Legal Bulletin No. 219
This bulletin was issued on 11 July 2025
Issued 11 July 2025
Welcome to the two hundred and nineteenth 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.
Supreme Court Decisions
Bridge v QBE Insurance (Aust) Ltd [2025] NSWSC 702
Administrative law; application for judicial review of decisions of Delegate of President of the Personal Injury Commission and of Appeal Panel; whether Delegate obliged to give reasons for decision to refer to Appeal Panel; whether Appeal Panel gave adequate reasons and exposed its actual path of reasoning; application dismissed.
Decision date: 4 July 2025 | Before: Acting Judge Schmidt
Buestami v Allianz Australia Finance Ltd [2025] NSWSC 465
Administrative law; Judicial review – Motor Accidents Compensation Act 1999 (NSW);decisions of medical assessor and delegate of President of Personal Injury Commission on review applications; failure of Review Panel to exercise jurisdiction as required; where Review Panel issued medical assessment certificate determining plaintiff’s whole person impairment at 8%;where Review Panel failed to determine the extent of whole person impairment as it existed at the time of assessment where Review Panel failed to determine whole person impairment relating to subsequent injury and conduct appropriate calculation as required errors established medical assessment and review determination set aside; matter remitted for re-determination
Decision date: 1 July 2025 | Before: Judge Garling
Motor Accidents non-Presidential Member Decisions
Roger Carr Harris v Allianz Australia Insurance Ltd [2025] NSWPIC 298
Motor Accident Injuries Act 2017; miscellaneous assessment matter; the claimant riding electric scooter along a suburban road; hit a bump/ pothole distortion of bitumen at 20km; the scooter then throwing the claimant over the handlebars causing him to hit the roadway and slide a further 10-20 metres; single vehicle accident; insurer argued failure to keep a proper lookout; failure to take appropriate action to avoid a pothole; condition of roadway; whether the accident was caused wholly or mostly by the fault of the injured person (claimant) for the purposes of sections 3.11 and 3.28; Held – the motor accident was not caused wholly or mostly by the fault on the injured person.
Decision date: 26 June 2025 | Member: Shana Radnan
Daniel Azzopardi v QBE Insurance (Australia) Ltd [2025] NSWPIC 308
Motor Accident Injuries Act 2017; discretionary exemption application by claimant; claim not suitable for assessment at the Personal Injury Commission pursuant to section 7.34 (1)(b); basis not suitable; claim involves complex liability, fault and causation, complex factual issues; a number of non-CTP parties involved; actions in civil liability and workers compensation; accident involved operation of paving machine; related proceedings to be commenced in District Court; both claimant and insurer consent to application; Personal Injury Commission Rules 2021 rules 99(3)(a)(b) and (d); Held – claim not suitable for assessment.
Decision date: 1 July 2025 | Member: Shana Radnan
Justin Cook v AAI Ltd t/as AAMI [2025] NSWPIC 309
Motor Accident Injuries Act 2017; settlement approval under section 6.23; claimant unrepresented; injured in a motor vehicle accident when he went to assist a neighbour who had driven into a metal awning; the insured driver reversed her car pinning the claimant between the vehicle and a metal pole; suffered a left knee injury including medial meniscus tear and comminated fracture of fibula; psychological injury and secondary back injury; employed on ad hoc basis as a plant operator; not fit to return to such role; now a self-employed courier driver earning equivalent or more on an average basis; matter referred to medical services for assessment of whole person impairment prior to approval pursuant to section 7.20; no entitlement to non-economic loss; settlement of $275,000 approved.
Decision date: 2 July 2025 | Member: Elizabeth Medland
Lieberman v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 310
Motor Accident Injuries Act 2017 (MAI Act); Personal Injury Commission Act 2020 (PIC Act); dispute about claim for reasonable and necessary travel expenses to attend treatment appointments under section 3.24(1)(b) of the MAI Act; claimant sought approval for ongoing travel assistance (private not public transport) to attend treatment appointments (physio, hydro, doctors, psychologist); insurer refused; internal review affirmed original decision; matters referred to Commission as medical assessment but referred to member under Schedule 2(3)(n); insurer alleged Commission had no jurisdiction on basis section 3.24(1)(b) of the MAI Act concerns expenses incurred (past) not ongoing (future) expenses; travel to treatment must be for treatment agreed or found to be reasonable and necessary and accident related; past travel expenses had not been sought from insurer; had not been denied by insurer and had not been referred for internal review by insurer as required by s 7.41(1); Held – Commission had no power to determine dispute; proceedings dismissed under section 54(b) of PIC Act.
