Legal Bulletin No. 234
This bulletin was issued on 24 October 2025
Issued 24 October 2025
Welcome to the two hundred and thirty fourth edition of the Personal Injury Commission’s Legal Bulletin. Please see here for details about the legal citations used for the Commission’s decisions. The decisions listed below are now available on AustLII and will be available shortly, on Jade and Lexis Nexis. Any legislative updates are provided at the base of the Bulletin.
Presidential Member Decisions
Shlimon v Steric Pty Ltd [2025] NSWPICPD 70
Workers compensation; consideration of deemed date of injury for a disease pursuant to section 15(1) of the Workers Compensation Act 1987; section 322(2) and (3) of the Workplace Injury Management and Workers Compensation Act 1998; Ozcan v Macarthur Disability Services Ltd [2021] NSWCA 56 considered and applied; Held – the Certificate of Determination dated 4 June 2025, subject to the following amendment, is confirmed; I amend Order 2 of the Certificate of Determination to insert the word “respiratory” immediately before the word “urinary” in that Order.
Decision date: 10 October 2025 | Before: President Judge Phillips
Investment Management Group Hotels Resources Pty Ltd v Barrow [2025] NSWPICPD 71
Workers compensation; relationship between the Workers Compensation Guidelines and section 119 of the Workplace Injury Management and Workers Compensation Act 1998; University of New South Wales v Lee [2021] NSWPICPD 4 considered and applied; no error in not dealing with a submission that was never put; Metwally v University of Wollongong [1985] HCA 28 applied; it is not permissible to read words into the legislation; Taylor v The Owners - Strata Plan No 11564 [2014] HCA 9 applied; adequacy of reasons; Sarian v Elton [2011] NSWCA 123; Beale v Government Insurance Office (NSW) (1997) 48 NSWLR 430 applied; Held – leave to appeal the interlocutory decision of the Member pursuant to section 352(3A) of the Workplace Injury Management and Workers Compensation Act 1998 is granted; the Member’s Certificate of Determination dated 19 August 2025 is confirmed; the matter is remitted to the same Member of the Commission for determination of the outstanding matters in dispute.
Decision date: 13 October 2025 | Before: Deputy President Elizabeth Wood
Brooks Farms Pty Ltd v Summers [2025] NSWPICPD 72
Workers compensation; Pre-Filing Statement struck out by order of the President; sections 151DA(3) and 151DA(4) of the Workers Compensation Act 1987 considered and applied; Luke v McCarthy [2008] NSWWCCPD 123 applied; Held – the respondent claimant’s Pre-Filing Statement dated 6 August 2024 is struck out pursuant to section 151DA(3) of the Workers Compensation Act 1987; no order as to costs.
Decision date: 15 October 2025 | Before: President Judge Phillips
Motor Accidents non-Presidential Member Decisions
Torbay v AAI Limited t/as AAMI [2025] NSWPIC 541
Motor Accident Injuries Act 2017; claimant suffered injury; the medical dispute related to whether the claimant sustained a non-threshold injury; a Medical Assessor (MA) found that the claimant suffered a non-threshold psychological injury; that medical assessment was not the subject of review and accepted by the insurer; another MA found that the physical injuries were threshold injuries; claimant sought to review that assessment; dismissal application exercised sparingly and with exceptional caution; Insurance Australia Ltd v Fayed applied; present review application restricted to threshold dispute which was no longer in issue; any response by the Review Panel on this dispute is not conclusive on the medical assessment matter pertaining to other disputes; Owen v Motor Accidents Authority, Allianz Australia Insurance Ltd v Girgis, Brown v Lewis, and Pham v Shui applied; Held – the application to review the medical assessment dismissed as frivolous and/or vexatious; the maintenance of the proceedings achieves no purpose in changing the outcome of the medical dispute.
