Legal Bulletin No. 254

Issued 2 April 2026

Welcome to the two hundred and fifty fourth edition of the Personal Injury Commission’s Legal Bulletin. Please see here for details about the legal citations used for the Commission’s decisions. The decisions listed below are now available on AustLII and will be available shortly, on Jade and Lexis Nexis. Any legislative updates are provided at the base of the Bulletin.

Motor Accidents non-Presidential Member Decision

McManus v QBE Insurance (Australia) Limited [2026] NSWPIC 175

Motor Accident Injuries Act 2017; miscellaneous claims assessment; whether the motor accident was caused wholly or mostly by the fault of the claimant under sections 3.11 and 3.28; claimant was driving his motor vehicle on a gravel road when he suffered a medical episode which was both unexpected and unforeseen; claimant was suffering from left cubital tunnel syndrome; claimant’s left arm and hand suddenly locked up and locked onto the steering wheel, which resulted in him losing control of the motor vehicle; motor vehicle left the road and struck an embankment; claimant sustained serious injuries; determined the claimant was not wholly or mostly at fault; Held – motor accident not caused wholly or mostly by the fault of the claimant; claimant is self-represented and therefore is not entitled to legal costs.

Decision date: 23 March 2026 | Member: David Ford

Workers Compensation non-Presidential Member Decisions

Shemoon v American Express Australia Pty Ltd [2026] NSWPIC 174

Workers Compensation Act 1987; section 60 claim for medical expenses; whether disease injury present at relevant time; claimed injury of cervical spine or acceleration of degenerative condition; deemed date of injury; evidence of injury at claimed time; other workplace injury accepted to have arisen at the time; injury claim form refers to other injuries but not to cervical spine; nature of supporting evidence for claimed cervical spine injury; Held – evidence insufficient to establish disease injury at time claimed; award granted to the respondent.

Decision date: 19 March 2026 | Member: Adam Halstead

Matthews v Goodyear Tyres Pty Ltd [2026] NSWPIC 176

Workers Compensation Act 1987; Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); Personal Injury Commission Act 2020 (PIC Act); injury to lumbar spine not disputed; reconsideration; deterioration; Samuel v Sebel Furniture Ltd, Target Australia Pty Ltd v Mansour, and Read v Liverpool City Council considered and applied; Held – certificate of determination dated 14 November 2016 is rescinded pursuant to section 57(1) of the PIC Act; matter is remitted to the President for a determination as to whether the applicant may be referred for a further assessment of permanent impairment by a Medical Assessor, as an alternative to an appeal, pursuant to section 329(1) of the 1998 Act.

Decision date: 24 March 2026 | Member: Anthony Scarcella

Motor Accidents Medical Review Panel Decisions

Allianz Australia Insurance Limited v Khoshaba [2026] NSWPICMP 205

Motor Accident Injuries Act 2017; assessment of threshold injury; insurer’s application for review under section 7.26; motor accident; claimant failed to attend or participate in two re-examination appointments; claimant’s solicitor ceased to act; claimant failed to respond to the Personal Injury Commission’s communication; Review Panel determined re-examination required; Review Panel recommended proceedings be dismissed; President delegated function of dismissing to Member on Review Panel; Held – claimant had not been paid statutory benefits since July 2020; claimant’s damages claim made late and no explanation had been provided; no steps taken by claimant to pursue or prosecute her claim; Member satisfied claimant had abandoned her claims; proceedings dismissed under section 54(b) as proceedings now lack substance as claims not being pursued; no need for insurer to pursue the Review Panel proceedings.

Decision date: 13 February 2026 | Panel Member: Member Belinda Cassidy| Injury module: Mental and behavioural

Allianz Australia Insurance Limited v Liu [2026] NSWPICMP 206

Motor Accident Injuries Act 2017; motor accident; rear end collision; issue of threshold psychological injury; original Medical Assessor (MA) found accident caused post-traumatic stress disorder (PTSD); new medical assessment; claimant refused to attend; Review Panel determined  the matter on the papers noting claimant bears onus of proof; motor accident not sufficiently significant to satisfy criterion A for PTSD; minor damage, no attendance by emergency services, car driveable and no medical attention for one month; Held – original MA’s assessment that psychological condition in remission adopted; post-accident symptoms determined on review of medical evidence;   original assessment revoked; claimant found to have sustained adjustment disorder; threshold injury.

