Legal Bulletin No. 218

Issued 4 July 2025

Welcome to the two hundred and eighteenth edition of the Personal Injury Commission’s Legal Bulletin. Please see here for details about the legal citations used for the Commission’s decisions. The decisions listed below are now available on AustLII and will be available shortly, on Jade and Lexis Nexis. Any legislative updates are provided at the base of the Bulletin.

Presidential Member Decision

Rotella v AAI Ltd t/as AAMI [2025] NSWPICPD 49

Motor accidents; application for redaction and/or de-identification of aspects of a Medical Review Panel Certificate; rule 132 of the Personal Injury Commission Rules 2021 considered and applied; section 58 of the Personal Injury Commission Act 2020 considered; Held – pursuant to rule 132 of the Personal Injury Commission Rules 2021, I order that paragraph [23] of the Certificate of the Medical Review Panel issued 11 April 2025 (R-M23167/24) be redacted in full.

Decision date: 26 June 2025 | Before: President Judge Phillips

Motor Accidents non-Presidential Member Decisions

Ul Haq v Transport Accident Commission [2025] NSWPIC 277

Motor Accident Injuries Act 2017; assessment of claim part heard; application to refer matter back for medical assessment under section 7.24(1) to consider causation of injury to the lumbar spine; claimant conceded dishonesty in history given to medical practitioners and to his college; Held –Trazivuk v Motor Accidents Authority of New South Wales and Ors cited; no injustice to the insurer; Medical Assessor (MA) reviewed scans and concluded change in pathology post-accident; causation not limited to claimant’s subjective complaints of pain; determination of MA and Review Panel made in light of knowledge of claimant’s dishonesty; Allianz Australia Insurance Limited v Bell, and Allianz Australia Insurance Limited trading as Allianz v Susak cited; concept of procedural fairness does not require medical assessor to test credibility of claimant; application refused.

Decision date: 30 May 2025 | Member: Susan McTegg

Macdonald v Allianz Australia Insurance Limited [2025] NSWPIC 284

Motor Accident Injuries Act 2017; miscellaneous claims assessment; whether the claimant  was mostly or wholly at fault pursuant to sections 3.11 and 3.28; claimant a bicycle rider who collided with a bus; claimant has no recollection of the collision on account of his significant injuries; Held – claimant wholly or mostly at fault for the accident; entered the intersection against give way requirement into the path of the insured bus.

Decision date: 19 June 2025 | Member: Elizabeth Medland

AAI Limited t/as AAMI v Briffa [2025] NSWPIC 285

Motor Accident Injuries Act 2017; assessment of damages; liability admitted; claimant suffered physical injury including a fracture of her dominant left wrist and psychological injury; no entitlement to non-economic loss; claim for past and future economic loss; Held – claimant had a loss of capacity to earn that was likely to be productive of financial loss; awards made for past and future economic loss; buffer of $175,000 allowed for future economic loss; total damages assessed $185,695.

Decision date: 20 June 2025 | Senior Member: Brett Williams

Thomas v QBE Insurance (Australia) Limited [2025] NSWPIC 289

Motor Accident Injuries Act 2017; claim for statutory benefits; insurer’s denial of liability for ongoing benefits under sections 3.11 and 3.28; claimant’s application under Schedule 2(3)(d) and (e); single vehicle accident; claimant had no memory of the accident; possibilities raised by insurer considered included seizures, sleep apnoea, speed, and animal on the roadway; assessment on the papers; claimant self-represented; Held – manner of driving caused the accident; claimant contributed to cause of accident; claimant’s departure from standard of care not the most extreme and did not justify 100% deduction; contributory negligence assessed at 30%; cases cited; AAI Limited t/as GIO v Evic as to approach to single vehicle accident fault disputes; Australian Broadcasting Tribunal v Bond, and Insurance Australia Limited t/as NRMA v Richards followed as to inferences and application of res ipsa loquitor; Axiak v Ingram, Davis v Swift, and Serrao (by his Tutor Serrao) v Cornelius (No 2) followed regarding assessment of contributory negligence in single vehicle accident cases.

