Legal Bulletin No. 269

Issued 17 July 2026

Welcome to the two hundred and sixty-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 external site and will be available shortly, on Jade external site and Lexis Nexis. Any legislative updates are provided at the base of the Bulletin.

Supreme Court Decisions

Walton v State of New South Wales (Hunter New England Local Health District) [2026] NSWSC 824

Administrative law; judicial review of Medical Appeal Panel decision; where Panel overturned medical assessment certificate determining whole person impairment of 15%; whether Panel correctly applied section 323 of the Workplace Injury Management and Workers Compensation Act 1998 (NSW); Held – a declaration is made pursuant to section 69 of the Supreme Court Act 1970 (NSW) that the decision and the statement of reasons for decision of the third defendant and issued by the second defendant are void and of no effect; the decision of the third defendant given on 16 September 2025 is set aside; the matter is remitted to the second defendant for determination according to law by a differently constituted Appeal Panel constituted under section 328 of the Workplace Injury Management and Workers Compensation Act 1998 (NSW); the first defendant is to pay the plaintiff's costs of the proceedings; no order is made as to costs in respect of the second and third defendants; any variation of the costs order should be sought within seven days.

Decision date: 14 July 2026 | Before: Elkaim AJ

Denshire v Médecins Sans Frontières Australia Ltd [2026] NSWSC 792

Workers compensation; medical assessment; alleged apprehended bias on part of medical assessor; judicial review of Appeal Panel decision on legal question which has only one right answer;  appropriate and sufficient to focus on whether or not assessor’s decision was infected by bias; assessor’s use of word “risible” in certificate said to give rise to apprehended bias; decision-makers expressing disagreement with law; the lay observer would understand that administrators are not required to agree with legal or administrative standards; apprehended bias not established thus Appeal Panel’s decision correct; Held – the plaintiff’s further amended summons is dismissed.

Decision date: 9 July 2026 | Before: Kirk J

Presidential Member Decisions

University of New South Wales v Dinh [2026] NSWPICPD 26

Workers compensation; industrial deafness; whether worker employed by the appellant in an employment to the nature of which the injury was due; duty of expert witness; necessity for factual assumptions made by experts to be proven; South Western Sydney Area Health Service v Edmonds [2007] NSWCA 16 considered and applied; sufficiency of evidence of noisy employment;

Dawson t/as The Real Cane Syndicate v Dawson [2008] NSWWCCPD 35 considered; Held – appeal dismissed; the Member’s Certificate of Determination dated 13 October 2025 is confirmed.

Decision date: 7 July 2026 | Before: Acting Deputy President Paul Sweeney

Reid v Community Plan 270347 [2026] NSWPICPD 27

Workers compensation; material lodged on appeal in the absence of leave: Bale v Mills [2011] NSWCA 226; exercise of discretion by a member regarding the conduct of a hearing; leave to bring an interlocutory appeal pursuant to s 352(3A) of the Workplace Injury Management and Workers Compensation Act 1998; Adam P Brown Male Fashions Pty Ltd v Phillip Morris Inc [1981] HCA 39; 148 CLR 170; Held – the appellant’s application for leave to bring this appeal pursuant to s 352(3A) of the Workplace Injury Management and Workers Compensation Act 1998 is refused; the matter is remitted to the Division Head, Workers Compensation, for the allocation of a hearing date.

Decision date: 7 July 2026 | Before: Deputy President Michael Snell

Stanton v F.L.T. (NSW) Pty Ltd [2026] NSWPICPD 28

Workers compensation; expert evidence in the Commission; payment of compensation as an admission;  pleadings in the Commission; issues of causation; Held – the appellant’s appeal is dismissed; the Certificate of Determination dated 17 September 2025 is confirmed.

Decision date: 9 July 2026 | Before: Deputy President Michael Snell

Motor Accidents non-Presidential Member Decisions

Sonter v Allianz Australia Insurance Limited [2026] NSWPIC 300

Motor Accident Injuries Act 2017; insurer’s application for discretionary exemption from assessment under section 7.34(1)(b); preliminary assessment of claim; complex issues arising; amongst other matters; Held – a court hearing is more likely to result in the just, quick and cost-effective resolution of the real issues in dispute between the parties; the claim is not suitable for assessment; recommendation made that the claim be exempted; recommendation subsequently approved by the Division Head, as the President’s delegate.

