Transport Accident Commission v Haimour

[2020] NSWSC 868

Supreme Court

New South Wales

Medium Neutral Citation:

Transport Accident Commission v Haimour [2020] NSWSC 868

Hearing dates:

30 April 2020

Date of orders:

13 July 2020

Decision date:

08 July 2020

Jurisdiction:

Common Law

Before:

Fullerton J

Decision:

1. The decision of the Review Panel of 15 April 2019 is set aside.

2. The matter is to be returned to the Medical Assessment Review Panel constituted by the second, third and fourth defendants for determination according to law.

3. A copy of this judgment is to be provided to the Medical Assessment Review Panel.

4. The first defendant is to pay the plaintiff’s costs.

Catchwords:

ADMINISTRATIVE LAW – judicial review – Motor Accidents Compensation Act 1999 (NSW) – whether medical review panel’s decision was affected by jurisdictional error – whether permanent impairment guidelines as to apportionment for pre-existing or subsequent condition were correctly applied

Legislation Cited:

Motor Accidents Compensation Act 1999 (NSW)

Category:

Principal judgment

Parties:

Transport Accident Commission of Victoria (Plaintiff)
Yasmin Haimour (1st Defendant)
Dr Christopher Bench (2nd Defendant)
Dr Thomas Newlyn (3rd Defendant)
Dr Anthony Samuells (4th Defendant)
State Insurance Regulatory Authority (5th Defendant)
The Medical Assessor’s Review Panel constituted by the 2nd to 4th Defendants (6th Defendant)

Representation:

Counsel:
J Turnbull SC (Plaintiff)
M Robinson SC / J Lucy (1st Defendant)

Solicitors:
Carroll & O’Dea Lawyers (Plaintiff)
NSW Compensation Lawyers (1st Defendant)

File Number(s):

2019/183632

Judgment

1. HER HONOUR: By an amended summons filed on 23 April 2020, the plaintiff, the Transport Accident Commission of Victoria, seeks an order in the nature of certiorari or, alternatively, a declaration setting aside as invalid a certificate issued by the Medical Assessor’s Review Panel on 15 April 2019 pursuant to s 63 of the Motor Accidents Compensation Act 1999 (NSW) (the MAC Act) in which the first defendant’s whole person impairment (WPI) by reason of the psychiatric and/or psychological injuries she sustained in a motor vehicle accident on 14 June 2014 was assessed at 21%.

2. The Medical Assessor’s Review Panel (“the Review Panel” - the sixth defendant to the amended summons) was constituted by three medical practitioners. They were named, respectively, as the second, third and fourth defendants to the amended summons. The State Insurance Regulatory Authority was named as the fifth defendant. All filed submitting appearances.

3. It is the plaintiff’s case that the Review Panel fell into jurisdictional error when assessing the first defendant’s WPI at 21% and, in the alternative, that in making that assessment the Panel erred in failing to properly exercise its statutory power, amounting to a constructive failure to exercise jurisdiction.

4. In summary, although without reference to paragraph 14 of the amended summons and the various sub paragraphs (i)-(xii) where a range of legal errors were particularised, the plaintiff’s pleaded case is as follows:

1. The Review Panel’s assessment of the first defendant’s pre-existing and/or subsequent impairment for injuries unrelated to the motor vehicle accident at 1% was flawed having regard to its finding that the domestic violence the first defendant was exposed to before and after the accident contributed significantly to the exacerbation of her symptomology.

2. In making its assessment of the pre-existing and/or subsequent whole person impairment at 1%, the Review Panel failed to properly apply the Motor Accident Permanent Impairment Guidelines.

3. The Review Panel’s assessment of the first defendant’s WPI failed to properly assess, or assess at all, the effect of its finding that her injuries were significantly exacerbated by events unrelated to the motor vehicle accident, in particular her exposure to domestic violence.

4. The Review Panel’s assessment of the first defendant’s whole person impairment at 21% was, in all the circumstances, legally unreasonable.

The approach of the parties at the hearing

5. The plaintiff read the affidavit of Jelena Prodanovic, filed 30 July 2019, in support of the relief sought. It was an affidavit of considerable length.