Decision date: 23 June 2025 | Member: Belinda Cassidy

Dolbel v Allianz Australia Insurance Limited [2025] NSWPIC 290

Motor Accident Injuries Act 2017; claimant was injured in a motor vehicle accident; insurer admitted liability but alleged contributory negligence; assessment of damages; claim for damages pursuant to section 7.36; non-economic and economic loss damages for physical and psychological injury; past economic loss; Division 4.2 applied; Livingstone v Rawyards Coal Co applied; Medlin v State Government Insurance Commission applied; Husher v Husher applied; future economic loss; Nominal Defendant v Livaja applied; section 4.7 applied; IAG Ltd t/as NRMA Insurance v Damian Mares applied; Allianz Australia Insurance Ltd v Kerr applied; non-economic loss; section 4.11; Hodgson v Crane applied; Planet Fisheries Pty Ltd v La Rosa applied; James Hardie & Co v Newton applied; Coles Supermarkets Australia Pty Ltd v Meneghello applied; Held – damages non-economic loss, buffer for past and future economic loss, and Fox v Wood assessed at $570,414; claimant’s costs assessed at $67,621.63 inclusive of GST.

Decision date: 23 June 2025 | Member: Terence Stern OAM

Macdonald v Allianz Australia Insurance Limited (No 2) [2025] NSWPIC 291

Motor Accident Injuries Act 2017; damages assessment; liability denied; assessment of both liability and quantum; claimant a bicycle rider who collided with a bus; claimant has no recollection of the collision on account of his significant injuries; statutory benefits miscellaneous claims dispute that was heard concurrently found the claimant was wholly or mostly at fault; submissions requested on application of Part 5 “no-fault accident” provisions to the claim; Held – insured did not breach his duty of care; entered the intersection against give way requirement into the path of the insured bus; Part 5 applies; contributory negligence assessed at 75%; damages awarded at $186,277.83 plus costs; cases considered; Axiak v Ingram, Davis v Swift, and Nominal Defendant v Dowedeit.

Decision date: 24 June 2025 | Member: Elizabeth Medland

AAI Limited t/as GIO v Harris [2025] NSWPIC 293

Motor Accident Injuries Act 2017; settlement approval; 51-year-old motorcyclist struck by the insured motor vehicle at a T intersection; sustained avulsion fracture of right 5TH finger and right knee fracture of lateral femoral condyle with partial tearing of post cruciate ligament; claimant is a motor mechanic; short periods off work post-accident; employer has allowed him to also work as an advisor; possibility he may have a right knee replacement in the future sustained a non-threshold injury; insurer admitted liability; no entitlement to non-economic loss; claim for past and future economic loss; total amount of damages proposed is $150,000 less statutory payments made to the claimant; Held – the proposed settlement is just, fair and reasonable; settlement approved under section 6.23(2)(b).

Decision date: 25 June 2025 | Member: David Ford

Workers Compensation non-Presidential Member Decisions

Katkarovski v State of New South Wales (NSW Police Force) [2025] NSWPIC 278

Workers Compensation Act 1987; claim for psychological injury; claim amended to only request treatment expenses pursuant to section 60; whether the applicant sustained a psychological injury in accordance with section 4 as a result of exposure to traumatic employment events; AV v AW, Hancock v East Coast Timber Products Pty Limited, Paric v John Holland (Constructions) Pty Limited, Paric v John Holland (Constructions) Pty Limited considered; whether the respondent can establish (pursuant to section 11A) that the applicant's psychological injury was wholly or predominantly caused by reasonable action taken or proposed to be taken by it with respect to performance appraisal and/or discipline; Pirie v Franklins Limited, Department of Education and Training v Sinclair, Manly Pacific International Hotel Pty Limited v Doyle, Insurance Australia Group Services Pty Limited v Outram, Ponnan v George Weston Foods Limited, Temelkov v Kemblawarra Portugese Sports and Social Club Limited, and Smith v Roads and Traffic Authority of NSW considered; Held – applicant sustained injury in the form of post-traumatic stress disorder (PTSD) (section 4); respondent has failed to establish its defence under section 11A; applicant is entitled to payment of his reasonably necessary expenses pursuant to section 60.

