Legal Bulletin No. 243

Issued 16 January 2026

Welcome to the two hundred and forty third 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 Decision

Donhad Pty Ltd v Asbury [2025] NSWSC 1548

Administrative law; judicial review of appeal panel decision; assessment of whole person impairment; where appeal panel provided five different statements of reasons for decision and five corresponding medical assessment certificates; whether appeal panel erroneously failed to make a section 323 deduction for pre-existing injury, condition or abnormality; whether appeal panel failed to respond to clearly articulated argument; whether appeal panel made an irrational or illogical finding of fact; adequacy of reasons of appeal panel; no reviewable error established despite poor quality of appeal panel’s documentation; Held – the summons filed 17 June 2025 is dismissed, with no order as to costs.

Decision date: 18 December 2025 | Before: Griffiths AJ

Presidential Member Decision

Dotti v State of New South Wales (Northern Sydney Local Health District) [2025] NSWPICPD 84

Workers compensation; section 11A(1) of the Workers Compensation Act 1987; Pollard v RRR Corporation Pty Ltd [2009] NSWCA 110 considered and applied; error in drawing inferences on causation from clinical notes of medical practitioner without reference to arguably different opinion in medical report; St George Leagues Club Ltd v Wretowska [2013] NSWWCCPD 64 considered; whether member should have considered appellant’s argument that the respondent’s failure to tender a statement from the complainant went to the reasonableness of the finding of misconduct; whether member should have considered appellant’s argument that failure to grant an extension of time to respond to proposed penalty went to the issue of reasonableness; Held – the Certificate of Determination dated 29 May 2025 is revoked; the matter is remitted to another non-presidential member to redetermine the issues between the parties.

Decision date: 15 December 2025 | Before: Acting Deputy President Paul Sweeney

I&C Homes Proprietary Limited v Cain [2025] NSWPICPD 85

Workers compensation; sections 254 and 261 of the Workplace Injury Management and Workers Compensation Act 1998; finding of injury to the cervical spine; sufficiency of reasons; Held – the appeal is dismissed and the Certificate of Determination dated 16 July 2025 is confirmed.

Decision date: 17 December 2025 | Before: Acting Deputy President Geoffrey Parker SC

State of New South Wales (NSW Police Force) v Culhana [2025] NSWPICPD 86 (Culhana No 4)

Workers compensation; burden of proof, “balance of probabilities”, “comfortably satisfied”; Drca v KAB Seating Systems Pty Ltd [2015] NSWWCCPD 10 considered and applied; Presidential member function on remitter from Court of Appeal, nature of orders made, doctrine of stare decisis; Burwood Council v PD Mayoh Pty Ltd [1997] NSWCA 53 considered and applied; Held – the Certificate of Determination dated 17 May 2024 is confirmed; the appellant is to pay the respondents’ costs of the appeal; the matter is remitted to the same Member to deal with the outstanding issues identified in Culhana No 1 at reasons [232].

Decision date: 18 December 2025 | Before: President Judge Phillips

Motor Accidents non-Presidential Member Decisions

Saadouni v Allianz Australia Insurance Limited [2025] NSWPIC 673

Motor Accident Injuries Act 2017; miscellaneous claims assessment; whether claimant wholly or mostly at fault; sections 3.11 and 3.28; claimant sustained injury; claimant alleged insured vehicle collided with rear of her scooter; Held – inconsistency in evidence of claimant; damage to driver’s door of insured vehicle; claimant not travelling in front of insured vehicle but lane filtering and in doing so collided with side of insured vehicle; claimant failed to take reasonable care; insured driver conceded he did not see scooter at all; claimant not wholly at fault; as per Podrebersek v Australian Iron and Steel claimant’s contributory negligence assessed at 80%; claimant mostly at fault for the accident.

Decision date: 11 December 2025 | Senior Member: Susan McTegg

Kipa v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 675

Motor Accident Injuries Act 2017; assessment of damages pursuant to sections 7.36(3) and 7.36(4); non-economic loss; injuries included tibial fracture requiring surgery, aggravation to degenerative cervical spine changes, bilateral subacromial subdeltoid bursitis, and rotator cuff tears; ongoing neck, shoulders and knee pain; Held – past economic loss ($209,478.18); future economic loss ($745,095); partial retained earning capacity $400 weekly considered and increased vicissitudes 20%; heavier type roles would cease before age 67 years.

Decision date: 12 December 2025 | Member: Shana Radnan

Hokianga v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 678

Motor Accident Injuries Act 2017; whether the person is wholly or mostly at fault; insured vehicle turning right; collision at intersection; both parties claiming to have green traffic control signal facing their direction of travel; claimant cross-examined at assessment conference; insured driver did not attend assessment conference; claimant significantly prejudiced by non-attendance of insured driver; claimant’s evidence clear without embellishment; no impingement of claimant credit or credibility; insured driver failed to make right hand turn with safety; claimant did not see insured truck until less than five metres away from it; claimant travelling too fast in all the circumstances; claimant driving inattentively; Held – insurer established contributory negligence; driver primarily at fault; contributory negligence 40%.

Decision date: 15 December 2025 | Member: Hugh Macken

Buller v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 684

Motor Accident Injuries Act 2017; claim for damages; motorcycle struck by insured driver; numerous and significant orthopaedic injuries; lumbar spine fracture; multiple pelvic fractures; wrist fractures; ruptured bladder; nerve damage; right foot drop; leg shortening; residual learning capacity; significant psychological injury; post-traumatic stress disorder and major depressive disorder; Held – assessment of non-economic loss; impaired earning capacity; pre-accident career path; interplay of physical and psychiatric injuries; damages assessed in sum of $1,501,251.

Decision date: 17 December 2025 | Member: Hugh Macken

AAI Limited t/as Suncorp Insurance v Bentley [2025] NSWPIC 690

Motor Accident Injuries Act 2017; settlement approval; claimant was injured; claimant was working at the time of the accident; claimant is aware no entitlement to future statutory benefits once settlement is approved; the settlement complies with clause 7.37 of the Motor Accident Injuries Guidelines (version 9.3); Held – settlement approved in the amount of $121,300; consisted of nil non-economic loss and past economic loss of $121,300 and nil future economic loss.

Decision date: 19 December 2025 | Member: Philip Carr

Workers Compensation non-Presidential Member Decisions

Loau v HME Services [2025] NSWPIC 584

Workers Compensation Act 1987; closed head injury; whether continuing symptomatology causally connected; Held – claim for injury to nervous system referred to Medical Assessor.

Decision date: 29 October 2025 | Member: Lea Drake

Mackaway v Alliance Electric Pty Ltd t/as Alliance SI & Ors [2025] NSWPIC 668

Workers Compensation Act 1987; claim for compensation under section 25(1); Held – injury had not been established under sections 4(b)(i) and 4(b)(ii); Seltsam Pty Limited v McGuiness, and James Hardie & Coy v McGuiness applied relating to facts amounting to conjecture when determining causation; Kooragang Cement v Bates applied relating to lack of causal chain; Nguyen v Cosmopolitan Homes applied in relation to onus of proof.

Decision date: 10 December 2025 | Member: Josephine Bamber

BYZ v BQZ [2025] NSWPIC 669

Workers Compensation Act 1987; claim for psychological injury; section 11A defence; performance appraisal, discipline, and consideration of causation; Held – psychological injury not wholly or predominantly caused by reasonable action by the respondent with respect to performance appraisal or discipline; award for the applicant for weekly compensation.

Decision date: 10 December 2025 | Member: Michael Wright

Outim v State of New South Wales (Western Sydney Local Health District) [2025] NSWPIC 670

Workers Compensation Act 1987; claim for proposed right knee arthroscopy and radiofrequency ablation; injury and causation are not in issue; respondent disputes the surgery is reasonably necessary treatment in circumstances where the applicant has had two prior arthroscopic procedures and has mental health issues; Held – proposed surgery is reasonably necessary treatment as a result of the injury in the course of the applicant’s employment with the respondent;  Diab v NRMA Ltd applied; order made that the respondent is to pay the costs of the proposed surgery recommended being right knee arthroscopy and radiofrequency ablation.