Decision date: 27 May 2026 | Member: Philip Carr

AAI Limited t/as AAMI v Everingham [2026] NSWPIC 320

Motor Accident Injuries Act 2017; approval of $160,000.00; pursuant to section 6.23(b); 25-year old claimant involved in a motor accident on 27 November 2023; liability admitted; injuries included comminuted fractures of the right tibia and fibula, keloid scars from the operation sites, occupational physician noted no deformity, swelling or tenderness, full ROM in all dimensions, no crepitus or muscular spasm, no muscle atrophy or shortening, no pain or disability in the right knee, mild discomfort over the fracture site; claimant completed Bachelor of Medical Science and progressing with Medical Degree; capacity to earn not likely to be impacted; past economic loss assessed at $35,000.00; buffer of $125,000.00 for future economic loss; no claim for non-economic loss; $160,000.00 approved as just, fair and reasonable.

Decision date: 3 June 2026 | Member: Michael Inglis

Holmes v Allianz Australia Insurance Limited [2026] NSWPIC 389

Motor Accident Injuries Act 2017; whether accident caused wholly or mostly by the fault of the claimant; accident occurred during the course of testing for provisional rider licence; front wheel of scooter locked after claimant applied the brakes while performing a “quick stop test” in the wet; Vairy v Wyong Shire Council, Imbree v McNeilly, McNeilly v Imbree, Davis v Swift, and AAI Limited t/as GIO v Evic applied; Held – the front wheel of scooter locked because claimant applied brakes too harshly; claimant failed to exercise reasonable care; accident caused by the fault of the claimant; contributory negligence of 40% assessed; accident not caused wholly or mostly by fault of the claimant.

Decision date: 22 June 2026 | Senior Member: Brett Williams

Piper v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPIC 390

Motor Accident Injuries Act 2017; whether accident at intersection not governed by traffic lights caused wholly or mostly by the fault of the claimant; Podrebersek v Australian Iron & Steel Pty Ltd ; AAI Limited t/as GIO v Evic applied; Held – accident was caused by the fault of both drivers; claimant’s contributory negligence assessed at 60%; accident not caused wholly or mostly by the claimant’s fault.

Decision date: 23 June 2026 | Senior Member: Brett Williams

Drew v AAI Limited t/as AAMI & Anor [2026] NSWPIC 395

Motor Accident Injuries Act 2017; claimant’s application for miscellaneous claims assessment; preliminary conference held to clarify dispute between parties; claimant injured in accident on country road involving cattle on the road and headlights from an oncoming vehicle; claim for statutory benefits made against AAMI the claimant’s own insurer; claimant wanted claim transferred to Nominal Defendant on basis oncoming vehicle could not be established after due enquiry and search; claims for damages made against AAMI and Nominal Defendant; Member found there was no issue of fault in the statutory benefits claim, AAMI had accepted the claim and paid benefits; claimant conceded the Commission had no power to direct a statutory benefits claim be transferred from one insurer to another and that section 3.3(2) gave the Personal Injury Commission (Commission) power to determine which of two insurers should accept a claim for benefits but as AAMI had accepted the claim there was no dispute to be determined Allianz Australia Insurance Limited v Insurance Australia Limited t/as NRMA Insurance, AAI Limited t/as AAMI v Allianz Australia Insurance Limited, and Insurance Australia Limited t/as NRMA Insurance v Allianz Australia Insurance Limited referred to; any dispute about liability in the damages claim to be determined by the Commission on filing of an application for claims assessment or by the Court if the claim was exempt; any dispute under section 3.12 about a “pending claim for damages” is a declared merit review matter and not a miscellaneous claims assessment matter QBE Insurance (Australia) Limited v Lay referred to. Held – proceedings dismissed pursuant to section 54(b) of the Personal Injury Commission Act 2020 on the basis they are misconceived and lacking in substance.