Decision date: 17 June 2025 | Member: Gaius Whiffin

Daniel v Flick Anticimex Pty Ltd [2025] NSWPIC 279

Workers Compensation Act 1987; consequential condition; Kumar v Royal Comfort Bedding Pty Ltd, and Kooragang Cement Pty Ltd v Bates applied; competing expert evidence; Charles Sturt University v Manning, and Ly v Jitt Offset Pty Ltd applied; Held – applicant has not discharged her onus in establishing a consequential gastrointestinal condition in the form of an acute bowel obstruction requiring emergency hospital admission and surgery.

Decision date: 18 June 2025 | Member:  Mitchell Strachan

Raso v Australian Turf Club Ltd [2025] NSWPIC 281

Workplace Injury Management and Workers Compensation Act 1998; claim for weekly compensation after 260 weeks at a higher rate; dispute concerning the extent and quantification of the worker’s capacity to earn in suitable employment; where worker had returned to work in own dog grooming business; claim for discretionary interest pursuant to section 109; timing of duly made claim; Held – the worker had capacity to work 25 hours per week as a dog groomer; other roles identified in respondent’s evidence were not suitable having regard to the nature of the incapacity, education, skills and experience; amount able to earn in suitable employment indexed in line with indexation of pre-injury average weekly earnings (PIAWE); application for discretionary interest declined.

Decision date: 19 June 2025 | Member: Rachel Homan

BOH v Engineering Solutions and Services Pty Ltd [2025] NSWPIC 283

Workers Compensation Act 1987 (WCA Act); Personal Injury Act 2020 (PIC Act); Mental Health and Cognitive Impairment Forensic Provisions Act 2020 (MHCIFP Act); worker suffered injury when he fell from a ladder; claim for medical expenses and weekly compensation pursuant to section 38 of the WCA Act; orders previously made in favour of applicant for payment of section 60 of the WCA Act expenses for ongoing psychiatric condition; applicant unsuccessful in claim pursuant to section 38 of the WCA Act; application for reconsideration pursuant to section 57 of the PIC Act; applicant self-represented; allegations of lack of procedural fairness including not being advised that he could discontinue the original proceedings, imbalance in legal representation, and being found to be psychiatrically incompetent; criminal charges against applicant relating to threats against insurer previously dismissed under the MHCIFP Act suggesting that applicant was psychiatrically incompetent during hearing rejected on the facts; other allegations factually incorrect; allegations rejected but more appropriately should be considered by way of an appeal; Held – application for reconsideration rejected.

Decision date: 19 June 2025 | Principal Member: John Harris

Maddox v T L Vegetation Management Pty Ltd & Ors [2025] NSWPIC 286

Workers Compensation Act 1987 (WCA Act); Workplace Injury Management and Workers Compensation Act 1998 (WIMWC Act); claim for benefits in respect of the death of a worker; apportionment of lump sum payable under section 25(1)(a) of the WCA Act; together with claim for interest; consideration of who was dependent for support on the worker; TNT Group 4 Pty Limited v Halioris, Youseph v Homebush Unit Trust t/as Primo Smallgoods considered; consideration of appropriateness of apportionment agreed between the parties in relation to the lump sum payable under section 25(1)(a) of the WCA Act; consideration as to interest awards under section 109 of the WIMWC Act; Pheeney v Doolan (No 2), and Mudgee Explorer Tours Pty Ltd v Clarke considered; Held – no other persons but the applicant, the second respondent, the third respondent and the fourth respondent were dependent for support on the worker; apportionment of the lump sum payable under section 25(1)(a) as agreed between the parties approved; awards entered in favour of the applicant, the second respondent, the third respondent and the fourth respondent in relation to their apportioned entitlements (plus interest) to the lump sum payable under section 25(1)(a) of the WCA Act; consent awards also entered in relation to claims pursuant to sections 26 and 28 of the WCA Act.