Decision date: 10 October 2025 | Principal Member: John Harris
Insurance Australia Limited t/as NRMA Insurance v Fraser [2025] NSWPIC 542
Motor Accident Injuries Act 2017; settlement approval; claimant was a rear seat passenger in a motor vehicle in which the insured driver lost control and the vehicle collided with a cement culvert and tree; claimant sustained extensive bruising, cuts, and abrasions to the legs and hips, and a partially torn anterior cruciate ligament of the left knee; at the time of the accident he was a school student then commenced an apprenticeship as a heavy diesel mechanic; completed nearly three years of the apprenticeship but was unable to continue and ceased the apprenticeship; subsequently obtained employment as a farmhand which involves work planting crops and tractor driving; suffers from continuing back pain but has been able to play rugby union and attend a gym on a regular basis; sustained a non-threshold injury; insurer admitted liability; no entitlement to non-economic loss; claim for past and future economic loss; the total amount of damages proposed is $100,000 on a buffer basis; Held – the proposed settlement is just, fair and reasonable; settlement approved under section 6.23(2)(b).
Decision date: 13 October 2025 | Member: David Ford
AAI Limited t/as GIO v Yin [2025] NSWPIC 543
Motor Accident Injuries Act 2017; miscellaneous claims; settlement approval; motor vehicle accident whilst travelling on a bus; sudden breaking causing claimant to fall; left distal third humoral fracture; requirement for surgical repair; subsequent surgery to remove plate and screws; minor weakness and loss of abduction in left shoulder; concerns about heavy lifting or re-injuring arm; no entitlement to non-economic loss; calculation of past economic loss foreclosed period; allowance more than adequately covers loss including employer, and superannuation contribution; possible difficulties with left arm; restrictions on working as a geologist and undertaking fieldwork; adverse effect on post-accident employment tasks; calculation of basis of buffer for future economic loss; no allowance for past treatment as no recovery sought by insurer; provisions and claim processes in place for future treatment expenses; no requirement for voluntary or commercial domestic assistance; insurer to have credit for payments made for lost wages; Held – settlement approved.
Decision date: 13 October 2025 | Member: Hugh Macken
Liton v Allianz Australia Insurance Limited [2025] NSWPIC 547
Motor Accident Injuries Act 2017; claim for statutory benefits; consideration of section 6.13; dispute regarding whether claimant has a full and satisfactory explanation for delay in making claim; Karambelas v Zaknic (No 2), and Rahman v Al-Maharmeh considered and applied; consideration of full and satisfactory explanation; claim made within three years after date of the motor vehicle accident; Held – claimant’s explanation is full and satisfactory; claim made within three years of date of accident; claim may be made.
Decision date: 15 October 2025 | Member: Bianca Montgomery-Hribar
Alibabic v AAI Limited t/as GIO [2025] NSWPIC 548
Motor Accidents Compensation Act 1999 (MAC Act); Personal Injury Commission Act 2020 (PIC Act); the Medical Assessor assessed claimant at 2% and found none of the treatment was caused by the accident; claimant review of medical assessment; matter referred to Review Panel; Review Panel required to re-examine to determine issue; claimant failed to attend medical examination, failed to explain her non-attendance, and did not respond to directions from Review Panel; claimant provided with further opportunity to respond and did not reply to direction; Held – dismissal application exercised sparingly and with exceptional caution; Perera v Genworth Financial Mortgage Insurance Pty Ltd applied; application for review of the medical assessment dismissed pursuant to section 54 of the PIC Act due to a failure to prosecute proceedings with due dispatch and failure to respond to directions.
Decision date: 17 October 2025 | Principal Member: John Harris
Workers Compensation non-Presidential Member Decisions
Schweikert v State of New South Wales (Mid North Coast Local Health District) [2025] NSWPIC 394
Workers Compensation Act 1987; weekly payments and medical expenses claim; the applicant suffered an accepted left shoulder injury in the course of her employment; claimant also claimed a cervical spine injury in the nature of an aggravation to underlying pathology which was disputed; Held – the applicant suffered cervical spine and left shoulder injury in the course of her employment with the respondent; as a result of her injury the applicant suffered ongoing partial incapacity for the period claimed; the surgery carried out to the applicant’s neck was reasonably necessary as a result of her injury; the respondent is to pay the applicant weekly compensation on an ongoing basis in respect of a partial incapacity, and for the costs of and incidental to the neck surgery.