6. Having regard to the issues raised by plaintiff’s amended summons and the further confinement of the plaintiff’s case at the hearing of the amended summons, the parties agreed that rather than deal with the first defendant’s objections to Ms Prodanovic’s affidavit, Mr Turnbull, senior counsel for the plaintiff, would focus his submissions upon the certificate issued by the Review Panel and the reasons for decision embodied in it.

7. The parties also agreed that the Court would not need to concern itself with the many annexures to Ms Prodanovic’s affidavit which chronicled the five year history of the medical dispute which preceded the determination by the Proper Officer on 8 January 2019 that the most recent medical assessment of the first defendant’s WPI at 7% by Assessor Reutens on 18 October 2018 would be reviewed by a Review Panel in accordance with s 63(3) of the MAC Act, given that the Panel referred in detail to that assessment, as it did to an earlier assessment by Assessor Parmegiani of the first defendant’s WPI at 8% on 10 December 2015; a further application for assessment by Assessor Morris on 29 March 2017 where her WPI was assessed at 17% and a review of that decision by a differently constituted Review Panel on 25 September 2019 where her WPI was assessed at 16%.

8. The Court was also relieved of the need to consider a range of medical and treatment records, police records and other primary source materials annexed to Ms Prodanovic’s affidavit as the Review Panel had also referred in detail to this body of material (described by them as “collateral materials”) in the reasons for decision. These materials were treated by the Panel as “highly persuasive” and were in contrast to the self-report of the first defendant and the account given by her husband on a number of issues, most importantly that there were no incidents of domestic violence where the first defendant’s husband was a violent and controlling aggressor.

9. As the following extract from the Review Panel’s reasons for decision under the subheading “Apportionment for Pre-Existing or Subsequent Symptomatic Impairment” makes clear, the “collateral material” was relied upon in the Panel’s finding that the first defendant was in fact subjected to a pattern of both physical and emotional abuse in a dysfunctional marriage which both pre-dated and post-dated the accident. That is, the Review Panel found, as a fact, that the first defendant was exposed to multiple traumatic events of which the subject motor vehicle accident was one.

…. the Review Panel noted the claimant has been subjected to domestic violence pre-dating and post-dating the motor vehicle accident. Moreover, the domestic violence was reported to have been repeated and serious. The Review Panel concluded that in this context, the domestic violence incident in January 2016 was not an isolated incident causative of a subsequent impairment. Rather, it was the pattern of domestic violence that was ongoing pre-dating the motor vehicle accident and persisting following the motor vehicle accident in a chronic fashion [that] was causative of the exacerbation of her impairment.

10. It will be necessary to return to this critical factual finding later, since it is the plaintiff’s case that in the passage immediately following the extract above, the Review Panel made a further factual finding, namely, that the first defendant’s impairment was “provoked by the motor vehicle accident and the domestic violence” attracting the Panel’s observation that despite there being “no medical or scientific evidence” that might dictate the level of apportionment of an impairment resulting from one traumatic event versus another traumatic event:

… any apportionment of such impairments would need to be completed on an administrative and legal basis.

The statutory scheme

11. It is not necessary for the purposes of these proceedings to refer in detail to the legislative scheme in the MAC Act which operates to compensate persons injured in motor vehicle accidents, or the Motor Accidents Medical Guidelines issued by the State Insurance Regulatory Authority under s 44(1)(d) of the MAC Act (including, of particular relevance to these proceedings, the Motor Accident Permanent Impairment Guidelines in effect as at 1 June 2018 – “the Guidelines”) pursuant to which an injured person’s whole person impairment is to be assessed as part of the legislative scheme as provided for in s 133(2)(a) of the MAC Act. Suffice to note the following:

1. Section 131 of the MAC Act provides that the first defendant has no right to recover damages for any non-economic loss she suffered as a consequence of the injuries sustained in the motor vehicle accident unless her whole person impairment, resulting from all those injuries, exceeds 10%.

2. Section 63 of the MAC Act provides that either party to a medical dispute may apply to the proper officer for an order referring the medical assessment by a single medical assessor to a review panel of medical assessors for review where it is said that the initial assessment of a claimant’s whole person impairment was incorrect in a material respect.

3. Section 63(3A) of the MAC Act provides that the review is to be by way of a fresh assessment of all of the matters with which the medical assessment is concerned. Subsection (4) provides that the review panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters with which the certificate is concerned.

