Legal Bulletin No. 239
This bulletin was issued on 28 November 2025
Issued 28 November 2025
Welcome to the two hundred and thirty ninth 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
CSR Pty Limited (formerly CSR Limited) v Hayes [2025] NSWPICPD 79 (Hayes No 3)
Workers compensation; consideration of State of New South Wales v Culhana [2025] NSWCA 157 on appeals; whether a non-presidential decision may be subject to a second appeal after determination by a Presidential member; held second appeal not permitted as non-presidential decision displaced by Presidential member’s decision; Presidential member’s decision the operative determination; Wishart v Fraser [1941] HCA 8; 64 CLR 470 considered and applied; sections 56 & 57 of the Personal Injury Commission Act 2020; width of reconsideration power and exercise of discretion; Schipp v Herfords Pty Ltd [1975] 1 NSWLR 412 considered and applied; House v The King [1936] HCA 40; 55 CLR 499 considered and applied; Piening v Wanless [1968] HCA 7; 117 CLR 498; R v Unger (1977) 2 NSWLR 990; section 352 of the Workplace Injury Management and Workers Compensation Act 1998; Held – the appellant’s application that the Presidential decision of 4 July 2025 be reconsidered pursuant to s 57 of the Personal Injury Commission Act 2020 is declined; the appellant’s application for leave to file a second appeal out of time against the non-presidential member’s decision of 12 September 2024 is declined. The second appeal is dismissed.
Decision date: 20 November 2025 | Before: President Judge Phillips
Motor Accidents non-Presidential Member Decisions
AAI Limited t/as GIO v Miller [2025] NSWPIC 610
Motor Accident Injuries Act 2017; settlement approval; claimant was injured; claimant was not working at the time of the accident and in receipt of the aged pension; Held – settlement complies with clause 7.37 of the Motor Accident Injuries Guidelines (version 9.3); settlement approved in the amount of $375,000.00 for non-economic loss.
Decision date: 17 November 2025 | Member: Philip Carr
AAI Limited t/as GIO v Kozlik [2025] NSWPIC 611
Motor Accident Injuries Act 2017; settlement approval under section 6.23(2)(b); includes non-economic loss, past economic loss, and future economic loss; 66-year-old male; self-employed marine mechanic; multiple fractures in both wrists, pelvis, and left ankle, soft-tissue injuries shoulders, cervical spine, and ongoing neck pain and stiffness; injuries impact claimant’s ability to undertake tasks with fine motor skills and heavier in nature; past and future economic loss; ongoing reduction in earning capacity to age 75 allowed by insurer; Held – settlement complied with clause 7.37 of the Motor Accident Injuries Guidelines version 9.3.
Decision date: 17 November 2025 | Member: Shana Radnan
Ul Haq v Transport Accident Commission [2025] NSWPIC 613
Motor Accident Injuries Act 2017; assessment of damages; 31-year-old claimant sustained injury in a motor vehicle accident; injury to lumbar spine leading to anterior and posterior fusion, injury cervical spine, and major depressive disorder; surveillance footage suggests exaggeration as to extent of disability; prior L4/5 discectomy and laminectomy in 2012; claimant conceded he had lied to university and treating doctors prior to accident to facilitate absence from study; question of reliability of claimant’s evidence; assessed as having sustained greater than 10% permanent impairment in respect of injury to lumbar spine and also in respect of major depressive disorder; totally unfit for work to date and for next five years; having regard to exaggeration as to extent of physical capacity but given disabling extent of psychological injury and uncertainty about return to work assessment of future economic loss after five years subject to increase in vissisitudes to 25%; Held – non-economic loss assessed at $425,000; total damages assessed in sum of $2,177,315 plus costs.
Decision date: 18 November 2025 | Senior Member: Susan McTegg
AAI Limited t/as AAMI v Ul Hassan [2025] NSWPIC 616
Motor Accident Injuries Act 2017; settlement approval pursuant to section 6.23; self-represented claimant suffered orthopaedic injuries including left second-fifth rib fractures, right scaphoid and trapezius fracture, and a small undisplaced fracture of the anterior distal tibia; claimant made a good recovery but continued to suffer symptoms and incapacity and disability which impacted his capacity to earn; claimant declined to undergo independent whole person impairment assessment; Held – past economic loss and future economic loss in a proposed settlement was approved; insurer to have credit in respect to statutory payments made to or on behalf of the claimant.