Decision date: 3 July 2026 | Member: Belinda Cassidy

Pirkovik v AAI Limited t/as AAMI [2026] NSWPIC 396

Motor Accidents Compensation Act 1999; liability wholly admitted; claimant is a 40-year old line marker who has not worked since the accident; dispute as to extent to which reduction in earning capacity due to injuries suffered in two previous motor accidents; claims for past and future care disputed as to entitlement; all other heads of damage disputed as to amount; Held – damages for future care and future treatment awarded as buffers; future loss of earning capacity calculated mathematically; total damages awarded $3,251,360 subject to credit for section 83 expenses and repayment of worker's compensation benefits received.

Decision date: 6 July 2026 | Member: Gary Victor Patterson

Workers Compensation non-Presidential Member Decisions

Fox v State of NSW (Fire and Rescue NSW) [2026] NSWPIC 391

Workers Compensation Act 1987; whether the applicant sustained the injury of interstitial lung disease in the course of his employment as a fire fighter between 1965-1969 and whether employment was a substantial contributing factor; whether treatment expenses claimed are reasonably necessary; Nguyen v Cosmopolitan Homes, Kooragang Cement Pty Ltd v Bates, Dayton v Coles, State Cover Mutual Lt v Smith, Paric v John Holland, and Hancock v East Coast Timber Products considered; Held – applicant has not established his employment was a substantial contributing factor to the development  of interstitial lung disease; applicant’s qualified evidence was found to be ipse dixit and the conclusions drawn failed to properly consider foundational material; applicant relied on a number of clinical studies which were largely unrelated or irrelevant to the factual scenario; applicant’s medical opinion not based in a fair climate; not actually persuaded or comfortably satisfied that the applicant discharged the onus of proof with regards to diagnosis and causation; award for respondent.

Decision date: 1 July 2026| Member: Diana Benk

Thelander v Austrans Transport Pty Ltd [2026] NSWPIC 392

Workplace Injury Management and Workers Compensation Act 1998; lump sum claim for accepted physical injuries and consequential sleep disorder; respondent disputed the consequential sleep disorder and disputed it should be referred for assessment of permanent impairment and sought an award for the respondent; Held – satisfied when the totality of the evidence is weighed in the balance that the applicant has suffered a consequential sleep disorder as a result of his work injury; after taking all of the evidence into account including the applicant’s statement evidence and the various clinical reports but also in particular noting that the independent medical examiners qualified on behalf of each party considered, after taking a proper history and having regard to the other evidence including the ENT opinion and the sleep studies, that the applicant has suffered a sleep disorder consequential to his work injury; where they differ is in the assessment of permanent impairment under the SIRA Guidelines, 4th ed; this constitutes a medical dispute and is one that should properly be remitted for referral to a Medical Assessor.

Decision date: 1 July 2026 | Member: Jane Peacock

Espana v Architectural Projects Pty Ltd [2026] NSWPIC 393

Workers Compensation Act 1987 (1987 Act); Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); miscellaneous application seeking review of weekly payments; 260 weeks paid; whether payments made for the period prior to lodgement of claim and acceptance of liability were unlawful; whether section 267 of the 1998 Act provided a separate and distinct entitlement to 12 weeks of payments during the provisional liability period; whether insurer erred by applying the maximum weekly compensation amount cap in section 34 of the 1987 Act; application for discretionary interest on amounts allegedly underpaid; Held – applicant did not demonstrate that he was underpaid; award for the respondent.

Decision date: 2 July 2026| Senior Member: Rachel Homan

Kromo v Opal Healthcare [2026] NSWPIC 394

Workers Compensation Act 1987; the applicant claimed weekly benefits payable under section 37 and medical or related treatment expenses payable under section 60 resulting from alleged psychological injury sustained in the course of her employment, with deemed date of injury of 5 September 2024; respondent did not dispute the applicant sustained the psychological injury alleged; respondent did not dispute the applicant has had no current capacity for work resulting from the injury and the respondent did not dispute the applicant required medical or related treatment for the injury; however, the respondent disputed the applicant had entitlement to compensation payable under the Act as her injury was wholly or predominantly caused by reasonable action taken or proposed to be taken by or on behalf of the employer with respect to discipline; Held – the applicant’s psychological injury was not wholly or predominantly caused by reasonable action taken or proposed to be taken by or on behalf of the employer with respect to discipline; applicant has entitlement to weekly benefits payable under section 37 and the applicant has entitlement to medical or related treatment expenses payable under section 60.