Decision date: 11 December 2025| Member: Josephine Bamber

Eaton v Quick Service Restaurants Finance Pty Ltd [2025] NSWPIC 671

Workers Compensation Act 1987; claim for weekly benefits compensation pursuant to sections 33 and 38; applicant had accepted psychological injury; whether the applicant had no current work capacity as a result of the accepted psychological injury and is likely to continue indefinitely to have no current work capacity; Held – the applicant had no current work capacity as a result of the accepted psychological injury and is likely to continue indefinitely to have no current work capacity; the respondent to pay the applicant weekly compensation pursuant to section 38(2); liberty to apply within 14 days in respect of calculation of the weekly compensation amounts.

Decision date: 11 December 2025 | Member: Karen Garner

Wilmott-Connie v Flamestop Australia Pty Ltd [2025] NSWPIC 672

Workers Compensation Act 1987; section 60; Murphy v Allity Management Services, Briginshaw v Briginshaw, Hancock v East Coast Timber Products, and Paric v John Hollandcited and applied; Held – the C4/5 and C5/6 anterior discectomies with decompression and foraminotomies with disc arthroplasty and fusion surgery is not reasonably necessary as a result of the accepted injury; award for the respondent in respect to the claim made pursuant to section 60 for the costs of and incidental to C4/5 and C5/6 anterior discectomies with decompression and foraminotomies, with disc arthroplasty and fusion surgery.

Decision date: 11 December 2025 | Member: John Turner

Mansfield v Brickworks Ltd [2025] NSWPIC 679

Workers Compensation Act 1987; weekly compensation and medical expenses in respect of psychological injury; section 11A; applicant suffered a psychological injury in the course of his employment with the respondent; liability in relation to that injury was declined on the basis it was wholly or predominantly caused by the respondent’s reasonable actions with regards to discipline; the applicant was the subject of disciplinary action by his supervisors for taking a smoke break for an extended period; there is no issue the applicant is totally incapacitated as a result of his injury, and his preinjury earnings were also agreed; Held – respondent has not discharged its onus of establishing the whole or predominant cause of the applicant’s injury was the conduct on which it relies; respondent offered no expert medical opinion on the question of causation; respondent relied on an absence of complaint to the applicant’s GP; where there are competing factors relied on by the parties as the cause of the injury, the absence of medical opinion in support of the respondent’s claims in relation to causation is fatal to the defence under section 11A; Hamad v Q Catering Limited followed; absence of corroboration is not fatal to the acceptance of the applicant’s claim in civil proceedings; Chanaa v Zarour noted; nature of psychological injuries is such that people suffering from them often do not identify as doing so, and it is unnecessary (or even a relevant consideration) that someone must do so; Patrech v State of New South Wales cited; defence under section 11A is not made out; conduct of the respondent was not, in all the circumstances, reasonable; respondent is ordered to pay the applicant’s weekly compensation as claimed; respondent is ordered to pay the applicant’s reasonably necessary medical and treatment expenses.

Decision date: 15 December 2025 | Member: Cameron Burge

Giles v Secretary, Department of Communities and Justice [2025] NSWPIC 680

Workers Compensation Act 1987 (1987 Act); Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); section 57 of the Personal Injury Commission Act 2020 (PIC Act); sections 327 and 329 of the 1998 Act; reconsideration; mistake or oversight by legal advisers; exceptional circumstances; Samuel v Sebel Furniture, Atomic Steel Constructions Pty Ltd v Tedeschi, Hurst v Goodyear Tyre and Rubber Company, Aliprad v Abbey Manufacturing Group, Hilliger v Hilliger, and Yacoub v Pilkington considered and applied; Held – Certificate of Determination is rescinded; appeal against the decision of Medical Assessor lodged in accordance with the direction is referred to the President including any issues pertaining to section 327(3) and/or (5) of the 1998 Act.

Decision date: 16 December 2025 | Member: John Turner

Aryal v Waratah Private Hospital Pty Ltd [2025] NSWPIC 681

Workers Compensation Act 1987 (1987 Act); section 57 of the Personal Injury Commission Act 2020 (PIC Act); application for reconsideration determined on the papers; Samuel v Sebel Furniture considered and applied; Held – application for reconsideration is refused.

Decision date: 16 December 2025 | Member: John Turner

Di Stefano v Delairco (Newcastle) Pty Ltd & Anor [2025] NSWPIC 682

Workers Compensation Act 1987; claim in respect of hearing loss; whether the applicant has conducted due search and inquiry and established the first respondent was uninsured at the deemed date of injury; applicant alleged an injury in the nature of hearing loss while working with the first respondent, subsequently deregistered in the 1990s; whether the applicant has established, as required under section 140(1), that the first respondent was uninsured at the deemed date of injury; applicant can recover compensation from the second respondent as nominal insurer; Held – evidence discloses the applicant has inquired of all licenced insurers for the relevant period; none had a responding policy of insurance; absence of actual evidence of insurance when the applicant has made such significant inquiries; not appropriate to infer the first respondent had insurance at the relevant time either because it previously held it or because of the nature of the business which it carried on; applicant has established the first respondent did not hold a valid policy of insurance at the deemed date of injury and accordingly is entitled to recover compensation from the second respondent as nominal insurer.

Decision date: 17 December 2025 | Member: Cameron Burge

Kaur v Meditech Pty Ltd ATF Meditech Trust [2025] NSWPIC 683

Workers Compensation Act 1987; ‘disease injury’ under section 4(b)(i); claim for permanent impairment; disease injury to right wrist as a result of work duties undisputed; claim for disease injury to right elbow and right shoulder disputed; alternatively argued elbow and shoulder consequential to accepted wrist injury; Held – right elbow and right shoulder determined to be disease injury contracted in the course of employment; elbow and shoulder conditions not consequential to wrist; all conditions developed concurrently; remitted to President for referral to Medical Assessor in relation to assessment of whole person impairment (WPI) for right wrist, right elbow, and right shoulder conditions.

Decision date: 17 December 2025 | Member: Adam Halstead

Singh v CMA Ecocycle Pty Ltd [2025] NSWPIC 687

Workers Compensation Act 1987; claim for lump sum compensation including for disputed back injury; consideration of medical records; Mason v Demasi considered; Held – applicant suffered back injury; referred to Medical Assessor.

Decision date: 18 December 2025 | Member: Michael Wright

Al Kibbah v Ready Workforce (a Division of Chandler Macleod Group) Pty Ltd [2025] NSWPIC 688

Workers Compensation Act 1987; claim for weekly compensation for disputed injurious event for back injury and secondary psychological injury; consideration of CCTV and surveillance footage, and medical evidence; Held – applicant suffered injury and psychological condition; award for the applicant.

Decision date: 18 December 2025 | Member: Michael Wright

Blake v B W & J W Schumann Pty Ltd [2025] NSWPIC 689

Workers Compensation Act 1987; head injury; applicant has no recollection of events leading to injury; findings of fact where no direct evidence; Nguyen v Cosmopolitan Homes applied; Held – award for the applicant.

Decision date: 19 December 2025 | Member: Mitchell Strachan

Rasoli v S Gul & MA Kazimi [2025] NSWPIC 691

Workers Compensation Act 1987; lump sum claim; undisputed fall from height; undisputed injury to left shoulder; dispute about injury to right knee, lumbar spine and cervical spine and an allegation of primary psychological injury; issue of lack of contemporaneous records in clinical notes; all evidence to be weighed in the balance; Held – satisfied on the balance of probabilities that the applicant had suffered injuries as alleged; matter remitted to the President for referral to a Medical Assessor.

Decision date: 22 December 2025 | Member: Jane Peacock

Motor Accidents Medical Review Panel Decisions

Kvackovksi v Allianz Australia Insurance Limited [2025] NSWPICMP 971

Motor Accident Injuries Act 2017; threshold injury and degree of permanent impairment disputes; claimant was the front seat passenger in a vehicle waiting to turn right at a red traffic control light; a broken-down truck was stationary in the left lane; cars in the left lane were merging into the right lane; insured vehicle hit the claimant’s vehicle on its left passenger side door; claimant was assessed and then went home; claimant consulted her general practitioner the next day; claimant did not require any specific treatment; claimant did not return to driving or return to work; claimant experienced left-sided neck pain and left shoulder pain; claimant also experienced symptoms of psychological disturbance following the accident; Medical Assessor (MA) found that all injuries caused by the motor accident are threshold injuries; MA declined to assess the whole person impairment (WPI); Held – Review Panel accepted the finding of the claimant’s independent medical examination that the accident-related radiculopathy in lumbar spine had been present since the motor accident; Review Panel relied upon David v Allianz Australia Insurance Limited in finding that claimant has had radiculopathy in lumbar spine for some time since the accident; Review Panel accepts that lumbar spine injury is non-threshold; Panel found that all other injuries relevantly are threshold; Review Panel found pre-existing spinal impairment such that there is a net 0% WPI from spinal injuries caused by the subject accident; Review Panel found 7% WPI arising from left shoulder injury based upon reduced active range of movement in comparison to full active range of movement in the uninjured right shoulder; both certificates revoked.