Decision date: 11 August 2025 | Member: Cameron Burge
Bradshaw v Newcastle Recycling Group Pty Ltd [2025] NSWPIC 330
Workers Compensation Act 1987; whether the applicant suffered consequential conditions to his left wrist and hand as a result of accepted injury to the left shoulder, elbow, and radial nerve; the value of contemporaneous evidence; Nguyen v Cosmopolitan Homes, Kooragang Cement Pty Ltd v Bates, and Makita (Australia) Pty Ltd v Sprowles considered; Held – the applicant has consequential conditions to the left hand and wrist arising out of surgical complications to the left upper extremity; an unbroken chain of causation was found; matter referred to a Medical Assessor for assessment of whole person impairment of left shoulder, elbow, radial nerve, wrist, hand, and scarring.
Decision date: 10 July 2025 | Member: Diana Benk
CNN v State of New South Wales (Northern Sydney Local Health District) [2025] NSWPIC 526
Workers Compensation Act 1987; claim for psychological injury within section 4(b); Held – award for the respondent as applicant did not establish that employment was the “main contributing factor” to any aggravation; discussion regarding treating notes and how they should be interpreted; applicant and family members names to be de-identified due to sensitive nature of the medical evidence.
Decision date: 7 October 2025 | Senior Member: Elizabeth Beilby
Zovidavi v Pro-Pac Packaging (Aust) Pty Ltd [2025] NSWPIC 529
Workers Compensation Act 1987; permanent impairment compensation; whether the applicant suffered injuries in the nature of disease processes to his lumbar spine, right knee and/or ankle in addition to accepted frank injuries to those body systems; applicant suffered accepted frank injuries to his lumbar spine and right lower extremity; also claims injuries in the nature of disease processes or aggravations of disease processes to the same body systems; respondent denies liability in relation to the claimed disease injuries; Held – applicant suffered disease injury to his right lower extremity (knee) and lumbar spine; applicant also suffered frank injuries to these body systems and to his right ankle; award for the respondent on the claim for disease injury to the right ankle; matter remitted to President for referral of above injuries to medical assessor to determine degree of permanent impairment; questions of aggregation are adjourned for further preliminary conference post-medical assessment certificate.
Decision date: 7 October 2025 | Member: Cameron Burge
Harvey v State of New South Wales (NSW Police Force) [2025] NSWPIC 530
Workers Compensation Act 1987; section 11A(1) and section 60; consequential condition; Trustees of the Roman Catholic Church for the Diocese of Parramatta v Brennan, Moon v Conmah Pty Limited, Kooragang Cement Pty Ltd v Bates, and Briginshaw v Briginshaw cited and applied; Held – the applicant has sustained a consequential condition of the left knee as a result of the accepted right knee injury; the respondent to pay the applicant’s reasonably necessary medical and treatment expenses pursuant to section 60 in respect to the left knee including the costs of and associated with the left knee high tibial osteotomy surgery; the respondent is to pay the applicant’s costs; a 15% costs uplift is awarded to both parties.
Decision date: 8 October 2025 | Member: John Turner
Maik v Woolworths Group Ltd [2025] NSWPIC 532
Workers Compensation Act 1987; claim for medical expenses pursuant to section 60 for surgery, costs of and incidental to right sided L5/S1 microdiscectomy, including pain and associated medication, and post-operative physiotherapy including hydrotherapy once per week for six months; applicant had accepted injury to lumbar spine; whether the surgery was reasonably necessary as a result of the accepted injury; Held – the surgery was reasonably necessary as a result of the accepted injury; the respondent to pay the applicant’s medical expenses in respect of the surgery and treatment pursuant to section 60.
Decision date: 8 October 2025 | Member: Karen Garner
Unriza Zapata v NRG Cleaners Pty Ltd [2025] NSWPIC 533
Workers Compensation Act 1987; claim for proposed L5/S1 anterior interbody fusion is reasonably necessary treatment as a result of the injury in circumstances where applicant was asymptomatic before the workplace injury; respondent disputes the surgery is reasonably necessary treatment as a result of the workplace injury; Held – the effects of the injury have not ceased and finding made that the proposed surgery is reasonably necessary treatment as a result of the workplace injury; Diab v NRMA Ltd, and Murphy v Allity Management Services Pty Ltd applied.