4. Clause 1.18 of the Guidelines provides that an assessment of the degree of permanent impairment involves three stages, inclusive of: (1) a review of medical and hospital records; (2) an interview and clinical examination; and (3) the preparation of a report using the method specified in the Guidelines which determines the percentage impairment, together with the evidence, calculations and reasoning on which that determination is based.

5. Clause 1.21 of the Guidelines provides that the degree of permanent impairment caused by a motor vehicle accident, whether that assessment is made by a medical assessor or a review panel, is to be evaluated at the time of the assessment.

6. Clause 1.31 of the Guidelines, which concerns pre-existing impairment, provides that where there is objective evidence of pre-existing symptomatic permanent impairment, its value is to be calculated and subtracted from the total whole person impairment, as assessed.

7. Clause 1.34 which concerns impairment which has occurred subsequent to the relevant motor vehicle accident, provides that where there is objective evidence of a subsequent and unrelated injury or condition resulting in permanent impairment in the same region as the impairment under assessment, its value should be calculated allowing for the whole person impairment resulting from the motor vehicle accident.

The Review Panel’s clinical evaluation

12. After considering all of the available evidence, including the multiple medical assessments that pre-dated their review, the Review Panel decided that a re-examination of the first defendant was necessary, in large part because they were unable to determine the appropriate levels of impairment referable to the Psychiatric Impairment Rating Scale (PIRS) without a clinical assessment. The Review Panel also expressed concern with the first defendant’s capacity as an historian and her credibility generally given the vast amount of material they considered as part of the assessment process which contradicted the account given by her of her psychiatric history and the state of her domestic circumstances at relevant times. They also noted that since the previous review in September 2017, additional information has been supplied that may have a substantial impact upon their assessment of her WPI, as they described it, “most notably with regard to the evidence that there was domestic violence in the marital relationship”.

13. The Review Panel recorded that they encountered a degree of hostility and a lack of cooperation in the clinical evaluation process when enquiring into the first defendant’s background, including her psychiatric history and social functioning prior to the motor vehicle accident. They expressed the view that this was not due to inattention or thought disorder but was wilful in nature with the first defendant’s level of cooperation greatly increasing, and the coherence of her responses improving markedly, once questioning focused on the motor vehicle accident itself and its sequelae, including her symptoms and impairments after that date.

14. The Review Panel recorded that the first defendant was born in Jordan, of Palestinian heritage, with her mother and many siblings resident in Jordan. She said her father died “a long time ago” (prior to the motor vehicle accident). She was educated to Higher School Certificate standard but did not work in Jordan. She migrated to Australia in 2005 at the age of 18. She has never been in paid employment in Australia. She reported having acted as a carer for her father-in-law in the years preceding the motor vehicle accident and was in receipt of the carer’s pension at that time. She said that in the months leading up to the motor vehicle accident she had plans to study childcare, a course which would be conducted in Arabic, and that she had applied to the Muslim Women’s Association for support in that endeavour. She has four children aged between five and thirteen. She is of the Muslim faith.

15. So far as concerns the first defendant’s pre-accident medical history, she initially denied having any mental health treatment or admissions. When confronted with the collateral material which indicated she had episodes of depression dating back to 2007, she rejected the offer to review the collateral materials and repeatedly stated that she had no past episodes of depression. She said she might have been prescribed Zoloft, an antidepressant medication, but she did not take it. Upon becoming increasingly irritable and hostile with any attempt to clarify her pre-existing psychiatric history, the Review Panel desisted from asking further questions.

16. When pressed as to the information in the collateral materials that she had been the victim of sustained domestic violence in her marriage (including her report to police in 2016), the first defendant denied having suffered any physical violence or having been subjected to threats of violence by her husband. The Review Panel noted that this was in direct contrast with New South Wales police records and records from the Lidcombe-Bankstown Hospital in January 2016 which recorded her complaints that she had been the subject of sustained domestic violence for ten years.

17. With regard to what was described as the “mental health sequelae” resulting from the motor vehicle accident, the Review Panel reported they were unable to obtain any coherent account of the first defendant’s emotions, physical symptoms or thoughts at the time of the motor vehicle accident but that she reported significant difficulties with depressive symptoms after the accident, including tearfulness, high baseline levels of irritability and hypervigilance, and anxiety when travelling in a motor vehicle with increased anxiety when her children were in the car. She confirmed that she had been diagnosed by her general practitioner after the motor vehicle accident with anxiety but was unsure of any further diagnosis upon referral to a treating psychiatrist. She has had no psychiatric supervision since 2018.