Decision date: 20 June 2025 | Member: Gaius Whiffin

McMillan v Secretary, Department of Education [2025] NSWPIC 287

Workers Compensation Act 1987; claim pursuant to section 66; parties agreed that claims in respect of injury to the left knee, the right knee and the back and the claim under section 4(b)(ii) in respect of the spine could be referred for assessment of permanent impairment; Held – the claims under section 4(b)(ii) in respect of injury to the left knee and the right knee were to be referred to a Medical Assessor for assessment of permanent impairment; insufficient evidence to discharge the onus of proof in respect of claims pursuant to section 4(b)(i) and/or section 4(b)(ii) to the bilateral hip, cervical spine, bilateral shoulders, thoracic spine, bilateral wrists, bilateral thumbs, bilateral ankles, and subtalar joints; award for respondent in respect of claims the bilateral hip, cervical spine, bilateral shoulders, thoracic spine, bilateral wrists, bilateral thumbs, bilateral ankles, and subtalar joints.

Decision date: 23 June 2025 | Member: Carolyn Rimmer

Usman v Woolworths Group Ltd [2025] NSWPIC 292

Workers Compensation Act 1987; claim for the cost of a right L4/5 foraminal discectomy for a consequential condition affecting the lumbar spine as a result of injury to both knees; respondent disputes the consequential condition to the lumbar spine and whether surgery is reasonably necessary as a result of the injury; consideration of Moon v Conmah P/L, and Kooragang Cement P/L v Bates; Held – worker suffers a consequential condition affecting his lumbar spine as a result of the injury to both knees; proposed surgery is reasonably necessary as a result of the work injury.

Decision date: 24 June 2025 | Member: John Isaksen

Motor Accidents Medical Review Panel Decisions

QBE Insurance (Australia) Limited v Tariq [2025] NSWPICMP 433

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); motor accident on 24 July 2019; prior motor accident in 2014 when claimant assessed by a previous Review Panel at 22%; history of complete recovery within short period following damages assessment for prior motor accident; no relevant principles in assessment of impairment; no deduction for pre-existing condition based on claimant’s statement of recovery; discussion of malingering; Held – Claimant’s degree of permanent impairment assessed at not greater than 10%; original assessment revoked; MAC revoked; new certificate issued.

Decision date: 19 June 2025 | Panel Members: Principal Member John Harris, Dr Himanshu Singh, and Dr Christopher Canaris | Injury module: Mental and Behavioural

Transport Accident Commission v Harris [2025] NSWPICMP 435

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); motor accident on 17 October 2019; assessment of whole person impairment (WPI) for psychiatric impairment; significant motor accident-causing post-traumatic stress disorder (PTSD); observations that adaptation affected despite pre-accident cessation of employment; no other relevant principles in assessment of impairment. Held – claimant’s degree of permanent impairment assessed at not greater than 10%; original assessment revoked; MAC revoked; new certificate issued.

Decision date: 19 June 2025 | Panel Members: Principal Member John Harris, Dr Matthew Jones, and Dr Christopher Canaris | Injury module: Mental and Behavioural

Insurance Australia Limited t/as NRMA Insurance v Ragni [2025] NSWPICMP 436

Motor Accidents Injuries Act 2017; review of Medical Assessment Certificate (MAC); original Medical Assessor (MA) assessed 11% whole person impairment (WPI) comprising of 5% neck and 6% right shoulder; Review Panel re-examination found inconsistent shoulder movements; claimant’s explanation not considered plausible; WPI evaluated by analogy using clinical judgement and analogy under clauses 6.24 and 6.84 of the Motor Accident Guidelines; symptoms from subsequent motor accidents (two) likely caused a temporary exacerbation of symptoms but no additional impairment; Held – Review Panel found cervical spine 0% WPI, right shoulder 2% WPI and left shoulder 1% WPI; claimant sustained injuries that gave rise to 3% WPI; MAC revoked; new certificate issued.

