Legal Bulletin No. 212
This bulletin was issued on 23 May 2025
Issued 23 May 2025
Welcome to the two hundred and twelfth 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.
Court of Appeal Decision
Allianz Australia Insurance Limited v Yangzom [2025] NSWCA 104
Administrative law; appeals; judicial review; whether the primary judge erred in holding that the medical assessor to whom the medical dispute was referred by the Personal Injury Commission under the Motor Accident Injuries Act 2017 (NSW) fell into jurisdictional error or error of law on the face of the record; where the primary judge did so err; administrative law; appeals; judicial review; whether the primary judge erred in holding that the delegate of the President of the Personal Injury Commission fell into jurisdictional error or error of law on the face of the record in concluding that he was not satisfied that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application under the Motor Accident Injuries Act 2017 (NSW); where the primary judge did so err; Held – leave to appeal is granted; applicant is to file its draft Notice of Appeal in the form in the combined red/white book by 4pm on 23 May 2025; appeal allowed; the orders of the primary judge made on 18 July 2024 are set aside and in lieu thereof the application for judicial review is dismissed; first respondent to pay the applicant’s costs of the appeal and of the proceedings at first instance.
Decision date: 16 May 2025 | Before: Leeming JA, Kirk JA, and Stern JA
Supreme Court Decisions
Abdal v Insurance Australia Limited t/as NRMA Insurance [2025] NSWSC 478
Administrative law; judicial review; medical assessor’s determination of whole person impairment for the purposes of the Motor Accident Injuries Act 2017 (NSW); assessment of whole person impairment as a result of psychiatric injury; whether the medical assessor took into account an irrelevant consideration; consideration that “no overt cognitive difficulties noted during the assessment” wrongly assigned to the “concentration, persistence and pace” area of functional impairment as defined in the Motor Accident Guidelines; error established; decisions and reasons of assessor set aside; administrative law; judicial review; where medical assessor’s function included obtaining necessary information to assess whole person impairment for the purposes of the Motor Accident Guidelines; where necessary information not obtained; medical assessment of class 2 for the “Concentration, consistency and pace” area of functional impairment; where class rating based on considerations that did not provide a basis for distinguishing between class rating 2 and class rating 3; error established; Held – the time for commencement of the proceedings in respect of the decision (including the reasons) of Medical Assessor Sidorov of 25 February 2024 is extended to 18 September 2024; the decision (including the reasons) of Medical Assessor Sidorov of 25 February 2024 is set aside; the decision of the delegate of the President of the Personal Injury Commission of New South Wales of 19 June 2024 is set aside; the matter is remitted to the President of the Personal Injury Commission of New South Wales to be dealt with in accordance with law; the first defendant is to pay the plaintiff’s costs; otherwise, there is no order as to costs.
Decision date: 16 May 2025 | Before: Wright J
Wetere v Coles Supermarkets Australia Pty Ltd [2025] NSWSC 474
Administrative law; application for judicial review of decision Personal Injury Commission Appeal Panel; where applicant had suffered psychological injury; whether Panel reasons were inadequate; whether Panel failed to adhere to applicable Guidelines and erred in having regard to a secondary psychological injury; decision set aside and remitted back to Personal Injury Commission; Held – pursuant to section 69 of the Supreme Court Act 1970 (NSW) that the Appeal Panel’s 26 August 2024 Certificate, decision and statement of reasons are void and of no effect and are set aside; that the matter be remitted to the Personal Injury Commission with a direction that a differently constituted Appeal Panel determine Mr Wetere’s appeal according to law; unless the parties approach to be heard within 14 days with short written submissions, the insurer is to bear Mr Wetere’s costs, as agreed or assessed.