Decision date: 20 June 2025 | Member: Belinda Cassidy
Workers Compensation non-Presidential Member Decisions
Merlo v Everly Howison Pty Ltd [2025] NSWPIC 236
Workplace Injury Management and Workers Compensation Act 1998 ; respondent accepted applicant suffered an injury to his lumbar spine but disputed his claim for a sleep disorder maintaining the diagnosis arose solely from a pain response and not a respiratory disorder making the claim invalid; applicant maintained the claim was valid as the medical evidence demonstrated the sleep disorder was a combination of pain and the use of medications which resulted in respiratory suppression; submitted determination and interpretation of the AMA V Guidelines was the exclusive domain of Medical Assessors; Held – the sleep disorder condition is a consequential condition arising from the accepted lumbar spine injury; the cause of the sleep disorder is multifactorial and not solely arising from pain; a medical dispute exists and the claim for the lumbar spinal impairment and consequential sleep condition is to be referred to a Medical Assessor.
Decision date: 29 May 2025 | Member: Diana Benk
Alomari v All Builds Pty Ltd [2025] NSWPIC 282
Workers Compensation Act 1987 ; claim for lump sum compensation for the lumbar and cervical spine and bilateral shoulders; no dispute regarding lumbar spine and bilateral shoulder conditions; issue is whether the applicant sustained a frank injury to the cervical spine; Held – the worker suffered injury to his cervical spine; medical evidence demonstrates sudden or identifiable pathological change; Kennedy Cleaning Services Pty Ltd v Petkovska; lumbar spine; cervical spine and bilateral shoulder impairment to be assessed by a medical assessor.
Decision date: 19 June 2025 | Member: Diana Benk
Workers Compensation Act 1987; miscellaneous claims assessment; application seeking orders that the applicant was not liable to reimburse the Insurance Fund an amount specified in a notice pursuant to section 145(1); whether injury pursuant to section 4; extent of incapacity resulting from injury; whether treatment expenses reasonably necessary; credibility of injured worker’s evidence and self-reporting of symptoms; Held – finding that injury sustained; the injured worker had current work capacity for part of the period in which he was paid on the basis of no current work capacity; amount the applicant is required to reimburse the insurance fund reduced; the medical and related treatment expenses were reasonably necessary as a result of injury.
Decision date: 30 May 2025 | Member: Rachel Homan
Succar v Crate N Packing Services Pty Ltd [2025]NSWPIC 242
Workers Compensation Act (1987); whether the applicant suffered consequential conditions to his right little finger and right wrist because of an accepted injury to the index, ring and middle fingers; gaps and inconsistencies in the medical evidence; the value of contemporaneous evidence; Nguyen v Cosmopolitan Homes; Kooragang Cement Pty Ltd v Bates (Constructions) Pty Ltd; Makita (Australia) Pty Ltd v Sprowles; Held – award for the respondent for claims relating to consequential right little finger condition; found the applicant has a consequential condition of the right wrist as a result of accepted right index, ring and middle fingers; matter referred to a Medical Assessor for assessment of whole person impairment.
Decision date: 2 June 2025 | Member: Diana Benk
Wood v Workforce Recruitment and Labour Services [2025] NSWPIC 269
Workplace Injury Management and Workers Compensation Act 1998; consequential condition; claim for lump sum compensation; applicant had accepted right shoulder injury and accepted left shoulder consequential condition; whether cervical spine was consequential; applicant need not show injury; Moon v Conmah Pty Limited applied; pathology identified for cervical spine condition; Grant v Dateline Imports Pty Ltd considered; Held – applicant suffered consequential condition in cervical spine; both shoulders and cervical spine referred for assessment before a Medical Assessor.
Decision date: 16 June 2025 | Member: Parnel McAdam
Kochappan v State of New South Wales (South Eastern Sydney Local Health District) [2025] NSWPIC 280
Workers Compensation Act 1987; section 4 ; whether applicant received injury to right shoulder during workplace incident; disputed on the basis that right shoulder symptoms said to be referred from cervical spine; section 60 medical expenses claim; applicant seeks an order the respondent pay costs of, and incidental to right shoulder surgery; whether not reasonably necessary; Held – discrete right shoulder injury during workplace incident; proposed treatment for right shoulder injury is reasonably necessary as a result of the injury; respondent ordered to pay the costs of and incidental to the recommended surgery.
Decision date: 18 June 2025 | Member: Adam Halstead
Michael Chapman v Lidcombe Ice Pty Ltd [2025] NSWPIC 294
Workers Compensation Act 1987 ; claim for administration of botox injections and medicinal cannabis; whether reasonably necessary; Held – both treatments reasonably necessary; claimant had already experienced beneficial effects of both modalities; criticism by respondent that the evidence given in support by the treating specialists had merit; caution to be applied in absence of independent medico-legal opinion; in this case the botox recommendations had such support with regard to cannabis oil treatment, observations made about professionalism of expert who supplied reports on letterhead of a business, and described himself as a top industry expert; f Crouch v Electus Distribution p/l considered; Held – the claims were made out.
Decision date: 25 June 2025 | Member: John Wynyard
Workers Compensation Act 1987; claim for weekly benefits and medical or related expenses resulting from alleged psychological injury; disputed whether injury arose out of the applicant’s employment and the employment was a substantial contributing factor considered; Held – the applicant sustained a psychological injury that arose out of his employment and the employment was a substantial contributing factor to the injury; orders for payment of weekly benefits and medical or related expenses resulting from the injury; publishable decision to be de-identified in accordance with rule 132 of the Personal Injury Commission Rules 2021.