Decision date: 19 November 2025 | Member: Michael Inglis
Workers Compensation non-Presidential Member Decisions
ASF Australia Pty Ltd v icare Workers Insurance [2025] NSWPIC 604
Work Injury Management and Workers Compensation Act 1998; application by employer against insurer seeking findings and orders that a person engaged by it was entitled to workers compensation; purported worker not a party to the proceeding and had commenced proceedings in the Supreme Court; workers compensation insurer denying indemnity; insurer sought dismissal of proceedings pursuant to section 54 of the Personal Injury Commission Act 2020; relevant findings cannot be made in the absence of an order; Widdup v Hamilton applied; ambit of section 287(a)(b); Transport Contract Services v Employers Mutual Ltd considered; purported worker cannot be made to claim compensation; purported worker by his actions not seeking compensation; any proceedings between employer and insurer not in connection with a claim for compensation within meaning of section 287(1)(b); Held – application summarily dismissed as vexatious and without substance.
Decision date: 10 November 2025 | Principal Member: John Harris
Gulasi v Qantas Ground Services Pty Ltd [2025] NSWPIC 606
Work Injury Management and Workers Compensation Act 1998; Workers Compensation Act 1987; injury; applicant claimed she injured her back; did not report injury; no medical attendances for almost three years; third party witness confirmed incident occurred; weight that could be given to a roster prepared by the respondent in the absence of original documents; clinical evidence all suggested insidious onset; Held – award for the respondent.
Decision date: 12 November 2025 | Member: Parnel McAdam
Work Injury Management and Workers Compensation Act 1998 (1998 Act); Workers Compensation Act 1987 (1987 Act); application for permanent impairment compensation; accepted lumbar spine injury; disputed claim for respiratory (obstructive sleep apnoea); various causes of applicant’s sleep disorder including narcotic analgesia, sleeping in supine position and pain; dispute issue regarding weight gain following injury; issue of what member decides in claim for respiratory disorder for sleep apnoea; consideration of Trustees for the Roman Catholic Church for the Diocese of Bathurst v Hine, Bindah v Carter Holt, and Jaffarie v Quality Castings Pty Ltd (No 2); effect of repeal of various provision including exclusive jurisdiction of Medical Assessors (section 65(3) of the 1987 Act)); member entitled to make any findings pursuant to section 105 of the 1998 Act; member can make findings pertaining to impairment; referral to Medical Assessor (MA) means certificate is conclusive evidence under section 326; potential inconsistency in findings between Member and MA; desirability of making a general finding of causation to avoid inconsistency; Held – general finding made of causative link between work injury and sleep disorder; claim referred to MA to include assessment of respiratory condition (obstructive sleep apnoea).
Decision date: 14 November 2025 | Principal Member: John Harris
Work Injury Management and Workers Compensation Act 1998; application for reconsideration of certificate of determination (COD) following Medical Assessment Certificate (MAC) for a section 66 claim; whether there has been a deterioration in the worker’s condition that results in an increase in permanent impairment; reference to Riverina Wines P/L v Registrar of the Workers Compensation Commission & Ors,and Petrovic v BC Service No 14 P/L & Ors; Held – medical evidence supports a deterioration in the worker’s condition; COD revoked pursuant to section 57(1) of the Personal Injury Commission Act 2020.
Decision date: 18 November 2025 | Member: John Isaksen
Athian v Green Formwork Group Pty Ltd [2025] NSWPIC 615
Workers Compensation Act 1987; claim for weekly compensation and medical expenses resulting from a right middle finger injury; whether the injury arose out of or in the course of employment Held – the applicant’s right middle finger injury did not arise out of or in the course of employment with the respondent pursuant to section 4; the employment was not a substantial contributing factor pursuant to section 9A; award for the respondent.