Decision date: 2 July 2026| Member: Jacqueline Snell

Roskell v Secretary, Department of Communities and Justice [2026] NSWPIC 398

Workers Compensation Act 1987; death claim; liability accepted; determination of dependency, payment of death benefit and interest; TNT Group 4 Pty Limited v Halioris, Richardson v Turfco Australia Pty Ltd discussed and applied; Held – applicant was the sole dependant; the whole of the death benefit is payable to the applicant; orders for payment to the applicant under section 85A of the 1987 Act; orders for discretionary interest.

Decision date: 7 July 2026 | Senior Member: Rachel Homan

Suresh v Arette Health Care (Bankstown) Pty Ltd [2026] NSWPIC 399

Workers Compensation Act 1987; Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); Personal Injury Commission Act 2020 (PIC Act); left upper extremity and cervical spine injury assessed by Medical Assessor at 4% whole person impairment; application to rescind a Certificate of Determination (Certificate) on the basis of a deterioration to give way to an appeal against the medical assessment and/or a further assessment as an alternative to an appeal; deterioration based on impairment arising from complex regional pain syndrome in the left upper extremity and a sleep condition which were not previously diagnosed or assessed as rateable impairments until after the issue of the Certificate resolving the medical dispute as to the degree of permanent impairment of the accepted injuries; O’Callaghan v Energy World Corporation Ltd, and Samuel v Sebel Furniture Ltd considered and applied; Held – Certificate rescinded pursuant to section 57(1) of the PIC Act; applicant is granted leave to lodge an appeal against the medical assessment pursuant to section 327(3)(a) and (b) of the 1998 Act within 28 days.

Decision date: 7 July 2026| Member: Kathryn Camp

Motor Accidents Medical Review Panel Decisions

Qian v Youi Limited [2026] NSWPICMP 464

Medical Review Panel; Motor Accident Injuries Act 2017; lumbar spine, cervical spine, right shoulder, and tear supraspinatus tendon; whole person impairment (WPI); treatment; the claimant suffered injury in an accident on 18 August 2023; Medical Assessor (MA)certified a 8% WPI; claimant sought review; Held –claimant sustained soft tissue injury to cervical and lumbar spine, and supraspinatus tendon tear caused by the accident; lumbar spine assessed as Diagnosis-Related Estimates (DRE) category I or 0% WPI; cervical spine assessed as DRE category II or 5% WPI; right shoulder assessed as 10% WPI; certificate MA revoked; total assessed at 15% WPI; report by case coordination services not reasonable or necessary and not relate to the injury caused by the accident; one hour domestic cleaning over 12 weeks relates to injury caused by the accident; but not reasonable and necessary.

Decision date:  17 June 2026 | Panel Members: Senior Member Susan McTegg, Dr David Gorman, and Dr Margaret Gibson | Injury module:  Spine, and Upper Limb; Treatment Type: Domestic Assistance

El-Halabi v Allianz Australia Insurance Limited [2026] NSWPICMP 466

Motor Accident Injuries Act 2017; Medical assessment of Whole Person Impairment (WPI) and Treatment and Care by Medical Assessor (MA); claimant injured in motor vehicle accident on 18 July 2022 when his vehicle was hit from behind; claimant lodged Application for Personal Injury Benefits on 6 October 2022; a dispute arose as to the degree of the claimant’s WPI and whether the proposed treatment and care was related to the injuries caused by the accident and whether it was reasonable and necessary in the circumstances; on 16 September 2025 MA determined that injuries sustained in the accident gave rise to 6% WPI; MA also certified that the proposed treatment and care was related to the injuries caused by the accident and was reasonable and necessary in the circumstances; the claimant sought a review of the assessment under section 7.26; the Review Panel re-examined the claimant on 1 May 2026; Held – as to the WPI dispute, the Medical Review Panel revoked the certificate of MA and substituted the determination that as a result of injuries sustained in the accident, the claimant sustained 3% WPI; as to the Treatment and Care dispute, the Panel affirmed the certificate of MA that the proposed treatment and care relates to the injuries caused by the accident; the Panel revoked the determination of MA and substituted the determination that the proposed treatment and care was not reasonable and necessary in the circumstances.