Decision date: 16 May 2025 | Before: Schmidt AJ
Presidential Member Decision
Workers compensation; calculation of ‘pre-injury average weekly earnings’ where a worker has been in receipt of payments of weekly compensation in respect of an earlier injury; Secretary, Department of Communities and Justice v Stewart [2024] NSWCA 59 considered and applied; construction of regs 8B, 8C and 8E of the Workers Compensation Regulation 2016; clause 3 of Schedule 3 of the Workers Compensation Act 1987; members not at liberty to ignore the terms of a remitter from a Presidential member; Secretary, Department of Communities and Justice v Pell [2023] NSWPICPD 19 distinguished; employment arrangement between employer and employee not limited to contractual relationship; requirement for employment arrangement to be identified; Secretary, Department of Communities and Justice v Nitchell [2023] NSWPICPD 36; Held – the Certificate of Determination dated 30 August 2024 is revoked; on redetermination pursuant to section 352(6A) of the Workplace Injury Management and Workers Compensation Act 1998, I determine that the respondent’s pre-injury average weekly earnings for the injury sustained by the respondent on 4 April 2022 is $807.59.
Decision date: 15 May 2025 | Before: President Judge Phillips
Motor Accidents non-Presidential Member Decisions
AAI Limited t/as GIO v Estate of the Late Arthur Mounter [2025] NSWPIC 94
Motor Accident Injuries Act 2017; settlement approval; claimant died two years post-accident; assessment of non-economic loss post-accident to date of death; contributory negligence 50%; pedestrian hit by car; analysis CCTV footage; failure to keep a proper lookout; claimant put himself in position of danger; traumatic brain injury; cognitive changes impact on claimant’s capacity; fractured clavicle, ribs, and lung contusion; facial lacerations; ongoing back pain; Held – settlement approved.
Decision date: 19 March 2025 | Member: Hugh Macken
Youi Pty Limited v Huray [2025] NSWPIC 127
Motor Accident Injuries Act 2017; settlement approval; 80-year-old woman struck in driveway; facial fractures, cervical spine fractures, lumbar spine fractures, clavicle fracture, rib fractures, and right foot injury; fractured pelvis requiring internal fixation and causing bladder injury; cognitive impairment requiring an appointment of a guardian; entitlement non-economic loss only; considerations in assessment of non-economic loss; severity of injuries; impact on activities of daily living; expeditious resolution of matter; Held – settlement approved.
Decision date: 7 April 2025 | Member: Hugh Macken
Fakhreddine v Allianz Australia Insurance Limited [2025] NSWPIC 160
Motor Accidents Compensation Act 1999; claims assessment dispute; amount of damages to be paid to the claimant under section 94(5); self-employed concreter; driver of a motor vehicle involved in a collision with the insured vehicle; claimant suffered soft tissue injuries to cervical spine, right limb and left shoulder; lumbar spine also suffered from a persistent depressive disorder; claimant also involved in a subsequent motor vehicle accident in May 2018 where he sustained injuries to his right shoulder and right wrist; no common law claim for damages made in respect of this later accident as the injuries were non threshold; submitted since the accident he suffered a diminution in earning capacity; liability admitted; claim for past and future economic loss; past and future treatment; past and future care; Held – claimant is entitled to damages for past economic loss and past treatment expenses.
Decision date: 20 April 2025 | Member: David Ford
AAI Limited t/as GIO v Cuthbert [2025] NSWPIC 191
Motor Accident Injuries Act 2017; claim for damages; claimant unrepresented; section 6.23; settlement approval; right shoulder injury requiring surgery; non-threshold injury; claim for economic loss; threshold for non-economic loss not met; no claim for non-economic loss; liability admitted; whether proposed settlement appropriate; whether proposed settlement understood by the claimant; Held – injury does not impact claimant’s current employment; no claim for past economic loss; buffer for potential future economic loss due to residual effects of injury; settlement within the range of likely potential damages assessment; settlement otherwise appropriate; settlement understood by claimant; settlement approved in the sum of $125,000.
Decision date: 7 May 2025 | Member: Bianca Montgomery-Hribar
Mellor-Langham v QBE Insurance (Australia) Limited [2025] NSWPIC 194
Motor Accident Injuries Act 2017; claim for statutory benefits; insurer denied liability under section 3.11 and 3.28 for ongoing statutory benefits on basis that claimant was wholly or mostly at fault; claimant’s application for miscellaneous claims assessment under Schedule 2(3)(d) and (e); claimant drove into curve on a wet semi-rural road at 60-65 kms which was below the speed limit (80 kms) but above the speed advisory sign (35 kms) and lost control of car; she says oily film or sheen on the road; Held – there was oily film on road and claimant departed from the standard of care of a reasonable person by not driving to the conditions and driving too fast; claimant’s contributory negligence assessed at 70% and she was therefore wholly or mostly at fault; AAI Limited t/as GIO v Evic referred to regarding approach to assessment of wholly or mostly at fault.
