer submits that the was no injury to the right shoulder caused by the motor accident or, alternatively, a deduction should be made for pre-existing impairment.
Right wrist
In relation to the right wrist, the insurer appears to concede that the claimant initially reported right hand and wrist pain following the motor accident. However, the insurer says
Dr Komonen’s examination on 14 May 2021 only revealed some tenderness with a full range of motion. Radiological evidence obtained in May to July 2021 with the insurer highlighting the presence of degenerative arthritic change and the absence of any fracture.Following the claimant’s right wrist surgery in September 2021, the insurer notes that the operating surgeon, Dr Nabarro found full wrist movement in May 2022 and again in August 2022. The insurer also notes that certificates of capacity/fitness indicated that the claimant returned to full-time employment and self-reported that he performed well.
It is asserted that the right wrist surgical scarring can only attract 0% WPI under the TEMSKI criteria, as found by the claimant’s expert Dr Porteous.
Right knee
The insurer’s submissions with respect to the right knee somewhat mirror those made to the right shoulder. Namely, that while there was an early complaint of right knee pain following the motor accident, there were no further complaints made to his GP Dr Komonen throughout 2021 and 2022. An X-ray in September 2023 found no evidence of any abnormality. The insurer refers to pre-accident complaints of right knee pain recorded by physiotherapist Mr George who recorded injuries to the right knee in October 2019 and received treatment for “arthralgias knees” in January 2021, only four months before the motor accident.
The insurer therefore submits that the motor accident only caused a soft tissue injury to the right knee with no assessable impairment.
SCOPE OF MEDICAL DISPUTE
The claimant made further submissions dated 5 May 2025 seeking to have an alleged injury to his right thumb be included in the Panel’s proceedings. The Panel noted that the right thumb was not in the list of injuries that were referred for assessment before Medical Assessor Woo. However, the Panel observed in the documentation that both Drs Dixon and Porteous gave an opinion on WPI of the right thumb. The Panel further observed that the claimant had surgery to his right wrist (an injury that was referred for assessment) which could have affected the right thumb.
The insurer was invited to provide submissions. In further submissions dated 10 July 2025, the insurer objected to the proposed examination of the claimant’s right thumb. The insurer says the Panel has no authority to examine the right thumb because the Panel is restricted to a new assessment of all the matters which the medical assessment was concerned. The insurer states s 7.26 of the MAI Act restricts the ambit of the Panel to the injuries before the original decision-maker which, in this instance, was Medical Assessor Woo.
Section 7.26(6) of the MAI Act states:
“The review of a medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned.”
In the present case, the “medical assessment matter” provided in schedule 2(2) of the MAI Act concerns the assessment of the dispute between the parties with respect to the permanent impairment of the injuries said to be caused by the motor accident.
The Panel notes that injury to the right thumb was not an injury that was originally referred to Medical Assessor Woo for medical assessment. Furthermore, it was also not an injury that was the subject of the particulars provided by the claimant for the purposes of its claim for damages.[2] The correspondence between the parties and the dispute referred to Medical Assessor Woo only concerned injuries to the right wrist/hand, right shoulder, right knee and scarring.
[2] Letter from Carroll & O’Dea Lawyers to NRMA Insurance dated 13 November 2023.
The claimant in the present case is in effect asking the Panel to conduct a new medical assessment on an injury that was not the concern of the medical assessment under review. The Panel does not consider s 7.26 of the MAI Act allows it to do so.
The Panel understands that the opinions of Drs Dixon and Porteous may support the claimant’s position that the right thumb was injured in the motor accident and there was assessable impairment, however the appropriate procedure is for the claimant to lodge a fresh application for medical assessment for the right thumb and any other injury that he claims to have resulted from the motor accident. This way, the insurer has an opportunity to properly consider the injury and provide any evidence and submissions in reply.
The Panel notes that this view is consistent with Mandoukos v Allianz Australia Insurance Limited,[3] where the Court of Appeal held that the phrase “about a medical assessment matter” in s 7.17 does not mean that the medical dispute necessarily encompasses the whole of the medical assessment matter which, in the present case, is the degree of permanent impairment of the claimant from the injury caused by the motor accident.