Decision date: 19 June 2025 | Panel Members: Member Jeremy Lum, Dr Margaret Gibson, and Dr Adeline Hodgkinson | Injury module: Spine, Upper Limb, Lower Limb, and Brain Injury

Allouche v QBE Insurance (Australia) Limited [2025] NSWPICMP 438

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); whether injuries from motor accident caused permanent impairment greater than 10%; alleged injuries to cervical spine, lumbar spine, left shoulder; pre-existing cervical condition with prior motor accident and surgical recommendation in 2016; subject accident occurred during employment involving forklift collision; clinical evidence indicated increased cervical symptoms; fusion surgery performed; issue of material contribution to surgery; Medical Assessor found surgery unrelated and applied 100% deduction; Held – Review Panel found motor accident materially contributed to need for fusion, resulting in DRE IV (25%) cervical spine impairment; no deduction applied due to absence of symptoms at time of accident; shoulder impairment assessed at 2% by analogy due to inconsistent findings; lumbar spine 0%; total whole person impairment (WPI) from motor accident assessed at 27%; MAC revoked; new certificate issued.

Decision date: 19 June 2025 | Panel Members: Member Elizabeth Medland, Dr Shane Moloney, and Dr Margaret Gibson | Injury module: Spine, and Upper Limb

QBE Insurance (Australia) Limited v Ruiz-Diaz [2025] NSWPICMP 440

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant was involved in a motor vehicle accident; claimant was driving a Ford Transit single-cab utility vehicle; claimant was sitting on a cushion; was positioned quite high in his seat; claimant’s vehicle was stationary in the left turn lane, his left hand was on the steering wheel, his right elbow was resting on the windowsill; claimant remembers the back of his head striking the rear glass panel; Held – Medical Assessor found that a soft-tissue injury to the right elbow including a tendon tear is a threshold injury; panel was satisfied by MRI scan that tear was pre-existing; no matter of principle; MAC revoked; new certificate issued.

Decision date: 23 June 2025 | Panel Members: Member Gary Victor Patterson, Dr Mohammed Assem, and Dr Christopher Oates | Injury module: Spine, and Upper Limb

Karnavas v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 441

Motor Accident Injuries Act 2017; permanent impairment; review of Medical Assessment Certificate (MAC); nexus between motor accident and lumbar spine condition; denial based on first note of lumbar spine complaints being one year after the accident and no contemporaneous complaints recorded; frank right shoulder injury with rotator cuff tear, cervical spine pain, and scarring; re-examination; Held – the Review Panel was satisfied that the accident caused or materially contributed to lumbar spine pain assessed as DRE I; Panel assessed 5% permanent impairment for right shoulder and scarring; MAC revoked; new certificate issued.

Decision date: 23 June 2025 | Panel Members: Member Terence O’Riain, Dr David Gorman, and Dr Shane Moloney | Injury module: Spine, Upper Limb, and Minor Skin

QBE Insurance (Australia) Limited v Abdi [2025] NSWPICMP 442

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury; claimant claimed tears to his shoulders and his knees as a result of the accident but insurer denied this same the condition was degenerative; claimant had been involved in an earlier accident in 2017 involving similar body areas of injury to the subject accident; issue about the age of the shoulder and knee tears; no complaint by the claimant at the time of the accident and immediately thereafter of acute pain in the shoulder and KNEES; Held – Review Panel not satisfied that the tears were anything other than age-related and a degenerative condition; MAC confirmed.

Decision date: 23 June 2025 | Panel Members: Member Alexander Bolton, Dr Christoper Oates, and Dr Margaret Gibson | Injury module: Spine, Upper Limb, and Lower Limb

Ghoz v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 443

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant suffered psychiatric injury in learning of the death of her son killed in a motor vehicle accident; Medical Assessor determined the claimant’s whole person impairment (WPI) as a result of the accident was 6%; claimant sought a review of the assessment under section 7.26 and the matter was referred to a Review Panel; the Review Panel conducted its own examination and found that WPI as a result of the psychiatric injuries sustained in the accident totalled 8%; MAC revoked; new certificate issued with 8% WPI.