Decision date: 8 October 2025 | Member: Josephine Bamber
Keremelevska v Qantas Airways Ltd [2025] NSWPIC 534
Workers Compensation Act 1987; permanent impairment; claim for consequential conditions said to arise as a result of accepted left knee injury; Held – the applicant suffered injury to her left knee on 21 May 2018; as a result the applicant suffered consequential conditions to her right lower extremity (ankle) and right upper extremity (shoulder); the applicant also suffered a frank injury to her right knee on 5 November 2020; matter remitted to President for referral to a Medical Assessor; claim for medical expenses adjourned; matter adjourned for further preliminary conference after issuing of medical assessment certificate for determining whether any impairments to the right knee arising from the consequential condition and form the frank injury can be aggregated.
Decision date: 8 October 2025 | Member: Cameron Burge
Shanahan v Illawarra Retirement Trust [2025] NSWPIC 535
Workplace Injury Management and Workers Compensation Act 1998; assessment of permanent impairment for the purpose of a threshold dispute for work injury damages; injury in 2019 in the employ of the respondent leading to surgery and subsequent injury in 2022 also resulting in surgery; State Government Insurance Commission v Oakley (Oakley), Secretary, New South Wales Department of Education v Johnson, and Ozcan v Macarthur Disability Services Ltd considered; Held – finding that the injury fell within the second category in Oakley and that the applicant’s impairment exceeds the threshold for a claim for work injury damages.
Decision date: 8 October 2025 | Member: Catherine McDonald
Carter v Sodexo Australia Pty Ltd [2025] NSWPIC 536
Workers Compensation Act 1987; claim for lump sum compensation; whether applicant sustained lumbar spine injury and/or consequential bilateral hip injuries in addition to accepted right knee injury; Held – the applicant sustained a lumbar spine injury on 14 February 2017 and consequential injury to both hips; claim for lump sum compensation to be remitted to the President for referral to a Medical Assessor.
Decision date: 9 October 2025 | Member: Fiona Seaton
Cant v Trabor Pty Ltd ATF Trabour Unit Trust t/as JTS Automotive Repairs [2025] NSWPIC 537
Workers Compensation Act 1987; claim for permanent impairment lump sum compensation pursuant to section 66; whether the applicant was a “worker” of the respondent pursuant to section 4; whether the applicant’s employment with the respondent ceased on or about 30 June 2007; whether the respondent was the last employer with whom the applicant was employed and to which the nature of the applicant’s hearing loss was due pursuant to section 17(c)(ii); whether the applicant sustained injury being bilateral hearing loss pursuant to section 4(b)(i); Held – the applicant was a “worker” of the respondent pursuant to section 4; the applicant’s employment with the respondent ceased on or about 30 June 2007; the respondent was the last employer with whom the applicant was employed and to which the nature of the applicant’s hearing loss was due pursuant to section 17(c)(ii); the applicant sustained injury being bilateral hearing loss pursuant to section 4(b)(i); matter remitted to the President to be referred to a Medical Assessor for assessment of whole person impairment.
Decision date: 9 October 2025 | Member: Karen Garner
Morris v Sika Australia Pty Ltd [2025] NSWPIC 539
Workers Compensation Act 1987; psychological injury; claim for weekly compensation and medical expenses; whether claim made in time; discussion surrounding correct deemed date of injury; whether date the applicant says he first experienced symptoms or date of initial incapacity; whether applicant’s employment was the main contributing factor to his condition; whether medical basis for assertion to contrary by respondent accords with the evidence; whether the injury was caused by perception of real events; whether the applicant’s injury was wholly or predominantly caused by the respondent’s reasonable actions with respect to transfer and/or provision of employment benefits; whether a temporal basis for the section 11A defence exists; whether the applicant is incapacitated for employment and if so to what extent; Held – applicant did not suffer incapacity in relation to his condition or receive a diagnosis of any psychological condition until 22 January 2025, which is the correct deemed date of injury; Haddad v the GEO Group Australia Pty Ltd followed; the evidence discloses the applicant was and remains totally incapacitated for employment and accordingly the respondent will be ordered to pay weekly compensation as claimed; respondent is to pay the applicant’s medical and treatment expenses pursuant to section 60.
