Legal Bulletin No. 215
This bulletin was issued on 13 June 2025
Issued 13 June 2025
Welcome to the two hundred and fifteenth 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 Appeal of Decisions
Insurance Australia Limited t/as NRMA Insurance v Le [2025] NSWCA 121
Administrative law; appeals; judicial review; decision of medical assessor referred to review panel; whether primary judge erred in finding that review panel determined the question of causation according to law; where primary judge did not so err; administrative law; appeals; judicial review; decision of medical assessor referred to review panel; whether primary judge erred in finding that review panel exposed its actual path of reasoning; where primary judge did not so err; Held – appeal dismissed; appellant to pay the costs of the appeal.
Decision date: 6 June 2025 | Before: Mitchelmore JA, Stern JA, and Ball JA
Khanna v Insurance Australia Limited [2025] NSWCA 125
Appeals; leave to appeal; leave required; no issue of principle, question of public importance, or reasonably clear injustice going beyond something that is merely arguable; leave refused; Held – leave to appeal refused; applicant to pay the respondent’s costs of the application for leave to appeal.
Decision date: 6 June 2025 | Before: Payne JA and Free JA
Presidential Member Decision
Anderson v Sydney Trains [2025] NSWPICPD 47
Workers compensation; section 10(3A) of the Workers Compensation Act 1987; whether real and substantial connection between accident on journey and employment; Bina v ISS Property Services Pty Limited [2013] NSWWCCPD 72 and Dewan Singh and Kim Singh t/as Krambach Service Station v Wickenden [2014] NSWWCCPD 13 considered; whether Member erred by applying a test of causation between accident and employment; Held – the Certificate of Determination dated 2 August 2024 is confirmed.
Decision date: 3 June 2025 | Before: Acting Deputy President Paul Sweeney
Motor Accidents non-Presidential Member Decisions
Alonso v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 233
Motor Accident Injuries Act 2017; assessment of damages pursuant to section 7.36(3) and section 7.36(4); Held – non-economic loss; agreed $250,000 injuries included multiple facial fractures, left jaw injury, lacerations to face and left thigh, scarring, soft-tissue injuries to left shoulder, arm, lumbar spine, left ankle and hip resolved; past economic loss closed-period $61,453.55 and small buffer future economic loss $25,000; impact of Centrelink disability applications prior and post-accident.
Decision date: 22 May 2025 | Member: Shana Radnan
Transport Accident Commission v Jantschulev [2025] NSWPIC 240
Motor Accident Injuries Act 2017; claim for damages; where settlement approval by the Commission is required; claimant is legally unrepresented; section 6.23; high speed head on collision; whiplash injury; mild to moderate traumatic brain injury with post-injury confusion lasting at least five to seven days; soft tissue injuries to right hip and right shoulder; post-traumatic stress disorder; where claimant refuses to submit herself to medical assessments by the Commission; no entitlement to damages for non-economic loss; approval sought for proposed settlement in the sum of $200,000 for damages for past and future economic loss; Held – proposed settlement approved under section 6.23(2)(b); there are no deductions to be made by the insurer from the proposed settlement for any other matters.
Decision date: 2 June 2025 | Member: Maurice Castagnet
AAI Limited t/as GIO v Sharpe [2025] NSWPIC 246
Motor Accident Injuries Act 2017; settlement approval pursuant to section 6.23(2)(b); Held –proposed sum of $81,270 approved; injuries to left calf, ankle and knee; pre-existing condition; whole person impairment (WPI) assessed at 7% for physical injuries; no entitlement to non-economic loss; closed period past economic loss and small buffer for future economic loss.
Decision date: 3 June 2025 | Member: Shana Radnan
Kwon v Allianz Australia Insurance Limited [2025] NSWPIC 248
Motor Accident Injuries Act 2017; claim for statutory benefits; insurer denied ongoing benefits on basis claimant wholly or mostly at fault; claimant bus passenger who fell before getting off; bus stopped suddenly; assessed on the papers; Held – claimant’s actions contributed to cause of accident; bus driver breached duty; relative culpability assessed at 50:50; claimant not wholly or mostly at fault; cases cited; AAI Limited t/as GIO v Evic regarding approach to fault disputes in statutory benefits; Podrebersek v Australian Iron and Steel Pty Limited, and Allianz Australia Limited v Shuk as to relative culpability; section 5R Civil Liability Act 2002 cited for test of contributory negligence.