Decision date: 25 June 2025 | Member: Fiona Seaton
Falcon Manpower Solution Pty Ltd v Muzafar Ahmad Tahir [2025] NSWPIC 296
Workers Compensation Act 1987; death claim; determination of dependency and payment of death benefit and interest; Held – no dependants; order for payment of the death benefit and interest to the estate of the deceased.
Decision date: 25 June 2025 | Member: Glenn Chapel
Marcus Dunstan v El-Gra Engineering Pty Ltd [2025] NSWPIC 297
Workplace Injury Management and Workers Compensation Act 1998; section 261 six-month period for making a claim for workers compensation; claim made more than six months after injury but within three years; claim may be accepted if late claim due to ignorance, mistake or other reasonable cause; onus on applicant to establish state of knowledge; Held – more likely than not applicant decided to pursue other legal rights instead of making a claim for workers compensation; applicant failed to establish with evidence his state of knowledge within the relevant six-month period; award respondent.
Decision date: 25 June 2025 | Member: Adam Halstead
BVB v Workers Compensation Nominal Insurer (iCare) & Ors [2025] NSWPIC 299
Workplace Injury Management And Workers Compensation Act 1998; claim made for weekly benefits; credit; whether applicant a worker; failure to give notice of injury/make claim; whether applicant sustained a psychological injury; section 344 costs application; Held – applicant was a worker and sustained a psychological injury; no adverse credit finding; any failure to give notice/make claim not a bar to recovery; application for costs indemnity under section 344(1)(c) declined; first respondent to pay applicant weekly benefits.
Decision date: 26 June 2025 | Member: Fiona Seaton
Blake Brian Lisson v State of New South Wales (NSW Police Force) [2025] NSWPIC 300
Workers Compensation Act 1987 (WC Act); Workplace Injury Management and Workers Compensation Act 1998 (WIMWC Act); applicant a police officer; claim for various physical injuries and a psychological injury; physical injuries alleged to be due to nature and conditions of employment; whether applicant suffered an injury within the meaning of section 4 of the WC Act; psychological injury due to exposure to various trauma; diagnosis of PTSD; claim not made until 8 years after employment ceased; section 254 and 261 of the WIMWC Act; applicant claimed entitlement to dual benefits; Held – award for the respondent for physical injuries; applicant had failed to make a claim due to ignorance, mistake or other reasonable cause; weekly payments awarded for psychological injury.
Decision date: 27 June 2025 | Member: Parnel McAdam
Jarrod Christopher Bryce v Qantas Airways Ltd [2025] NSWPIC 301
Workers Compensation Act 1987; claim for weekly compensation and surgery costs; applicant long-term pilot; alleged work-related aggravation of cervical spine pathology resulting in disc herniation; respondent denied injury; whether employment was the main contributing factor to aggravation under section 4(b)(ii); not underlying condition; Federal Broom v Semlitch, Australian Conveyor v Mecha, and Dayton v Coles considered; only one main contributing factor required; causation assessed via commonsense approach; Kooragang Cement applied; lay and medical evidence supported gradual onset linked to work; discectomy found reasonably necessary; weekly compensation awarded at statutory rate subject to indexation; surgery costs payable; respondent credited for prior payments; applicant re-credited sick leave; Held - The applicant’s work suffered an injury incapacity in the course of his employment; the respondent must pay statutory maximum weekly compensation, surgery costs, and necessary medical expenses.
Decision date: 27 June 2025 | Member: Cameron Burge
Mateo Alofaki v Southern Steel Group Pty Ltd [2025] NSWPIC 302
Workers Compensation Act 1987; claim for weekly compensation and treatment expenses for ulceration of toes and osteomyelitis caused by rubbing of steel capped boots on dorsum of the toes; applicant had pre-existing diabetes and peripheral neuropathy; whether employment was the main contributing factor to an aggravation of a disease; extent of incapacity resulting from injury as opposed to ongoing diabetic condition; Held – the applicant sustained an injury pursuant to section 4(b)(ii); the applicant did not discharge his onus of demonstrating incapacity resulting from the injury in the period of weekly compensation claimed; award for the applicant for medical and related treatment expenses.
Decision date: 27 June 2025 | Member: Rachel Homan
Mu Guang Lin v Axis Commercial Pty Ltd Atf Axis Commercial Unit Trust [2025] NSWPIC 303
Workers Compensation Act 1987; claim for lump sum compensation; accepted injury to left leg which required multiple surgical procedures; whether worker suffered a personal injury or aggravation of a disease in respect of the lumbar spine; mechanism of injury; inconsistency in reporting of injury; injury simpliciter; relevance of contemporaneity of evidence; whether opinions prepared in a ‘fair climate’; evidence of causation; Container Terminals Australia Ltd v Huseyin; Mason v Demasi, State of New South Wales (Department of Primary Industries v Legrand ; Rail Services Australia v Dimovski & Anor; Military Rehabilitation and Compensation Commission v May; Kennedy Cleaning Services Pty Ltd v Petkoska considered and applied; Held – applicant discharged onus of proof that he suffered an injury to his lumbar spine pursuant section 4(a) and (b); matter remitted to the President for referral to a Medical Assessor for assessment of whole person impairment pursuant to section 66.