[3] [2024] NSWCA 71 (4 April 2024).
That being the case, at the Panel’s re-examination, the claimant complained of restrictions to his right thumb and right hip to the Panel Medical Assessors. While the Panel Medical Assessors examined both the right thumb and right hip, the examination findings are recorded in an annexure at the end of these reasons. It has been included to assist the parties’ understanding of the claimant’s current presentation but does not form any part of the Panel’s decision.
REVIEW OF THE EVIDENCE
General observations
On 16 April 2025, the Panel issued a direction to the parties requiring indexed and paginated bundles of the information they relied upon. The Panel stated that unless documents are uploaded to the Review file, the Panel would not be able to read and consider those documents. The parties duly responded with the claimant’s bundle comprising of pages 1-437 and the insurer’s 1-216.
The Panel has read and discussed the documentation with the relevant material referred to in the Panel’s examination report and the Panel’s findings below.
Additional material
The additional report of Dr Drew Dixon, orthopaedic surgeon, dated 29 February 2024 was also reviewed. Dr Dixon found a combined total of 22% upper extremity impairment (UEI) or 13% WPI from loss of range of motion in the right shoulder, right wrist and right thumb. The retro-crepitus in the right knee was assessed at 2% WPI. The scarring was assessed at 1% WPI. Total combined 16% WPI.
The evaluation of Dr Dixon was similar to that of Dr Andrew Porteous who found a total combined WPI of 19%. Dr Porteous, however, allowed 5% WPI for the thoracic spine and nil impairment for scarring.
Dr Rimmer found loss of range of motion in the right wrist and assessed 9% UEI or 5% WPI. He found no impairment for the right shoulder or the right knee.
There was also additional material in the form of clinical notes from the claimant’s general practitioner Dr Pham and treating orthopaedic surgeon Dr Kirsh. The documentation all post-dated the subject accident and refer to ongoing issues with the claimant’s accident-related and non-accident-related injuries. Although the Panel called for the documentation, the documentation did not add to the Panel’s understanding of the issues in dispute or the injuries referred for assessment.
RE-EXAMINATION REPORT
At the preliminary conference on 3 June 2025, the Panel determined that the claimant be re-examined. The re-examination report of Medical Assessor Oates is as follows:
DOLREICH SALINS
Age: 57
Date of Accident: 13 May 2021
Date of Examination: 18 July 2025
Permanent impairment disputes to be assessed
· Right wrist/ right hand: Triscaphe joint capsular tear; Grade 2 sprain of the dorsal intercarpal ligament. Triangular fibrocartilage complex tear.
· Scarring – right wrist and forearm at surgical site
· Right shoulder – mild traumatic subacromial bursitis with impingement
· Right knee – musculoligamentous strain
Details of who attended the Assessment
Mr Salins attended the PIC Medical Suites unaccompanied for Medical Panel re-examination by Medical Assessors Oates and Couch on behalf of the Panel as arranged on 18/7/2025.
HISTORY
Pre-accident medical history and relevant personal details
Mr Salins, the claimant, confirmed he was born in India and raised in Kenya, coming to Australia in 1991 to complete university studies. He returned to Kenya and then returned to Australia in 1996 to undertake a Master’s degree in Information and Communication, after which he commenced employment with the Reserve Bank of Australia from 1998.
At the time of the subject accident, he was a senior analyst developer and wrote software.
He said he had had no previous injuries to the body parts referred for this assessment.
He had three eye operations for correction of strabismus as a child. He had bilateral inguinal hernia repair in 2002.
He was on no regular medications. His general health was good.
He was in the habit of attending a gymnasium three times a week.
History of the motor accident
The claimant confirmed on 13/5/2021 he was on his way to work, walking to a railway station at around 8.45am. He was in the middle of a zebra crossing when he was hit by a Chrysler 300 car coming from his right, and striking his right hand and wrist and right knee. He recalls his right wrist was crushed against the side of his body by the impact.