Decision date: 23 June 2025 | Panel Members: Member Terence Stern OAM, Dr Christopher Canaris, and Dr Matthew Jones | Injury module: Mental and Behavioural

Mallia v AAI Limited t/as GIO [2025] NSWPICMP 450

Motor Accidents Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury dispute; whether musculoskeletal injuries aggravated pre-existing Crohn’s disease; Medical Assessor found all injuries to be threshold injuries with no aggravation of pre-existing Crohn’s disease; Review Panel conducted re-examination on Microsoft Teams; no record of abdominal injury caused by the motor accident; Crohn’s episodic with disease being severe just two months before motor accident; no change in medication pre-and-post motor accident; blood tests showed no increase in C-reactive protein; no abnormality in serial colonoscopies performed; on balance claimant’s report of right hip pain causing stress and increasing Crohn’s symptoms cannot be supported; Held – panel did not accept there was an aggravation of Crohn’s disease caused by the motor accident; MAC confirmed.

Decision date: 25 June 2025 | Panel Members: Member Jeremy Lum, Dr Margaret Gibson, and Dr Christopher Oates | Injury module: Spine, Upper Limb, Lower Limb, and Digestive System

Workers Compensation Medical Appeal Panel Decisions

McSpadden v State of New South Wales (NSW Police Force) [2025] NSWPICMP 428

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of orthopedic injuries; Medical Assessor noted no imaging was available but did not request X-rays permitted under s 324; X-rays reviewed; Held – MAC revoked; new certificate issued.

Decision date: 18 June 2025 | Panel Members: Member Catherine McDonald, Dr Drew Dixon, and Dr Andrew Porteous | Body system:  Cervical Spine, Lumbar Spine, Left Upper Extremity, Left Lower Extremity, Left Lower Extremity, and Right Lower Extremity

Meehan v K IBY & E.I Wallace t/as Foxxy Studios [2025] NSWPICMP 429

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal concerning assessment of psychiatric impairment under the psychiatric impairment rating scale (PIRS) in respect of employability; Held – Appeal Panel agreed with appellant that the Medical Assessor erred in his assessment of psychiatric impairment under the psychiatric impairment rating scale (PIRS) in respect of employability; evidence supported a higher rating; MAC revoked; new certificate issued.

Decision date: 18 June 2025 | Panel Members: Member Deborah Moore, Dr Douglas Andrews, and Dr John Lam-Po-Tang | Body system: Psychological/Psychiatric

State of New South Wales (Northern NSW Local Health District) v Van Der Poel [2025] NSWPICMP 430

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); psychological injury; psychiatric impairment rating scale (PIRS) disputed across social and recreational activities, concentration, persistence and pace, and employability; Held – MAC revoked; new certificate issued.

Decision date: 18 June 2025 | Panel Members: Member Catherine McDonald, Dr John Baker, and Dr Ash Takyar | Body system: Psychological/Psychiatric

Harvey v Earth AI Operations Australia Pty Ltd [2025] NSWPICMP 431

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); Appeal based upon incorrect assessment of two PIRS categories; Ferguson v State of NSW & Ors [2017] NSWSC 857 (Ferguson) and Parker v Select Civil Pty Ltd [2018] NSWSC 140 applied; no error made out; Held – no error made out; MAC confirmed.

Decision date: 19 June 2025 | Panel Members: Senior Member Elizabeth Beilby, Dr Michael Hong, and Dr John Lam-Po-Tang | Body system: Psychological/Psychiatric

Coolway Trans Pty Ltd ATF The Coolway Trans Trust v Stoddart [2025] NSWPICMP 432

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether Medical Assessor (MA) erred by not making a deduction under section 323(1); Held – respondent had pre-existing abnormality contributing to permanent impairment; consequently the MA erred by not making a deduction under section 323(1); MAC revoked; new certificate issued.