Decision date: 18 November 2025 | Member: Fiona Seaton
Motor Accidents Medical Review Panel Decisions
Kyemereh v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 599
Motor Accident Injuries Act 2017; review of certificate and reasons of Medical Assessor (MA); issue of whether injuries to the claimant’s cervical spine, right shoulder, and lumbar spine with threshold injuries; the MA found that these were threshold injuries; following the accident the claimant had radiological investigations which showed intrasubstance tears in the supraspinatus tendon; claimant alleged that this was caused by the accident but it was evident that there was no oedema and no disruption in the fibres which evidenced that the intrasubstance tears were old in origin; Review Panel not satisfied that the tears arose from the accident; Held – original certificate confirmed and the Review Panel was satisfied that the claimant had suffered threshold injuries.
Decision date: 12 August 2025 | Panel Members: Member Alexander Bolton, Dr Alan Home, and Dr Christopher Oates | Injury module: Spine, and Upper Limb
Insurance Australia Limited t/as NRMA Insurance v Cox [2025] NSWPICMP 643
Motor Accidents Compensation Act 1999; review of medical assessment; psychiatric injury; passenger on motorbike hit by two cars; lower leg fracture; surgical arterial repair; developed deep vein thrombosis; ongoing psychiatric treatment; trauma specific anxiety and depressive symptoms; post-traumatic stress disorder with comorbid persistent major depressive disorder; exposed to serious injury; presence of intrusion symptoms; no psychological or psychiatric condition predated the motor accident; Held – certificate of Medical Assessor confirmed; 17% whole person impairment.
Decision date: 27 August 2025 | Panel Members: Member Hugh Macken, Dr Thomas Newlyn, and Dr Paul Friend | Injury module: Mental and Behavioural
Insurance Australia Limited t/as NRMA Insurance v Elmir [2025] NSWPICMP 661
Motor Accidents Compensation Act 1999; review of medical assessment; gastro-oesophageal reflux disease analgesic gastropathy; medication-induced gastrointestinal motility disorder; whole person impairment (WPI); no direct impact to chest or abdomen; chronic pain in neck, shoulders, elbow, pelvis, and left knee; visceral hypersensitivity of the gastrointestinal tract; constitutional condition unrelated to and completely independent of the motor vehicle accident; gastrointestinal symptoms have not arisen from the motor vehicle accident; Held – no rating for WPI is applicable.
Decision date: 1 September 2025 | Panel Members: Member Hugh Macken, Dr David McGrath, and Dr Margaret Gibson | Injury module: Spine, Upper Limb, and Lower Limb
AAI Limited t/as GIO v Rexhepi [2025] NSWPICMP 683
Motor Accident Injuries Act 2017; review of medical assessment; assessment of treatment and care; causation; claimant sustained non-threshold injuries; whole person impairment is 0%; CT spec scans; no immediate post-accident medical treatment; no suggestion of chest injury; no airbag deployment; no mention of any respiratory complaint; Held – CT spec scan does not relate to the injuries caused by the motor accident; scan is appropriate in the clinical context; not reasonable and necessary in the circumstances as it does not arise from any injuries caused by the motor accident.
Decision date: 8 September 2025 | Panel Members: Member Hugh Macken, Dr Richard Haber, and Dr Margaret Gibson | Injury module: Treatment Type: Radiological Investigations
Sanhard v Insurance Australia Ltd t/as NRMA Insurance (No 2) [2025] NSWPICMP 688
Motor Accidents Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant involved with near head on collision with secondary impact on side of road barrier; injuries to cervical spine and head with headaches; whether headaches can be assessed for permanent impairment; Held – Review Panel accepted injury to the cervical spine but no evidence of a head injury; Review Panel accepted headache alone is not accessible due to clause 6.162 of the Motor Accident Guidelines (Guidelines); Review Panel found the claimant’s headaches and skull pain followed the distribution of the right greater occipital nerve and always occurred together with the neck pain; Review Panel concluded skull pain and occipital nerve symptoms were related to a cervical spine injury; assessment of a C2 nerve root condition is made under clause 6.139 of the Guidelines; Review Panel found the claimant’s neck injury with secondary headaches resulted in a 1% whole person impairment; MAC revoked.