He fell forward onto the bonnet of the car and banged on the bonnet with his right hand, trying to alert the driver to stop, but it did not until he banged a second time and then the car stopped. He did not fall onto the road.
The driver wound his window down and asked whether he was all right and then drove away. The claimant took a photograph of the car’s registration plate. A passing female motorist got out and helped the claimant to the footpath and called an ambulance. The male driver who had hit him then returned to the scene but did not speak to him.
The ambulance then called the police, who briefly interviewed the claimant.
He was assessed by the paramedics and diagnosed with soft tissue injury, with no suspicion of fractures. They then drove him home, which was a short distance away. He was told if his pain worsened, to see his GP for follow-up.
At the time, he recalls having pain in the right hand and wrist which had become red and swollen, and also soreness in the right knee and soreness in the right shoulder.
History of symptoms and treatment following the motor accident
The claimant is right hand dominant.
He took some Nurofen anti-inflammatory and rested at home. He then saw his GP, Dr Komonen, at Padstow on 14/5/2021, that is the day after the accident.
He had an x-ray of the right wrist and ultrasound right shoulder, and was prescribed Celebrex anti-inflammatory. He then had a CT scan of the right wrist.
He had physiotherapy for the shoulder, but it did not help.
He had worsening pain in the right wrist and was referred to Dr Nabarro, orthopaedic surgeon. He had MRI scan of the right wrist showing a Triscaphe joint capsular tear. Wrist pain was radiating to the ulnar border of the hand with cramping in the fingers and soreness in the knuckles, particularly the thumb and index finger, and soreness in the thenar eminence of the right hand.
He had a cortisone injection to the ulnar aspect of the right wrist but there was no benefit.
He had TFCC arthroscopy (triangular fibrocartilage complex) on 17/9/2021 with some improvement in the wrist but ongoing difficulties.
He had further physiotherapy. This was directed to the right wrist and hand.
He had a progress MRI scan on 8/6/2022 and was referred to Professor Gumley for second opinion on 8/3/2023. Professor Gumley was unsure whether ulnar shortening would help his situation.
He was having increasing difficulty using the keyboard for long periods of time and requested a change of job to project management from July 2022, and this was accepted. There is less computer work involved in this role.
Subsequently, Dr Nabarro saw him on 21/6/2023 after a further ultrasound-guided steroid injection of the right pisotriquetral joint, but there was no real benefit from this procedure. Keyboard and mouse use still irritated the wrist.
After this, Dr Nabarro recommended arthroscopy and open repair of the TFCC, excision of the pisiform bone in the right wrist, but as there was no guarantee that it would help, only 33%, he decided not to proceed with surgery.
He had continuing pain and stiffness in the right thumb and index finger, with difficulty with use of a mouse.
Therapy continued for the wrist.
The right shoulder would get worsening pain with a change to project management because of increased static loading of the shoulder when using a rotary mouse in the right hand.
He had started driving again in July or August 2022 and noticed right shoulder pain when turning a steering wheel on roundabouts.
He was referred to Dr Kirsch, orthopaedic surgeon, Kogarah, on 18/12/2024. He had an ultrasound and MRI scan of right shoulder, and had a cortisone injection to the shoulder which helped for only three or four days, reducing pain from 7/10 to 4/10, after which the pain returned to its usual levels. A request for a second cortisone injection for the shoulder was rejected by the insurer.
He also noticed that his right knee was giving way, and the patella seemed to be moving laterally. Dr Kirsch recommended physiotherapy and strengthening for the buckling sensation in the right knee, and the associated lateral right hip area pain.
The claimant found that massage helped the knee for about one and a half days, but then the knee continued to give way with patellar pain. This was especially noticeable going downstairs and stepping off the kerb.
He used Therabands for strengthening, however, he found that physiotherapy did not help long-term.
Dr Kirsch then recommended an exercise physiologist, which he started two weeks ago. There is treatment for the knee, hip and shoulder. He has eight sessions, after which he has been allowed four sessions to teach himself management.
His next appointment with Dr Kirsch is to be arranged.