Decision date: 3 June 2025 | Member: Belinda Cassidy
Simenes v Allianz Australia Insurance Limited [2025] NSWPIC 249
Motor Accident Injuries Act 2017; damages assessment pursuant to section 7.6; liability admitted; claimant knocked off her electric scooter after vehicle disobeyed a red light at an intersection; claim for past and future economic loss; Fox v Wood; no claim for non-economic loss as claimant did not exceed the threshold; primary injury fracture wrist of dominant hand; claimant submitted such impacted severely upon her career trajectory and likely remuneration that involved a significant component of physical work that she can no longer undertake; insurer disputed the injury had any significant impact on the claimant’s earning capacity; buffer awards for past and future economic loss; Penrith City Council v Parks considered; Held – damages assessed at $501,252 plus regulated costs.
Decision date: 3 June 2025 | Member: Terrence Broomfield
Workers Compensation non-Presidential Member Decisions
Workers Compensation Act 1987 (1987 Act); Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); worker; injury; serious and wilful misconduct; first respondent uninsured; credit of applicant and witness for the first respondent; applicant claimed he was an employee of the first respondent; respondent says he was a contractor; applicant says he was injured mustering sheep; first respondent says he was doing donuts; cross examination of witness; Malco Engineering Pty Ltd v Ferreira, Brown v Tavern Operator Pty Ltd, and Watson v Foxman considered; Held – applicant lacked credibility; applicant was not a worker; applicant was not injured whilst mustering sheep but whilst doing donuts.
Decision date: 21 May 2025 | Member: Parnel McAdam
Shields v State of New South Wales (Ambulance Service NSW) [2025] NSWPIC 234
Workers Compensation Act 1987 (1987 Act); Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); claim for lump sum compensation; event of injury admitted by the respondent; respondent conceded injury to the back but disputed injury to the left hip; Held – award in favour of applicant in relation to the alleged injury to the left hip on basis of applicant’s evidence and contemporaneous medical records and reports; matter referred to Medical Assessor; no issue of principle.
Decision date: 29 May 2025 | Member: Michael Moore
Dotti v State of New South Wales (Northern Sydney Local Health District) [2025] NSWPIC 235
Workers Compensation Act 1987; claim for weekly benefits in relation to a psychological injury; fact of injury admitted; respondent relies on section 11A in relation to discipline and transfer; misconduct investigation; misconduct found by the employer; formal warning applied; secondment terminated; worker returned to substantive position; whether employer action predominant cause of psychological condition; reasonableness of respondent employer action; Held – psychological injury arose from employer action with respect to discipline and transfer; action by respondent accepted as reasonable; section 11A defence established; award for the respondent.
Decision date: 29 May 2025 | Member: Adam Halstead
King v R A Motors [2025] NSWPIC 237
Consequential injury; accepted injury to left knee; left leg later developed symptoms of complex regional pain syndrome (CRPS); whether applicant suffered a consequential condition in right leg; symptoms appeared spontaneously due to mirroring; requirement for pathology in a consequential condition; Grant v Dateline Imports Pty Ltd discussed; Moon v Conmah Pty Limited, Trustees of the Roman Catholic Church for the Diocese of Parramatta v Brennan applied; specific issues in CRPS cases; Elsworthy v Forgacs Engineering Pty Ltd discussed; Held – applicant suffered a consequential condition in his right lower extremity; matter referred for assessment of impairment.
Decision date: 29 May 2025 | Member: Parnel McAdam
Wilczak v PT Painting Pty Ltd [2025] NSWPIC 241
Workplace Injury Management and Workers Compensation Act 1998; whether applicant was a worker; considered and applied Stevens v Brodribb Sawmilling Co Pty Ltd, Malivanek v Ring Group Pty Ltd, and On Call Interpreters and Translators Agency Pty Ltd v Commissioner of Taxation (No 3); indicia of employment to be considered within context of overall relationship between the parties; Held – applicant was a worker in the employ of the respondent.