Decision date: 9 September 2025 | Panel Members: Member Jeremy Lum, Dr Les Barnsley, and Dr Sophia Lahz | Injury module: Spine, and Brain Injury
Transport Accident Commission v Morosin [2025] NSWPICMP 701
Motor Accidents Compensation Act 1999; review of further Medical Assessment Certificate (MAC); motor accident; original medical assessment only concerned a soft tissue injury to the nose and was assessed at 0% whole person impairment (WPI); further medical assessment assessed 11% WPI for injuries to loss of smell, hearing loss, tinnitus, dizziness, nose and air passage including nasal obstruction, external nasal deformity, nostril stenosis, and trigeminal nerve injury (ENT injuries); no complaint of ENT injuries for three years after the motor accident; delay stated by claimant as due to accident-related musculoskeletal injuries which were assessed at 6% WPI; Held – Review Panel found documented evidence does not support ENT injuries to be caused by the motor accident; claimant had opportunities to report ENT injuries to other medical practitioners and at time of the original medical assessment; ENT injuries found to be not causally related to the motor accident; MAC revoked.
Decision date: 11 September 2025 | Panel Members: Member Jeremy Lum, Dr Michael McGlynn, and Dr Thandavan Raj | Injury module: Ear, Nose, Throat and Related Structures
Ayoub v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 843
Motor Accidents Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant was driving his van when a vehicle entered into his path causing a T-bone collision; claimant assessed by original Medical Assessor as having 10% whole person impairment (WPI) comprising of 5% WPI for the cervical spine and 5% for the lumbar spine; causation of bilateral shoulder injuries not accepted due to delayed onset of symptoms; re-examination by Review Panel; Held – Review Panel found 5% WPI for the cervical spine and 0% for the lumbar spine; no discrete injury to bilateral shoulders causing rotator cuff tears; bilateral shoulder restrictions found to emanate from the neck; Nguyen v The Motor Accidents Authority of NSW & Anor principle applied; bilateral shoulders assessed at 2% WPI each; final impairment was 9% WPI; apportionment for pre-existing symptoms not required as pre-accident complaints related to lower extremities which were not related to the injuries sustained in the subject accident; MAC revoked; new certificate issued.
Decision date: 31 October 2025 | Panel Members: Member Jeremy Lum, Dr Drew Dixon, and Dr Margaret Gibson | Injury module: Spine, and Upper Limb
Boyle v Allianz Australia Insurance Limited [2025] NSWPICMP 889
Motor Accident Injuries Act 2017; insurer’s review of Medical Assessment Certificate (MAC) under section 7.26; whole person impairment (WPI) dispute; physical injury to spine (including neurological injury to upper and lower limbs), fracture of sternum and subluxation of the sternoclavicular joint, and consequential fracture of left foot and ankle; claimant had pre-existing shoulder problem and poorly controlled diabetes; claimant re-examined; Held – claimant could have and did sustain injuries to sternum, cervical, thoracic, and lumbar spine; injury to left ankle not caused; WPI assessed at 3%; loss of sensation in upper and lower limbs consistent with peripheral neuropathy not radiculopathy; reduction in foot reflexes but not knee reflexes also indication of neuropathy; MAC confirmed; no issue of principle.
Decision date: 13 November 2025 | Panel Members: Member Belinda Cassidy, Dr Alan Home, and Dr Sophia Lahz | Injury module: Spine, Upper Limb, and Lower Limb
Lifetime Care and Support Authority of New South Wales v Mangano [2025] NSWPICMP 890
Motor Accident Injuries Act 2017; motor accident causing serious injuries; claimant transitioned to Lifetime Care and Support Authority; subsequent injury to left thumb whilst cutting bread with fused right wrist; assessment of whether certain treatment for left thumb injury related to the injury from the motor accident; no need for examination; reasonable and necessary not disputed; medical examination would not assist in resolution of causation issue; acceptance that arthrodesis of right wrist caused by the motor accident; right wrist was weak with limited mobility; claimant failed to use a non-slip mat as part of food preparation equipment provided by the insurer; strong causal connection between motor accident and the incident involving the left thumb injury; Held – insurer’s submission that failure to use equipment constituted a novus actus; Mahony v J Kruschcih (Dmeolitions) Pty Ltd, March v Stramare, and State for New South Wales v Cullen referred to and applied; claimant’s conduct may have been careless in not using the non-slip mat but was of a minor nature and did not constitute a break in the chain of causation; Held – claimant established that the need for treatment of the left thumb was causatively related within the meaning of section 3.24.