Decision date: 3 March 2026 | Panel Members: Principal Member John Harris, Dr Surabhi Verma, and Dr Christopher Canaris | Injury module: Mental and behavioural

AAI Limited t/as AAMI v Cardona [2026] NSWPICMP 207

Motor Accident Injuries Act 2017; Medical Review Panel; application to lodge additional documents; rule 67C Personal Injury Commission Rules (PIC Rules); insurer filed an application to lodge additional documents for consideration by a Review Panel conducting the review of a medical assessment relating to permanent impairment of the cervical spine, the lumbar spine, both shoulders and the right hip; application opposed by claimant; Allianz Australia Insurance Limited trading as Allianz v Susak, and Allianz Australia Insurance Limited v Bell considered and applied; Held – discretion to admit additional documents governed by rule 67C of the PIC Rules; claimant prejudiced by the delay; if documents admitted into evidence the claimant will require evidence in response; Review Panel not required to choose between competing medical opinions and will be undertaking own examination; evidence of limited relevance to dispute to be determined by the Review Panel; reports only relied upon to allege inconsistency in claimant’s presentation but given need to guard against drawing, unfairly, of conclusions about inconsistencies in the claimant’s presentation; not necessary to facilitate the resolution of the real issues in the proceedings; Review Panel declined to grant leave to the insurer to rely upon the additional reports.

Decision date: 12 March 2026 | Panel Members: Senior Member Susan McTegg, Dr Shane Moloney, and Dr David Gorman | Injury module: Mental and behavioural

Elyassih v QBE Insurance (Australia) Limited [2026] NSWPICMP 201

Motor Accident Injuries Act 2017; review of medical assessment; assessment of degree of permanent impairment; claimant driving vehicle when struck on driver side; prior cervical spine injury; claimant had history of neck condition that was quiescent in the period before the accident; lumbar spine injury; reduced flexion and rotation in thoracic spine; diagnosis of soft tissue injury; non-verifiable radicular complaints at cervical spine; shoulder injury; Held – whole person impairment assessed at 12%

Decision date: 17 March 2026 | Panel Members: Member Hugh Macken, Dr Michael Couch, and Dr Christopher Oates | Injury module: Spine, Upper Limb, and Lower Limb

AAI Limited t/as GIO v Batmaz [2026] NSWPICMP 209

Motor Accident Injuries Act 2017; degree of permanent impairment; threshold injury disputes; claimant was the seat-belted driver; claimant was employed as a bus driver; insured vehicle was turning left from a side street at speed when the driver lost control; insured vehicle collided with the right side of the claimant’s vehicle; claimant was able to self-extricate; claimant was taken to hospital; claimant was complaining of a painful left shoulder and left elbow; he had radiology performed including a CT scan of the brain; claimant was kept for observation and discharged later; claimant alleges he sustained soft tissue injuries to the neck, back, both shoulders and left elbow; allegations of bilateral tinnitus and worsening hearing loss are made; Medical Assessor (MA) certified injuries to both shoulders, thoracic and lumbar spine, left elbow all are threshold injuries; MA found 21% whole person impairment (WPI); 15% WPI cervicothoracic; 5% WPI each shoulder; MA found C6 radiculopathy; insurer’s review application allowed on basis that MA did not consider, nor put to claimant, inconsistencies between medical records and the claimant’s history; claimant re-examined by a MA; Review Panel found threshold injury to cervical spine, lumbar spine, thoracic spine, both shoulders; left elbow injury found not caused; Review Panel did not accept C6 radiculopathy; Held – 9% WPI; certificate revoked.

Decision date: 19 March 2026 | Panel Members: Member Gary Victor Patterson, Dr Mohammed Assem, and Dr Margaret Gibson | Injury module: Spine, Upper Limb, and Ears

Allianz Australia Insurance Limited v DSS [2026] NSWPICMP 210

Motor Accident Injuries Act 2017; dispute about whether psychological injury was a threshold injury; where the Medical Assessor at first instance found that psychological injuries; specifically phobia (driving) and an aggravation of bipolar disorder were caused by the motor accident and are not threshold injuries; re-examination by the Review Panel; Review Panel found that a psychological injury of post-traumatic stress disorder was caused by the motor accident and is not a threshold injury; Held – original assessment revoked.

