Tyerman v Insurance Australia Limited t/as NRMA Insurance

[2025] NSWPICMP 267

DETERMINATION OF REVIEW PANEL

CITATION:

Tyerman v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 267

CLAIMANT:

Lorraine-Lee Tyerman

INSURER:

Insurance Australia Limited t/as NRMA Insurance

REVIEW PANEL

MEMBER:

Gary Victor Patterson

MEDICAL ASSESSOR:

David Gorman

MEDICAL ASSESSOR:

Tai Tak Wan

DATE OF DECISION:

17 April 2025

CATCHWORDS:

MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); degree of permanent impairment dispute; claimant sustained injury to her back; diagnostic scans at Broken Hill Hospital confirmed a wedged compression fracture of the L1 vertebral body; claimant was referred for treatment of significant spinal pain post-accident; issue as to extent of wedge compression fracture of L1 vertebral body; claimant’s IME assessed at 20% whole person impairment (WPI); insurer’s IME assessed 10% WPI; Review Panel noted that claimant’s IME used MRI scans for measurement purposes; clause 6.148 of the Motor Accident Guidelines prescribe use of x-ray or CT scans; Review Panel called for and examined actual x-ray and CT scans; both Medical Assessors independently measured the compression fracture as being in the range 25-50% giving a DRE III impairment (10% WPI); actual physical examination not required; Held – MAC confirmed.

DETERMINATIONS MADE:  

CERTIFICATE

REVIEW PANEL ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT

Certificate issued under s 7.26(7) of the Motor Accident Injuries Act2017 (the Act)

1.     The Review Panel confirms the certificate of Medical Assessor Clive Kenna dated 11 July 2024.

·

STATEMENT OF REASONS

INTRODUCTION

1. On 30 April 2021, Lorraine-Lee Tyerman (the claimant) was a front seat passenger in a car being driven by her partner on a remote dirt access road leading from a rural property in the Tibooburra area. The accident occurred before sunrise. It was a dry day. The vehicle was travelling about 40 kilometres per hour when it went into a washout gutter, caused by heavy rains, which had built up on the road and was unsighted to the driver. The dirt bank solidified and was effectively a road hump. The car came to a sudden stop. Notwithstanding that the claimant was wearing a seatbelt, she was thrown upwards and then came down, sustaining an injury to her back. The claimant experienced severe pain and subsequently was unable to stand. The claimant was driven by her partner to a clinic in Tibooburra and was then air lifted to Broken Hill Hospital where diagnostic scans confirmed a wedged compression fracture of the L1 vertebral body. The claimant remained as an Inpatient for approximately four to five weeks.

2. The claimant was referred to a neurosurgeon in Melbourne, for treatment of significant spinal pain post-accident, for the previous 11 months. The claimant was experiencing bilateral sciatica. The claimant underwent a range of facet joint injections with little relief. The claimant was reviewed by Professor Jin Tee, in June 2023, who was of the view that, as a result of the wedged compression fracture at L1, the claimant had developed T12/L1 facet joint arthropathy. As the MRI did not show any neural compression, Professor Tee considered that surgery was a possibility, but that conservative pain management should be tried initially.

3. NRMA (the insurer) indemnifies the owner and/or the driver of the vehicle for liability to pay to the claimant any damages and/or statutory compensation benefits under the Motor Accident Injuries Act 2017 (the Act). The insurer admitted liability for the damages claim but does not concede that the claimant exceeds the 10% whole person impairment threshold.

4. There is a dispute between the parties about the degree of permanent impairment under Schedule 2, cl 2(a) of the Act. The claimant was referred to Medical Assessor Clive Kenna for assessment of the following injury:

   ·        lumbar spine – wedged compression fracture.

ASSESSMENT UNDER REVIEW

1. Medical Assessor Kenna certified on 11 July 2024 as follows:

The following injuries caused by the motor accident give rise to a permanent impairment of 10% and IS NOT GREATER THAN 10%:

• Lumbar spine – Wedged compression fracture L1 vertebra

Medical Assessor Kenna made no adjustment for pre-existing/subsequent impairment, apportionment or treatment effects.