Decision date: 14 November 2025 | Panel Members: Principal Member John Harris, Dr Michael Couch, and Dr Shane Moloney | Injury module: Treatment Type: Medical Specialist Consultation
Sammon v QBE Insurance (Australia) Limited [2025] NSWPICMP 891
Motor Accident Injuries Act 2017; insurer’s review of Medical Assessment Certificate (MAC) under section 7.26; threshold injury dispute; psychiatric injury; claimant pedestrian hit by police car, claimant not immediately aware of injury but attended hospital two days later; physical injuries were assessed as soft tissue and threshold; claimant re-examined; Held – accident could have and did cause or materially contribute to a psychiatric disorder; psychiatric disorder diagnosed as persistent depressive disorder which is a non-threshold injury; MAC revoked; no issue of principle.
Decision date: 14 November 2025 | Panel Members: Member Belinda Cassidy, Dr Christopher Canaris, and Dr Ankur Gupta | Injury module: Mental and Behavioural
AAI Limited t/as GIO v CCL [2025] NSWPICMP 895
Motor Accident Injuries Act 2017; insurer’s review of Medical Assessment Certificate (MAC) under section 7.26; whole person impairment (WPI) dispute 13% assessed; psychiatric injury; causation issue; subject accident in 2015; subsequent accident in 2019; further incidents in 2023; claimant re-examined; Held – motor accident of 2015 could have and did cause psychological injury; injury caused diagnosed as major depressive disorder (MDD) with anxiety and post-traumatic features; 2019 accident caused MDD to develop into persistent depressive disorder and post-traumatic stress disorder; no pre-existing condition and 2023 events caused exacerbation but not long term effects; current impairment assessed at 4% WPI; GIO General v Smith, State Government Insurance Commission v Oakley, and Slade v Insurance Australia Limited t/as NRMA (Slade) cited concerning assessment of subsequent impairment claimant’s injury in 2019 was found to be Slade category 2 case and all impairment taken as caused by 2015 accident; MAC revoked.
Decision date: 17 November 2025 | Panel Members: Member Belinda Cassidy, Dr Christopher Canaris, and Dr Ankur Gupta | Injury module: Mental and Behavioural
QBE Insurance (Australia) Limited v Najjarin [2025] NSWPICMP 897
Motor Accident Injuries Act 2017; motor accident; assessment of permanent impairment for psychiatric condition; history in medical records of seeking help for mental health and time away from work before the accident related mental health conditions; claimant’s history to Medical Assessors before the accident and symptoms after the accident inconsistent with records; insurer alleged history of mental health problems and drug and alcohol abuse with criminal history; Review Panel considered claimant’s vulnerability, current self-representation, and other factors which could diminish his reliability as witness but did not accept claimant’s account unless corroborated; diagnosing psychological condition depended on acceptance of claimant; Whisprun Pty Ltd v Dixon applied on weight to be given to reports based on incorrect history; Review Panel not satisfied that accident caused psychiatric condition; no assessment of permanent impairment required; Held – original assessment revoked.
Decision date: 18 November 2025 | Panel Members: Member Terence O’Riain, Dr Gerald Chew, and Dr Surabhi Verma | Injury module: Mental and Behavioural
Pelekanos v Allianz Australia Insurance Limited [2025] NSWPICMP 898
Motor Accident Injuries Act 2017; review of medical assessment; threshold injury; whole person impairment (WPI); head injury-cervicogenic pain; occipital neuralgia; claimant sustained injuries as she fell on a bus; left side head injury; thoracic spine; lumbar spine; sudden extension of cervical spine; accident worsened a documented pre-existing condition; accident a cause of exacerbation of lumbar spinal injury; temporary symptom relief through repeated nerve block injection; no documented evidence of status of left hip prior to accident; no documentation of range of movement of in the left knee prior to accident; Held – WPI 11%.