18. With regard to her psychiatric symptomology at the time of clinical evaluation, the first defendant said she was fully compliant with prescribed medications but that she suffered drowsiness and tiredness and reported her mood as “very depressed”. The medications prescribed at the time of evaluation included Zoloft (two tablets per day), Avanza (two tablets at night) and Chlorpromazine as required. The first defendant also reported experiencing nightmares each week, waking in a state of hyper-alertness and anxiety and that all of her nightmares were associated with the motor vehicle accident with intrusive thoughts and images of the accident.

19. So far as her current functioning was concerned, she reported being sleepy from the medication, spending most of the time at her home withdrawn from others, frequently lying down and trying to sleep. She claimed a loss of friendships and that her relationship with her children is “not that good”. She reported a lack of motivation and being generally inattentive to her personal hygiene. She does no domestic chores and does not cook for her family.

20. Although maintaining that she was not the victim of any domestic violence before or after the accident, the first defendant reported she was now separated but living under the same roof with her husband.

The Review Panel’s deliberations and findings

21. The following injuries were the subject of firm diagnosis following clinical evaluation by the Review Panel and supported by the collateral materials:

1. Posttraumatic Stress Disorder, chronic;

2. Exacerbation of Persistent Depressive Disorder with anxious distress;

3. Somatic Symptom Disorder with predominant pain.

(The injury in (c) has no bearing upon the issue arising in these proceedings and does not require further elaboration - see [26] below.)

22. The Review Panel concluded that the motor vehicle accident satisfied Criterion A in the Diagnostic and Statistical Manual of Mental Disorders (5^th edition) for Posttraumatic Stress Disorder, it being a stressor that involved a potential for death and/or serious injury.

23. Having concluded that the collateral materials established pre-existing depression dating back to 2007, 2008 and 2011 with antidepressant medication being prescribed at that time, the Review Panel went on to say “a deduction must be made for the pre-existing conditions of Persistent Depressive Disorder”.

24. Under the sub-heading of “Apportionment for Pre-existing or Subsequent Symptomatic impairment” following on from the extract at [9] above, the Review Panel said:

… the domestic violence incident in January 2016 was not an isolated incident causative of a subsequent impairment. Rather, it was the pattern of domestic violence that was ongoing pre-dating the motor vehicle accident and persisting following the motor vehicle accident in a chronic fashion [that] was causative of the exacerbation of her impairment.

25. When dealing with the question of causation later in the reasons for decision, the Review Panel recording the following:

Whereas the Review Panel noted that given the significant domestic violence that had occurred throughout the marriage could have provoked Posttraumatic Stress Disorder pre-dating and post-dating the motor vehicle accident, there was insufficient collateral material to support that she had met diagnostic criteria for Posttraumatic Stress Disorder pre-dating the motor vehicle accident. Nonetheless, there was clearly documented evidence of depressive symptoms pre-dating the motor vehicle accident.

The Review Panel concluded she has suffered an exacerbation of Persistent Depressive Disorder provoked by the motor vehicle accident and the domestic violence situation she had been embroiled in during her marital relationship, both pre-dating and post-dating the motor vehicle accident. The Review Panel thus concluded that the motor vehicle accident was not the sole cause, but was a contributing cause, which is more than negligible. As such, as per the Motor Accident Permanent Impairment Guidelines, the motor vehicle accident caused her Persistent Depressive Disorder. The motor vehicle accident and domestic violence she was subjected to both met Criterion A for Posttraumatic Stress Disorder and in spite of her protestations to the contrary, the Review Panel concluded that such prolonged and serious domestic violence has caused her Posttraumatic Stress Disorder. The Review Panel thus concluded that the motor vehicle accident was not the sole cause, but was a contributing cause, which is more than negligible. As such, as per the Motor Accident Permanent Impairment Guidelines, the motor vehicle accident caused her Posttraumatic Stress Disorder.

The Review Panel concluded that her Persistent Depressive Disorder with anxious distress and Posttraumatic Stress Disorder were exacerbated by the combination of the motor vehicle accident and the subsequent domestic violence. The Review Panel noted the contribution of the domestic violence to the exacerbation of her symptomatology was significant.