Decision date: 9 May 2025 | Member: Belinda Cassidy
Kadour v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 195
Motor Accident Injuries Act 2017; claim for damages; failure to provide relevant particulars required by section 6.25; deemed withdrawal of claim for damages by operation of section 6.26; application for reinstatement three years or more after accident; reinstatement not opposed by insurer; statutory declarations provided by claimant; consideration of full and satisfactory explanation for failure to provide required particulars; consideration of total amount of damages likely to be awarded; Held – claimant’s explanation full and satisfactory; claimant’s total amount of damages likely to be awarded exceeds threshold provided by section 6.26(7); claim should be reinstated.
Decision date: 9 May 2025 | Member: Bianca Montgomery-Hribar
Tan v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 196
Motor Accident Injuries Act 2017; assessment of a claim for damages; liability not disputed; no contributory negligence alleged; physical injuries and psychiatric/psychological injuries; claimant’s reliability as a historian in issue; no entitlement to non-economic loss; claim for past and future economic loss; insufficient evidence to enable an assessment of economic loss; consideration and application of section 4.7; Medlin v State Government Insurance Commission, Husher v Husher, and Penrith City Council v Parks considered; Held – claimant is not entitled to damages for past and future economic loss; insurer to pay the claimant’s legal costs and disbursements in accordance with Part 8 and the Motor Accidents Injuries Regulation 2017 as agreed or assessed.
Decision date: 9 May 2025 | Member: Anthony Scarcella
O'Connor v QBE Insurance (Australia) Limited [2025] NSWPIC 197
Motor Accident Injuries Act 2017; claim for statutory benefits and claimant’s application that the motor accident was not caused wholly or mostly by her fault under sections 3.11 and 3.28; claimant driving from Dubbo at night on straight country road; police travelling in same direction as claimant with headlights on and red and blue warning lights activated; police overtake at the same time claimant turns right into a parking area on the other side of the road; insurer alleges claimant wholly or mostly at fault; Held – claimant was wholly or mostly at fault; contributory negligence assessed at 80-100%; costs allowed and assessed at $4,382.20; section 42 of the Personal Injury Commission Act 2020 and rule in Browne v Dunn, and Jones v Dunkel considered; AAI Limited t/as GIO v Evic, and Allianz Australia Insurance Limited v Shuk applied regarding approach to assessment of contributory negligence; Logar v Ambulance Service of NSW applied regarding road rules and social utility of emergency vehicles having right of way.
Decision date: 12 May 2025 | Member: Belinda Cassidy
Maamary v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 202
Motor Accident Injuries Act 2017; damages; liability not disputed; physical and psychiatric/psychological injuries; entitled to non-economic loss; claim for past and future economic loss; consideration of medico-legal examinations, vocational assessments and lay evidence; claimant lost partial use of right hand and has continuing lumbar spine pain; returned to part time work; continuing reduction of earning capacity; consideration and application of section 4.7; Held – damages assessed for non-economic loss, past economic loss as weekly loss, and future economic loss calculated on 45% vicissitudes discount; claimant’s legal costs and disbursements assessed.
Decision date: 13 May 2025 | Member: Terence O'Riain
Allianz Australia Insurance Limited v Tan [2025] NSWPIC 203
Motor Accident Injuries Act 2017; claim for damages; liability admitted; claimant unrepresented; section 6.23; settlement approval; lower back and neck injury; claim for economic loss; threshold for non-economic loss not met; whether proposed settlement appropriate; whether proposed settlement understood by the claimant; Held – claimant has returned to pre-accident capacity; claimant able to perform pre-accident work without restrictions; claimant unlikely to require future invasive or surgical treatment; settlement within the range of likely potential damages assessment; settlement otherwise appropriate; settlement understood by claimant; settlement approved in the sum of $36,000.