Decision date: 18 November 2025 | Panel Members: Member Hugh Macken, Dr Margaret Gibson, and Dr Christopher Oates | Injury module: Spine, Lower Limb, and Brain Injury
Insurance Australia Limited t/as NRMA Insurance v CUB [2025] NSWPICMP 902
Motor Accident Injuries Act 2017; section 3.24; claim for statutory benefits for payment of treatment and care expenses; request by the claimant for payment of treatment by way of a trial of cannabis product to assist with management of chronic pain arising from his injuries; whether the proposed treatment is reasonable and necessary in the circumstances; whether it is related to the injuries caused by the accident; Held – the certificate of the single Medical Assessor’s finding that the proposed treatment is reasonable and necessary in the circumstances and is related to the injuries caused by the accident; certificate is revoked.
Decision date: 19 November 2025 | Panel Members: Member Maurice Castagnet, Dr David Gorman, and Dr David McGrath | Injury module: Treatment Type: Medication (Prescription)
Workers Compensation Medical Appeal Panel Decisions
Willoughby City Council v Bennell [2025] NSWPICMP 886
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); injury to cervical spine; claim for permanent impairment; no complaint on appeal about the overall impairment level assessed; Medical Assessor (MA) made no deduction under section 323 which was the subject of the appeal by the employer; a deduction under section 323 can only be made if the pre-existing condition, abnormality, or injury has contributed to the level of permanent impairment assessed; MA found no such contribution for the reasons they gave; MAC must be read as a whole; MA was clearly cognisant that the IMEs had made a deduction; Held – the reasons given were adequate and open to the MA in the exercise of his clinical judgment; making no deduction under section 323 is consistent with the available evidence for the reasons given by the MA and the Appeal Panel can discern no error; MAC confirmed.
Decision date: 12 November 2025 | Panel Members: Member Jane Peacock, Dr James Bodel, and Dr Alan Home | Body system: Cervical Spine, and Scarring (TEMSKI)
Graydon v Joshua Raymond Falk [2025] NSWPICMP 887
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); injury to lumbar spine; claim for permanent impairment; no complaint on appeal about the overall impairment level assessed; Medical Assessor (MA) deducted one-half under section 323 which was the subject of the appeal by the worker; Held – in making a deduction of one-half to take account of the prior injury the MA has made a demonstrable error; this is because the extent of the deduction is at odds with the available evidence; as a result of the prior injury the appellant underwent a microdiscectomy (decompression surgery) because of radiculopathy; there was no residual radiculopathy following the first surgery and the appellant recovered and was able to return to work; after the subject injury he came to a two-level fusion and has not been able to return to work; whilst there has been a contribution by the pre-existing injury to the level of permanent impairment assessed as a result of the subject injury it is too difficult to assess and accordingly a deduction of one-tenth should have been made; MAC revoked.
Decision date: 12 November 2025 | Panel Members: Member Jane Peacock, Dr Drew Dixon, and Dr Christopher Oates | Body system: Lumbar Spine, and Scarring
K & R Fabrications (W'gong) Pty Ltd v Wallace [2025] NSWPICMP 892
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal by employer against failure by Medical Assessor (MA) to apply section 323; whether error of fact by MA; whether adequate reasons given; Held – applying Cole v Wenaline Pty Ltd the MA had failed to explain why evidence of extensive treatment was not relevant; pre-existing condition demonstrated thereby section 323(2) applied as too difficult to assess the extent; MAC revoked.
Decision date: 14 November 2025 | Panel Members: Member John Wynyard, Dr David Crocker, and Dr Drew Dixon | Body system: Cervical Spine, Lumbar Spine, and Right Upper Limb
Bourke v Pymble Ladies College [2025] NSWPICMP 893
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); medical appeal; maximum medical improvement (MMI); not fully ascertainable; Medical Assessor (MA) concluded that left lower extremity had not reached MMI; proceeded to asses lumbar spine; appeal against lumbar spine only; Appeal Panel called for submissions; reference to Sleiman v Gadalla Pty Ltd; preliminary review that MA should not have assessed lumbar spine; Held – MAC revoked; all body parts not fully ascertainable; matter to be referred to a new MA by President.