Decision date: 19 June 2025 | Panel Members: Member Marshal Douglas, Dr Gregory McGroder, and Dr Rob Kuru | Body system:   Lumbar Spine, Left Lower Extremity, and Scarring

Tomazos (Deligiannis) v Insurance Australia Ltd [2025] NSWPICMP 445

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant alleged error in application of section 323 and failure to account for reduced capacity in daily activities in assessment of whole person impairment (WPI); section 323 was misapplied and 10% deduction should have been applied; no error in assessment of daily living impairment and failing to increase WPI; Held – MAC revoked; new certificate issued.

Decision date: 24 June 2025 | Panel Members: Member Jacqueline Snell, Dr James Bodel, and Dr Alan Home | Body system:  Cervical Spine, Gastrointestinal System, and Scarring

Savva v R & L Sparkes Pty Ltd [2025] NSWPICMP 446

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether the Medical Assessor (MA) had the appropriate qualifications and conducted a complete lumbar spine assessment; Held – MA was qualified, but MAC did not confirm assessment of all criteria for radiculopathy; appellant re-examined; MAC revoked; new certificate issued.

Decision date: 24 June 2025 | Panel Members: Member Marshal Douglas, Dr Alan Home, and Dr James Bodel | Lumbar Spine, Right Upper Extremity, and Left Upper Extremity

Rivalea (Australia) Pty Ltd v Price [2025] NSWPICMP 447

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); Medical Assessor (MA) assessed 12% whole person impairment (WPI) for hearing loss with no deduction under section 232; Held – history obtained was not an amendment of applicant’s statement; grounds of appeal not established; MAC confirmed.

Decision date: 24 June 2025 | Panel Members: Member Carolyn Rimmer, Dr Henley Harrison, and Dr Thandavan Raj | Body system: Hearing Loss

Nguyen v Bakers Maison Australia Pty Ltd [2025] NSWPICMP 448

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether the Medical Assessor (MA) erred by not assessing appellant’s impairment of the appellant’s right shoulder in the circumstance where the appellant exhibited an inconsistent presentation during MA’s examination of her; respondent conceded the MA erred; Held – Appeal Panel found Medical Assessor erred; appellant re-examined; MAC revoked; new certificate issued.

Decision date: 24 June 2025 | Panel Members: Member Marshal Douglas, Dr Mohammed Assesm, and Dr Drew Dixon | Body system:  Left Upper Extremity, and Right Upper Extremity

Motor Accidents Merit Review Decisions

Dadisho v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMR 19

Motor Accident Injuries Act 2017; merit review; dispute over weekly statutory benefits payable under Division 3.3; Schedule 2(1)(a); Pre-Accident Weekly Earnings; PAWE; PAWE calculation; Earnings as an earner; change of circumstances; claimant seeking gross contractor’s earnings before expenses; insurer amended PAWE twice in claimant’s favour as information became available; insurer relied on period of earning as contractor to calculate gross profit after expenses; Insurance Australia Limited t/as NRMA Insurance v Iskander considered and followed; Held – insurer’s final reviewable decision affirmed.

Decision date: 25 June 2025 | Merit Reviewer: Terence O'Riain

Thapa v Allianz Australia Insurance Limited [2025] NSWPICMR 20

Motor Accident Injuries Act 2017; merit review application for payment of weekly benefits; at the time of accident claimant was self-employed and earning $700 per week in cash which the insurer accepted; claimant lodged initial application for benefits five days post-accident but only provided certificates of capacity to 19 October 2023 and thereafter provided no certificates of capacity until 30 May 2024; insurer denied payment for this period and no certificates of capacity have been provided since; insurer lost contact with the claimant and closed its file in January 2024 but the claimant provided limited certificates of capacity in June 2024; claimant submits that he was unable to work for the period in which no certificates of capacity have been provided, due to surgery and recovery; Held – the insurer does not have to continue weekly payments for the period 20 October 2023 to 29 May 2024 until a certificate of capacity is served by the claimant or a notice of suspension is served by the insurer.

Decision date: 27 June 2025 | Merit Reviewer: Alexander Bolton

This publication is for information only. The publication is not legal advice.  The information provided is not a substitute for reading the decisions. The Commission does not accept liability for the information in this publication or for way the information is used.

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