Decision date: 30 June 2025 | Member: Kathryn Camp
Steven Denshire v Medecins Sans Frontieres Australia Ltd [2025] NSWPIC 304
Workers Compensation Act 1987; past and future treatment; whether treatment reasonably necessary; applicant claimed medical expenses pursuant to section 60; being medicinal cannabis for the treatment of post-traumatic stress disorder; no opinion provided from a psychiatrist; Diab v NRMA Ltd applied; Held – applicant failed to satisfy on balance of probabilities; medicinal cannabis not reasonably necessary; award for the respondent.
Decision date: 1 July 2025 | Member: Parnel McAdam
Rachael Ellen Hull v Estia Health [2025] NSWPIC 305
Workers Compensation Act 1987; claim for compensation for medical treatment pursuant to section 60; accepted work injury to cervical spine; applicant claimed compensation for cost of C5/6 and C6/7 anterior cervical discectomy and fusion surgery; whether the surgery was reasonably necessary as a result of the accepted injury; Held – C5/6 and C6/7 anterior cervical discectomy and fusion surgery is reasonably necessary treatment as a result of the accepted cervical spine injury; order that the respondent to pay the costs of and incidental to the surgery pursuant to section 60.
Decision date: 1 July 2025 | Member: Karen Garner
Elizabeth Borg v Le Mac Personnel Pty Ltd [2025] NSWPIC 306
Workers Compensation Act 1987; right ulnar nerve condition; claimant performed heavy and repetitive work over five years causing various injuries and resultant surgeries; right arm condition developed following left arm surgery; medical evidence supported possible link between overuse and medical condition; lack of scientific precision does not prevent finding on balance of probabilities; EMI (Australia) Pty Ltd v Bes applied; evidence of over-use and temporal connection with development of right arm symptoms sufficient to establish causal connection; ongoing right ulnar condition causatively related to work injuries; injury is a material contributing factor to the ongoing condition; Murphy v Allity Management Services Pty Ltd applied; Held – applicant entitled to costs of surgery for right ulnar nerve transposition.
Decision date: 1 July 2025 | Member: Principal Member John Harris
Geoffrey John Geale v KJR Piping Pty Ltd [2025] NSWPIC 307
Workers Compensation Act 1987; claim for permanent impairment lump sum compensation pursuant to section 66; accepted injury to bilateral knees, bilateral elbows, right shoulder and scarring, left shoulder and scarring; whether applicant sustained injury pursuant to sections 4(a) and 9A to the cervical spine, lumbar spine and nervous system; Held – not satisfied on the balance of probability that the applicant sustained injury pursuant to sections 4(a) and 9A to the cervical spine, lumbar spine and nervous system; matter remitted to the President to be referred to a Medical Assessor for assessment of whole person impairment (WPI) in respect of the accepted injuries.
Decision date: 1 July 2025 | Member: Karen Garner
Motor Accidents Medical Review Panel Decisions
Vella v Allianz Australia Insurance Ltd [2025] NSWPICMP 449
Motor Accident Injuries Act 2017; claimant’s review of Medical Assessment Certificate (MAC) under section 7.26; threshold injury dispute; psychiatric injury; claimant involved in rear-end collision; physical injuries assessed as soft tissue; claimant had pre-existing anxiety disorder and developed some post-traumatic symptoms; Medical Assessor diagnoses adjustment disorder which was a threshold injury.; Review Panel considered diagnoses of adjustment disorder, posttraumatic stress disorder and major depressive disorder; Held – claimant sustained an adjustment disorder and did not satisfy criteria for other possible diagnoses raised by health practitioners; adjustment disorder is a threshold injury; MAC confirmed.
Decision date: 25 June 2025 | Panel Members: Member Belinda Cassidy, Dr Alan Doris, and Dr Wayne Mason| Injury module: Mental and Behavioural
Caldwell v Allianz Australia Insurance Ltd [2025] NSWPICMP 437
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); ; assessment of treatment and care; causation; shoulder surgery; improved symptoms following disputed surgery; impact of exacerbating injuries; persistent symptoms to right shoulder; arthroscopic debridement and lateral clavicle excision; variable but persistent symptoms since accident; injury caused or materially contributed to by motor vehicle accident; meaning of reasonable and necessary; claimant always symptomatic and suffering pain; Held –treatment and care relate to the injuries and reasonably necessary; MAC confirmed.