Decision date: 14 May 2025 | Member: Bianca Montgomery-Hribar
Workers Compensation non-Presidential Member Decisions
Lucas v State of New South Wales (Fire & Rescue NSW) [2025] NSWPIC 130
Workplace Injury Management and Workers Compensation Act 1998; application by employer for reconsideration of Medical Assessment Certificate; consideration by Medical Assessor (MA) of further documents lodged shortly before examination by MA; consideration of Procedural Direction PIC7; Held – application declined; competing timeframes of the parties; longer timeframe for explanation preferred.
Decision date: 7 April 2025 | Member: Michael Wright
Almahmoody v Formtastic Group Pty Ltd [2025] NSWPIC 136
Workers Compensation Act 1987; claim pursuant to section 60 for proposed right shoulder surgery; injury recorded initially as right thumb injury; later recorded as right shoulder injury at date of accident as well; consideration of factual circumstances and pathology; Paric v John Holland (Constructions) Pty Ltd, and Kooragang Cement Pty Ltd v Bates considered; Held – right shoulder injury and pathology resulted from injury in course of employment; award in favour of applicant.
Decision date: 9 April 2025 | Member: Michael Wright
Fabian v Poletech Pty Ltd [2025] NSWPIC 141
Workplace Injury Management and Workers Compensation Act 1998; claim for lump sum compensation for undisputed left knee injury and disputed consequential conditions; credit submissions; New South Wales Police Force v Winter considered and applied; consequential conditions; Kumar v Royal Comfort Bedding Pty Ltd, and Moon v Conmah Pty Limited considered and applied; common sense causation; Kooragang Cement Pty Ltd v Bates applied; Held – claimed consequential conditions resulted from subject injury; referred for medical assessment.
Decision date: 10 April 2025 | Member: Michael Wright
White v Gilda Fabrics Pty Ltd [2025] NSWPIC 192
Workers Compensation Act 1987; claim for compensation pursuant to section 60 for past and future medicinal cannabis treatment; accepted injury resulting in further amputation of the right leg above the knee; historical cannabis use and high tolerance; actual and likely effectiveness of treatment; co-morbidities; dispute as to whether the proposed treatment is reasonably necessary as a result of accepted injury; principles in Diab v NRMA Limited, Rose v Health Commission (NSW), Kooragang Cement Pty Ltd v Bates, and Murphy v Allity Management Services Pty Ltd considered and applied; Held – claim for past medical expenses discontinued; award in favour of the applicant for a trial of 6-months for medicinal cannabis pursuant to section 60.
Decision date: 7 May 2025 | Member: Kathryn Camp
Angelkoski v Woolworths Group Ltd [2025] NSWPIC 193
Workers Compensation Act 1987; claim for further section 66 lump sum compensation in respect of accepted lumbar injury in 2010; complying agreement for 7% whole person impairment (WPI) in 2012; whether lumbar surgeries performed in 2015 and 2022 were reasonably necessary “as a result of” the accepted work injury; where evidence of sudden onset of new symptoms and changes in pathology caused by later events recorded in the evidence; Kooragang Cement Pty Ltd v Bates, and Murphy v Allity Management Services Pty Ltd considered and applied; Held – applicant did not discharge his onus of demonstrating that the accepted work injury “materially contributed” to the need for the surgeries; matter remitted for further assessment of the degree of permanent impairment resulting from the accepted injury.
Decision date: 7 May 2025 | Member: Rachel Homan
Spicer v Tamworth Regional Council [2025] NSWPIC 198
Workplace Injury Management and Workers Compensation Act 1998; psychological injury; whether wholly or predominantly caused by reasonable actions of employer with respect to transfer and/or provision of employment benefits; applicant suffered a psychological injury in the course of his employment for which liability was declined based on section 11A; claims weekly benefits and permanent impairment compensation; respondent alleged the applicant’s injury was wholly or predominantly caused by its reasonable actions; Held – the totality of the evidence demonstrates the causes of the applicant’s injury were multi-factorial; neither transfer nor the provision of employment benefits has been demonstrated to have been the whole or predominant cause of the injury; defence under section 11A must fail and the permanent impairment claim remitted to the President for referral to a Medical Assessor.