1. In coming to his assessment, Medical Assessor Kenna used the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides), page 102, finding a compression fracture between 25-50% that prescribes a diagnostic related estimate (DRE) Category III impairment of the lumbar spine with a 10% whole person impairment.

THE REVIEW

1. The claimant sought a review of Medical Assessor Kenna’s certificate, on the grounds that the medical assessment was incorrect, within the meaning of s 7.26 of the Act, in a number of material respects. The claimant relies on the particulars set out in the application and supporting documentation.

2. The claimant brought the application within the time prescribed by s 7.26(10)(a) of the Act, and cl 34 of Procedural Direction PIC 7 (28 days).

3. Noting that Medical Assessor Kenna based his finding of 10% whole person impairment upon a compression fracture between 25-50%, the claimant submitted that the Medical Assessor erred in the following respects:

   (a)    failing to expose his path of reasoning and provide intelligible reasoning;

   (b)    failing to apply cl 6.18 of the Motor Accident Guidelines (the Guidelines);

   (c)    making findings where there is no evidence to support such findings, and

   (d)    failing to apply cl 6.41 of the Guidelines.

   The claimant’s submissions addressed each of those alleged errors individually.

4. The claimant’s submissions compare and review the findings of the claimant’s qualified orthopaedic specialist, Dr James Bodel, with the findings of the insurer’s qualified orthopaedic specialist, Dr John Bentivoglio. Dr Bodel assessed 20% whole person impairment based upon a 60% wedged compression fracture. Dr Bentivoglio assessed 10% whole person impairment based upon a 25-50% compression fracture of the L1 vertebra. It is not clear if Dr Bodel saw the actual films or relied upon the reports of those diagnostic investigations. Dr Bentivoglio relied upon the reports without seeing the actual films.

5. The nub of the claimant’s submissions was that Medical Assessor Kenna did not state why he preferred the findings of Dr Bentivoglio to those of Dr Bodel.

6. The claimant’s review application was opposed by the insurer on various grounds. As those submissions were not accepted by the President’s delegate, it is not necessary to summarise them in detail. Briefly, the insurer submits that Medical Assessor Kenna acknowledged that he had considered the radiological evidence (to which the claimant’s submissions refer) and the competing opinions of Dr Bodel and Dr Bentivoglio. The insurer notes that Medical Assessor Kenna recorded the observations of his own findings upon clinical examination in accordance with the Guidelines. He was not required to choose between those competing opinions and provided adequate reasons for making his own assessment.

7. President’s delegate Stephanie Wigin issued a Determination of an Application for Review of a Medical Assessment on 4 October 2024 which stated the satisfaction of the President’s delegate that there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect. The President’s delegate noted the claimant’s submissions in relation to the comprehensive assessment of Dr Bodel with reference to measurement of the actual scans. The President’s delegate stated that it appears Medical Assessor Kenna has not provided a clear path of reasoning concerning his assessment of the wedged compression fracture being between 25-50%, and thus how he arrived at the ultimate determination of the lumbar spine in this matter.

8. Accordingly, the review application was accepted and was referred to the Review Panel, which is to reassess the injury referred to Medical Assessor Kenna. Given the nature of the issue for determination, the Review Panel does not propose to conduct a re-examination of the claimant, but rather to have regard to the actual plain X-rays of the claimant’s lumbar spine.

9. The Review Panel noted that the Motor Accident Guidelines, clause 6.148 states that:

   “… The preferred method of assessing the amount of compression is to use a lateral
   X-ray of the spinal region with the beam parallel to the disc spaces… Caution should be used in measuring small images as the error rate will be significant unless the medical Assessor has the ability to magnify the images electronically. Medical Assessors should not rely on the estimated percentage compression reported on the radiology report, but undertake their own measurements to establish an accurate percentage … “.

10. Directions were issued for the production of the diagnostic imaging specified in paragraphs 20 and 21 of the Review Panel Report and Directions issued on 18 December 2024. The insurer subsequently uploaded a whole spine X-ray – anteroposterior and lateral views – performed on 1 June 2022 by Epworth Imaging comprising eight pages of images. The Review Panel is of the opinion that those images are inadequate as the crush fracture is barely visible.

11. The claimant’s review bundle contains a series of MRI scans which comprise multi-images of the claimant’s spine. It seems to the Review Panel that Dr Bodel probably based his findings of 60% compression fracture upon that material.