Decision date: 2 June 2025 | Member: Mitchell Strachan
Tsakiris v Active Pools and Spas Pty Ltd [2025] NSWPIC 243
Workplace Injury Management and Workers Compensation Act 1998; whether applicant was a worker; considered and applied Stevens v Brodribb Sawmilling Co Pty Ltd, Malivanek v Ring Group Pty Ltd, and On Call Interpreters and Translators Agency Pty Ltd v Commissioner of Taxation (No 3); indicia of employment to be considered within context of overall relationship between the parties; Held – applicant failed to discharge onus in establishing he was a worker in the employ of the respondent.
Decision date: 3 June 2025 | Member: Mitchell Strachan
Nunan v State of New South Wales (NSW Police Force) [2025] NSWPIC 244
Workers Compensation Act 1987; claim for permanent impairment lump sum compensation pursuant to section 66 and compensation for pain and suffering pursuant to section 67; applicant was a police officer with the NSW Police Force and accordingly ‘exempt’ from 2012 amendments to the Act; accepted injury to lumbar spine and right knee pursuant to section 4(b)(ii) (as it then applied) as a result of the nature and conditions of the applicant’s work; whether applicant sustained injury to the lumbar spine, right hip and bilateral shoulders pursuant to section 4(b)(ii) (as it then applied); Held – applicant sustained injury to the lumbar spine and right hip pursuant to section 4(b)(ii); applicant did not sustain injury to the bilateral shoulders pursuant to section 4(b)(ii) (as it then applied); matter remitted to the President to be referred to a Medical Assessor for assessment of whole person impairment.
Decision date: 3 June 2025 | Member: Karen Garner
Sarcia v Enjin Clean Pty Ltd [2025] NSWPIC 245
Workers Compensation Act 1987 (1987 Act); Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); claim for weekly compensation; worker; deemed worker; injury and capacity disputed; considered Nilon v Berens Constructions Pty Ltd; indicia of control; factual findings; Held – applicant was a worker; injury was sustained in the course of employment; applicant failed to discharge onus as to capacity; award for respondent for weekly compensation claim.
Decision date: 3 June 2025 | Member: Michael Wright
Motor Accidents Medical Review Panel Decisions
Insurance Australia Limited t/as NRMA Insurance v McPherson [2025] NSWPICMP 376
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); treatment and impairment disputes; insurer’s single application for review under section 7.26; Medical Assessor diagnosed post-traumatic stress disorder (PTSD); diagnosis challenged because claimant had no memory of accident; impairment for three of six functional areas challenged; Held – claimant has PTSD caused by accident on background of pre-existing conditions; current whole person impairment (WPI) 8%; pre-existing WPI 2%; WPI caused by accident 6%; all treatment allowed; WPI MAC revoked; treatment MAC confirmed; no matter of principle.
Decision date: 29 May 2025 | Panel Members: Member Belinda Cassidy, Dr Melissa Barrett, and Dr Sharon Reutens | Injury module: Mental and Behavioural; Treatment Type: Psychological Treatment
Najjar v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 377
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of permanent impairment; claimant suffered injury in a motor accident when his vehicle was rear ended by the insured vehicle causing his vehicle to collide with the vehicle travelling in front of him; pre-existing conditions to the same body parts being assessed; cervical spine, lumbar spine and both shoulders; whether a deduction should be made for pre-existing impairment; Held – MAC of 9% permanent impairment revoked; replacement certificate issued with a finding of a degree of permanent impairment of 9% based on different reasons and conclusions.
Decision date: 29 May 2025 | Panel Members: Member Maurice Castagnet, Dr Shane Moloney, and Dr Margaret Gibson | Injury module: Spine, and Upper Limb
Insurance Australia Limited t/as NRMA Insurance v Aduah [2025] NSWPICMP 378
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant suffered injury in a motor vehicle accident; Medical Assessor determined whole person impairment (WPI) as 15%; insurer made application under section 7.26 referral of assessment to the Review Panel; Review Panel conducted its own examination and found that whole person impairment (WPI) as a result of injuries sustained in the accident totalled 5%; MAC revoked; Review Panel substituted a 5% WPI as a result of the accident.
Decision date: 29 May 2025 | Panel Members: Member Terence Stern OAM, Dr Samson Roberts, and Dr Ankur Gupta | Injury module: Mental and Behavioural
Formoli v QBE Insurance (Australia) Limited [2025] NSWPICMP 379
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant suffered injury in a motor vehicle accident; Medical Assessor determined the claimant’s whole person impairment (WPI) as a result of the accident was 10%; claimant made an application under section 7.26 for referral of assessment to the Review Panel; Review Panel conducted its own examination and found that WPI as a result of injuries sustained in the accident totalled 6%; MAC revoked; Review Panel substituted a 6% WPI as a result of the accident.