Decision date: 12 May 2025 | Member: Cameron Burge
Riley v Valaze Group Number 4 Pty Ltd ATF Valaze 4 Trust [2025] NSWPIC 199
Workers Compensation Act 1987; claim for weekly benefits compensation pursuant to sections 33 and 37 and medical expenses pursuant to section 60; applicant had accepted injury to right knee; whether the applicant had no current work capacity as a result of the accepted injury since 16 August 2024; Held – applicant had no current work capacity as a result of the accepted right knee injury from 16 August 2024 ongoing; respondent pay the applicant weekly compensation pursuant to section 37(1); liberty to apply within 14 days in respect of calculation of the weekly compensation amounts; the respondent to pay the applicant’s medical expenses in respect of the injury pursuant to section 60.
Decision date: 13 May 2025 | Member: Karen Garner
Hazelton v Royal Freemasons Benevolent Institution [2025] NSWPIC 200
Workers Compensation Act 1987; claim for lump sum compensation pursuant to section 66 in respect of a primary psychological injury; injury disputed; delay in giving notice of injury and making a claim of approximately 12-months; where workplace described favourably in exit interview; concurrent personal stressors and prior history of psychological symptoms and treatment; Held – worker sustained an injury in the nature of an aggravation, exacerbation or deterioration of her pre-existing psychological condition; real events in the workplace perceived as hostile causing a deterioration in the applicant’s condition; treating evidence supportive of employment being the main contributing factor to the injury; delay adequately explained by the seriousness of the applicant’s condition in the period following the cessation of work; medical dispute remitted to the President for referral to a Medical Assessor.
Decision date: 13 May 2025 | Member: Rachel Homan
Salam v BioGiene Services Pty Ltd [2025] NSWPIC 201
Workers Compensation Act 1987; claim for weekly payments for injury to both shoulders; whether worker has no current work capacity or a partial incapacity for work; whether there are any real jobs in the labour market in which the worker would be able to work; Wollongong Nursing Home P/L v Dewar, and Gradan Bathrooms P/L v Workers Compensation Nominal Insurer considered; whether the worker meets the criteria for weekly benefits of compensation after the second entitlement period; Held – worker has had no current work capacity since weekly payments of compensation terminated; award of weekly payments of compensation pursuant to sections 37 and 38.
Decision date: 13 May 2025 | Member: John Isaksen
Motor Accidents Medical Review Panel Decisions
QBE Insurance (Australia) Limited v Tugaga [2025] NSWPICMP 252
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of whole person impairment (WPI); alleged injuries to the cervical and lumbar spine, left leg, and both arms caused by motor accident; claimant standing in a car yard when was knocked over by a vehicle; Held – injuries to the arms found to be not caused by the motor accident; WPI arising from injuries to the cervical spine, lumbar spine and left leg assessed at 9%; MAC revoked.
Decision date: 11 April 2025 | Panel Members: Member Elizabeth Medland, Dr Tania Rogers, and Dr Shane Maloney | Injury module: Spine, Upper Limb, and Lower Limb
Graham v Allianz Australia Insurance Limited [2025] NSWPICMP 247
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); whole person impairment (WPI); right knee injury; comminuted fracture right tibial plateau; C7 facet joint fracture; lateral tibial plate with 15 screws; plate and screw removal; post-operative infections; anterior tibial artery filling defect; cervical spine fracture treated conservatively; right lower extremity scarring; mild medial lateral laxity; cruciate ligaments graft; tricompartmental osteoarthritis; Held – 6% WPI assessed; MAC revoked.
Decision date: 9 April 2025 | Panel Members: Member Hugh Macken, Dr Alan Home, and Dr Mohammed Assem | Injury module: Lower Limb
AAI Limited t/as GIO v McCartney [2025] NSWPICMP 321
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury dispute; where Medical Assessor (MA) found post-traumatic stress disorder (PTSD) caused by the accident not a threshold injury; Held – claimant suffered specific phobia (cars) as a result of the accident; the diagnosed psychological injury is not a threshold injury; MAC revoked as the Review Panel’s diagnosis differed from that of the MA; new certificate issued.