Decision date: 10 October 2025 | Member: Cameron Burge
Sami v Unilever Australia Pty Ltd [2025] NSWPIC 540
Workers Compensation Act 1987; consequential condition; whether applicant suffered a consequential condition in her neck as a result of accepted shoulder injury; different onset of date of symptoms reported to different doctors; different mechanisms causing condition; ACQ Pty Ltd v Cook referred to; contradicting medical opinion that neck condition due to degenerative change not accepted; Held – applicant suffered consequential condition in cervical spine; award for medical expenses made.
Decision date: 10 October 2025 | Member: Parnel McAdam
Hinds v A Class Door Services Pty Ltd [2025] NSWPIC 544
Workers Compensation Act 1987; section 4(b)(ii) and section 60; disease injury; as a result of an injury; main contributing factor; Kooragang Cement Pty Ltd v Bates, Briginshaw v Briginshaw, AV v AW, Ariton Mitic v Rail Corporation of NSW, and Taxis Combined Services (Victoria) Pty Ltd v Schokman cited and applied; Held – the applicant has suffered injury as defined by section 4(b)(ii) to both his knees; the proposed bilateral total knee replacement surgery is reasonably necessary as a result of the injury; pursuant to section 60 the respondent is to pay the costs of and ancillary to bilateral total knee replacement surgery as proposed.
Decision date: 13 October 2025 | Member: John Turner
Cruceanu v Vix Technology (Aust) Pty Ltd [2025] NSWPIC 545
Workers Compensation Act 1987; claim for a lump sum payment for permanent impairment of the cervical spine as a result of a disease injury pursuant to section 4(b)(ii); worker previously unsuccessful in a claim of a frank injury to the cervical spine; whether the worker can recover compensation when notice of injury not given as soon as possible after alleged injury happened; whether the worker can recover compensation when claim for compensation not made within 6-months of when alleged injury happened; consideration of Albury Real Estate Pty Ltd v Rouse; whether the worker’s employment was the main contributing factor to the aggravation of the disease injury; consideration of AV v AW, and Mannie v Bauer Media Pty Ltd; Held – worker can recover compensation despite not giving notice of the alleged injury as soon as possible because the respondent has not been prejudiced by any failure to give such notice; worker can recover compensation despite not making a claim for compensation within 6-months of the alleged injury because the worker has provided reasonable cause for that omission; worker has not met the onus of proof required to establish that his employment is the main contributing factor to the aggravation of a degenerative cervical spine condition; award for the respondent on the claim made by the worker.
Decision date: 14 October 2025 | Member: John Isaksen
Lobel v Secretary, Department of Customer Service [2025] NSWPIC 546
Workers Compensation Act 1987; claim for psychological injury; claim for lump sum compensation pursuant to section 66; consideration of applicant’s statements, medical reports and other treatment records, claim correspondence, and other factual material; consideration of injury and causation; consideration of material contributing factor; Kooragang Cement Pty Limited v Bates, Federal Broom Co Pty Ltd v Semlitch, AV v AW, Nguyen v Cosmopolitan Homes (NSW) Pty Limited, Briginshaw v Briginshaw, Helton v Allen, Austin v Director General of Education, and Duncan v Roads & Traffic Authority of NSW and Anor; Held – the applicant’s employment with the respondent has been the main contributing factor to the aggravation, acceleration, exacerbation and/or deterioration of the applicant’s psychological condition (chronic post-traumatic stress disorder) pursuant to section 4(b)(ii); the matter is referred to the President for referral to a Medical Assessor for determination of whole person impairment.