12. The Review Panel notes that paragraph 6.148 of the Guidelines (Version 9.3 issued on 6 December 2024) prescribed that the preferred method of assessing the amount of compression fracture is to use a lateral X-ray of the spinal region. If this is not available, a CT scan can be used. No mention is made of MRI scans.

13. The following diagnostic material was provided by the claimant’s solicitors on or about 6 March last:

    ·        X-ray of thoracic spine performed on 15 June 2021 at Broken Hill Base Hospital;

    ·        CT scan of lumbar spine performed on 8 December 2021, and

    ·        X-ray of thoracic and lumbar spine performed on 27 February 2025.

    That material was of considerable assistance to the Medical Assessors who did not need to conduct a physical examination of the claimant.

OTHER ASSESSMENTS

1. Medical Assessor Abhishek Nagesh certified on 31 October 2024 as follows:

The following injuries caused by the motor accident give rise to a permanent impairment of 6% and IS NOT GREATER THAN 10%:

·     Major Depressive Disorder

Medical Assessor Nagesh made no adjustment for pre-existing or subsequent impairment nor treatment effects. It is not known if that certificate is the subject of a separate review.

STATUTORY PROVISIONS

1. A medical assessment matter is determined in accordance with s 63 of the Act. The matter is determined at first instance by a Medical Assessor pursuant to and, on review, by a Review Panel consisting of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).

2. Part 5 of the Personal Injury Commission Act 2020 (the PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a Panel, reviewing a decision of a Medical Assessor.[1]

   [1] Section 41(2) of the PIC Act.

3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the PIC Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written Application.[2]

   [2] Rule 128 of the PIC Rules.

4. The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[3]

   [3] Section 7.26(6) of the Act.

5. All members of the Review Panel had no previous involvement with the claimant or with this matter.

MATERIAL BEFORE THE REVIEW PANEL

1. The claimant relied upon the following material which the Review Panel has considered:

Doc No.	Document Description	Date	Page No.
A1	Claimant’s submissions made to President’s delegate	7 August 2024	1-8

Previously summarised.

A2 Determination of President’s delegate 4 October 2024 9-12

See previously.

A3	Claimant’s submissions made to Medical Assessor Clive Kenna	29 February 2024	13-14
A4	Certificate of Medical Assessor Clive Kenna	11 July 2024	15-26

See previously.

A5	Statement of Lorraine-Lee Tyerman	14 October 2022	27-32
A6	Statement of Geoffrey Dennis Davis	30 March 2023	33-37
A7	Application for Personal Injury Benefits	28 October 2021	38-43
A8	Letter requesting insurer to concede 20% whole person impairment	16 October 2024	44-45
A9	X-ray thoracic spine report	15 June 2021	46

“REPORT:

There is smooth thoracic kyphosis and prominent lumbar lordosis. There is a fracture of the superior end plate of L1 producing vertebral body wedging. Approximately 30% reduction of the anterior cortex height. There is no significant change compared with a previous X-ray from 17/5/2021.

Dr J Schatz

A10	Certificate of Capacity/Fitness	2 November 2021	47 – 49
A11	CT lumbar spine report	8 December 2021	50 - 51

FINDINGS:

Anterior wedge fracture involving the superior end plate of L1 is again observed. The anterior aspect of the vertebral body demonstrates approximately 40% loss of height. The degree of wedge deformity has become progressively worse since the previous study in April 2021 and also the X-ray performed on 17/5/2021.

No new fracture is demonstrated in the rest of the lumbar vertebrae.

The L4/L5 intervertebral disc demonstrates broad based posterior central and posterolateral protrusion. This contributes to narrowing of the lateral recesses on both sides. There is no evidence of compression on the exiting L4 nerve.

The rest of the intervertebral discs appear unremarkable.

There is no significant degenerative change in the facet joints.

COMMENT:

The know L1 fracture has demonstrated progressive loss of height anteriorly with more conspicuous anterior wedge deformity. The L4/L5 intervertebral disc shows broad based postero central and posterolateral bulge contributing to narrowing of the lateral recesses on both sides. The descending L5 nerves could be compressed at this point. Clinical correlation is required and perineural injection of the L5 nerves can be considered as pain relief.