Decision date: 8 May 2025 | Panel Members: Senior Member Brett Williams, Dr Gerald Chew, and Dr Alan Doris | Injury module: Mental and Behavioural
Allianz Australia Insurance Limited v Mansour [2025] NSWPICMP 322
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); whole person impairment; exacerbation of post-traumatic stress disorder (PTSD); previous treatment in respect to psychiatric injuries; prior motor vehicle accident; previous PTSD claim; relevance of severity of accident; mental state examination; assessment of current functioning; minimise her persisting psychiatric symptoms; criteria for PTSD; previous relapse of PTSD; psychiatric impairment rating scale (PIRS); Held – MAC revoked; new certificate issued.
Decision date: 8 May 2025 | Panel Members: Member Hugh Macken, Dr Melissa Barrett, and Dr Sharon Reutens | Injury module: Mental and Behavioural
Insurance Australia Limited t/as NRMA Insurance v Tji [2025] NSWPICMP 323
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury; where Medical Assessor (MA) found the exacerbation of major depressive disorder caused by accident not a threshold injury; Held – as a result of the accident the claimant suffered psychological injury diagnosed as post-traumatic stress disorder (PTSD); PTSD is not a threshold injury; MAC revoked as the Review Panel’s diagnosis of injury differed from that of the MA; new certificate issued.
Decision date: 9 May 2025 | Panel Members: Senior Member Brett Williams, Dr John Baker, and Dr Himanshu Singh | Injury module: Mental and Behavioural
Estall v QBE Insurance (Australia) Limited [2025] NSWPICMP 324
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant suffered injury in a motor vehicle accident on 28 May 2021; Medical Assessor (MA) determined the claimant’s whole person impairment (WPI) as a result of the accident was 5%; claimant sought a review of the assessment under section 7.26; Held – Review Panel conducted its own examination and found that WPI as a result of injuries sustained in the accident totalled 9%; MAC revoked; new certificate issued.
Decision date: 9 May 2025 | Panel Members: Member Terence Stern OAM, Dr Shane Moloney, and Dr Christopher Oates | Injury module: Spine, Upper Limb, and Lower Limb
Allianz Australia Insurance Limited v Sekar [2025] NSWPICMP 329
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); treatment and care dispute; request for cervical discectomy and fusion surgery; denial by insurer under section 3.24; whether proposed treatment and care relates to injury resulting from the motor accident; whether proposed treatment and care is reasonable and necessary in the circumstances; claimant re-examined; Held – proposed treatment and care relates to injury caused by motor accident; proposed treatment and care is reasonable and necessary in the circumstances; MAC confirmed.
Decision date: 12 May 2025 | Panel Members: Member Bianca Montgomery-Hribar, Dr Drew Dixon, and Dr David Gorman | Treatment Type: Surgery
Saab v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 330
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC) under section 7.26 of whole person impairment (WPI) assessment of jaw and dental injuries; Medical Assessor (MA) found injuries not caused and did not assess WPI; claimant alleged no frank injury to jaw or teeth but that jaw pain and bruxism developed after the accident as a result of other physical injuries and psychological stress; claimant examined by one MA; Held – bruxism long standing and not caused or aggravated by motor accident; not satisfied on the evidence before the Review Panel that jaw pain was caused by the accident; WPI assessed at 0% as no impairment of mastication or deglutition; MAC confirmed; Chapter 9 of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides) and clauses 6.38, 6.195, and 6.197 of the Motor Accident Guidelines applied.
Decision date: 12 May 2025 | Panel Members: Member Belinda Cassidy, Dr Geoffrey (Paul) Curtin, and Dr Adrian Vertoudakis | Injury module: Dental Injury
BSX v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 331
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC) under section 7.26; whether degree of permanent impairment of the claimant that resulted from psychological injury caused by the accident is greater than 10%; Medical Assessor found that unspecified trauma- and stressor-related disorder caused by the accident had resolved and gave rise to no assessable permanent impairment; Held – claimant developed generalised anxiety disorder as a result of the accident that gave rise to a 7% permanent impairment; MAC revoked and new certificate issued certifying that the degree of permanent impairment that has resulted from the psychological injury caused by the accident is not greater than 10%.