Decision date: 29 May 2025 | Panel Members: Member Terence Stern OAM, Dr Thomas Rosenthal, and Dr Shane Moloney | Injury module: Spine, Upper Limb, and Lower Limb
Nelson v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 380
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury dispute; aggravation of pre-existing Crohn’s disease following motor accident; MAC determined motor accident caused a contemporaneous flare of Crohn’s disease which returned to its normal status and therefore the injury resolved; Review Panel accepted musculoskeletal injury from the accident but no abdominal injury; Review Panel found claimant had commenced biological agent infusions (Infliximab and Vedolizumab) before the accident which led to his Crohn’s disease coming under control; Review Panel found Crohn’s disease relapsed due to claimant’s non-compliance with the infusions in the months leading up to the motor accident; Held – causation was not established because the motor accident had a nil or negligible contribution to the flare ups of the pre-existing Crohn’s disease; MAC revoked; new certificate issued.
Decision date: 29 May 2025 | Panel Members: Member Jeremy Lum, Dr Margaret Gibson, and Dr Alan Home | Injury module: Spine and Digestive System
Insurance Australia Limited t/as NRMA Insurance v Mohammed [2025] NSWPICMP 381
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of 15% impairment; insurer’s application for review under section 7.26 on basis insufficient reasons for neck assessment and inconsistency in shoulder measurements; Held – claimant re-examined; claimant demonstrated consistent range of motion, variation in other assessments due to time and related to activity levels; assessment of impairment 5% neck; 8% shoulder; total greater than 10%; MAC revoked; no matter of principle.
Decision date: 29 May 2025 | Panel Members: Member Belinda Cassidy, Dr Drew Dixon, and Dr Margaret Gibson | Injury module: Spine, Upper Limb, and Lower Limb
Insurance Australia Limited t/as NRMA Insurance v Jaczak [2025] NSWPICMP 382
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC) under section 7.26; threshold injury dispute; causation issue; claimant had two accidents four days apart; diagnosis issue; treating psychiatrist diagnosed post-traumatic stress disorder (PTSD); Held – claimant did not satisfy criteria A and B for PTSD; claimant satisfied criteria for major depressive disorder; disorder caused by both accidents; disorder not a threshold injury; MAC confirmed.
Decision date: 30 May 2025 | Panel Members: Member Belinda Cassidy, Dr Gerald Chew, and Dr Himanshu Singh | Injury module: Mental and Behavioural
Agyei v AAI Limited t/as AAMI [2025] NSWPICMP 383
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury and treatment disputes; Medical Assessor certified adjustment disorder with mixed anxiety and depressed mood caused by accident was a threshold injury and referral to a psychiatrist relates to psychological injury caused by the accident and is reasonable and necessary in the circumstances; Held – post-traumatic stress disorder (PTSD) caused by the accident was not a threshold injury; MAC revoked; new certificate issued; certificates relating to treatment confirmed.
Decision date: 30 May 2025 | Panel Members: Senior Member Brett Williams, Dr Wayne Mason, and Dr Himanshu Singh | Injury module: Mental and Behavioural
Insurance Australia Limited t/as NRMA Insurance v Elcheikh [2025] NSWPICMP 384
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); section 7.26; whether claimant’s degree of permanent impairment that has resulted from the psychological injury caused by the accident is greater than 10%; Medical Assessor certified that the accident caused post-traumatic stress disorder (PTSD) gave rise to a permanent impairment that was greater than 10%; Held – MAC revoked; new certificate issued; Review Panel certified the claimant’s degree of permanent impairment that has resulted from the panic disorder caused by the motor accident is not greater than 10%.