Decision date: 11 December 2025 | Panel Members: Member Gary Victor Patterson, Dr Shane Moloney, and Dr Christopher Oates | Injury module: Spine, Upper Limb, and Digestive System

Doyle v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 972

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); 75 year old claimant walking along footpath when knocked over by a reversing truck with a double-axle trailer and then subsequently run over up to three times; multiple injuries including fractured right pelvis; following surgery to pelvis, complaints to right hip; subsequent total right hip replacement surgery not referred for assessment; procedural fairness considerations; Mandoukos v Allianz Australia Insurance Limited cited; causation of subsequent surgery; impairment evaluation of right hip; assessed by original Medical Assessor as having 0% whole person impairment (WPI) as all injuries had resolved; Held – Review Panel accepted causation of right hip injury; subsequent surgery included in WPI calculation; right hip assessed as ‘fair result’ at 20% WPI; MAC revoked; new certificate issued.

Decision date: 11 December 2025 | Panel Members: Member Jeremy Lum, Dr Margaret Gibson, and Dr Shane Moloney | Injury module: Spine, Upper Limb, and Lower Limb

Mizdrak v CIC Allianz Insurance Limited [2025] NSWPICMP 973

Motor Accidents Compensation Act 1999; claimant suffered injury in a motor vehicle accident when his vehicle was hit from behind; claimant lodged a personal injury claim form; dispute arose as to the claimant’s degree of whole person impairment (WPI); Medical Assessor (MA) determined that the claimant’s injuries were not caused by the accident; WPI was not assessable; claimant made an application under section 63 of the Act for referral of assessment to the Review Panel; Held – Review Panel conducted its own examination and found that the injuries referred to the Review Panel were not caused by the accident; WPI was not assessable; certificate of MA was affirmed.

Decision date: 12 December 2025 | Panel Members: Member Terence Stern OAM, Dr Thomas Newlyn, and Dr Himanshu Singh | Injury module: Mental and Behavioural

McCulloch v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 974

Motor Accident Injuries Act 2017; claimant suffered injury in a motor vehicle accident when she was knocked off of her scooter by a car coming from her right side; dispute arose as to whole person impairment (WPI); Medical Assessor (MA) determined the claimant’s WPI as a result of the physical injuries sustained in the accident was 8%; claimant made an application under section 7.26 of the Act for referral of assessment to the Medical Review Panel; Held – Review Panel conducted its own examination and found that WPI as a result of injuries sustained in the accident totalled 16%; certificate of MA was revoked.

Decision date: 12 December 2025 | Panel Members: Member Terence Stern OAM, Dr Drew Dixon, and Dr David Gorman | Injury module: Spine, Upper Limb, and Lower Limb

Allianz Australia Insurance Limited v Babak [2025] NSWPICMP 975

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of threshold injury; Medical Assessor (MA) diagnosed post-traumatic stress disorder caused by the accident; non-threshold injury; insurer’s application for review under section 7.26; dispute regarding accident circumstances; claimant examined by Medical Assessors of Panel; Held – diagnosis of adjustment disorder; psychological injury caused by accident; threshold injury; post-traumatic stress disorder considered; Review Panel not satisfied DSM-5-TR criterion have been met at any stage post-accident; MAC revoked and new certificate issued.

Decision date: 12 December 2025 | Panel Members: Member Bianca Montgomery-Hribar, Dr Himanshu Singh, and Dr Melissa Barrett | Injury module: Mental and Behavioural

Allianz Australia Insurance Limited v Akkaoui [2025] NSWPICMP 976

Motor Accident Injuries Act 2017; motor accident; high speed collision; dispute related to whether the degree of permanent impairment was greater than 10%; claimant re-examined; previous examination determined claimant not stable due to recent thumb surgery; treatment dispute determined at that time; re-examination by Review Panel eight months later of permanent impairment of all body parts; claimant suffered multiple rib fractures, lacerations, right thumb fracture, various scars, soft tissue injuries and aggravation of cervical spine condition; Held – degree of permanent impairment assessed at 14%.

Decision date: 12 December 2025 | Panel Members: Principal Member John Harris, Dr Christopher Oates, and Dr Margaret Gibson | Injury module: Spine, Upper Limb, Lower Limb, Brain Injury, and Skin

Insurance Australia Limited t/as NRMA Insurance v Read [2025] NSWPICMP 977

Motor Accident Injuries Act 2017; claimant was injured in a motor vehicle accident; food delivery truck turned in front of the claimant and he fell off of his motorbike and was run over by the truck’s wheel; Medical Assessor (MA) determined the claimant’s whole person impairment (WPI) was 15%; insurer applied under section 7.26 of the Act for referral of assessment to the Review Panel; Held – Review Panel conducted its own examination and found that WPI as a result of injuries sustained in the accident was 11%; certificate of the MA was revoked.

Decision date: 12 December 2025 | Panel Members: Member Terence Stern OAM, Dr Christopher Oates, and Dr Michael Couch | Injury module: Spine, Upper Limb, Lower Limb, and Minor Skin

Khan v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 978

Motor Accident Injuries Act 2017; claimant suffered injury in a motor vehicle accident when he was riding his scooter and was knocked to the ground by a car; claimant lodged a personal injury claim form; Medical Assessor (MA) determined the claimant’s whole person impairment (WPI) was 7%; claimant made an application under section 7.26 of the Act for referral of assessment to the Review  Panel; Held – Review Panel conducted its own examination and found as a result of psychiatric injuries sustained the claimant suffered a total WPI of 7%; certificate of MA was affirmed.

Decision date: 12 December 2025 | Panel Members: Member Terence Stern OAM, Dr Christopher Rikard-Bell, and Dr Himanshu Singh | Injury module: Mental and Behavioural

Insurance Australia Limited t/as NRMA Insurance v Barton [2025] NSWPICMP 979

Motor Accident Injuries Act 2017; claimant suffered injury in a motor vehicle accident when a car pulled out in front and her vehicle T-boned the other car; claimant lodged an application for Personal Injury Benefits; Medical Assessor (MA) determined the claimant’s whole person impairment (WPI) was 15%; insurer made an application under section 7.26 of the Act for referral of assessment to the Review Panel; Held – Review Panel conducted its own examination and found that the total WPI as a result of injuries sustained in the accident was 7%; certificate of the MA was revoked.

Decision date: 12 December 2025 | Panel Members: Member Terence Stern OAM, Dr Alan Doris, and Dr Surabhi Verma | Injury module: Mental and Behavioural

Allianz Australia Insurance Limited v Meilak [2025] NSWPICMP 980

Motor Accident Injuries Act 2017; threshold injury dispute; claimant developed psychological symptoms following physical injuries from the motor accident; original Medical Assessor diagnosed post-traumatic stress disorder which was not a threshold injury; scope of medical dispute;  Mandoukos v Allianz Insurance Australia Ltd considered; Held – Review Panel found criterion A under the DSM-5-TR for a diagnosis of post-traumatic stress disorder not satisfied; Review Panel diagnosed persistent depressive disorder which is not a threshold injury; different diagnosis to original assessment; certificate revoked.

Decision date: 12 December 2025 | Panel Members: Member Jeremy Lum, Dr Christopher Rikard-Bell, and Dr Himanshu Singh | Injury module: Mental and Behavioural

Perras v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 981

Motor Accident Injuries Act 2017; claimant suffered injury in a motor vehicle accident when a vehicle failed to stop at a stop-sign and collided with the driver-side door of the claimant’s vehicle; dispute as to the claimant’s whole person impairment (WPI) arose; Medical Assessor (MA) determined on 14 May 2025 that the Claimant’s whole person impairment (WPI) as a result of the accident was 3%; claimant made an application under section 7.26 of the Act for referral of assessment to the Review Panel; Held – Review Panel conducted its own examination and found that WPI as a result of injuries sustained in the accident totalled 4%; certificate of MA was revoked.