Decision date: 3 July 2026 | Panel Members: Member Terence Stern OAM, Dr Sophia Lahz, and Dr Margaret Gibson | Injury module:  Spine, and Upper limb; Treatment Type: Facet joint injections, domestic assistance, and pain management program

Shimon v AAI Limited t/as AAMI [2026] NSWPICMP 473

Motor Accident Injuries Act 2017; insurer’s application for review under section 7.26 of a determination that left and right shoulder injuries were not threshold injuries; error in insurer’s name on application for review; consideration of Rules 19, 20 and 21 of the Personal Injury Commission Rules 2021 (Rules); whether leave should be granted referred to Member to determine; another Medical Assessor had determined claimant’s psychological injury was not a threshold injury; utility of the Panel assessing physical injuries delegated to Member to determine; Meeuwissen v Boden distinguished; section 54 of the Personal Injury Commission Act 2020 and rule 77 of the Rules considered; Held – leave to amend name of insurer given; proceedings dismissed as lacking in substance.

Decision date: 3 July 2026 | Panel Member: Member Belinda Cassidy | Injury module: Brain injury, Spine, and Upper limb

Kocagoz v Allianz Australia Insurance Limited [2026] NSWPICMP 467

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC) regarding  whole person impairment (WPI); psychological injury; delay in claimant’s reporting of psychological symptoms and injuries; consideration of post-traumatic stress disorder; whether impairment permanent and suitable for assessment; Held – accident did not satisfy criterion A of the DSM-5-TR for post-traumatic stress disorder; diagnosis of panic disorder, agoraphobia, specific phobia (driving), and persistent depressive disorder; impairment permanent and suitable for assessment; WPI resulting from accident caused injuries assessed at 24%; MAC revoked; new MAC issued

Decision date: 3 July 2026 | Panel Members: Member Bianca Montgomery-Hribar, Dr Wayne Mason, and Dr Alan Doris | Injury module: Mental and behavioural

Leygo v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 470

Motor Accident Injuries Act 2017; review of certificate and reasons of the original Medical Assessor (MA) dated 25 July 2025 who assessed the claimant as having a whole person impairment (WPI) of 18%; claimant injured in a motor vehicle accident on 21 November 2022; claimant had been separately assessed for psychiatric disability; following the accident claimant claimed to have developed in addition to physical disabilities; postural perceptual dizziness/benign paroxysmal positional vertigo; claimant was assessed for her orthopaedic injuries by the second MA and for her neurological injuries by a third MA; the second MA assessed the claimant as having a WPI of 9%;  a fourth MA concluded that neurologically there was no impairment typical of vestibular neuronitis or post-traumatic benign paroxysmal positional vertigo as a consequence of the accident but the claimant was found to have postural perceptual dizziness which is a somatic symptom disorder brought on by anxiety and which is a psychiatric impairment; Held – certificate of original MA  revoked and a new certificate issued with the Review Panel assessing the claimant as having a 9% WPI.

Decision date: 6 July 2026 | Panel Members: Member Alexander Bolton, Dr John O’Neill, and Dr Shane Moloney | Injury module: Spine, Upper limb, and Neurological

Morgan v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 471

Motor Accident Injuries Act 2017; Medical Review Panel; assessment of whole person impairment (WPI); claimant sustained L2 superior endplate fracture and alleged bilateral shoulder injuries following motor vehicle collision; dispute as to reliability of shoulder range of motion findings and causation of left shoulder symptoms; Review Panel held active shoulder movements were variable and inconsistent and could not be used as a valid impairment parameter under the Motor Accident Guidelines; right shoulder assessed by analogy as a mild soft tissue injury; insufficient contemporaneous or objective evidence to establish left shoulder injury or consequential overuse injury; lumbar fracture assessed as Diagnosis-Related Estimates Category II; Held – accident caused L2 superior endplate fracture and right shoulder soft tissue injury only; left shoulder injury not established; combined permanent impairment assessed at 7% WPI, not greater than 10%.