Decision date: 17 November 2025 | Panel Members: Member Parnel McAdam, Dr Todd Gothelf, and Dr Andrew Porteous | Body system: Left Lower Extremity, Lumbar Spine, and Scarring (TEMSKI)
Kowalik v State of New South Wales (Sydney Local Health District) [2025] NSWPICMP 894
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant submits that the Medical Assessor erred in his assessment of two psychiatric impairment rating scale (PIRS) categories; Held – Appeal Panel found no errors; the assessments were consistent with the evidence; MAC confirmed.
Decision date: 17 November 2025 | Panel Members: Member Deborah Moore, Dr Ash Takyar, and Dr Graham Blom | Body system: Psychological/Psychiatric
Hovius v Speno Rail Maintenance Australia Pty Ltd [2025] NSWPICMP 900
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal of the 18% whole person impairment (WPI) assessment regarding the left knee, hip, and scarring; whether additional evidence should be admitted; whether further additional evidence (filed after the Appeal Panel had convened) should be admitted; whether Medical Assessor erred in measurements recorded in the physical examination; Held – respondent agreed that measurements anatomically impossible and consented to a re-examination; fresh evidence contained within the appeal documents filed rejected as no application made pursuant to section 328(3) or section 327(3)(b); evidence filed after the Appeal Panel had convened rejected; Part 11 of the Personal Injury Commission Rules considered and applied; claimant re-examined; MAC revoked.
Decision date: 18 November 2025 | Panel Members: Member John Wynyard, Dr James Bodel, and Dr Andrew Porteous | Body system: Right Lower Extremity, and Scarring (TEMSKI)
Philips v TCL Services Pty Ltd [2025] NSWPICMP 901
Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether Medical Assessor (MA) erred by not assessing appellant’s permanent impairment of the appellant’s knees by reference to cartilage loss; whether MA erred by not calling for films of weight-bearing x-rays of appellant’s knees; Held – MA was unable to assess appellant’s impairment by reference to cartilage loss because the evidence before the MA did not establish whether and to what extent the appellant had any cartilage loss in his knees; however weight-bearing x-rays had been done of the appellant’s knees that would establish that and the MA was aware of this; the MA erred by not exercising his discretion to call for the production of the films of those x-rays; Appeal Panel called for production of the films of the x-rays which established the appellant had cartilage loss in his left knee; MAC revoked.
Decision date: 18 November 2025 | Panel Members: Member Marshal Douglas, Dr James Bodel, and Dr Margaret Gibson | Body system: Left Lower Extremity, Right Lower Extremity, and Lumbar Spine
Motor Accidents Merit Review Decisions
CPP v Youi Pty Limited [2025] NSWPICMR 27
Motor Accident Injuries Act 2017; merit review; dispute regarding calculation of pre-accident weekly earnings (PAWE); calculation under Schedule 1 clause 4(1); whether redundancy payment and employee termination payment constitute earnings; whether redundancy payment and employee termination payment were received by an earner as an earner; Project Blue Sky Inc v Australian Broadcasting Authority, Allianz Insurance Australia Limited v Shahmiri, AAD v AAI Limited t/as AAMI, and Iskandar v Insurance Australia Limited t/as NRMA Insurance considered and followed; Held – redundancy payment and employee termination payment are not earnings for the purposes of Schedule 1 clause 4(1); redundancy payment and employee termination payment were not received by an earner as an earner; reviewable decision affirmed.
Decision date: 17 September 2025 | Merit Reviewer: Biana Montgomery-Hribar
Asraf v QBE Insurance (Australia) Limited [2025] NSWPICMR 34
Motor Accident Injuries Act 2017; claim for statutory benefits; dispute about calculation of pre-accident weekly earnings (PAWE); whether earning capacity relevant to PAWE; whether PAWE calculation in relation to prior accident relevant; whether earning continuously in casual employment during weeks no hours provided by employer; clause 4(2)(a); clause 4(4) meaning of earning continuously; clause 4(1); Allianz Insurance Australia Limited v Shahmiri,and Wei v Allianz Australia Insurance Limited considered; Held – the reviewable decision is affirmed.
Decision date: 18 November 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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