Decision date: 12 December 2025 | Panel Members: Member Terence Stern OAM, Dr Les Barnsley, and Dr Margaret Gibson | Injury module: Spine, and Upper Limb

Sayed v QBE Insurance (Australia) Limited [2025] NSWPICMP 982

Motor Accident Injuries Act 2017; medical assessment of whole person impairment (WPI) by Medical Assessor (MA); claimant injured in motor vehicle accident when his vehicle was rear-ended at a red light; claimant lodged application for Personal Injury Benefits; dispute arose as to the claimant’s WPI as a result of the accident; MA determined the claimant’s WPI at 0%; claimant sought a review of the assessment under section 7.26; Review Panel re-examined the claimant; Held – Review Panel revoked certificate of MA and substituted the determination of 25% WPI.

Decision date: 12 December 2025 | Panel Members: Member Terence Stern OAM, Dr Margaret Gibson, and Dr Shane Moloney | Injury module: Spine, and Lower Limb

AAI Limited t/as GIO v Coates [2025] NSWPICMP 989

Motor Accident Injuries Act 2017; claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) determined the injuries to the cervical spine and right shoulder were threshold injuries; MA determined the injuries to the thoracic spine and right hand were not caused by the accident; MA determined the claimant’s disputed treatment (right shoulder reconstruction surgery) was related to the injuries caused by the accident and was reasonable and necessary in the circumstances; dispute about treatment and threshold injury; Review Panel conducted its own examination; Held – concluded that the injury to the right shoulder was a non-threshold injury; certificate of MA was revoked; treatment in dispute was related to the accident and was reasonable and necessary in the circumstances; certificate of MA was affirmed.

Decision date: 15 December 2025 | Panel Members: Member Terence Stern OAM, Dr Drew Dixon, and Dr Michael Couch | Injury module: Spine, and Upper Limb; Treatment Type: Surgery

Lawless v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 990

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant hit by a car as a pedestrian at a crossing suffering a head injury with psychiatric sequalae; assessed by original Medical Assessor (MA) as having 6% whole person impairment (WPI) for post-traumatic stress disorder and major depressive disorder; Held – Panel could not diagnose post-traumatic stress disorder as claimant had no recollection of the accident; Panel diagnosed major depressive episode with anxious distress; impairment assessed at 9% WPI under the psychiatric impairment rating scale (PIRS); MAC revoked; new certificate issued.

Decision date: 15 December 2025 | Panel Members: Member Jeremy Lum, Dr Alan Doris, and Dr Himanshu Singh | Injury module: Mental and Behavioural

Bruce-Smith v Allianz Australia Insurance Limited [2025] NSWPICMP 991

Motor Accident Injuries Act 2017; threshold injury dispute; claimant was driving to work in the morning and still dark; claimant’s vehicle had travelled through a roundabout; insured vehicle had been stationary on the side of the carriageway, pulled out suddenly into the claimant’s lane; despite braking and attempting to steer to the right, claimant’s vehicle collided with the front right-hand corner of the insured vehicle; airbags in the claimant’s vehicle did not activate; ambulance and police did not attend; claimant’s vehicle was drivable; claimant continued on to his place of employment; claimant began to experience soreness in his left shoulder and elbow during the course of the day; claimant began to experience left leg pain within the next few days; claimant was referred to a neurosurgeon who did not recommend surgery; Medical Assessor (MA) found accident-related lumbar injury to be a threshold injury; claimant’s review application; claimant re-examined; Held – Review Panel satisfied the claimant had recurrent episodes of back pain following an earlier accident; Review Panel satisfied MRI scans of lumbar spine performed after subject accident reported no significant abnormalities and no neural compression; Review Panel not satisfied that lumbar radiculopathy was present or caused by motor accident, contrary to findings of the claimant’s independent medical examination; certificate confirmed.

Decision date: 15 December 2025 | Panel Members: Member Gary Victor Patterson, Dr Michael Couch, and Dr Shane Moloney | Injury module: Spine

Sonter v Allianz Australia Insurance Limited [2025] NSWPICMP 992

Motor Accident Injuries Act 2017; review of medical assessment; threshold injury; post-traumatic stress disorder; police officer; scene of accident with numerous young people caught in vehicle; persons catastrophically injured and deceased; vehicle caught fire; recurring intrusive memory; deterioration of relationship; suicidal ideation; impaired psychological functioning; post-accident treatment; triggers for intrusive memory; no prior post-traumatic symptoms; Held – causation determined by subject motor accident; non-threshold injury.

Decision date: 15 December 2025 | Panel Members: Member Hugh Macken, Dr Paul Friend, and Dr Christopher Canaris | Injury module: Mental and Behavioural

Insurance Australia Limited t/as NRMA Insurance v Jose [2025] NSWPICMP 993

Motor Accident Injuries Act 2017; medical assessment of whole person impairment (WPI) by Medical Assessor (MA); claimant injured in motor vehicle accident when she was inspecting her broken-down car when a vehicle hit the car and knocking her onto the road; dispute arose as to the claimant’s WPI; Medical Assessor (MA) determined the claimant’s WPI at 17%; insurer sought a review of the assessment under section 7.26; Held – Review Panel re-examined the claimant; Review Panel revoked certificate of the MA; substituted determination of 7% WPI.

Decision date: 15 December 2025 | Panel Members: Member Terence Stern OAM, Dr Gerald Chew, and Dr Alan Doris | Injury module: Mental and Behavioural

Ali v AAI Limited t/as GIO [2025] NSWPICMP 994

Motor Accidents Compensation Act 1999; review of Medical Assessment Certificate (MAC); nervous shock claim; claimant suffered psychiatric injury following news of his son’s death in a motor accident; claimant assessed by original Medical Assessor (MA) as having 7% whole person impairment (WPI) for persistent depressive disorder with ongoing major depressive disorder; inconsistencies in documentation and claimant’s presenting history; Held – Panel agreed with the original MA’s diagnosis; Review Panel’s assessment under the psychiatric impairment rating scale (PIRS) was also 7% WPI; MAC confirmed.

Decision date: 16 December 2025 | Panel Members: Member Jeremy Lum, Dr Douglas Andrews, and Dr Michael Hong | Injury module: Mental and Behavioural

Phimphakaysone v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 995

Motor Accident Injuries Act 2017; motor accident; rear end collision; assessment of whole person impairment (WPI) for psychiatric impairment and issue of threshold injury; no prior psychiatric symptoms; absence of treatment; claimant’s lack of English adequate explanation for non-reporting of symptoms; clinical expertise of Medical Assessors satisfied that claimant suffered a major depressive disorder; non-threshold psychological injury; assessment of permanent impairment; some loss of function across various psychiatric impairment rating scale categories; no issues of principle; claimant assessed at 6% WPI; Held – original assessment revoked.

Decision date: 16 December 2025 | Panel Members: Principal Member John Harris, Dr John Baker, and Dr Christopher Canaris | Injury module: Mental and Behavioural

Choubassi v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 998

Motor Accident Injuries Act 2017; review of certificate and reasons of Medical Assessor (MA); finding of 6% whole person impairment (WPI) by way of a further assessment review for a major depressive disorder; claimant injured in a T-bone collision/accident; assessment involved consideration of the claimant subsequently being charged with various drug related offences; serving a term of imprisonment and publicity surrounding charges; MA not initially aware of criminal charges at the time of his initial examination of the claimant and when assessing 15% WPI; claimant had also denied a criminal record to other examiners; claimant diagnosed by the Medical Assessors as having a persistent depressive disorder with anxious distress and not satisfied that criminal activities and penalties impacted his psychiatric disability; claimant assessed by the Medical Assessors as having 7% WPI; Held –  certificate and reasons of the MA revoked.

Decision date: 17 December 2025 | Panel Members: Member Alexander Bolton, Dr Ankur Gupta, and Dr Christopher Canaris | Injury module: Mental and Behavioural

Allianz Australia Insurance Limited v Kim [2025] NSWPICMP 999

Motor Accident Injuries Act 2017; claimant was injured in a motor vehicle accident; Medical Assessor (MA) issued a certificate assessing 12% whole person impairment (WPI); medical dispute arose as to total WPI; insurer sought a review of the Medical Assessment under section 7.26; Review Panel conducted an examination and considered the factors contributing to the injury according to section 6.6 of the Motor Accident Guidelines; Held –  MA determination was revoked; Review Panel substituted the determination that the claimant sustained WPI of 11%.