Decision date: 19 March 2026 | Panel Members: Member Maurice Castagnet, Dr Himanshu Singh, and Dr Christopher Rikard-Bell | Injury module: Mental and behavioural

AAI Limited t/as GIO v Lim [2026] NSWPICMP 214

Motor Accident Injuries Act 2017; degree of permanent impairment dispute; claimant was driving and stopped at the traffic lights; insured vehicle did not stop and collided with the rear of the claimant’s vehicle; claimant’s car was pushed forward and impacted the vehicle in front; claimant consulted a GP with initial symptoms of left shoulder and lower back pain; claimant underwent physiotherapy and acupuncture; claimant denies any accidents or injuries since the subject accident; Medical Assessor (MA) certified 19% whole person impairment (WPI) for soft tissue strains to both shoulders, lumbar spine and cervical spine with aggravation of underlaying pre-existing degenerative disc disease; soft tissue injury to left knee found to be not caused; insurer’s review application allowed on basis that insurer’s clearly articulated arguments not addressed; claimant re-examined by both MAs who found 0% WPI for injuries to cervical spine, lumbar spine and both shoulders; differing findings to original MA; claimant’s independent medical examiner explained on basis of differing examination findings at time of assessment; Held – certificate revoked.

Decision date: 20 March 2026 | Panel Members: Member Gary Victor Patterson, Dr Margaret Gibson, and Dr Rhys Gray | Injury module: Spine, Upper Limb, and Lower Limb

IAG Limited t/as NRMA Insurance v Dergham [2026] NSWPICMP 217

Motor Accident Injuries Act 2017; review of certificate and reasons of Medical Assessor (MA); whether the claimant, who was injured in a motor vehicle accident suffered threshold injuries to her lumbar spine, right shoulder and with subacromial bursitis and disruption of disc fibrocartilage at C4/5 level and an annular fissure; force of collision involved each car travelling at 50 km/h; claimant did not complain of cervical spine pain at the scene of the accident; subsequently when transported by ambulance to hospital the claimant made such complaint and underwent subsequent investigations by x-ray in hospital with nothing remarkable evidenced; subsequent complaints made to general practitioner and ultimately an MRI scan was undertaken which revealed an annular fissure at the C4/5 level; no evidence of an annular fissure pre-accident although there were minor degenerative conditions; Review Panel satisfied that the annular fissure was caused by the dynamics of the accident and that it was only after investigations by an MRI scan that this was revealed; Held – certificate and reasons of the original certificate affirmed.

Decision date: 23 March 2026 | Panel Members: Member Alexander Bolton, Dr Christopher Oates, and Dr Sophia Lahz | Injury module: Spine, and Upper Limb

Rai v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 218

Motor Accident Injuries Act 2017; review  of medical assessment of Medical Assessor; whether the claimant suffered a threshold injury; physical injury; whether angulation to the coccyx as seen on radiology was caused by the accident; found that the abnormality is within the normal variants of the general population; mechanism of the motor accident could not have given rise to the abnormality; implausible that the accident could give rise to the angulation and be asymptomatic for a period of a month and then later symptomatic; traumatic origin would have caused immediate significant pain; Held – found that the accident could not have given rise to the injury and did not cause the injury; soft tissue injury to the lumbar spine found which is a threshold injury.

Decision date: 24 March 2026 | Panel Members: Member Elizabeth Medland, Dr Les Barnsley, and Dr David McGrath | Injury module: Spine

Workers Compensation Medical Appeal Panel Decisions

Sprayco Poly Pty Ltd v Peihopa [2026] NSWPICMP 208

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of the right lower extremity; whether the Medical Assessor (MA) failed to provide adequate reasons; whether the MA failed to undertake a proper enquiry into other potential causes of impairment, when the evidence showed a previous injury four months prior to the workplace injury; whether the MA failed to correctly apply section 323 for the assessment of the right shoulder; Held – MA erred in failing to adequately provide reasons for finding no previous injury and in applying section 323; worker suffered from a previous injury in the nature of a subluxation of the right shoulder which left him with residual instability prior to the workplace injury; previous injury contributed to the impairment assessed; a deduction of one-tenth applied pursuant to section 323; MAC revoked.

