Shales v AAI Ltd t/as GIO - [2025] NSWPICMP 460

DETERMINATION OF REVIEW PANEL
CITATION:	Shales v AAI Ltd t/as GIO [2025] NSWPICMP 460
CLAIMANT:	Glen Shales
INSURER:	AAI Ltd t/as GIO
REVIEW PANEL
MEMBER:	Terence Stern OAM
MEDICAL ASSESSOR:	Dr Gerald Chew
MEDICAL ASSESSOR:	Dr Christopher Rikard-Bell
DATE OF DECISION:	27 June 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017 (MAI Act); review of Medical Assessment Certificate (MAC); the claimant was injured in a motor vehicle accident; a medical dispute arose as to whether the psychiatric injuries sustained were threshold injuries; a dispute also arose as to total whole person impairment (WPI); the claimant sought a review of the Medical Assessment under section 7.26 of the MAI Act; the Review Panel conducted an examination and considered the factors contributing to the injury according to section 6.6 of the Motor Accidents Guidelines; Held – MAC revoked; the Review Panel determined that the claimant had sustained a psychiatric condition arising from the injuries sustained in the accident; WPI due to the psychiatric injury caused by the accident resulted in 6% WPI.
DETERMINATIONS MADE:	1. The Review Panel revokes the certificate of Medical Assessor Friend of 29 January 2024 (threshold dispute) that: (a) nil psychiatric condition arising from the injuries sustained in the motor vehicle accident, and (b) the determination as to whether these injuries were threshold was not required for the purposes of the Motor Accident Injuries Act 2017. 2. The Medical Review Panel revokes the certificate of Medical Assessor Friend of 2 February 2024 in which the Medical Assessor determined that Mr Shales had not sustained a psychiatric injury. 3. The Review Panel determines that Mr Shales sustained whole person impairment as a result of the accident of 6%.

STATEMENT OF REASONS

INTRODUCTION

The claimant, Glen Shales (Mr Shales), was injured in a motor vehicle accident (the accident) on 21 November 2018.
The third-party insurer of the vehicle which is alleged to have caused the accident is AAI Limited T/As GIO Insurance (GIO).
Two disputes have been referred to the Panel:
(a) a threshold injury dispute, and
(b) a whole person impairment (WPI) dispute.
Under the provision of the Motor Accident Injuries Act 2017 (MAI Act) in force at the time of the accident the statutory benefits for treatment and care cease after 26 weeks if “the person’s only injuries resulting from the motor accident were minor (threshold) injuries”.
Mr Shales submitted an Application for Personal Injury Benefits on 17 December 2018.

Threshold injury dispute

Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matters, including whether the injury caused by the motor accident was a threshold injury.
A medical assessment matter was determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.
The insurer has consistently taken the view that Mr Shales’ psychiatric symptoms were as a result of a pre-existing condition.
Further, GIO considers that the psychiatric consequences of this accident were threshold in nature.

Threshold injury- statutory provisions

Assent was…

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 460
Decision Date: 27 June 2025

CaseChat Overview and Summary

The case of Shales v AAI Ltd t/as GIO involved a dispute regarding the assessment of injuries sustained in a motor vehicle accident. The claimant sought a review of a Medical Assessment Certificate (MAC) issued under the Motor Accident Injuries Act 2017 (MAI Act). The key issues were whether the psychiatric injuries sustained by the claimant met the threshold for compensable injuries and the total whole person impairment (WPI) due to the psychiatric injury. The Review Panel was tasked with examining the medical evidence and determining the validity of the MAC.

The legal issues before the court centred on the interpretation and application of the Motor Accident Injuries Act 2017 and the Motor Accidents Guidelines. Specifically, the court had to consider the criteria for determining compensable psychiatric injuries and the methodology for assessing WPI. The Review Panel was required to conduct a thorough examination of the evidence and apply the relevant statutory provisions and guidelines to make a determination on the validity of the MAC and the appropriate WPI assessment.

The Review Panel concluded that the claimant had sustained a psychiatric condition that arose from the injuries sustained in the motor vehicle accident. The panel found that the claimant's psychiatric injuries met the threshold for compensable injuries under the MAI Act. Additionally, the panel determined that the WPI resulting from the psychiatric injury was 6%. The panel's decision was based on a detailed examination of the medical evidence and a consideration of the factors contributing to the injury according to section 6.6 of the Motor Accidents Guidelines. The Review Panel's findings led to the revocation of the original MAC.

The court's final orders included the revocation of the original Medical Assessment Certificate and the issuance of a new certificate reflecting the panel's determination that the claimant had sustained a compensable psychiatric injury and that the whole person impairment due to the psychiatric injury was 6%. The claimant was thus entitled to compensation for the psychiatric injury sustained in the motor vehicle accident.

Orders