Decision date: 17 December 2025 | Panel Members: Member Terence Stern OAM, Dr Mohammed Assem, and Dr Drew Dixon | Injury module: Spine, and Upper Limb

Druma v QBE Insurance (Australia) Limited [2025] NSWPICMP 1000

Motor Accident Injuries Act 2017; medical assessment of whole person impairment (WPI) by Medical Assessor (MA); claimant injured in motor vehicle accident when her vehicle was hit from behind; claimant lodged Application for Personal Injury Benefits; dispute arose as to the claimant’s WPI as a result of the accident; MA determined the claimant’s WPI as a result of injuries sustained in the accident at 0%; claimant sought a review of the assessment under section 7.26; review panel re-examined the claimant; Held – Review Panel revoked certificate of the MA and substituted the determination of 4% WPI.

Decision date: 18 December 2025 | Panel Members: Member Terence Stern OAM, Dr Margaret Gibson, and Dr Drew Dixon | Injury module: Spine, Upper Limb, and Lower Limb

Allianz Australia Insurance Limited v Miles [2025] NSWPICMP 1001

Motor Accident Injuries Act 2017; claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) certified 12% whole person impairment (WPI) for injury to lumbar spine, right shoulder, and right arm; history of pre-existing complaints; Held –  causation of injury to lumbar spine established; injury to lumbar spine soft tissue injury; assessed as DRE category II or 5% WPI; no frank injury to right shoulder in accident; claimant sustained injury to the right shoulder (rotator cuff tear) when her left leg gave way after undergoing cortisone injection to lumbar spine; causation established having regards to clause 6.5 to 6.7 of the Motor Accident Guidelines; Briggs v IAG Limited Trading cited; section 5D of the Civil Liability Act 2002 cited; claimant sustained soft tissue injury to right arm (resolved); no assessable impairment of right arm; claimant underwent surgery to right shoulder; Held – Review Panel declined to assess WPI where condition not stable; further medical examination; right shoulder injury assessed at 6% WPI; combined assessment of 11% WPI certificate of MA revoked; certified injury to lumbar spine and right shoulder gave rise to WPI of 11%.

Decision date: 18 December 2025 | Panel Members: Senior Member Susan McTegg, Dr David Gorman, and Dr Rhys Gray | Injury module: Spine, and Upper Limb

Insurance Australia Limited t/as NRMA Insurance v Alzanati [2025] NSWPICMP 1002

Motor Accident Injuries Act 2017; medical assessment of 23% whole person impairment (WPI); insurer’s application for review; diagnoses of persistent depressive disorder and posttraumatic disorder challenged; degree of WPI in issue; claimant examined by both Medical Assessors; Held – claimant’s symptoms fit a diagnosis of major depressive disorder; circumstances of accident not severe enough for a diagnosis of posttraumatic stress disorder; other diagnoses addressed; causation found; claimant complained of severe pain which affected his functioning; WPI assessed at 7%; no adjustment for pre-existing impairment (none), treatment (no effect) or subsequent impairment (from cardiac episode); certificate of original medical assessor revoked; no issues of principle.

Decision date: 18 December 2025 | Panel Members: Member Belinda Cassidy, Dr John Baker, and Dr Surabhi Verma | Injury module: Mental and Behavioural

QBE Insurance (Australia) Limited v Dang [2025] NSWPICMP 1003

Motor Accident Injuries Act 2017; medical assessment of threshold (then minor) injury; insurer’s review of Medical Assessor (MA) decision under section 7.26; diagnosis made by original assessor was of persistent depressive disorder, alcohol use disorder, and a driving phobia; claimant had previous motor accident with previous symptoms; General Practitioner notes disclosed pre-accident alcohol issues; claimant examined by both Medical Assessors; Held – claimant’s evidence unreliable due to unresolved inconsistencies; Review Panel satisfied accident could have and did cause psychological symptoms; Review Panel satisfied claimant sustained an aggravation of a pre-existing alcohol use disorder; Review Panel not satisfied any other disorder present or able to be diagnosed due to presentation at the re-examination; an aggravation of a pre-existing non-threshold injury is also a non-threshold injury; Todev v AAI Limited, and AAI Limited v Hoblos followed; certificate revoked due to difference in diagnosis.

Decision date: 18 December 2025 | Panel Members: Member Belinda Cassidy, Dr Christopher Canaris, and Dr Himanshu Singh | Injury module: Mental and Behavioural

Dao v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 1004

Motor Accident Injuries Act 2017; assessment of injuries (physical); claimant’s application for review under section 7.26; claimant alleged injuries to left shoulder, cervical spine, lumbar spine, right leg and left knee; claimant examined by one member of the Panel; claimant conceded right leg and left knee injuries were threshold; significant controversy over shoulder injury and tear to supraspinatus and whether claimant had radiculopathy; Held – Review Panel satisfied alleged injuries could have occurred; Panel satisfied neck injury was soft tissue and threshold injury with no evidence of cervical radiculopathy; claimant’s shoulder symptoms were related to the neck injury and no mechanism for a frank left shoulder injury; lumbar injury caused but claimant does not have lumbar radiculopathy; certificate of Medical Assessor confirmed.

Decision date: 18 December 2025 | Panel Members: Member Belinda Cassidy, Dr Shane Moloney, and Dr Christopher Oates | Injury module: Spine, Upper Limb, and Lower Limb

Insurance Australia Limited t/as NRMA Insurance v Petratos [2025] NSWPICMP 1006

Motor Accident Injuries Act 2017; medical assessment of whole person impairment (WPI); insurer’s review of Medical Assessor (MA) decision under section 7.26; diagnosis made by original assessor was of posttraumatic stress; claimant had previous motor accident with previous symptoms reported in General Practitioner notes; claimant had two children under four and was pregnant again with insurer arguing impairment not permanent; claimant examined by both medical assessors and was honest and open in her history; Held – Review Panel satisfied accident could have and did cause psychological symptoms; Review Panel satisfied claimant sustained a posttraumatic stress disorder due to circumstances of accident and behaviour of driver and others at the scene; injuries were stable and her impairment was permanent; WPI assessed at 5% and not adjusted further; no issue of principle; certificate revoked.

Decision date: 18 December 2025 | Panel Members: Member Belinda Cassidy, Dr Christopher Canaris, and Dr Himanshu Singh | Injury module: Mental and Behavioural

Zaric v QBE Insurance (Australia) Limited [2025] NSWPICMP 1012

Motor Accident Injuries Act 2017; assessment of degree of permanent impairment dispute; claimant was a seat-belted driver; claimant had a green light; insured vehicle turned at speed across the path of the claimant’s vehicle causing a severe collision; claimant’s airbags deployed; claimant was shocked and had immediate onset of chest pain, neck pain and back pain; claimant managed to self-extricate from her vehicle; Medical Assessor (MA) found 5% WPI for cervical spine; MA found injuries to right upper extremity not caused by the subject accident; Review Panel of the contrary opinion; Held – Review Panel assessed 10% WPI; no matters of principle; certificate revoked.

Decision date: 19 December 2025 | Panel Members: Member Gary Victor Patterson, Dr Christopher Oates, and Dr Michael Couch | Injury module: Spine, Upper Limb, and Lower Limb

AAI Limited t/as GIO v Pi [2025] NSWPICMP 1013

Motor Accident Injuries Act 2017; assessment of treatment and care disputes; claimant was a seat-belted driver; the vehicle behind her side swiped the rear passenger side of the claimant’s vehicle; claimant maintains that the accident caused injuries to her neck, back and left shoulder; claimant concedes she had problems with all three areas in the past; claimant did not seek any treatment; claimant consulted her local general practitioner whose clinical notes indicated that the claimant had significant problems with her neck in the past; insurer’s independent medical examination opined that mechanism of accident unlikely to cause frank injury to left shoulder; little consideration of likely aggravation, acceleration, worsening of underlying generative condition due to subject accident; Medical Assessor (MA) found that proposed surgery to repair subscapularis tendon and relocation/stabilisation of biceps tendon relates to the injury caused by the subject accident, is reasonable and necessary, and likely to improve claimant’s recovery; insurer’s review application; claimant re-examined; Held – Review Panel satisfied as to likely causation of left shoulder injury; in the alternative, aggravation of underlying condition, due to subject accident; certificate confirmed.