The Review Panel concluded the exacerbation of her Persistent Depressive Disorder with anxious distress, and the Posttraumatic Stress Disorder has provoked a permanent impairment.

(Emphasis added.)

The Review Panel’s ultimate decision

26. Having regard to the various factual findings set out above, the Review Panel concluded that the motor vehicle accident caused the three psychiatric injuries in [21] above. While the Persistent Depressive Disorder with anxious distress and chronic Posttraumatic Stress Disorder gave rise to an assessable permanent impairment under the Guidelines, the Somatic Symptom Disorder did not.

27. The Review Panel then calculated the degree of WPI of the two assessable psychiatric injuries (namely, the Persistent Depressive Disorder with anxious distress and Posttraumatic Stress Disorder) in accordance with the Psychiatric Impairment Rating Scale (PIRS) and an aggregate whole person impairment of 22% was appointed. However, when the Review Panel then turned to an assessment of the degree of permanent impairment for pre-existing and subsequent impairments in accordance with the Guidelines, no allowance at all was made for the first defendant’s Posttraumatic Stress Disorder; in fact reference to it was omitted altogether.

28. After applying the criteria in the PIRS, a value of 1% was assigned to the first defendant’s Depressive Disorder pre-dating the motor vehicle accident, including the domestic violence to which she was subjected before that date which exacerbated that disorder, but no value assigned to the degree of permanent impairment resulting from the Posttraumatic Stress Disorder post-dating the accident, despite the Panel finding that it was also the result of sustained domestic abuse.

29. The Review Panel ultimately expressed their finding as to the degree of the first defendant’s WPI as a result of the injuries caused by the motor accident in the following way:

The total percentage whole person permanent impairment for assessed psychiatric injuries caused by the motor accident (and domestic violence) is 21%. Therefore the total whole person impairment is greater than 10%.

(Emphasis added.)

30. Having reached different findings as to the nature of the psychiatric injuries caused by the accident to those arrived at by Assessor Reutens, the Review Panel revoked the certificate and issued a new Permanent Impairment certificate.

The final submissions of the parties

31. The plaintiff’s written submissions focused on establishing legal unreasonableness in the Review Panel’s decision allowing only 1% of the first defendant’s whole person impairment for her pre-existing depressive disorder and the psychologically injurious impact of a history of being subjected to episodic domestic violence.

32. Whilst not abandoning the submission that the decision of the Review Panel was vitiated by legal unreasonableness, Mr Turnbull focused his oral submissions on what he contended was the Review Panel’s failure to discharge its statutory duty in accordance with both the MAC Act and the Guidelines to review the question whether the degree of permanent impairment of the first defendant caused by the motor vehicle accident exceeded 10%.

33. In the written submissions filed on behalf of the first defendant it was submitted that, properly understood, the plaintiff’s submissions and the relief sought in the amended summons is an impermissible attempt to have this Court undertake a merits review of the matters which were before the Review Panel for their consideration and determination. At the hearing, Mr Robinson, senior counsel for the first defendant, was invited to focus his oral submissions on the particular matters addressed by Mr Turnbull in his oral submissions as establishing legal error, and the issues the Court had identified to the parties in argument, including the Review Panel’s approach to the interrelated issues of causation and the apportionment of the defendant’s pre-existing and subsequent impairment in its assessment of her WPI as reflected in its reasons for decision.

34. Mr Turnbull’s oral submissions were developed in a number of ways. He submitted that the most glaring legal error was the Review Panel’s attribution of the total percentage of the first defendant’s WPI at 21% to injuries caused by the motor accident and domestic violence, the language in which the Review Panel expressed itself in the final determination of the review process as extracted above at [29]. Mr Turnbull submitted that by expressing itself in that way the Panel has allowed the first defendant to recover damages for non-economic loss for a cause unrelated to the legislative scheme in the MAC Act without providing any explanation or insight into what percentage of her WPI is to be attributed to the motor vehicle accident and what percentage to domestic violence.

35. I accept that if the Review Panel is to be understood to have simply intended in the extract at [29] to emphasise that there had been an apportionment of 1% of WPI to account for the Depressive Disorder that was attributable to domestic violence pre-dating the motor vehicle accident, and that the reference to “domestic violence” in parentheses is to be understood on that basis, it may not constitute an error of law sufficient to invalidate the certificate. However, the difficulty the Court is confronted with is coming to a concluded view as to what the Review Panel in fact intended to convey by attributing the first defendant’s WPI of 21% to a cause unrelated to the MAC Act.