Decision date: 14 October 2025 | Member: Anne Gracie
Motor Accidents Medical Review Panel Decisions
Insurance Australia Limited t/as NRMA Insurance v Rose [2025] NSWPICMP 780
Motor Accidents Compensation Act 1999; motor accident; assessment of whole person impairment (WPI) for psychiatric impairment; claimant passenger in vehicle collision with tree; remittal from Supreme Court; previous Review Panel set aside and disregarded in this decision; procedural unfairness by previous Review Panel in using opinion suggesting exaggeration; opinion disregarded; claimant presented with significant ongoing pain which had been excluded from any assessment (clause 1.215 of the Motor Accident Permanent Impairment Guidelines (the Guidelines)); pre-existing deduction (clause 1.31); IAG Ltd v Chahoud applied; reliance on pre accident clinical records; Held – claimant’s degree of permanent impairment assessed at not greater than 10%; original assessment revoked.
Decision date: 9 October 2025 | Panel Members: Principal Member John Harris, Dr Thomas Newlyn, and Dr Gerald Chew | Injury module: Mental and Behavioural
AAI Limited t/as GIO v Leverrier [2025] NSWPICMP 781
Motor Accident Injuries Act 2017; claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) determined the claimant’s whole person impairment (WPI) as a result of injuries sustained in the accident was 13%; the 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 8%; certificate of MA revoked; Review Panel substituted 8% WPI as a result of the accident.
Decision date: 9 October 2025 | Panel Members: Member Terence Stern OAM, Dr Christopher Oates, and Dr Shane Moloney | Injury module: Spine, Upper Limb, Lower Limb, and Minor Skin
Khan v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 782
Motor Accident Injuries Act 2017; physical injury; threshold dispute; application of principles in David v Allianz Australia Ltd (David); David applied by Supreme Court in Allianz Australia Insurance Ltd v Susak; no evidence claimant suffered radiculopathy at any time; allegation of herniated disc caused by motor accident; absence of early complaint relevant but not determinative of causation; Norrington v QBE Insurance (Australia) Ltd applied; accident not likely to have caused or aggravated herniated disc in low back; clinical record at hospital suggested pelvic fracture was based on photocopy of records; conclusion that photocopy missed words; matter brought to parties attention; further records not produced; suggestion of pelvic fracture inconsistent with other clinical notes and nature of accident; Held – claimant only suffered threshold injuries; original assessment confirmed.
Decision date: 9 October 2025 | Panel Members: Principal Member John Harris, Dr Sophia Lahz, and Dr Margaret Gibson | Injury module: Spine, Upper Limb, Lower Limb, Nervous System (Neurological), and Digestive System; Treatment Type: Radiological Investigations
Insurance Australia Limited t/as NRMA Insurance v Hicks [2025] NSWPICMP 786
Motor Accident Injuries Act 2017; motor accident; assessment of whole person impairment (WPI) for psychiatric impairment; claimant pillion passenger in vehicle collision with branch lying on road; claimant had returned to work and living independently; loss of relationship and interaction; no issues of principles; Held – claimant’s degree of permanent impairment assessed at not greater than 10%; original assessment revoked.
Decision date: 13 October 2025 | Panel Members: Principal Member John Harris, Dr Christopher Canaris, and Dr John Baker | Injury module: Mental and Behavioural
AAI Limited t/as GIO v Worth [2025] NSWPICMP 787
Motor Accident Injuries Act 2017; permanent impairment; review; insurer disputed causation and permanent impairment; alleging psychological disorder before accident including drug use; Commission referred psychiatric condition to assess permanent impairment; Medical Assessor’s (MA) certificate assessed 15% permanent impairment for post-traumatic stress disorder (PTSD) and major depression; referred for review; re-examination; claimant was cooperative and consistent; accident was capable of causing referred injuries; substance use disorder in remission; 12% permanent impairment with different clinical findings; Held – Review Panel revoked original Medical Assessment Certificate; permanent impairment greater than 10%.