Decision date: 19 June 2025 | Panel Members: Member Hugh Macken, Dr Shane Moloney, and Dr Drew Dixon| Treatment Type: Surgery
Sarofim v Allianz Australia Insurance Limited [2025] NSWPICMP 434
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); degree of permanent impairment disputes; claimant was driving; claimant had been to have her eyes checked that morning; claimant’s vehicle was stationary waiting to turn left when the insured utility vehicle ran into the back of the claimant’s vehicle at speed; claimant believes that the insured driver did not see her vehicle; claimant was wearing a seatbelt; her airbags did not deploy; claimant recalls a jolt and her head striking the back headrest at the time of the collision; claimant was diagnosed with a right vitreous detachment with no retinal complications; claimant suffered various other physical injuries; after carefully reviewing the evidence and examining the claimant; Held – the Review Panel was not satisfied that the claimant’s posterior vitreous detachments were caused by the accident; claimant did not provide any expert evidence to the contrary; vitreous detachment in right eye not diagnosed in right eye until 3 months post-accident; vitreous detachment in left eye not diagnosed until later; MAC confirmed.
Decision date: 19 June 2025 | Panel Members: Member Gary Victor Patterson, Dr Malcolm Capon, Dr Ian Webster| Injury module: Visual system
AAI Ltd t/as Suncorp Insurance v Jannings [2025] NSWPICMP 403
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); degree of permanent impairment disputes; claimant was a pillion passenger on a motorcycle; claimant was wearing a helmet; insured vehicle collided with the motorcycle; claimant was thrown off the motorcycle and may have lost consciousness briefly; insurer’s IME found 0% whole person impairment (WPI); Medical Assessor certified 15% WPI for injuries to the cervical spine, lumbar spine, left shoulder and scarring; Review Panel made different findings in relation to the cervical and lumbar spine; Review Panel certified 6% WPI; no issues to principle; Held – MAC revoked; new certificate issued.
Decision date: 6 June 2025 | Panel Members: Member Gary Victor Patterson, Dr Margaret Gibson, and Dr Ian Cameron| Injury module: Spine, Limb, Skin
AAI Ltd t/as Suncorp Insurance v Corish [2025] NSWPICMP 400
Motor Accident Injuries Act 2017;review of Medical Assessment Certificate (MAC); Review Panel assessment threshold injury; muscular tears within gluteus maximus; distinct issue as to injury and body part; tear in right glute; no requirement for further examination; intramuscular tears; tear in muscle is not analogous to a tear in a tendon; Held – no evidence of damage to a tendon; intramuscular means the tears were situated inside the muscle; no evidence of the existence of a parcel or complete rupture of tendon; threshold injury; MAC revoked; new certificate issued.
Decision date: 5 June 2025 | Panel Members: Member Hugh Macken, Dr Margaret Gibson, Dr Christipher Oates| Injury module: Visual system
Vincenzo Sellaro v QBE Insurance (Australia) Ltd [2025] NSWPICMP 455
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); degree of permanent impairment dispute; claimant was in his usual workspace standing next to a bench; fellow employee drove a forklift and over the claimant’s left foot causing a severe crush injury; Medical Assessor found 11% whole person impairment (WPI) for left lower extremity and surgical scarring; Review Panel adopted different methodology for assessment of left lower extremity; proper application of clause 6.85 of the Guidelines; Held – Review Panel found dysmetria arising from chronic antalgic gait caused by subject accident; Review Panel assessed 12% WPI; MAC revoked; new certificate issued.
Decision date: 26 June 2025 | Panel Members: Member Gary Victor Patterson, Dr David Gorman, Dr Shane Moloney| Injury module: Foot, Spine, Knee, Scarring, Psychiatric condition
David Roberts v QBE Insurance (Australia) Ltd [2025] NSWPICMP 456
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) determined the claimant’s whole person impairment (WPI) as a result of the accident was 19%; insurer made an application under section 7.26 for referral of assessment to the Review Panel; the Review Panel conducted its own examination and found that WPI as a result of injuries sustained in the accident totalled 3%; Held – MAC revoked; Review Panel substituted a 3% WPI as a result of the accident.
Decision date: 26 June 2025 | Panel Members: Member Terrence Stern OAM, Dr Sophia Lahz, Dr Margaret Gibson | Injury module: Spine, Shoulder, Hip, Knee, Leg, Psychiatric condition
Mary Minna v AAI Ltd t/as GIO [2025] NSWPICMP 457
Review of medical assessment; review of Medical Assessment Certificate (MAC); assessment of treatment and care; causation; exacerbation of persistent depressive disorder; threshold injury; prior back injury; multiple medical issues; proposed surgical procedures; lengthy history of psychological and psychiatric difficulties; no ongoing psychiatric or psychological treatment; long history of depressive and anxious symptoms; chronic adjustment disorder related to long-standing pain and various psychosocial stressors; symptoms not consistent with a more pervasive mood disorder or anxiety disorder; no recognised psychiatric illness; exacerbation of depressive disorder; eight sessions of psychological therapy did arise because of the aggravation of symptoms; Held – therapy entirely appropriate for the symptoms which developed; psychological therapy considered reasonable and necessary; MAC revoked.