Dr C Wong

A12	Referral to Dubbo Base Hospital	15 December 2021	52 – 53
A13	MRI lumbar spine report	20 January 2022	54

FINDINGS:

There is evidence of an acute end plate fracture of L1 with loss in height through the mid body up to 50% with mild marrow oedema. The remainder of the lumbar spine is grossly normal. No other definite acute fracture is seen.

T12/L1: There is a small degree of retro pulsion of the posterior bone fragment but without evidence of canal stenosis.

L1/L2: No disc abnormality.

L2/L3: No significant disc abnormality. The central canal and neural foramina are normal.

L3/L4 and L4/L5: No disc abnormality.

L5/S1: There is a small focal central disc bulge but without evidence of significant central canal stenosis or nerve root compression. Incidental vertebral haemangioma of L5 is noted.

There is multilevel facet joint generative change. The facet joints are normal.

CONCLUSION:

1.Acute end plate fracture of L1 with loss in height of up to 30% - 40%.

2.Mild disc herniation is throughout the lumbar spine. No evidence of definite nerve root compression or significant canal stenosis.

Dr R Kapoor

A14	Referral to Professor Mathew McDonald	1 February 2022	55 – 56
A15	Referral to Associate Professor Jin Tee	14 February 2022	57 – 58
A16	Referral for SPECT CT spine	21 February 2022	59
A17	Whole body bone scan report	25 February 2022	60

REPORT:

Initial blood flow and blood pool imaging centred over the lumbar spine and pelvis considered within normal limits. Whole body planar imaging shows morbid obesity. Some mild uptake in upper lumbar spine and at both wrists and knees to reflect arthropathy. SPECT examination and CT co-registration imaging identifies end plate uptake at L1 brought consistent with superior end plate crush injury and mild increase in metabolic activity. No prominent facet joint uptake. No abnormal uptake in S1 joints or hips. Soft tissue distribution uptake within normal limits.

CONCLUSION:

Mild increase in uptake superior end plate L1 suspicious of a potential crush injury.

Dr Michael Petrucco

A18 Report of Associate Professor Jin Tee 15 March 2022 61

Request for insurer to approve admission to Epworth Hospital, Richmond, Victoria, for further investigations of severe lower back pain secondary to a significant thoracic compression fracture with loss of height and alignment managed conservatively. Possibility of future surgery.

A19	Report of Guy Buchanan	19 June 2022	62 – 63
A20	Operation report of Dr Buchanan	5 September 2022	64 – 65
A21	Operation report of Dr Buchanan	8 September 2022	66 – 67
A22	Operation report of Dr Buchanan	13 September 2022	68 – 69
A23	Operation report of Dr Buchanan	15 September 2022	70 - 71
A24	Referral for MRI spine	24 April 2023	72
A25	Referral to SPECT CT spine	24 April 2023	73
A26	MR thoracolumbar spine report	25 May 2023	74 - 75

CONCLUSION:

1.Age-appropriate degenerative change

2.No cord compression

3.No significant lumbar canal stenosis

Dr Nicholas Gelber

A27 Bone scan report 25 May 2023 76

CONCLUSION:

1.Mild to moderate active facet arthritis on the right at T12/L1. Minor uptake on the left at that level.

2.Multi-level mild end plate activity in the thoracic spine, particularly at T12/L1.

3.Old crush fracture of L1.

4.No other crush fractures. Degenerative changes elsewhere as described.

Dr David Learmont-Walker

A28	Report of Associate Professor Jin Tee	5 June 2023 (x2)	77 – 78
A29	Radiological images of MR spine	25 May 2023	79 – 238
A30	Report of Dr Pouya Hafezi	1 July 2023	239

Letter to Associate Professor Jin Tee. Discussion of pain management modalities. Dr Hafezi agrees that fusion is an option but delaying the potential surgery will be in patient’s best interests.

A31  Medico-legal report of Dr James Bodel assessing 20% WPI 29 September 2023 240 - 250

Dr Bodel’s examination was conducted by Video Conference due to the COVID-19 pandemic.

SUMMARY OF INURIES

·Spinal fractures – burst fracture at L1, possible fracture at T9.

·Disc injury at the lumbosacral junction.