With respect to his employment, after the subject accident, he was off work until 18/6/2021. He was then again off work from September 2021 until April 2022, and from 9/4/2022 recommenced work part-time, which continued until 3/10/2022 when he attained full-time duties again and is still employed by the Reserve Bank.
Details of any relevant injuries or conditions sustained since the motor accident
He has had no further injury to the body parts referred for this assessment.
He developed low back pain one day, which was shooting into the right thigh but no paraesthesia, after getting out of bed one morning. He had investigations and was referred to Dr P Khong and underwent discectomy for decompressive surgery at L2/3.
He made a good recovery following this surgery from his back and right leg symptoms.
The claimant does not relate this condition to the subject motor vehicle accident.
Current symptoms
The claimant continues to have pain in the ulnar aspect of the right wrist, spreading across the dorsal wrist towards the thumb and index finger. He gets cramps between the fingers when he is writing. He can’t use a regular keyboard, and he had a workstation assessment by an occupational therapist and was given a split ergonomic keyboard with right and left-handed mouse.
The right wrist wakes him from sleep at night. Sometimes he uses a wrist splint at night with a rib. He gets shoulder pain which prevents him from sleeping comfortably on his right side. He wears a lightweight right wrist splint when he is doing keyboard work.
Shoulder pain is noted over the scapula and apex of the shoulder and into the right upper trapezius. He still has giving way at the right knee in the patellofemoral joint and some lateral right hip discomfort.
The scar over the ulnar aspect of the right wrist from surgery is tender if it is touched or knocked and he feels some burning discomfort in the area. The scar is not tethered.
He lives in a duplex with his wife, who is not working, and two sons aged 14 and 11. His wife has health problems, and they have a cleaner who comes every two or three weeks to do the heavier housework. There is also a gardener to mow the lawn and do the gardening. Mr Salins can’t vacuum because of his right arm problems.
He does not smoke and does not drink.
Current and proposed treatment
He is attending the exercise physiology program once a week and does home exercises as prescribed.
He takes Panadol Osteo, two tablets twice daily. If he is in more severe pain at work, he will have two Panadol at lunchtime. He has Mobic 40mg at night for the knee pain and magnesium tablets for the hand cramps.
He also uses a pulley to improve his shoulder movements.
IMAGING BROUGHT TO THE PANEL RE-EXAMINATION
18/5/2021 – X-ray right wrist, ultrasound right shoulder – Normal wrist study. Mild traumatic subacromial bursitis with impingement. No rotator cuff tear.
31/5/2021 – CT right wrist – Mild radiocarpal joint osteoarthritis.
24/6/2021 – MRI right wrist – Triscaphe joint capsular tear with Grade 2 sprain of the dorsal intercarpal ligament.
No scan evidence for recent fracture or RSD involving the right wrist and hand. Mild degenerative changes only.
8/6/2022 – MRI right wrist – No full-thickness tear of TFCC. There is a full-thickness tear of the lunotriquetral ligament. Signal changes at the ulnar attachment of the TFC suggest either post-surgical changes or strain of the TFC.
28/9/2022 – Bone scan – No abnormality found to explain right wrist and hand pain.
4/6/2023 – Bone scan – No report.
29/11/2024 – MRI right knee – Chondral fissuring at lateral facet patella.
2/12/2024 – MRI right knee – Minimal acute on chronic gluteus minimus tendinosis.
21/1/2025 – Ultrasound right shoulder – No evidence of rotator cuff tear. Subacromial/ subdeltoid bursitis.
30/5/2025 – Ultrasound right shoulder and scapula – Tender lump at medial border of scapula. Shoulder pain – No lump found at medial border of scapula. The symptoms may represent scapulothoracic bursitis.
30/5/2025 – MRI right shoulder – Myxoid degeneration superior labrum, moderate supraspinatus tendinosis and mild infraspinatus tendinosis. Mild subacromial/ subdeltoid bursitis. Mild quiescent AC joint arthrosis. Superficial chondral thinning of central glenohumeral articular cartilage
CLINICAL EXAMINATION
General presentation
He was of solid build. Height 173cm and weight 83kg. The claimant stated he was 74kg at the time of the accident.