Decision date: 26 June 2025 | Panel Members: Member Hugh Macken, Dr Michael Hong, Dr Matthew Jones| Injury module: Psychiatric condition
Charbil Aflak v Insurance Australia Ltd t/as NRMA Insurance [2025] NSWPICMP 458
Medical Review Panel; review of Medical Assessment Certificate (MAC); right knee injury; whether proposed arthroscopic surgery and MRI imaging were reasonable and necessary and causally related to the motor accident; claimant sustained posterior horn and root tear of medial meniscus with intra-articular loose bodies; Review Panel accepted traumatic causation and progressive mechanical symptoms following high-impact rear-end collision; insurer contended pathology was degenerative and surgery not clinically justified; treating surgeon recommended partial meniscectomy to relieve mechanical irritation; insurer’s own review accepted accident-related injury but denied MRI on utility grounds; Review Panel found imaging appropriate to guide surgical planning and intervention; Held – both arthroscopic surgery and MRI imaging were causally related to the motor accident and reasonable and necessary in the circumstances; MAC confirmed.
Decision date: 27 June 2025 | Panel Members: Member Bridie Nolan, Dr Drew Dixon, Dr Shane Moloney| Treatment Type: Surgery, Radiological Investigations
Raviteja Bollineni v AAI Ltd t/as GIO [2025] NSWPICMP 459
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of degree of permanent impairment; pedestrian hit by car; right thigh haematoma; right knee reconstruction; difficulty with activities of daily living; mild laxity, medial collateral ligament; retro patellar crepitus; sensory loss in the right knee; multiple visible scars around the right knee; reduced range of motion right knee; wasting of the right leg; claimant walks with a limp; scarring including dimpling (loss of contour); Held – MAC revoked; new MAC issued with 12% whole person impairment.
Decision date: 27 June 2025 | Panel Members: Member Hugh Macken, Dr Christopher Oates, Dr Drew Dixon | Injury module: Knee, Thigh, Scarring, Leg
Seonyi Park v QBE Insurance (Australia) Ltd [2025] NSWPICMP 463
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury dispute; consideration of impact of previous head injury; claimant examined; Held – no previous psychological symptoms or injuries; major depressive disorder with anxious stress caused by the accident; non-threshold injury; MAC confirmed.
Decision date: 30 June 2025 | Panel Members: Member Montgomery-Hribar, Dr Ankur Gupta, Dr Christopher Canaris| Injury module: Psychiatric
Young Joon Park v AAI Ltd t/as AAMI [2025] NSWPICMP 464
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); Panel Review of medical assessment as to whether injuries caused by the accident give rise to a permanent impairment of greater than 10%; radiology demonstrates widespread degenerative changes in the cervical and lumbar spines; originally found that accident did not cause disc degeneration of the spine; left shoulder has cuff tear and originally found as not related; Held – accident did not cause disc pathology to the cervical and lumbar spine; accident caused aggravation to pre-existing changes; accident did not cause cuff tear as no acute pain in the left shoulder at the time of the accident; whole person impairment assessed at 7%; MAC confirmed.
Decision date: 30 June 2025 | Panel Members: Member Elizabeth Medland, Dr David Gorman, Dr Margaret Gibson | Injury module: Spine, Knee, Shoulder, Scarring, Psychiatric Condition
Slavko Berber v AAI Ltd t/as GIO [2025] NSWPICMP 469
Motor Vehicle Injuries Act 2017; review of Medical Assessment Certificate (MAC); theclaimant was injured in a motor vehicle accident; a medical dispute arose as to whether the physical injuries sustained were threshold injuries; the claimant sought a review of the medical assessment under section 7.26; the Review Panel conducted an examination and considered the factors contributing to the injury according to section 6.6 of the Guidelines; Held – MAC confirmed; the Review Panel determined that the claimant had sustained a traumatic injury to his right shoulder in the accident, but that it was a non-threshold injury; the Review Panel determined that the injuries to the claimant’s cervical spine, left shoulder and lumbar spine were threshold injuries.
Decision date: 1 July 2025 | Panel Members: Member Terrence Stern OAM, Dr Les Barnsley, Dr Mohammed Assem| Injury module: Spine, Shoulder
AAI Ltd t/as GIO v Ahmet Duran Pinarbasi [2025] NSWPICMP 470
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant suffered injury in a motor accident when the bus he was driving was hit in the rear by another bus; dispute about whether the injuries caused by the accident were threshold injuries; whether the motor accident caused a rotator cuff tear in the right shoulder; mechanism of injury; absence of direct trauma or abnormal shoulder movement; delayed reporting or lack of evidence of early reporting of symptoms in the right shoulder; McTye v Ching Yu Chang by his tutor Leo Alexander Birch considered; Held – MAC revoked; injury to the right shoulder not caused by the motor accident.
Decision date: 1 July 2025 | Panel Members: Member Maurice Castagnet, Dr Les Barnsley, Dr Mohammed Assem| Injury module: Spine
Suzana Dragicevic v Insurance Australia Ltd t/as NRMA Insurance [2025] NSWPICMP 474
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant suffered injury in a motor accident; dispute about whether the injuries caused by the accident were threshold injuries; whether the motor accident caused a SLAP tear in the left shoulder; whether the motor accident caused an annular tear in the thoracic disc between T6 and T7; Held – MAC revoked; injury to the thoracic spine is not a threshold injury.