Dr Bodel gives a detailed description of the post-accident medical history.

INVESTIGATIONS

There are no X-rays as such for me to see except the films which are in the documentation provided. The MRI scan of all three levels of the spine which appears to be in the set of films dated 25 May 2023 does show the 60% wedge compression fracture with a central fracture on those films as I have indicated above. This measurement has been done using the method where the anterior vertebral body height of T11 and T12 and L2 are measured giving 1.2 cm measurement for T11, a 1.2 cm for T12 and L2 is 1.3 cm. The degree of compression at the most compressed segment of L1 is 0.5 cm. The equation therefore is 0.75 cm (the difference between the average of the normal heights and the compressed height over 1.25 x 101) which gives the 60% wedge compression that I have mentioned.

WHOLE PERSON IMPAIRMENT

I have assessed this lady in accordance with AMA 4. She has the wedge compression fracture which has been measured on the scans that you have provided. Without these scans, it would not be possible to give an accurate level of whole person impairment.

She has a DRE Thoracolumbar Category IV. Level of assessable impairment in accordance with the description in Table 74 on page 3/111 of AMA 4. She has a measured wedge compression fracture which is ‘more than 50% compressed’ and this gives a 20% Whole Person Impairment in this case. This is the WPI rating for a compression fracture ‘greater than 50% compression’.

There is no indication clinically of any pre-existing abnormality or condition and no basis for a deduction for pre-existing impairment.

A32 Medical report of Dr Ben Teoh assessing 17% WPI 18 November 2023 251 - 265

Dr Teoh is a consultant psychiatrist. He says that the claimant sustained significant depressive symptoms with a diagnosis of Major Depressive Disorder (DSM 5 Diagnostic Criteria) for which he assesses 19% WPI.

A33	Clinical records of Royal Flying Doctor Service – Clive Bishop Medical Centre	28 June 2023	266 – 328
A34	Clinical records of Broken Hill Hospital	27 October 2021	329 – 599
A35	Referral to Associate Professor Jin Tee	23 April 2024	600 – 601
A36	Dr Ho report requesting help with ADLs	16 July 2024	602
A37	Ipar – initial needs assessment report	20 August 2024	603 – 625
A38	Report of Associate Professor Jin Tee	4 September 2024	626
A39	Reports of Dr Pouya Hafezi	1 October 2024	627”

1. The insurer relied upon the following material which the Review Panel has considered:

Doc No.	Document Description	Document Date	Page No.
R1	Insurer’s submissions in reply to application for assessment of whole person impairment	21 March 2024	1-2

“The insurer refers to the MRI scan report of the thoracolumbar spine dated 31 May 2022 which revealed:

‘Appearances compatible with subacute-chronic L1 compression fracture with approximately 50% loss of vertebral height.’

(R5) - The insurer also refers to the X-ray report of the full spine dated 1 June 2022, which revealed:

‘L1 vertebral body wedge compression fracture with approximately 50% loss of height.’

The insurer relies on the findings of Dr Bentivoglio who found that the claimant’s scans (above) indicated that she had ‘somewhere between 25% and 50% compression fracture of the L1 vertebral body’ This equates to 10% WPI (DRE Category III) pursuant to page 102 of the AMA 4 Guides.

Pursuant to the Motor Accident Guidelines, if the loss of vertebral height is between 25% and 50%, the claimant would satisfy DRE III, which equates to 10% WPI.

In line with Dr Bentivoglio’s findings, the insurer submits that the vertebral compression fracture does not exceed 50% and therefore any finding of impairment should not exceed 10% WPI.

R2 Report to the insurer’s lawyers by Dr John Bentivoglio, orthopaedic surgeon 5 February 2024 3 - 10

DIAGNOSIS AND OPINION

This lady sustained a compression fracture of the L1 vertebral body in the motor vehicle accident. On today’s physical examination, there is no evidence of any nerve root, irritation or compression to suggest she would benefit by any modality of treatment.

RADIOLOGY

She did not have any radiological investigations with her today. I did viewed results of CT and MRI scans taken off her lumbar spine indicating she did have a significant compression of the L2 vertebral body. Her investigations indicate that she did have a somewhere between 25% and 50% compression fracture of the L1 vertebral body. I believe the T9 and T10 abnormalities are pre-existing not causing any symptoms.