Shoulders
Mild tenderness over right AC joint but not over apex or trapezius. The range of movement was assessed with a goniometer. There was some restriction of right shoulder movements reportedly due to pain.
Shoulder Movements
Active ROM Measured
RIGHT
Active ROM Measured
LEFT
Flexion
140°
180°
Extension
40°
70°
Adduction
50°
50°
Abduction
180°
with pain at the end of range
180°
Internal rotation
70°
with pain at the end of range
90°
External rotation
80°
with pain at the end of range
90°
Wrists
Tenderness over right distal radioulnar joint. No swelling or deformity. No joint instability. No wasting.
40mm well-healed, slightly pale surgical scar distal right ulna with no suture marks, no adherence and no trophic changes.
Wrist girth; right 16.5cm, left 16cm.
Wrist Movements
Active ROM Measured
RIGHT
Active ROM Measured
LEFT
Flexion
30°
70°
Extension
30°
50°
Radial deviation
10°
30°
Ulnar deviation
20°
30°
Left hand
Full range of movement.
Right hand
Full range of movement of index, middle, ring and little fingers.
Thumb movements: IP joint right 0 - 50°, left +10 - 70°. MP joint right 20 - 70°, left full.
Adduction right 30mm, left 50mm. Opposition right 30 mm, left 30mm.
Radial abduction right 50°, left 60°.
Hips
Thigh girth; right 47.5cm, left 49.5cm at 10cm above the superior patellar pole.
Calf girth; right 39.5cm, left 40cm at maximal circumference.
Gait showed negative Trendelenburg test. There was tenderness over the right greater trochanter.
Hip Movements
Active ROM Measured
RIGHT
Active ROM Measured
LEFT
Flexion
90°
110°
Extension
10°
10°
Abduction
30°
30°
Adduction
20°
40°
Internal rotation
30°
40°
External rotation
30°
40°
Knees
There was no heat or swelling in the knees, with normal alignment whilst standing. The right patellofemoral joint was irritable but there was no crepitus. The left patellofemoral joint was normal. There was no instability in either knee.
Range of movement measured with a goniometer.
Knee Movements
Active ROM Measured
RIGHT
Active ROM Measured
LEFT
Flexion
120°
140°
Extension
0°
0°
Comments on consistency
The claimant presented in a consistent manner. The Panel Medical Assessors were satisfied that the claimant was making a genuine effort to demonstrate his best active range of motion in the relevant joints tested.
FINDINGS
The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned.[4]
[4] Section 7.26(6) of the MAI Act.
The Panel should only consider the impairment as it is at the time of the Panel’s assessment.[5]
[5] Clause 6.21 of the Guidelines.
The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[6]
[6] Section 7.26(7) of the MAI Act.
The Panel refers to the above re-examination report of Medical Assessor Oates and adopts the findings in their entirety. The Panel reconvened on 4 August 2025 and discussed the re-examination report findings before collectively making the below determinations.
Diagnosis, causation and reasons
Causation is dealt with at cls 6.5-6.7 of the Guidelines. An abridged form of the requirements is contained in cl 6.7 which states:
“6.7 There is no simple common test of causation that is applicable to 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 a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question ‘Would this injury (or impairment) have occurred if not for the accident?’ may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
Further, the provisions of the Civil Liability Act 2002 apply, in particular ss 5D and 5E.
The diagnosis is soft tissue injury to right knee, right shoulder and right wrist including triscaphe joint capsular tear and Grade 2 ligament sprain and triangular fibrocartilage complex tear at the wrist.
The accident is considered to be a cause of these injuries, as the right knee was mentioned in the ambulance record and on the Claim Form and in the GP record of 14 May 2021. The right shoulder was mentioned in the GP record of 14 May 2021, in the certificate of even date, the Claim Form and underwent an ultrasound on 18 May 2021. The right wrist is mentioned in the ambulance record, the GP record of 14 May 2021, and the Claim Form and accompanying certificate.