Decision date: 12 May 2025 | Panel Members: Senior Member Brett Williams, Dr John Baker, and Dr Himanshu Singh | Injury module: Mental and Behavioural
Insurance Australia Limited t/as NRMA Insurance v Taleb [2025] NSWPICMP 332
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); psychological injury; post-traumatic stress disorder (PTSD); persistent depressive disorder; diagnosis; causation; Medical Assessor (MA) certified 16% whole person impairment (WPI) in respect of PTSD and persistent depressive disorder caused by the accident; Held – accident causative of persistent depressive disorder; symptoms insufficient to meet criteria for PTSD; MAC revoked; 7% WPI assessed as a result of persistent depressive disorder caused by accident.
Decision date: 12 May 2025 | Panel Members: Member Susan McTegg, Dr John Baker, and Dr Surabhi Verma | Injury module: Mental and Behavioural
Insurance Australia Limited t/as NRMA Insurance v Mihajlovski [2025] NSWPICMP 333
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant hit by a car while walking at a pedestrian crossing; claimant fell onto the ground on left side suffering left knee tibial plateau fracture requiring immediate surgery (open reduction and internal fixation); injuries to left shoulder, cervical spine, and lumbar spine emerged later; MAC assessed 13% whole person impairment (WPI); Held – causation established for all injuries referred for assessment; plausible that claimant could have sustained injuries to her cervical spine, lumbar spine, and left shoulder given the mechanism of injury (pedestrian vs motor vehicle) and the serious nature of the left knee tibial plateau fracture; differences in shoulder range of motion found by different medical practitioners not considered inconsistencies; MAC revoked; claimant sustained injuries that give rise to 11% WPI.
Decision date: 13 May 2025 | Panel Members: Member Jeremy Lum, Dr Drew Dixon, and Dr Margaret Gibson | Injury module: Spine, Upper Limb, Lower Limb, and Minor Skin
Tufuga v Allianz Australia Insurance Limited [2025] NSWPICMP 334
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant claimed to have sustained a psychological injury in a motor accident; whether psychological injury was a threshold injury; where the Medical Assessor at first instance found that a psychological injury (adjustment disorder with depressed mood) was caused by the motor accident; Held – MAC confirmed.
Decision date: 13 May 2025 | Panel Members: Member Maurice Castagnet, Dr Surabhi Verma, and Dr Thomas Newlyn | Injury module: Mental and Behavioural
Insurance Australia Limited t/as NRMA Insurance v Nassou [2025] NSWPICMP 336
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); whole person impairment (WPI); respiratory function; body mass index; weight gain; obstructive sleep apnoea; cataplexy; narcolepsy; MAC certified the claimant had 8% WPI of respiratory function due to increase in body mass index caused by motor vehicle accident; pre-accident history of obstructive sleep apnoea and gastric sleeve surgery; cataplexy and narcolepsy; Held – not convinced accident led to any consistent increase in weight given fluctuations since the accident; not satisfied any increase in weight and body mass index caused by accident; respiratory impairment due to increase in body mass not caused by accident; MAC revoked.
Decision date: 13 May 2025 | Panel Members: Member Susan McTegg, Dr Richard Haber, and Dr Margaret Gibson | Injury module: Respiratory System
Workers Compensation Medical Appeal Panel Decisions
Podesta v The Hills Shire Council [2025] NSWPICMP 319
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant submits that the Medical Assessor erred in his assessments under four categories of the psychiatric impairment rating scale (PIRS); Held – Appeal Panel found error in one category only; MAC revoked.
Decision date: 7 May 2025 | Panel Members: Member Deborah Moore, Professor Nicholas Glozier, and Dr Graham Blom | Body system: Psychological/Psychiatric
Byrne v Patrick Stevedores Holdings Pty Ltd [2025] NSWPICMP 320
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal from section 323 deduction of 50% for bilateral knee injuries; whether Medical Assessor (MA) had properly reviewed the evidence; whether MA had taken a proper history; whether adequate reasons given; Held – MA had not taken a proper history by limiting his report to what the worker had told him; MA had failed to refer to the relevant evidence; presumption of regularity rebutted; Jones v The Registrar WCC referred to; MA had not given adequate reasons; Wingfoot Australia Partners Pty Ltd v Kocak, and El Masri v Woolworths Ltd referred to and applied; MA wrongly relied on assumption and hypothesis; Cole v Wenaline Pty Ltd applied; Vitaz v Westform (NSW) Pty Limited considered; error noted in referral that the injury date was supposed to be deemed; Craigie v Faircloth & Reynolds Pty Ltd referred to; entirety of evidence considered; Elcheikh v Diamond Formwork (NSW) Pty Ltd referred to; MAC revoked.