Decision date: 18 March 2026 | Panel Members: Member Kathryn Camp, Dr David Crocker, and Dr Roger Pillemer | Injury module: Right Upper Extremity

Finch v State of New South Wales (NSW Police Force) [2026] NSWPICMP 211

Workplace Injury Management and Workers Compensation Act 1998; appeal in relation to a finding of DRE I for lumbar spine; Review Panel found that whilst the Medical Assessor (MA) has concluded that the appellant qualifies for DRE category I; MA failed to provide a chain of reasoning with respect to reaching that conclusion; re-examination required and finding of DRE category II in respect of lumbar spine; Held – MAC revoked.

Decision date: 19 March 2026 | Panel Members: Member Elizabeth Beilby, Dr Tim Anderson, and Dr Roger Pillemer | Injury module: Cervical Spine, and Lumbar Spine

Owen v Costco Wholesale Australia Pty Ltd [2026] NSWPICMP 212

Workplace Injury Management and Workers Compensation Act 1998; whether the Medical Assessor (MA) had proper regard to the evidence relating to the appellant’s impairment in travel and concentration, persistence, and pace;Held – Medical Assessor had proper regard to the evidence and that there was no error in his ratings of the appellant’s impairment in travel and concentration, persistence and pace; MAC confirmed.

Decision date: 19 March 2026 | Panel Members: Member Marshal Douglas, Professor Nicholas Glozier, and Dr Douglas Andrews | Injury module: Psychological/Psychiatric

Solo v Surry Hills Bistro Pty Ltd [2026] NSWPICMP 213

Workplace Injury Management and Workers Compensation Act 1998; Medical Appeal Panel; assessment under the psychiatric impairment rating scales; error found in assessment of concentration, persistence, and pace; Medical Assessor took into account worker’s ability to spell, failed to consider her loss of focus and loss of ability to read books; Held – Medical Assessment Certificate revoked.

Decision date: 19 March 2026 | Panel Members: Member Parnel McAdam, Dr Michael Hong, and Professor Nicholas Glozier | Injury module: Psychological/Psychiatric

Motor Accidents Merit Review Decisions

Yilmaz v QBE Insurance (Australia) Limited [2026] NSWPICMR 10

Motor Accident Injuries Act 2017; Personal Injury Commission Act 2020 (PIC Act); claim for statutory benefits; dispute about pre-injury average weekly earnings (PAWE); proceedings commenced without submission or an explanation as to what the alternative decision of the insurer should be or why the insurer’s decision should be changed; merit reviewer directed the claimant on two occasions to file submissions, none filed; insurer had revised its PAWE decision in its submissions, no response from claimant; Held – preliminary conference vacated and proceedings dismissed pursuant to section 54(c) of the PIC Act and rule 77(b)(ii) of the Personal Injury Commission Rules.

Decision date: 19 March 2026 | Merit Reviewer: Belinda Cassidy

Villanueva v Lifetime Care and Support Authority of NSW [2026] NSWPICMR 12

Motor Accident Injuries Act 2017; claim for statutory benefits; claimant’s dispute about the cost of attendant care services provided to her by her sister; Medical Assessment determined (confirmed by Review Panel) that eight hours of care provided by sister was reasonable and necessary and related to the accident; Villanueva v Lifetime Care and Support Authority of New South Wales considered; hourly rate determined in previous proceedings at $35 per hour; Villanueva v Insurance Australia limited t/as NRMA Insurance considered; claimant and her sister sought increase in rate to $60 per hour relying on a discounted NDIS rate; authority declined to pay and maintained $35 per hour was a reasonable rate; Held – Merit Reviewer bound by medical assessment finding of 8 hours per week; no variation in type of care provided; care was domestic services and some personal assistance but was not nursing care therefore rate of pay for nurses not appropriate; NDIS rate quoted by claimant was not appropriate rate; Centrelink carer payment not considered; market rate for commercial care not appropriate as carer is paying a non-market rent to live in the same house as the claimant; rate of gratuitous care under Motor Accidents Compensation Act and Civil Liability Act is a guide to what is a reasonable cost of care; rate is revised every six months and would take into account inflation and changes in wage rates; the Authority’s decisions remitted for reconsideration in accordance with Merit Reviewer’s directions.

Decision date: 24 March 2026 | Merit Reviewer: Belinda Cassidy

This publication is for information only. The publication is not legal advice.  The information provided is not a substitute for reading the decisions. The Commission does not accept liability for the information in this publication or for way the information is used.

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