Decision date: 6 July 2026 | Panel Members: Member Bridie Nolan, Dr Rhys Gray, and Dr Margaret Gibson | Injury module: Spine, and Upper limb

Wells v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 472

Motor Accident Injuries Act 2017; Medical Review Panel; assessment of whole person impairment (WPI); pedestrian struck by motor vehicle; dispute concerning cervical spine impairment, left shoulder range of movement following proximal humeral fracture, scarring, and alleged long thoracic nerve injury; Review Panel held earlier treating records showing substantial recovery did not preclude ongoing permanent shoulder impairment where repeated goniometer measurements on re-examination were reliable and consistent with the severity of the fracture; cervical soft tissue injury assessed as Diagnosis-Related Estimates Cervicothoracic Category II; no long thoracic nerve injury or scapular winging established; Held – cervical spine assessed at 5% WPI, left shoulder restriction assessed at 5% WPI, left shoulder scarring assessed at 3% WPI; combined impairment assessed at 13% WPI; exceeding the 10% threshold.

Decision date: 6 July 2026 | Panel Members: Member Bridie Nolan, Dr Michael Couch, and Dr Sophia Lahz | Injury module: Spine, and Upper limb

Lavis v IAG Limited t/as NRMA Insurance [2026] NSWPICMP 474

Motor Accident Injuries Act 2017; review of certificate and reasons of Medical Assessor (MA) dated 27 May 2025 for assessment of whole person impairment (WPI); claimant involved in an accident on 18 December 2022 when he was participating in a charity motor bike ride consisting of 150 motorbikes when the claimant was dislodged from his bike and then run over causing physical and psychiatric impairment; MA diagnosed the claimant as having persistent depressive disorder (dysthymia) and assessed 5% WPI; as a result of the accident the claimant was not able to continue running his business; his marriage ended and his ability to cope with day-to-day affairs became more difficult; Review Panel diagnosed the claimant as having a persistent depressive disorder (severe), and post-traumatic stress disorder; WPI assessed at 14%; Held –  certificate of MA revoked.

Decision date: 7 July 2026 | Panel Members:  Member Alexander Bolton, Dr John Baker, and Dr Wayne Mason | Injury module:  Mental and behavioural

Yang v Allianz Australia Insurance Limited [2026] NSWPICMP 479

Motor Accident Injuries Act 2017; review of medical assessment certificate (MAC); threshold injury dispute and treatment and care dispute; whether accident could have caused injuries; particularly right hip labral tear; consideration and application of Diab v NRMA Ltd ; Held – Review Panel reached the same findings as MAC in respect of treatment and care requests, non-threshold injury to the right hip, and threshold injury to the cervical spine, lumbar spine and right thigh, however found no distinct injury to the left arm; accordingly MAC revoked.

Decision date: 8 July 2026 | Panel Members: Member Bianca Montgomery-Hribar, Dr Sophia Lahz, and Dr Michael Couch | Injury module:  Spine, Upper limb, and Lower limb; Treatment Type: Physiotherapy, Facet joint injections, and Medical Specialist Consultation

Stirling v QBE Insurance (Australia) Limited [2026] NSWPICMP 480

Motor Accident Injuries Act 2017; whole person impairment (WPI) dispute; psychiatric injuries (nervous shock); claimant’s son tragically killed in a motor vehicle accident driven by her ex-husband; pre-accident symptoms of depression and anxiety; original Medical Assessment Certificate (MAC) assessed claimant at 17% WPI; Review Panel re-examined and found claimant’s functioning had improved considerably following the accident; Review Panel diagnosed post-traumatic stress disorder caused by the motor accident; assessment under the psychiatric impairment rating scale with classes rated as 2,2,3,2,3,3 resulting in 8% WPI; mild treatment effect (1% WPI uplift) as claimant undergoing regular sessions with psychologist; Review Panel acknowledged pre-accident psychiatric symptoms but found no psychiatric diagnosis; no apportionment was necessary; Held – claimant’s WPI assessed at 9% which is not greater than 10%; MAC revoked; new MAC issued.