Decision date: 30 May 2025 | Panel Members: Member Terence O’Riain, Dr Paul Friend, and Dr Wayne Mason | Injury module: Mental and Behavioural
QBE Insurance (Australia) Limited v BPO [2025] NSWPICMP 388
Motor Accidents Compensation Act 1999; review of Medical Assessment Certificate (MAC); motor accident; claimant riding bicycle collided with insured vehicle; whether the degree of permanent impairment was greater than 10%; claimant re-examined; claimant suffered degloving injury to leg and developed chronic pain condition; application of clause 1.215 of the Motor Accident Permanent Impairment Guidelines in excluding effects of pain from psychiatric impairment rating scale (PIRS) assessment; use of clinical observations from assessment in assessing PIRS category of concentration, persistence and pace; Abdal v Insurance Australia Ltd commented on; Held – claimant’s degree of permanent impairment assessed at 9% including an allowance of 1% for the effects of treatment; MAC revoked.
Decision date: 3 June 2025 | Panel Members: Principal Member John Harris, Dr John Baker, and Dr Christopher Rikard-Bell | Injury module: Mental and Behavioural
Lee v QBE Insurance (Australia) Limited [2025] NSWPICMP 389
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of threshold injury under section 1.6(3); claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) found claimant sustained an adjustment disorder with mixed anxious and depressed mood caused by the accident (threshold injury); claimant sought review; Held – claimant had sustained persistent depressive disorder caused by the accident; MAC revoked; persistent depressive disorder is a non-threshold injury.
Decision date: 3 June 2025 | Panel Members: Member Susan McTegg, Dr Ankur Gupta, and Dr Christopher Canaris | Injury module: Mental and Behavioural
Shabeeb v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 390
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); degree of permanent impairment; range of motion of both shoulders; inconsistencies between medical material and history given; passive shoulder movement limited due to pain; claimant use of walking stick; changing range of movement of shoulders; non-verifiable radiculopathy complaints; cervical spine; no signs of radiculopathy from lumbar spine; pre-existing tendinitis and bursitis; lack of shoulder movement entirely voluntary; Held – MAC revoked.
Decision date: 3 June 2025 | Panel Members: Member Hugh Macken, Dr David Gorman, and Dr Shane Moloney | Injury module: Spine, Upper Limb, and Lower Limb
QBE Insurance (Australia) Limited v McKenzie [2025] NSWPICMP 391
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); whether the injured person suffered threshold injuries; claimant (minor) a passenger in a vehicle that was collided with; claim of post-traumatic stress disorder (PTSD) arising therefrom; MAC confirmed diagnosis and not a threshold injury; insurer lodged a review application; history of behavioural issues; Held – Review Panel found the accident did cause PTSD which is not a threshold injury; MAC confirmed.
Decision date: 4 June 2025 | Panel Members: Member Elizabeth Medland, Dr Thomas Newlyn, and Dr Paul Friend | Injury module: Mental and Behavioural
Workers Compensation Medical Appeal Panel Decisions
Ram v National Workforce Pty Ltd [2025] NSWPICMP 373
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); Medical Assessor (MA) assessed 0% whole person impairment (WPI) of the cervical spine and 7% WPI of the left upper extremity; applicant appealed assessment of the left upper extremity on the basis that the Medical Assessor (MA) relied on adopted findings that were obtained in an examination under anesthesia nine years prior without an adequate explanation; Appeal Panel satisfied that the MA made a demonstrable error; worker re-examined in a joint re-examination and assessed as having 2% WPI of the left upper extremity; Held – MAC revoked and new certificate issued.
Decision date: 28 May 2025 | Panel Members: Member Carolyn Rimmer, Dr James Bodel, and Dr Tommasino Mastroianni | Body system: Cervical Spine, and Left Upper Extremity
Roy v Sydney Night Patrol and Inquiry Co Pty Ltd [2025] NSWPICMP 374
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal by worker against assessment of 5% whole person impairment (WPI) for injury to his left knee and scarring together with a consequential condition to the right knee; whether Medical Assessor (MA) erred in not treating the right knee as an injury; whether 0% for scarring was adequate and whether the MA had explained his reasons; whether application of section 323 contrary to authority; Held – unlikely that MA realised the assessment for the right knee was as a consequential injury; appellant's submissions in that regard misconceived; scarring assessment of 0% confirmed; application of section 323 incorrect as MA applied wrong test; Cole v Wenaline Pty Ltd applied; MA failed to identify relevant date; Craigie v Faircloth & Reynolds Pty Ltd applied; MA failed to give adequate reasons; El Masri v Woolworths Ltd applied; MAC revoked and new certificate issued.