36. That difficulty is further compounded by what I regard as dissonance in the Review Panel’s treatment of the first defendant’s Depressive Disorder which pre-dated the motor vehicle accident in the apportionment exercise provided for under the Guidelines and, in the same apportionment exercise, their treatment of her Posttraumatic Stress Disorder which they were satisfied was the result of prolonged and serious domestic violence and the trauma associated with the motor vehicle accident by omitting any reference to that psychiatric injury at all. While I accept that the Panel were not satisfied that there was sufficient material to support a finding that the diagnostic criteria for Posttraumatic Stress Disorder was met before the motor vehicle accident, they did find her chronic Posttraumatic Stress Disorder was exacerbated by a combination of the motor vehicle accident and the subsequent domestic violence, with the additional finding that the contribution of the domestic violence to the exacerbation of her symptomology referable to that particular psychiatric injury was significant.

37. Mr Robinson submitted that in circumstances where the Review Panel made it clear that it was unable to reach a diagnosis of a pre-existing Posttraumatic Stress Disorder, then despite the Panel utilising the language of causation when referring to the Posttraumatic Stress Disorder, it was relieved of any legal obligation to make any apportionment of her WPI to the symptoms of that psychiatric disorder which presented at the time of the clinical evaluation.

38. I am not able to accept that submission. Having concluded that the first defendant’s Posttraumatic Stress Disorder was causally connected to both the motor vehicle accident and her exposure to domestic violence (the most graphic episode being revealed in the collateral materials being in January 2016, two years after the motor vehicle accident when she was admitted to hospital), and having concluded that the exacerbation of her symptomology as a result of the domestic violence was significant, in my view the Review Panel was obliged to undertake an apportionment of her whole person impairment referable to her exposure to that trauma in determining the degree of her whole person impairment as a result of the injuries caused by the motor vehicle accident. While I accept that it was apparently the considered view of each of the expert members of the Review Panel that there is no medical or scientific evidence that might inform that exercise, they were nonetheless obliged to engage in the apportionment exercise that was required by the Guidelines and informed by the application of the PIRS in discharge of their statutory duty under s 63 of the MAC Act.

39. In addressing that part of the Review Panel’s decision in the italicised part of the extract above at [25], Mr Turnbull submitted that if the Panel is to be understood to have approached the issue of the apportionment of the first defendant’s psychiatric or psychological impairments between two traumatic and otherwise causative events (namely, the motor vehicle accident in June 2014 and the trauma associated with sustained and serious domestic violence both before and after that date) on the basis that apportionment is not a matter for them but rather a matter to be resolved either within the administrative process by which a claim for damages is assessed under the legislative scheme in the MAC Act or by a court in the process of a litigated damages claim, that constitutes an abrogation of jurisdiction amounting to an error of law. He further submitted that if that error in approach is the reason the Review Panel omitted to refer at all to the Posttraumatic Stress Disorder in undertaking the apportionment exercise required by the Guidelines, the error of law complained of is compounded.

40. In Mr Robinson’s submission, the Review Panel’s reference to apportionment on an administrative basis is simply another way of describing the Panel’s appreciation of their obligation to undertake the process of review, including the question of apportionment in accordance with the MAC Act and the Guidelines. Were that interpretation accepted, as it might be, in my view it further exposes what I am satisfied is an error of law in the Panel’s failure to undertake for themselves an assessment of the degree to which one episode of trauma versus an unrelated episode of trauma or, in this case episodic trauma, contributed to the first defendant’s WPI for the purposes of the MAC Act. In circumstances where this was a significant, if not the predominant issue considered by the Panel in the comprehensive review undertaken by them, the resolution of which was fundamental to the exercise of the Panel’s statutory function under the Act, I am satisfied the legal error contended for by the plaintiff is made out.

Orders

41. I make the following orders:

1. The decision of the Review Panel of 15 April 2019 is set aside.

2. The matter is to be returned to the Medical Assessment Review Panel constituted by the second, third and fourth defendants for determination according to law.

3. A copy of this judgment is to be provided to the Medical Assessment Review Panel.

4. The first defendant is to pay the plaintiff’s costs.

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Decision last updated: 13 July 2020