Decision date: 2 July 2025 | Panel Members: Member Maurice Castagnet, Dr Leslie Barnsley, Dr Margaret Gibson | Injury module: Spine, Shoulder, Psychiatric condition
Workers Compensation Medical Appeal Panel Decisions
T.N.T. Plumbing & Drainage Pty Ltd v Jeffery Auburn Robinson [2025] NSWPICMP 452
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant employer alleges error by Medical Assessor in failure to adequately explain and apply the provisions of section 323 having regard to periods when the worker was self-employed and exposed to noise; consideration of the linear method when assessing hearing loss due to exposure noise during employment both inside and outside of New South Wales; Cuskelly v New England Milk Industries Pty Ltd considered; Held – there was a demonstrable error in the Medical Assessment Certificate by the failure to properly explain the one-tenth deduction for hearing loss during periods of self-employment; Appeal Panel found that one-tenth as provided for by section 323(2) is appropriate; MAC confirmed.
Decision date: 25 June 2025 | Panel Members: Member John Isakesen, Dr Paul Niall, Dr Thandavan Raj | Body system: Hearing loss
Sanaz Captanis v Swarovski Australia Pty Ltd [2025] NSWPICMP 453
Workplace Injury Management and Workers Compensation Act 1998; psychological injury; review of Medical Assessment Certificate (MAC); appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of assessments under three of the psychiatric impairment rating scale (PIRS) categories self-care and personal hygiene, social functioning and employability; Held – Appeal Panel found error in the categories of social function (which was assessed as Class 1 and should have been assessed as Class 2) and employability (which was assessed as Class 3 and should have been assessed as Class 5); MAC revoked.
Decision date: 26 June 2025 | Panel Members: Member Jane Peacock, Dr Michael Hong, Dr Nicholas Glozier| Body system: Psychological/ Psychiatric
Nik Diesel Jayden v Ikea Pty Ltd [2025] NSWPICMP 454
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); the appellant submits that the Medical Assessor erred in his whole person impairment (WPI) assessment of three of the categories of the psychiatric impairment rating scale (PIRS), namely social and recreational activities, travel and employability; Held – no error with the assessments for any category; appellant’s submissions often misguided, and the appellant seeks to cavil with matters of clinical judgment; MAC confirmed.
Decision date: 26 June 2025 | Panel Members: Member Deborah Moore, Dr Douglas Andrews, Dr Michael Hong | Body system: Psychological/ psychiatric
Nicole Cormack v Alpha Personnel Pty Ltd [2025] NSWPICMP 461
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of the left upper extremity and cervical spine; challenged on appeal by the worker based on inadequacy of examination findings and reasons, and application of incorrect criteria; Held – Appeal Panel found error and considered a re-examination was necessary in the circumstances; MAC revoked.
Decision date: 27 June 2025 | Panel Members: Member Jane Peacock, Dr Roger Pillemer, Dr Gregory McGroder | Body system: Cervical Spine, Left upper extremity
Woolworths Group Ltd v Renae Lynne Tucker [2025] NSWPICMP 462
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether medical dispute included the degree of permanent impairment the respondent has from an injury to her left wrist; whether medical dispute included permanent impairment the respondent has of left wrist from an injury to her left hand; whether Medical Assessor (MA) erred by assessing permanent impairment of respondent’s left wrist; Held – Appeal Panel held medical dispute did not involve an injury to respondent’s left wrist or include degree of her permanent impairment of her left wrist from a left hand injury and MA was consequently wrong to assess impairment of respondent’s left wrist; MAC revoked.
Decision date: 27 June 2025 | Panel Members: Member Marshal Douglas, Dr Drew Dixon, Dr Marshal Douglas | Body system: Left Upper Extremity, Right Upper Extremity
Workers Compensation Nominal Insurer v Robert Warner [2025] NSWPICMP 465
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); Medical Assessor (MA) found no section 323 deduction in Table 2 certificate but at [11] held there should be a 1/10 deduction; scarring assessed when not in the referral; parties agreed that scarring was not part of the dispute; Held – MAC conclusive that no deduction was appropriate except for [11] which contradicted MA findings as to there being no background of contributory underlying degenerative changes by asserting that there was a background of an asymptomatic arthritic condition; no such condition was reported in the present case and contents of [11] the result of inadvertent error; MAC revoked.