Decision date: 7 May 2025 | Panel Members: Member John Wynyard, Dr Doron Sher, and Dr Greg McGroder | Body system: Left Lower Extremity (Knee), and Right Lower Extremity (Knee)
Shaye Paper Products Pty Ltd v Tran [2025] NSWPICMP 325
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant submits that the Medical Assessor (MA) erred by failing to consider whether any portion of the impairment was the result of a secondary psychological injury and/or failing to provide any adequate reasons as to why this is not possible to determine; MA erred in his assessment of the psychiatric impairment rating scale (PIRS) category of travel; Held – Appeal Panel agreed; re-examination required; MAC revoked.
Decision date: 9 May 2025 | Panel Members: Member Deborah Moore, Dr Michael Hong, and Dr John Lam Po Tang | Body system: Psychological/Psychiatric
Secretary, Department of Education v Hill [2025] NSWPICMP 326
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); psychological injury; appellant employer alleged assessment on the basis of incorrect criteria and demonstrable error in the making of assessments under one of the psychiatric impairment rating scale (PIRS) categories namely social functioning; Held – Appeal Panel found error and a re-examination was considered necessary; MAC confirmed.
Decision date: 9 May 2025 | Panel Members: Member Jane Peacock, Dr Michael Hong, and Dr Douglas Andrews | Body system: Psychological/Psychiatric
State of New South Wales (Fire & Rescue NSW) v Farrell [2025] NSWPICMP 327
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant submits that the Medical Assessor (MA) erred in his whole person impairment (WPI) assessment of one of the categories of the psychiatric impairment rating scale (PIRS) namely concentration, persistence and pace; MA failed to apply any deduction for pre-existing condition or abnormality under section 323; Held – Appeal Panel found error in the PIRS rating but no error regarding section 323; MAC revoked.
Decision date: 12 May 2025 | Panel Members: Member Deborah Moore, Professor Nicholas Glozier, and Dr Douglas Andrews | Body system: Psychological/Psychiatric
Ahava Australia Pty Ltd v Chung [2025] NSWPICMP 328
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of the left lower extremity, lumbar spine, and left upper extremity; employer appealed; examination findings not clear; Held – error found and re-examination considered necessary; MAC revoked.
Decision date: 12 May 2025 | Panel Members: Member Jane Peacock, Dr Drew Dixon, and Dr Christopher Oates | Body system: Lumbar Spine, Left Upper Extremity (Shoulder), and Left Lower Extremity (Knee)
Motor Accidents Merit Review Decisions
Shahajada v QBE Insurance (Australia) Limited [2025] NSWPICMR 10
Motor Accident Injuries Act 2017; merit review application as to amount of weekly payments of statutory benefits payable under Division 3.3; calculation of the claimant’s pre-accident weekly earnings (PAWE); claimant alleges being a taxi driver and Uber driver; claimant asserted that PAWE should be calculated based on 2024 financial year; Held – decision affirmed; accident occurred on 2 May 2024 and therefore the 2024 taxation return does not accurately cover the relevant period being 52-weeks prior to the accident (clause 4(1) of Schedule 1); evidence not sufficient to establish earnings as a taxi driver; PAWE calculated on basis of earnings as an Uber driver; claimant absent overseas for several weeks during the relevant period; Allianz Insurance Australia Limited v Shahmiri applied.
Decision date: 19 March 2025 | Merit Reviewer: Elizabeth Medland
Charity v QBE Insurance (Australia) Limited [2025] NSWPICMR 15
Motor Accident Injuries Act 2017; merit review; whether cost of treatment and care provided or to be provided to the claimant is reasonable for the purposes of section 3.24(1) (entitlement to statutory benefits for treatment and care); attendant care services; whether loss of income of provider of gratuitous services recoverable as statutory benefits; where injured person is a minor; section 3.25; section 3.26; merit review; jurisdiction; Schedule 2(1)(i); Held – the reviewable decision is affirmed.
Decision date: 8 May 2025 | Merit Reviewer: Katherine Ruschen
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