The scarring on the right wrist has resulted from surgery. It is therefore also related to the accident.
The Panel did not consider there to be any break in the chain of causation by reason of the claimant making little to no complaints of his right shoulder and right knee following the initial complaints in May 2021 to December 2023. As detailed in the history given to the Panel and the clinical notes, the initial focus was on the claimant’s right wrist injury for which the claimant had extensive treatment from physiotherapy initially to a TFCC arthroscopy and a steroid injection.
Furthermore, there is a clear history of injury to the right shoulder and right knee with no evidence of any subsequent injury in the medical records. The mention in the physiotherapy notes of pre-accident symptoms to the right knee/calf and a stiff right shoulder in October 2019 and November 2020 respectively are explained by the claimant being a keen runner and from his regular attendance at the gymnasium. There is no evidence of any persisting symptoms or impairment from these complaints.
Permanent impairment
The assessment of the degree of permanent impairment is to be made in accordance with the Motor Accident Guidelines (the Guidelines).[7]
[7] See section 7.21 of the MAI Act.
Version 9.3 of the Guidelines applies to the Review. Part 6 deals with the assessment of permanent impairment.
With respect to the right shoulder, there is loss of active range of motion, which gives rise to assessable impairment. 140° flexion gives 3% UEI, 40° extension gives 1% and 70° internal rotation gives 1%. Adding these gives 5% UEI.
As noted in the Panel re-examination report, the Panel did not find any inconsistencies in shoulder movement nor observe the voluntary guarding that was seen by Medical Assessor Woo. The Panel rejects the insurer’s assertion that the Panel should find that the claimant is malingering.
Similarly with respect to the right wrist, flexion 30° gives 5% UEI, extension 30° gives 5%, radial deviation 10° gives 2% and ulnar deviation 20° gives 2%. Adding these gives 14% UEI.
Combining 14% by 5% gives 18% UEI, equivalent to 11% WPI.
There is no assessable impairment arising from the right knee.
With respect to scarring and in accordance with the TEMSKI criteria, the best fit is 0% WPI for scarring. The injured person is conscious of the scar and there is slight colour contrast with surrounding skin. The person is able to locate the scar. There are no trophic changes. There are no visible staple or suture marks. The anatomical location of the scar would be visible with a short-sleeved shirt. There is no contour defect, no effect on ADLs, no requirement for treatment, and no adherence.
The majority of descriptors fall in the 0% WPI column.
CONCLUSION
The claimant’s final combined WPI as a result of the motor accident is 11% by 0% giving 11% and is greater than 10%. The Panel’s impairment percentages result in a material change in the medical assessment under review as the claimant’s impairment is found to be greater than 10% WPI.
As such, the Panel revokes the certificate of Medical Assessor Woo dated 18 February 2025.
A new certificate is issued at the front of the Panel’s determination.
ANNEXURE
Injuries not referred for assessment
Right thumb
With respect to the right thumb, the Panel Medical Assessors noted some restriction of active range of motion, giving to rise to assessable impairment:
IP joint flexion to 50° gives 2% thumb impairment, 0° extension gives 1% thumb impairment;
MP joint 20° lack of extension gives 1% thumb impairment ;
Radial abduction is normal;
Adduction of 3cm means 5cm “lack” giving 6% thumb impairment.
Opposition is equally restricted in both thumbs resulting in zero net impairment for the injured right thumb.
With respect to the left thumb (uninjured as used as a baseline):
Adduction of 5cm means 3cm “lack” giving 3% impairment thumb impairment.
For the injured right thumb, adding 6 % plus 3% plus 1% gives 10 % impairment of the thumb.
Using the uninjured left thumb as a baseline, 10% - 3% gives 7% net impairment of the right thumb, which is 3% of the hand, or 3% upper extremity impairment.
Right hip
With respect to the right hip, the Panel Medical Assessors noted loss of active range of motion gives rise to assessable impairment. Flexion 90° gives 5% lower extremity impairment. The impairment is therefore 5% lower extremity impairment.
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