Decision date: 8 July 2026| Panel Members: Member Jeremy Lum, Dr Alan Doris, and Dr Gerald Chew | Injury module: Mental and behavioural

Akalu v AAI Limited t/as GIO Insurance [2026] NSWPICMP 481

Motor Accident Injuries Act 2017; Medical Review Panel; whole person impairment (WPI) assessment; dispute concerning cervical spine, lumbar spine, bilateral shoulders, and pre-existing impairment; insurer challenged Medical Assessor’s deduction for pre-existing impairment and causation of left shoulder pathology; Review Panel held the Motor Accident Guidelines require assessment of a ratable pre-existing symptomatic permanent impairment; not arbitrary percentage deductions; left shoulder impairment accepted as resulting from accident-related soft tissue injury with trapezial pain, supraspinatus tendinosis and subacromial bursitis, but adhesive capsulitis not established; lumbar spine assessed as Diagnosis-Related Estimates (DRE) Category II for non-verifiable S1 radicular complaints; cervical spine assessed as DRE Category I; resolved right shoulder soft tissue injury attracted no impairment; Held – no deduction for pre-existing impairment; left shoulder assessed at 6% WPI; lumbar spine assessed at 5% WPI; cervical spine and right shoulder assessed at 0% WPI; combined impairment assessed at 11% WPI; exceeding the 10% threshold; Medical Assessment Certificate revoked.

Decision date: 8 July 2026 | Panel Members: Member Bridie Nolan, Dr Drew Dixon, and Dr Shane Moloney | Injury module: Spine, and Upper limb

Puyat v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 482

Motor Accident Injuries Act 2017;Medical Review Panel; assessment of whole person impairment (WPI); cyclist sustained left clavicle fracture, rib fractures, and alleged bilateral shoulder injuries; dispute as to whether ongoing bilateral shoulder restriction represented permanent impairment caused by the motor accident; contemporaneous records established left clavicle fracture and only minor right shoulder soft tissue injury; later physiotherapy; medico-legal evidence; social media material and re-examination demonstrated near-full shoulder function and high-level physical activity; Review Panel held any minor restriction was not permanent impairment caused by the accident; Held – healed rib fractures, healed left clavicle fracture with resolved associated symptoms, and resolved right shoulder soft tissue injury produced no assessable permanent impairment; combined assessment of a 0% WPI; Medical Assessor’s certificate revoked.

Decision date: 8 July 2026 | Panel Members: Member Bridie Nolan, Dr Mohammed Assem, and Dr Shane Moloney | Injury module: Upper limb

Workers Compensation Medical Appeal Panel Decisions

Lewis v State of New South Wales (NSW Police Force) [2026] NSWPICMP 465

Workplace Injury Management and Workers Compensation Act 1998; appeal from 8% whole person impairment assessment for psychological injury; whether Medical Assessor (MA) erred in four of the six categories of the psychiatric impairment rating scale; whether MA bound to compare claimant’s pre-injury  state with post injury: whether adequate reasons given; whether MA should have drawn inference from unrelated evidence; Secretary, New South Wales Department of Education v Johnson considered; Held – submission that MA function ipsative and not normative misconceived; adequate reasons given; inference from unconnected evidential sources not available; alleged connection ignored by all expert witnesses; Medical Assessment Certificate confirmed.

Decision date: 2 July 2026| Panel Members: Member John Wynyard, Dr Michael Hong, and Dr Douglas Andrews| Injury module: Psychiatric/psychological

Nitchell v Health Care Complaints Commission [2026] NSWPICMP 468

Workplace Injury Management and Workers Compensation Act 1998; appeal from decision of Medical Assessor; application to adduce additional evidence on appeal; Ross v Zurich Workers Compensation Insurance, Lukacevic v Coates Hire Operation Pty Ltd, LPDT v Minister for Immigration, Citizenship, Migrant Services and Multicultural Affairs, and MZAPC v Minister for Immigration and Border Protection considered and applied; additional evidence rejected; failure to consider relevant material; whether material relevant; consideration of irrelevant material; whether failure material; Held – no material error; Medical Assessment Certificate confirmed.