Decision date: 19 December 2025 | Panel Members: Member Gary Victor Patterson, Dr Margaret Gibson, and Dr Drew Dixon | Treatment Type: Surgery

Zlatanovic v Allianz Australia Insurance Limited [2025] NSWPICMP 1014

Motor Accident Injuries Act 2017; assessment of whole person impairment (WPI); claimant’s application for review under section 7.26; claimant was married with three children (one with a disability) and had been subjected to violence in the marriage; claimant reported some symptoms of posttraumatic stress before accident but received no treatment; accident involved head on collision and injury to one of the claimant’s children in the back of the car; claimant re-examined by both Medical Assessor (MA); Held –  accident could have and did cause post-traumatic stress disorder; WPI 6%, pre-existing impairment mild and assessed at 1%; no subsequent conditions and no adjustment for the effect of treatment; certificate revoked (no change to outcome).

Decision date: 19 December 2025 | Panel Members: Member Belinda Cassidy, Dr Alan Doris, and Dr Wayne Mason | Injury module: Mental and Behavioural

Allianz Australia Insurance Limited v Jang [2025] NSWPICMP 1015

Motor Accident Injuries Act 2017; assessment of threshold injury (psychiatric); insurer’s application for review under section 7.26; Medical Assessor (MA) diagnosed a major depressive disorder and driving phobia but did not address all the criteria in DSM-5-TR; General Practitioner records indicated panic attack disorder before the accident and there was a delay in reporting the accident and seeking treatment; claimant re-examined by both MAs; Held – some aspects of the claimant’s history were inconsistent and claimant could not recall other aspects; claimant’s condition is best diagnosed as an exacerbation of a pre-existing panic disorder; causation was established; an exacerbation injury of a non-threshold disorder is a non-threshold injury; Todev v AAI Limited, and AAI Limited t/as GIO v Hoblos followed; certificate revoked (no change in outcome).

Decision date: 19 December 2025 | Panel Members: Member Belinda Cassidy, Dr John Baker, and Dr Surabhi Verma | Injury module: Mental and Behavioural

Insurance Australia Limited t/as NRMA Insurance v Msallam [2025] NSWPICMP 1016

Motor Accident Injuries Act 2017; assessment of impairment resulting from psychiatric injuries and insurer’s application for review under section 7.26; complex medical history including exposure to war in home country; work accident; two or more previous accidents; and a subsequent accident four months later; claimant studied medicine overseas as doctor but struggled to have qualifications recognised and never practiced in Australia; Medical Assessor (MA) diagnosed adjustment disorder and assessed whole person impairment (WPI) at 22%; claimant examined by both Medical Assessors; Held –  claimant’s evidence unreliable; claimant had a symptomatic pre-existing psychiatric disorder before the accident; disorder was an adjustment disorder; claimant’s current disorder was a major depressive disorder; impairment assessed at 7%; no adjustment for treatment (ineffective); no adjustment for subsequent accident (no additional impairment); pre-existing impairment assessed at 2%; total impairment 5% and certificate of MA was revoked.

Decision date: 19 December 2025 | Panel Members: Member Belinda Cassidy, Dr John Baker, and Dr Christopher Canaris | Injury module: Mental and Behavioural

Rizz v AAI Limited t/as GIO [2025] NSWPICMP 1018

Motor Accidents Compensation Act 1999; claimant’s application for review of Medical Assessor’s determination; permanent impairment dispute; treatment and care dispute; causation of lower back injury; pre-existing spondylolisthesis; claimant suffered lower back injury in second motor accident; anterior lumbar interbody fusion surgery (ALIF); whether fusion surgery related to lower back injury caused by the  subject accident and was reasonable and necessary in the circumstances; moderate forces involved in the mechanism of subject accident; biomedical engineering report considered; scope of review and ambit of treatment dispute considered; Held –  certificate of Medical Assessor revoked.

Decision date: 19 December 2025 | Panel Members: Member Maurice Castagnet, Dr Mohammed Assem, and Dr Shane Moloney | Injury module: Spine; Treatment Type: Surgery

AAI Limited t/as GIO v Dakali [2025] NSWPICMP 1019

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of threshold injury; Medical Assessor (MA) diagnosed major depressive disorder caused by the accident (non-threshold injury); insurer’s application for review under section 7.26; claimant examined by Medical Assessors of Panel; Held – diagnosis of adjustment disorder with mixed anxiety and depressed mood; psychological injury caused by accident; threshold injury; major depressive disorder considered; Review Panel not satisfied DSM-5-TR criterion have been met at any stage post-accident; David v Allianz Australia Insurance Limited, and Lynch v AAI Ltd considered; MAC revoked; new certificate issued.

Decision date: 19 December 2025 | Panel Members: Member Bianca Montgomery-Hribar, Dr Himanshu Singh, and Dr Melissa Barrett | Injury module: Mental and Behavioural

QBE Insurance (Australia) Limited v Druma [2025] NSWPICMP 1020

Motor Accident Injuries Act 2017; medical assessment of threshold Injury and Treatment and Care by Medical Assessor (MA); claimant injured in motor vehicle accident when his vehicle was hit from behind; claimant lodged Application for Personal Injury Benefits; dispute arose as to whether the claimant suffered threshold Injuries; whether the C3-4 Anterior Cervical Decompression and Fusion surgery was related to the injuries caused by the accident; whether it was reasonable and necessary in the circumstances; MA determined that injuries to the cervical spine, lumbar spine, left shoulder, and right shoulder were threshold Injuries; claimant sought a review of the assessment under section 7.26; MA also certified that the C3/4 Anterior Cervical Decompression and Fusion surgery was related to the injuries caused by the accident and was reasonable and necessary in the circumstances; the insurer sought a review of the assessment under section 7.26 of the MAI Act; the Review Panel re-examined the claimant; Held – Review Panel revoked the certificate of MA the for threshold Injury dispute and substituted the determination that injuries to the cervical spine, left shoulder, and right shoulder were non-threshold injuries; injuries to the thoracic spine and lumbar spine were threshold injuries; Review Panel affirmed the determination of the MA for the Treatment and Care dispute; C3-4 Anterior Cervical Decompression and Fusion surgery relates to the injuries caused by the accident and was reasonable and necessary in the circumstances.

Decision date: 22 December 2025 | Panel Members: Member Terence Stern OAM, Dr Drew Dixon, and Dr Margaret Gibson | Injury module: Spine, and Upper Limb; Treatment Type: Surgery

Siu v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 1021

Motor Accident Injuries Act 2017; assessment of impairment resulting from physical injuries and treatment disputes; claimant’s application for review under section 7.26; claimant sustained fractured sternum and alleged right ankle and shoulder, lower back and neck injuries; claimant alleged her spinal injuries caused cervical and lumbar radiculopathy; General Practitioner’s notes indicated some pre-accident neck complaints; claimant examined by one Medical Assessor (MA); Held – claimant was co-operative and consistent and had further recovered since earlier assessments; all injuries alleged accepted as caused; claimant’s leg swelling not caused by accident but due to venous insufficiency and various venis; claimant assessed as DRE I in both neck and lower back; 4% whole person impairment (WPI) for loss of right shoulder motion; 0% for right ankle impairment and the sternal fracture had recovered; none of the treatment was considered reasonable and necessary or related to the accident; certificate revoked although no change in the ultimate outcome.

Decision date: 22 December 2025 | Panel Members: Member Belinda Cassidy, Dr David Gorman, and Dr Michael Couch | Injury module: Spine, Upper Limb, and Lower Limb

Msallam v AAI Limited t/as GIO [2026] NSWPICMP 1

Motor Accident Injuries Act 2017; assessment of a threshold injury (psychiatric) dispute and insurer’s application for review under section 7.26; complex medical history covered in related decision; Medical Assessor (MA) diagnosed adjustment disorder which is a threshold injury; claimant examined by both Medical Assessors; Held –  adopting findings from the related decision the claimant’s evidence unreliable; claimant had a symptomatic pre-existing psychiatric disorder from a 3 August 2018 accident before the current 30 December 2018 accident; that disorder was a major depressive disorder; claimant’s current disorder was an exacerbation of this major depressive disorder; Todev v AAI Limited, and AAI Limited v Hoblos followed; decision made that the exacerbation injury was a non-threshold injury; certificate of MA revoked.