Decision date: 13 October 2025 | Panel Members: Member Terence O'Riain, Dr Christopher Canaris, and Dr Himanshu Singh | Injury module: Mental and Behavioural
QBE Insurance (Australia) Limited v Ford [2025] NSWPICMP 788
Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); alleged psychiatric injuries when vehicle in the opposite direction crossed into path of claimant’s vehicle causing collision; original Medical Assessor diagnosed post-traumatic stress disorder and assessed 17% whole person impairment (WPI); Review Panel noted history of opioid addiction (with methadone treatment) dating back to 2003 which was ongoing and present at the time of the motor accident; Review Panel satisfied claimant had a pre-existing opioid use disorder which contributed to increased anxiety and panic attacks; Review Panel satisfied motor accident caused a panic disorder; Held – panic disorder assessed at 8% WPI; pre-existing opioid use disorder assessed at 1% WPI; final impairment caused by the motor accident was 7% WPI; MAC revoked; new certificate issued.
Decision date: 13 October 2025 | Panel Members: Member Jeremy Lum, Dr John Baker, and Dr Surabhi Verma | Injury module: Mental and Behavioural
Habib v Allianz Australia Insurance Limited [2025] NSWPICMP 789
Motor Accident Injuries Act 2017; medical dispute about threshold injury and treatment; assessment review under section 7.26; claimant injured neck and lumbar spine; alleged lumbar spine annular fissure; pre-accident lumbar spine conditions; thoracic spine pain; insurer alleged symptoms due to degenerative conditions; original Medical Assessor (MA) assessed accident did not cause lumbar or cervical spine injury and declined treatment; Held – accident mechanism consistent with cervical injury claimed but did not cause injury as first symptoms were recorded ten months after accident; 2022 accident did not cause lumbar spine annular fissure; did not cause injuries that required cervical MRI; treatment not necessary and reasonable; consulting neurosurgeon for thoracic spine pain caused by accident and reasonable and necessary; threshold certificate upheld and previous treatment certificate revoked.
Decision date: 13 October 2025 | Panel Members: Member Terence O’Riain, Dr Drew Dixon, and Dr Leslie Barnsley | Injury module: Spine; Treatment Type: Medical Specialist Consultation, and Diagnostic Radiology Treatment
Workers Compensation Medical Appeal Panel Decisions
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of cauda equina syndrome; where loss of efficient use of each leg at or above the knee was referred for assessment; whether Medical Assessor erred in failing to take account of restriction in motion and sensory symptoms; Held – error in failing to take account of both; worker examined and assessed by Appeal Panel; MAC revoked and replaced.
Decision date: 24 June 2025 | Panel Members: Member Richard Perrignon, Dr Drew Dixon, and Dr Margaret Gibson | Body system: Lumbar Spine
Santoso v Alcon Laboratories [2025] NSWPICMP 776
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether the Medical Assessor (MA) erred by failing to take into account relevant material when rating the appellant’s impairment; psychiatric impairment rating scale (PIRS) categories of self care and personal hygiene, social and recreational activities, concentration persistence and pace, and employability; Held – MA took into account all relevant matters with respect to his rating of the appellant’s impairment in self care and personal hygiene and his rating was correct; MA’s ratings of the appellant’s impairment in social and recreational activities, concentration persistence and pace, and employability were incorrect; MAC revoked.
Decision date: 16 September 2025 | Panel Members: Member Marshal Douglas, Dr Michael Hong, and Dr Douglas Andrews | Body system: Psychological/Psychiatric
Starling v Tweed Coast Properties Pty Ltd t/as LJ Hooker Kingscliff [2025] NSWPICMP 777
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal from decision of Medical Assessor (MA); whether the MAC contains an obvious error and/or relies on incorrect criteria; appellant suffered a psychological injury in the course of her employment; referred to a MA to determine whole person impairment (WPI); a MAC was issued and assessed the appellant as suffering 9% WPI reflecting a median class 2 impairment; appellant challenged three of the classes under the psychiatric impairment rating scale (PIRS) scales (namely self-care and personal hygiene, social and recreational activities and travel); alleging the Medical Assessor used incorrect criteria and that the MAC contained obvious errors; Held – the MAC contains no obvious error; the findings of the MA were open to him on the evidence available and none of them are glaringly improbable; the criteria used by the MA were not incorrect and were appropriate based on the totality of the evidence; MAC confirmed; appeal dismissed.