WHOLE PERSON IMPAIRMENT

Using AMA 4 from page 102 with the compression fracture between 25 – 50%, she would have a DRE Category III impairment of her lumbar spine with a 10% whole person impairment rating. All of this impairment relates to the specific injury, There is no pre-existing condition.

R3	Clinical records of Epworth Healthcare	Various	11 – 104
R4	Imaging scans of Epworth Healthcare	Various	105 - 359
R5	Insurer’s submissions in reply – Review of Medical Assessment Certificate of Medical Assessor Kenna”	22 August 2024	360 - 363

EXAMINATION REPORT

1. The report of Medical Assessor David Gorman is as follows:

   “Lorraine-Lee Tyerman

   Review of images by Medical Assessor Gorman on 15 March 2025

   Methodology

   The methodology used as directed in paragraph 6.148 in the NSW Motor Accident Guidelines (Version 9.3) on page 109 was used.

   The preferable images are X ray images.

   The electronic images were enlarged and then printed to enable measurement. The measurements are as measured in the printed films.

   Results

   1.     X rays from Broken Hill Hospital on 15 June 2021:

   Two images were available for measurement.

   Image 1 –

   T12 height – 27mm

   L1 height – 16mm

   L2 height – 30mm

   The average of the two adjacent vertebrae is 28.5mm.

   28.5-16 equals 12.5.

   12.5/28.5 equals 43.9% compression.

   Image 2 –

   T12 height - 24mm

   L1 height – 15mm

   L2 height – 24mm

   The average of the two adjacent vertebrae is 24mm.

   24-15 = 9mm

   9/24mm equals 37.5% compression

   2.     CT scan from 8 December 2021

   Report states 40% loss of height with the wedge deformity becoming progressively worse since the previous study in April 2021 and also since the X ray performed on 16 May 2021.

   3.     X ray from 27 February 2025

   Image 1 –

   T12 height - 15mm

   L1 height – 8mm

   L2 height – 14mm

   Average 14.5mm

   14.5-8=6.5mm

   6.5/14.5 equals 44.8% compression

   Image 2 –

   Poor quality and without image of L2.

   T12 – 14mm

   L1 – 7mm

   14-7 = 7mm

   7/14 equal 50% compression

   Conclusion

   None of the x rays or scans give a compression greater than 50%. There has been some progression of the compression but no scan shows compression of greater than 50%. All are in the range 25-50% giving a DRE III impairment (10% WPI) based on Table 6.7 on page 103 of the NSW Guides and Table 72 of the AMA 4^th Edition Guides.

   I note that Dr Bodel used the MRI scan at arrive at the 60% compression he concluded. Using MRI can give misleading results and MRIs are not suggested for use to assess the degree of compression in the NSW Guidelines. X-rays or CT scans are to be used.”

2. Medical Assessor Tai-Tak Wan independently examined the X-ray images on screen with 200% enlargement and then printed the images on A4 paper. He measured the compression and arrived at similar figures to the measurements by Medical Assessor Gorman. Medical Assessor Wan found a maximum measured compression of 45% and a minimum 38% measured compression. Both Medical Assessors agree there is no diagnostic film that shows a greater than 50% compression.

3. The Medical Assessors see no reason to examine the claimant as no other impairments have been advanced.

FINDINGS

1. The Review Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[4] The Review Panel adopts the measurements and findings of the Medical Assessors.

   [4] Section 7.26(6) of the Act

2. The Review Panel is not required to choose between competing medical opinions and is required to form its own opinion.[5] The Medical Assessors have explained the basis of their assessments. Their findings are the same as those of Medical Assessor Kenna and Dr Bentivoglio. The Medical Assessors believe their measurements are different to those of Dr Bodel, as he based his measurement upon a MRI scan which is not the preferred methodology, as Medical Assessor Gorman notes.

   [5] Alliance Australia Group Limited v Keen [2021] NSWCA 287 and Insurance Australia Group v Marsh [2021] NSWCA 31

CONCLUSION

1. For the above reasons, the Review Panel concludes that the certificate issued by Medical Assessor Clive Kenna on 11 July 2024 should be confirmed.