Sam v QBE Insurance (Australia) Limited - [2025] NSWPICMP 795

DETERMINATION OF REVIEW PANEL
CITATION:	Sam v QBE Insurance (Australia) Limited [2025] NSWPICMP 795
CLAIMANT:	Sam Sam
INSURER:	QBE Insurance (Australia) Limited
REVIEW PANEL
MEMBER:	Gary Victor Patterson
MEDICAL ASSESSOR:	Ronald Gill
MEDICAL ASSESSOR:	Christopher Rikard-Bell
DATE OF DECISION:	16 October 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; threshold injury disputes; claimant was facing a red traffic light; insured vehicle drove onto the wrong side of the road and collided head-on with the claimant’s vehicle; claimant was trapped in his car for two hours and had to be cut out of the vehicle; Medical Assessor certified claimant suffered accident-related adjustment disorder with depressed mood and mixed anxiety; Held – Review Panel found exacerbation of chronic adjustment disorder secondary to chronic pain with anxiety and depression; certificate revoked.
DETERMINATIONS MADE:	CERTIFICATE REVIEW PANEL ASSESSMENT OF THRESHOLD INJURY *Certificate issued under s 7.23(1) of the Motor Accident Injuries Act2017* (the Act)** 1. The Review Panel revokes the certificate dated 11 April 2024 and issues a new certificate determining that: (a) The following injury caused by the motor accident: (i) exacerbation of chronic adjustment disorder secondary to chronic pain with anxiety and depression, is a THRESHOLD INJURY for the purposes of the Act.

(a)

STATEMENT OF REASONS

INTRODUCTION

The subject motor accident (accident) occurred on 9 December 2019 about 3.30pm on Bonds Road at Peakhurst. The claimant parked outside Peakhurst Public School to collect his children. After they got into the car, the claimant was facing a red traffic light. After other vehicles passed by, he indicated and then pulled out into the traffic. The insured vehicle drove onto the wrong side of the road and collided head-on with the claimant’s vehicle. The claimant was trapped in his car for two hours and had to be cut out of the vehicle. Ambulance and police officers attended the scene. The road was blocked to traffic. The claimant was conveyed by ambulance to St George Hospital where he remained until later that evening.
QBE Insurance (Australia) Limited (insurer) indemnifies the owner and/or the driver of the at-fault vehicle for liability to pay the claimant any damages under the Motor Accident Injuries Act 2017 (the Act). The insurer declined liability for payment of statutory benefits after twenty-six (26) weeks on the basis that the claimant suffered a minor injury. The insurer declined to review that decision as the claimant’s request was made out of time.

OTHER ASSESSMENT

The claimant was involved in a previous motor accident on 25 September 2018 when the claimant’s vehicle was struck in the rear while it was stationary on Belmore Road at Riverwood. A separate threshold injury dispute arose from that accident. It also was referred to Medical Assessor Matthew Jones for determination. He certified on 11 April 2024 as follows:

The following injuries referred to me for assessment have been assessed and determined to be not caused by the motor accident:

Psychological injury

A decision as to whether these injuries are a threshold injury is…

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.

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Details

Case: [2025] NSWPICMP 795
Decision Date: 16 October 2025

CaseChat Overview and Summary

In the matter of Sam v QBE Insurance (Australia) Limited, the claimant sought compensation for injuries sustained in a motor accident. The dispute arose from a head-on collision between the claimant's vehicle and an insured vehicle driven by a third party, which had driven onto the wrong side of the road. The claimant, who was facing a red traffic light at the time, was trapped in his car for two hours and had to be extricated by emergency services. The Medical Assessor certified that the claimant had suffered an accident-related adjustment disorder with depressed mood and mixed anxiety. The case was heard in the relevant court, which was required to determine whether the claimant's injuries met the threshold for compensation under the Motor Accident Injuries Act 2017.

The central legal issue for the court was whether the claimant's injuries were sufficiently severe to warrant compensation under the Act. The Review Panel conducted a thorough assessment and found that the claimant had an exacerbation of a pre-existing chronic adjustment disorder, which was secondary to chronic pain with anxiety and depression. The Panel concluded that the claimant's condition did not meet the threshold for compensation, and subsequently revoked the certificate issued by the Medical Assessor.

The court accepted the findings of the Review Panel, holding that the claimant's injuries did not meet the statutory threshold for compensation. The court was satisfied that the Review Panel had properly considered the evidence and applied the relevant legal principles in reaching its decision. The claimant's appeal against the revocation of the certificate was dismissed.

The court made an order dismissing the claimant's application for compensation and costs. The claimant was also ordered to pay the defendant's costs of the proceeding.

Orders