Decision date: 15 January 2026 | Panel Members: Member Belinda Cassidy, Dr John Baker, and Dr Christopher Canaris | Injury module: Mental and Behavioural

Workers Compensation Medical Appeal Panel Decisions

Longo v DCL Engineering Group [2025] NSWPICMP 966

Workplace Injury Management and Workers Compensation Act 1998; appeal against assessment in the psychiatric impairment rating scale (PIRS) of Class 2 for social and recreational activities on the basis that the factual assumptions in the Medical Assessment Certificate (MAC) did not support the assessment; Appeal Panel satisfied that the reasons provided by the Medical Assessor (MA) were sufficient to support a mild level of disability in this scale even excluding the regular telephone conversations with her brother as an irrelevant consideration; assessment of Appeal Panel was the same as that made by the MA and has not led to a different result; Held – MAC confirmed.

Decision date: 10 December 2025 | Panel Members: Member Carolyn Rimmer, Dr Graham Blom, and Professor Nicholas Glozier | Body system: Psychological/Psychiatric

Chrystal v State of New South Wales (NSW Police Force) [2025] NSWPICMP 967

Workplace Injury Management and Workers Compensation Act 1998; appeal against assessment in the psychiatric impairment rating scale (PIRS) of concentration, persistence and pace on the basis that the Medical Assessor (MA) relied on inaccurate evidence in relation to the playing of video-games; appellant’s submissions contained factual matters which were disregarded by the Appeal Panel; Appeal Panel accepts that examples of activities are not criteria or tests and that the MA did not apply incorrect criteria; no evidence that the MA relied on inaccurate evidence; no error in the assessment of Class 2 for concentration, persistence and pace; Held – MAC confirmed.

Decision date: 10 December 2025 | Panel Members: Member Carolyn Rimmer, Dr Douglas Andrews, and Dr John Lam-Po-Tang | Body system: Psychological/Psychiatric

Keegan v Murravale Retirement Home Ltd [2025] NSWPICMP 968

Workplace Injury Management and Workers Compensation Act 1998; whether Medical Assessor’s (MA) ratings of the appellant’s impairment in self-care and personal hygiene, social and recreational activities, and concentration, persistence and pace involved error; Held – Medical Assessor’s ratings of the appellant’s impairment in self-care and personal hygiene and social and recreational activities involved no error, but her rating of the appellant’s impairment in concentration, persistence and pace did; MAC revoked.

Decision date: 10 December 2025 | Panel Members: Member Marshal Douglas, Professor Nicholas Glozier, and Dr Douglas Andrews | Body system: Psychological/Psychiatric

Legrand v State of New South Wales (Department of Primary Industries) [2025] NSWPICMP 969

Workplace Injury Management and Workers Compensation Act 1998; appeal by claimant regarding assessments for the cervical spine, both shoulders and digestive system for a 2005 injury, and impairment to the neck from a 2000 injury; whether adequate reasons had been given for the 2000 injury assessment in view of subsequent awards made over the years; whether Medical Assessor (MA) had erred in finding 0% for the shoulders; whether the MA had erred in applying the provisions of section 323 regarding the assessment of the cervical spine; whether the MA had erred in applying the provisions of section 323 regarding the digestive system; whether further submissions should be accepted; Held – being within the 5465 pages of material, prior MACs and awards relating to both injuries, the MA failed to explain his assessment of the Table of Disabilities injury to the neck in 2000 or the WPI cervical spine injury in 2005; Cole v Wenaline, Wingfoot v Kocak, Campbelltown City Council v Vegan, Rail Services Australia v Dimovski, and AV v AW considered; MA erred in finding there had been no injury to the shoulders, as they had been referred as consequential conditions; digestive system assessment reasons inadequate; appellant's further submissions said to be in reply to the respondent's submissions rejected as a matter of policy; submissions misconceived in any event; claimant re-examined; Held – MAC revoked.

Decision date: 11 December 2025 | Panel Members: Member John Wynyard, Dr John Garvey, and Dr Robert Kuru | Body system: Cervical Spine, Right Upper Extremity, Left Upper Extremity, and Digestive System

Burns v The University of Sydney [2025] NSWPICMP 970

Workplace Injury Management and Workers Compensation Act 1998; appeal against Medical Assessment Certificate (MAC) for 8% whole person impairment (WPI); whether right hip condition contributed to impairment caused by injury to lumbar spine; whether referral terms complied with; whether section 323 deduction of 100% for right hip erroneous; Held – error in complying with referral; Medical Assessor (MA) assumed wrongly that right hip condition was the cause of injury when evidence showed it was the aggravation of degenerative changes; MA made no deduction for lumbar spine; error in referral as assessment of right hip intended to be as a consequential injury; no error in MA treating right hip injury as occurring on date of lumbar spine injury as it appeared on the referral; Skates v Hills Industries Ltd referred to; apparent agreement that right hip to be assessed as consequential; Elcheikh v Diamond Formwork (NSW) Pty Ltd (in liq) considered in re-assessment by Panel; MAC revoked and section 323 deduction reduced to 50%.

Decision date: 11 December 2025 | Panel Members: Member John Wynyard, Dr Tim Anderson, and Dr Roger Pillemer | Body system: Lumbar Spine, Lower Extremity, Upper Digestive Tract, and Scarring

Shams v Mastercard Asia Pacific (Australia) Pty Ltd [2025] NSWPICMP 983

Workplace Injury Management and Workers Compensation Act 1998; appellant submits that the Medical Assessor erred in his assessment of the psychiatric impairment rating scale (PIRS) category of employability; fresh evidence rejected; Held – Panel agreed; MAC revoked.

Decision date: 12 December 2025 | Panel Members: Member Deborah Moore, Professor Nicholas Glozier, and Dr Douglas Andrews | Body system: Psychological/Psychiatric

Winmill v MWR Transport Pty Ltd [2025] NSWPICMP 984

Workplace Injury Management and Workers Compensation Act 1998; appellant suffered lumbar spine injury assessed at 7% whole person impairment (WPI) including an allowance of 2% for the effects on the activities of daily living (ADLs); appellant suffered chronic pain and developed sleep apnoea; claim referred for assessment under the respiratory system for obstructive sleep apnoea; discussion of American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5) and SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed 1 March 2021 (the Guidelines) regarding assessment of sleep disorders under the respiratory chapter for obstructive sleep apnoea and/or due to neurological injury; rejection of appellant’s submission that Medical Assessor (MA) misunderstood nature of injury; acceptance of grounds of appeal relating to the failure to properly assess and provide reasons for the assessment of the ADLs under Table 13-4 of AMA5; application of Table 1-2 in assessing the effects on the ADLs when assessing impairment under Table 13-4; appellant re-examined for the purposes of determining the effects on the ADLs; original MA’s finding that appellant had a mild obstructive sleep apnoea confirmed; appellant can perform most ADLs and classified as Class 1 under Table 13-4; assessment within range of evaluative judgment informed by clinical impression; Vannini v Worldwide Demolitions cited; assessment of 6% for obstructive sleep apnoea confirmed; Held – MAC confirmed.

Decision date: 12 December 2025 | Panel Members: Principal Member John Harris, Dr Christopher Grainge, and Dr David Gorman | Body system: Lumbar Spine, and Respiratory System

Moosmann v Secretary, Department of Communities and Justice [2025] NSWPICMP 985

Workplace Injury Management and Workers Compensation Act 1998; Medical Assessor (MA) assessed 9% whole person impairment (WPI) in respect of a psychiatric condition; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the assessment of the psychiatric impairment rating scale (PIRS) of social and recreational activities; Held – no error found; MAC confirmed.

Decision date: 12 December 2025 | Panel Members: Member Carolyn Rimmer, Dr Michael Hong, and Dr Ash Takyar | Body system: Psychological/Psychiatric

Ability Options Ltd v Fowler [2025] NSWPICMP 986

Workplace Injury Management and Workers Compensation Act 1998; appeal from decision of Medical Assessor (MA); sufficiency of reasons given by MA; consideration of nature of international travel with reference to psychiatric impairment rating scale (PIRS) categories; Held – extended international travel extends beyond both actual travel and activities undertaken while overseas relevant to other PIRS categories; MAC revoked; new MAC issued.