Decision date: 30 June 2025 | Panel Members: Member John Wynyard, Dr Todd Gothelf, Dr Margaret Gibson | Body system: Lumbar Spine, Lower extremity
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC) application and rating of psychiatric impairment rating scale (PIRS) categories; whether the MAC contained incorrect criteria or contained a demonstrable error; the respondent worker suffered an accepted psychological injury which was referred for medical assessment; she was assessed as suffering a 15% whole person impairment (WPI); the employer appealed from the Medical Assessor’s (MA) findings in relation to three of the six PIRS categories, namely social functioning, concentration, persistence and pace, and employability; Held – the Appeal Panel determined the MAC contained an obvious error in that the MA’s classification of the respondent worker’s social functioning and employability were plainly contrary to the evidence before him including but not limited to the statement evidence of the respondent herself; MAC revoked; new certificate issued.
Decision date: 30 June 2025 | Panel Members: Member Cameron Burge, Dr Douglas Andrews, Dr Nicholas Glozier | Body system: Psychiatric condition
Shantelle Meehan v K Iby & E.I Wallace T/As Foxxy Studios [2025] NSWPICMP 467
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); the appellant submits that the Medical Assessor erred in his assessments under the psychiatric impairment rating scale (PIRS) in respect of employability; Held – the Review Panel agreed; the evidence supported a higher rating; MAC revoked.
Decision date: 30 June 2025 | Panel Members: Member Deborah Moore, Dr Douglas Andrews, Dr John Lam-Po-Tang | Body system: Psychological/ Psychiatric
Peter Bradbury v State of New South Wales (NSW Police Force) [2025] NSWPICMP 471
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); motor vehicle accident accepted as having caused aggravation of pre-existing condition which led to multiple strokes; Medical Assessor (MA) asked to assess nervous system; Held – MA failed to assess whole person impairment (WPI) because he considered that the strokes were not a result of the injury; Procedural Direction PIC 6 clause 29; re-assessment required; MAC revoked.
Decision date: 1 July 2025 | Panel Members: Member Catherine McDonald, Dr Michael Davies, Dr Sophia Lahz | Body system: Nervous system
Cerebral Palsy Alliance v Raeleen Thorburn [2025] NSWPICMP 472
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal against Medical Assessor (MA) decision regarding the provisions of Chapter 2.20 of the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment Guides relating to contralateral joints; whether MA erred by accepting a new history during the assessment that the applicant had suffered an injury to her contralateral left shoulder; present dispute concerning the right shoulder, when such a history not otherwise apparent in the material before MA; whether MA had gone outside the terms of the referral; Held – function of MA to form and give opinion on own expertise and experience; Wingfoot applied and significance or otherwise of issues raised in face-to- face consultation a matter for judgement by MA; Ferguson applied; MA judgement in accepting new history reasonable; worker consistent and no fresh evidence advanced seeking to dispute left shoulder injury; MAC revoked.
Decision date: 1 July 2025 | Panel Members: Member John Wynyard, Christopher Oates, James Bodel | Body system: Right Upper Extremity, Scarring
Hope Sullivan v Warrigal Care [2025] NSWPICMP 473
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of the left lower extremity and lumbar spine; left lower extremity of 0% whole person impairment (WPI) challenged on appeal by the worker on the basis of inadequacy of reasons and application of incorrect criteria; Appeal Panel could not discern error; the Medical Assessor (MA) has assessed on the basis of correct criteria on the basis of MA’s examination findings upon which they are entitled to rely; MA reasoning was adequately explained; MAC confirmed.
Decision date: 1 July 2025 | Panel Members: Member Jane Peacock, Dr Roger Pillemer, Dr Tim Anderson | Body system: Lumbar Spine, Left Lower Extremity (knee)
Motor Accidents Merit Review Decisions
Luke Ziegeler v Allianz Australia Insurance Ltd [2025] NSWPICMR 21
Motor Accident Injuries Act 2017 (MAI Act); Personal Injury Commission Act 2020 (PIC Act); costs dispute arising from statutory benefits claim; application for merit review of reasonable and necessary costs; substance of application required consideration of exceptional circumstances; issue of jurisdiction; consideration of Allianz Australia Insurance Limited v Rymer [2022] NSWPICMRP 6; guiding principle of PIC Act considered and applied; section 8.10(4) of MAI Act and meaning of “exceptional circumstances” considered; San v Rumble (No 2), Ho v Professional Services Review Committee No 295, AAI Ltd trading as GIO v Moon; and Yacoub v Pilkington (Australia) Ltd [2007] NSWCA 290 considered; whether costs reasonable and necessary; Held – not satisfied of existence of exceptional circumstances; legal costs up to maximum provided in the Motor Accident Injuries Regulation 2017 reasonable and necessary; no costs of merit review application.
Decision date: 27 June 2025 | Merit Reviewer: Montogomery-Hribar
CON v AAI Ltd t/as GIO [2025] NSWPICMR 18
Motor Accident Injuries Act 2017; miscellaneous claims assessment; insurer’s merit review application challenging entitlement to statutory benefits under Division 3.3; claimant alleged injuries from motor vehicle accident but did not remain at the scene; personal injury benefits claim lodged later; claimant’s explanations found inconsistent and implausible; Held – injury did not result from a motor vehicle accident in this state; claimant not entitled to statutory benefits under section 3.1.
Decision date: 23 June 2025 | Merit Reviewer: David Ford
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