Decision date: 8 October 2025 | Panel Members: Member Cameron Burge, Dr Douglas Andrews, and Dr Michael Hong | Body system: Psychological/Psychiatric
Uniting (NSW/ACT) v Azam [2025] NSWPICMP 778
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether Medical Assessor (MA) had regard to all relevant matters when rating the appellant’s impairment in travel and in employability; Held – MA did not have regard to all relevant matters when rating the appellant’s impairment; respondent re-examined; MAC revoked.
Decision date: 9 October 2025 | Panel Members: Member Marshal Douglas, Dr Douglas Andrews, and Dr Michael Hong | Body system: Psychological/Psychiatric
Qantas Airways Ltd v Worthington [2025] NSWPICMP 779
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); industrial deafness; appeal by employer against a medical assessment that included all frequencies; no error found; the Medical Assessor (MA) must conduct an independent assessment; the MA’s audiogram was entirely consistent with occupational noise exposure over a long history of noise exposure (some 42 years) and the Appeal Panel could discern no error in the MA’s assessment that included all frequencies and for which adequate reasons were given when the MAC is read as a whole; Held – MAC confirmed.
Decision date: 9 October 2025 | Panel Members: Member Jane Peacock, Dr Henley Harrison, and Dr Robert Payten | Body system: Hearing Loss
Freight On Board International Services Pty Ltd v Cumming [2025] NSWPICMP 784
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal by employer against 18% whole person impairment (WPI) assessment for psychological injury; whether Medical Assessor (MA) erred in rating for social and recreational activities, social functioning, or employability; Held – error found in failure by MA to explain how a class 4 rating in social and recreational activity had been given where some of claimant’s conduct (a trip to Adelaide to watch a cricket test) was appropriate to a class 3 rating; claimant re-examined; MAC confirmed.
Decision date: 10 October 2025 | Panel Members: Member John Wynyard, Dr Michael Hong, and Dr Ash Takyar | Body system: Psychological/Psychiatric
May v Secretary (Department of Education) [2025] NSWPICMP 785
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); psychological injury; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of an assessment under three of the psychiatric impairment rating scale (PIRS) categories (travel, social functioning, and concentration, persistence and pace); Held – Appeal Panel found error and considered a re-examination was necessary; MAC revoked.
Decision date: 10 October 2025 | Panel Members: Member Jane Peacock, Dr Michael Hong, and Dr Ash Takyar | Body system: Psychological/Psychiatric
Westpac Banking Corporation v Albertsen [2025] NSWPICMP 790
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether a report on surveillance the appellant had done of the respondent established the ground for appeal provided in section 327(3)(a); whether the ratings the Medical Assessor (MA) made for the respondent’s impairment in social and recreational activities and social functioning were based on a correct history; Held – the surveillance report was not additional relevant information and accordingly did not establish the ground for appeal provided in section 327(3)(a); the MA’s ratings of the respondent’s impairment in social and recreational activities and social functioning were not supported by the evidence; respondent re-examined; MAC revoked.
Decision date: 14 October 2025 | Panel Members: Member Marshal Douglas, Dr Graham Blom, and Dr Michael Hong | Body system: Psychological/Psychiatric
Motor Accidents Merit Review Decision
AAI Limited t/as AAMI v Elias [2025] NSWPICMR 31
Motor Accident Injuries Act 2017; merit review; dispute under section 6.24; whether a request for unredacted bank statements, notices of assessment, and superannuation statements is reasonable and whether the claimant has a reasonable excuse for failing to comply; inconsistencies in the evidence; incomplete evidence; unreliable evidence; credit issues; insurer seeks further documents to determine the claimant’s pre-accident weekly earnings (PAWE) (Schedule 1, clause 4(1)), the claimant’s post-accident loss of earnings for the purpose of payment of weekly benefits under Division 3.3, and to determine the validity of the claim and whether any part of the claim may be fraudulent; Held – the insurer’s request for further information and documents is reasonable and the claimant does not have a reasonable excuse for their failure to comply.
Decision date: 8 October 2025 | Merit Reviewer: Katherine Ruschen
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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