Decision date: 15 December 2025 | Panel Members: Member Mitchell Strachan, Dr John Lam-Po-Tang, and Dr Michael Hong | Body system: Psychological/Psychiatric

Knight v P & L Knight Builders Pty Ltd [2025] NSWPICMP 987

Workplace Injury Management and Workers Compensation Act 1998; appeal from decision of a Medical Assessor (MA); industrial deafness; section 323 deduction for prior self-employment; Rico Pty Ltd v Roads and Traffic Authority, A & G Engineering Pty Ltd v Civitarese, and OneSteel Ltd v Devine considered and applied; Held – industrial deafness injury deemed to have occurred in one blow; no deduction for prior industrial noise exposure; requirement to give reasons; Medical Assessor not required to comment on all material; consideration only to be had to relevant material; Ferguson v State of New South Wales considered; no error with respect to sufficiency of reasons; Medical Assessment Certificate revoked to correct error with respect to section 323 deduction; new certificate issued.

Decision date: 15 December 2025 | Panel Members: Member Mitchell Strachan, Dr Paul Niall, and Dr Thandavan Raj | Body system: Hearing Loss

Damann Pty Ltd (Deregistered) v Brooker [2025] NSWPICMP 988

Workplace Injury Management and Workers Compensation Act 1998; claim for permanent impairment; no complaint on appeal about the overall impairment level assessed for left lower extremity (knee); Medical Assessor (MA) made a one-tenth deduction under section 323; extent was the subject of the appeal by the employer; deduction of one-tenth can be made if the deduction is too difficult or costly to assess and this is the MA’s reasoning for making the one-tenth deduction;  deduction cannot be inconsistent with the available evidence; adequate path of reasoning must also be demonstrated; Medical Assessment Certificate (MAC) must be read as a whole and whilst the MA has referred to the opinion of an independent medical examination (IME) qualified to provide an opinion on behalf of the worker, the MA fails to identify that fact the IME made a deduction of one-half from his assessment of the left knee; MA need not refer to every aspect of the evidence; while MA has to make an independent assessment, the extent of the deduction made by a MA must be consistent with the available evidence; overwhelming consistency of the evidence, demonstrated with the extensive radiological investigations undertaken prior to injury as well as the other medical evidence before the MA and supported by the opinion of the IME; IME qualified to provide an opinion on behalf of the worker; a one-tenth deduction is inconsistent with the available evidence and inadequate to take account of the contribution of the pre-existing injury, abnormality, or injury to the left knee to the overall impairment assessed; Held – MAC revoked.

Decision date: 15 December 2025 | Panel Members: Member Jane Peacock, Dr Doron Sher, and Dr Andrew Porteous | Body system: Lumbar Spine, Right Lower Extremity, Left Lower Extremity, Left Upper Extremity, and Scarring (TEMSKI)

Wright v Cerebral Palsy Alliance - Accommodation Northern Sydney [2025] NSWPICMP 996

Workplace Injury Management and Workers Compensation Act 1998; appellant submits that the Medical Assessor erred in his assessment of two of the psychiatric impairment rating scale (PIRS) categories, namely travel and social functioning; Held – Appeal Panel found no errors; evidence was more relevant to other categories; Ballas v Department of Education (State of NSW) applied; MAC confirmed.

Decision date: 16 December 2025 | Panel Members: Member Deborah Moore, Professor Nicholas Glozier, and Dr Douglas Andrews | Body system: Psychological/Psychiatric

Coolamon Shire Council v Bartholomew [2025] NSWPICMP 997

Workplace Injury Management and Workers Compensation Act 1998; assessment of 25% whole person impairment (WPI) of the lumbar spine with a one tenth deduction made by the Medical Assessor (MA) pursuant to section 323; appeal pursuant to sections 327(3)(c) and (d) on the basis that a deduction of one tenth was inconsistent with the evidence of earlier injury and surgery to the lumbar spine and at odds with the evidence; Appeal Panel found that the MA failed to adequately address the medical evidence in the matter and relied on an incorrect history in making the deduction of one tenth for pre-existing condition; Appeal Panel found that a deduction of one tenth was at odds with the evidence; Held – error in making a deduction of one tenth; MAC revoked.

Decision date: 17 December 2025 | Panel Members: Member Carolyn Rimmer, Dr Christopher Oates, and Dr Roger Pillemer | Body system: Lumbar Spine

Medina v Secretary, Department of Communities and Justice [2025] NSWPICMP 1007

Workplace Injury Management and Workers Compensation Act 1998; psychological injury; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of assessments under two of the psychiatric impairment rating scale categories (PIRS), namely social and recreational activities, and concentration, persistence and pace; Appeal Panel considered that the Medical Assessor’s path of reasoning was inadequate, and it was not clearly discernible from the reasons given in the Medical Assessment Certificate (MAC) that the assessments under the contested PIRS categories were based upon the correct criteria; re-examination was considered necessary in the circumstances of a finding of error; Held – MAC revoked.

Decision date: 18 December 2025 | Panel Members: Member Jane Peacock, Professor Nicholas Glozier, and Dr Ash Takyar | Body system: Psychological/Psychiatric

BZY v Secretary, Department of Communities and Justice (Corrective Services) [2025] NSWPICMP 1008

Workplace Injury Management and Workers Compensation Act 1998; psychological injury; claim for permanent impairment; Medical Assessor found that the appellant had not reached maximum medical improvement (MMI); appellant worker appealed on the failure to give reasons; error found by the Appeal Panel in the failure to give adequate reasons; re-examination was considered necessary in the circumstances of a finding of error; Held – MAC confirmed.

Decision date: 18 December 2025 | Panel Members: Member Jane Peacock, Professor Nicholas Glozier, and Dr Ash Takyar | Body system: Psychological/Psychiatric

HammondCare v Kemp [2025] NSWPICMP 1009

Workplace Injury Management and Workers Compensation Act 1998; whether Medical Assessor (MA) erred by finding that a pre-existing condition formed no proportion of the respondent’s permanent impairment from her injury; whether MA had proper regard to photographic evidence depicting respondent engaged in recreational and domestic activity; whether MA erred by accepting respondent’s evidence on why she was able to engage in such activity; Held – MA erred by not making a deduction under section 323(1); MA erred by not having proper regard to photographic evidence; respondent re-examined; Medical Assessment Certificate revoked.

Decision date: 18 December 2025 | Panel Members: Member Marshal Douglas, Dr Roger Pillemer, and Dr David Gorman | Body system: Lumbar Spine

Hills Nursing Pty Ltd v Lu [2025] NSWPICMP 1010

Workplace Injury Management and Workers Compensation Act 1998; appeal from decision of Medical Assessor; psychological injury; Ferguson v State of New South Wales applied; findings substantially correct; Minister for Immigration & Ethnic Affairs v Wu Shan Liang applied; Held – MAC confirmed.

Decision date: 19 December 2025 | Panel Members: Member Mitchell Strachan, Dr Graham Blom, and Dr Douglas Andrews | Body system: Psychological/Psychiatric

Yu v Ensign Services Pty Ltd [2025] NSWPICMP 1011

Workplace Injury Management and Workers Compensation Act 1998; appeal from decision of a Medical Assessor; demonstrable error; incorrect criteria; assessment by analogy rather than range of motion; failure to give sufficient reasons; Held – Medical Assessment Certificate revoked due to insufficient reasons; on re-examination by Appeal Panel degree of permanent impairment not fully ascertainable.

Decision date: 19 December 2025 | Panel Members: Member Mitchell Strachan, Dr Christopher Oates, and Dr Doron Sher | Body system: Right Upper Extremity

Mining v Odin Pies & Pastries Pty Ltd [2025] NSWPICMP 1022

Workplace Injury Management and Workers Compensation Act 1998; whether Medical Assessor (MA) erred by not providing adequate reasons for his assessment; Appeal Panel found the MA did not adequately explain his assessment because his reasons were confusing and consequently, that amounted to a demonstrable error; on reassessment the Appeal Panel assessed the appellant’s permanent impairment of his back was the same as the MA assessed; Held – MAC confirmed.

Decision date: 22 December 2025 | Panel Members: Member Marshal Douglas, Dr Gregory McGroder, and Dr Drew Dixon | Body system: Back, Right Leg, Left Leg, and Severe Bodily Disfigurement

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