Decision date: 28 May 2025 | Panel Members: Member John Wynyard, Dr Doron Sher, and Dr Tommasino Mastroianni | Body system: Left Lower Extremity (Knee), Right Lower Extremity (Knee), and Scarring (TEMSKI)
Honey v Murray Constructions Pty Ltd [2025] NSWPICMP 375
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of the cervical spine; worker appealed submitting insufficient findings and inadequate reasons for failing to find non-verifiable radiculopathy; Held – no error found by Appeal Panel; MAC confirmed.
Decision date: 29 May 2025 | Panel Members: Member Jane Peacock, Dr Drew Dixon, and Dr Alan Home | Body system: Left Upper Extremity (Shoulder), Right Upper Extremity (Shoulder), and Cervical Spine
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether the Medical Assessor’s (MA) ratings of the respondent’s impairment in social and recreational activities due to matters unrelated to his injury; Held – the MA did not explore whether respondent’s impairment in social and recreational activities due only to matters unrelated to his injury which was an error on part of the MA; respondent re-examined; Appeal Panel rated the respondent’s impairment in social and recreational activities the same as the MA had rated it; MAC confirmed.
Decision date: 30 May 2025 | Panel Members: Member Marshal Douglas, Dr John Lam-Po-Tang, and Dr Michael Hong | Body system: Psychological/Psychiatric
Wang v CCZ Plasterboard Pty Ltd [2025] NSWPICMP 386
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant submits that the Medical Assessor (MA) incorrectly applied the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 1 March 2021, took into account irrelevant considerations, failed to afford procedural fairness, and failed to give adequate reasons; Held – no errors made; no foundation to the appellant’s submissions; MAC confirmed.
Decision date: 3 June 2025 | Panel Members: Member Deborah Moore, Dr Roger Pillemer, and Dr Alan Home | Body system: Left Lower Extremity
State of New South Wales (Western NSW Local Health District) v Broughton [2025] NSWPICMP 387
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant submits that the Medical Assessor (MA) erred in his assessments under two categories of the psychiatric impairment rating scale (PIRS) namely social and recreational activities, and travel; the MA further erred in finding the respondent worker had achieved maximum medical improvement (MMI) and in applying a 1% modifier for the effects of treatment as per paragraph 1.32 of the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 1 March 2021; both parties agreed that the 1% modifier for the effects of treatment was an error; re-examination required; no error in the PIRS categories appealed; reasons given as to why MMI had been reached; Held – MAC revoked because of the error re treatment effects; new certificate issued.
Decision date: 3 June 2025 | Panel Members: Member Deborah Moore, Dr Douglas Andrews, and Dr Graham Blom | Body system: Psychological/Psychiatric
Wellington Aboriginal Corporation Health Service v Tarrant [2025] NSWPICMP 392
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether Medical Assessor (MA) erred in assessing 22% whole person impairment (WPI) as a result of psychological injury after deducting one-tenth for a pre-existing condition; whether MA erred in assessing a class 5 impairment in respect of employability; whether MA erred in deducting one-tenth for a pre-existing condition; Held – no error in respect of the assessment of employability; error in respect of the deduction; Appeal Panel made its own assessment of the deduction; that assessment was one-tenth; no utility in revoking the MAC; MAC confirmed.
Decision date: 29 May 2025 | Panel Members: Member Richard Perrignon, Dr Michael Hong, and Professor Nicholas Glozier | Body system: Psychological/Psychiatric
Motor Accidents Merit Review Decision
CLO v AAI Limited t/as GIO [2025] NSWPICMR 13
Motor Accident Injuries Act 2017; merit review regarding a dispute as to whether the injured person is an “earner” for the purposes of Schedule 1, clause 3; insurer denied payments of weekly statutory benefits on the basis that evidence was not sufficient to establish the claimant was employed at the time of the accident; claimant alleges being employed in his brother’s car business from two weeks prior to the motor accident; payslips and bank statements provided in addition to other evidence; assessment conference took place however the claimant (unrepresented) became agitated and terminated his participation in the video conference; Held – the original decision is confirmed; inconsistencies in documentary evidence such that not sufficiently satisfied the claimant was working and an earner at the time of the motor accident.
Decision date: 26 March 2025 | Merit Reviewer: Elizabeth Medland
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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