Decision date: 3 July 2026| Panel Members: Member Mitchell Strachan, Dr John Baker, and Dr Douglas Andrew | Injury module: Psychiatric/psychological

State of NSW (NSW Police Force) v Kryzius [2026] NSWPICMP 469

Workplace Injury Management and Workers Compensation Act 1998; claim for permanent impairment for the left wrist and left elbow; appeal by the employer because the Medical Assessor included an assessment of the left shoulder despite the application to resolve a dispute pleading injury to the left wrist and elbow only in circumstances where the left shoulder claim had been disputed and was not before the Personal Injury Commission; on the authority of Skates v Hills Industries Ltd, the inclusion of the impairment rating for the left shoulder was in error; Held – Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 3 July 2026| Panel Members: Member Jane Peacock, Dr Roger Pillemer, and Dr Timothy Anderson| Injury module: Left Upper Extremity

Potter v Narromine Shire Council; Narromine Shire Council v Potter [2026] NSWPICMP 476

Workplace Injury Management and Workers Compensation Act1998; appeals by worker and employer; in the employer appeal, whether assessment of scarring/TEMSKI was made on incorrect criteria; whether adequate reasons given in the worker’s appeal; whether there should have been a section 323 deduction; Held – employer appeal successful; Medical Assessor (MA) reasons limited and capable of supporting either 1% or 2%, ambiguity made reasons inadequate; Medical Assessment Certificate (MAC) revoked and 1% whole person impairment substituted; worker appeal successful; MA failed to appreciate the injury date was deemed and therefore the relevant date for a pre-existing condition was the date of employment in 1995; Cullen v Woodbrae Holdings Pty Ltd considered and applied; Held – MAC revoked; deduction removed; new MAC issued.

Decision date: 7 July 2026| Panel Members: Member John Wynyard, Dr James Bodel, and Dr Margaret Gibson| Injury module: Lumbar Spine, and Scarring (TEMSKI)

Sydney Trains v Murphy [2026] NSWPICMP 478

Workplace Injury Management and Workers Compensation Act1998;  appeal by employer against failure to make section 323 deduction; whether asymptomatic pre-existing condition exempt from application of section 323; whether adequate reasons given; Donhab Pty Ltd v Asbury, Elcheikh v Diamond Formwork (NSW) Pty Ltd (in liq), Vitaz v Westform Pty Ltd, and Cole v Wenaline Pty Ltd considered and applied; Held – Medical Assessor (MA) made two errors; firstly he assumed that section 323 not applicable where pre-existing condition asymptomatic; claimant had osteoarthritis in both knees, each injured on a separate date; secondly, MA reasons not adequate, as he had not considered the evidence regarding the pre-existent condition, notwithstanding that he agreed it was present; section 323(2) applied; Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 7 July 2026 | Panel Members: Member John Wynyard, Dr Timothy Anderson, and Dr Robert Kuru| Injury module: Left Upper Extremity, Right Lower Extremity, Left Lower Extremity, and Scarring (TEMSKI)

Motor Accidents Merit Review Decision

Liu v QBE Insurance (Australia) Limited [2026] NSWPICMR 31

Motor Accident Injuries Act 2017 (MAI Act); claim for statutory benefits; pure mental harm; claimant alleged psychological injury arising from injury to partner in motor accident; whether claimant was a “close member of the family” of the injured person for the purposes of section 30 of the Civil Liability Act 2002 (NSW), as applied by section 3.39 of the MAI Act; claimant did not witness the injured person being injured or put in peril at the scene; whether claimant was the injured person’s de facto partner; meaning of “de facto partner” and “de facto relationship” in section 21C of the Interpretation Act 1987 (NSW); requirement of “relationship as a couple living together”; serious, exclusive and publicly acknowledged relationship; engagement and future marriage plans; claimant and injured person lived in different countries; intermittent short visits and hotel stays; insufficient evidence of common residence, shared domestic life, financial interdependence or household duties  full-time cohabitation not required, but material element of common residence or mutual domestic living required; NSW Trustee and Guardian v McGrath, NSW Trustee and Guardian v Payne, Sha & Cham, Jonah & White, and Vaughan v Hoskovich considered and applied; Held – reviewable decision affirmed.

Decision date: 1 July 2026| 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.

Subscribeto receive legal bulletins to your inbox.