Legal Bulletin No. 263

Issued 5 June 2026

Welcome to the two hundred and sixty-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.

Motor Accidents non-Presidential Member Decisions

Rainford v AAI Limited t/as AAMI [2026] NSWPIC 283

Motor Accident Injuries Act 2017; insurer’s application for exemption under section 7.34(1)(b); opposed by the claimant; liability denied; factual disputes between the parties; multiple lay witnesses likely to be required to give evidence; hearing will take a number of days; potential for duplication of work and costs; Held – the parties should be able to compel witnesses to produce documents and give evidence; parties should have rights and protections afforded by the Evidence Act; claim not suitable for assessment by the Personal Injury Commission; recommendation subsequently approved by the Division Head, as the President’s delegate.

Decision date: 24 April 2026| Senior Member: Brett Williams

Badger v Allianz Australia Insurance Limited [2026] NSWPIC 240

Motor Accident Injuries Act 2017; claimant injured in an accident on 1 July 2020 at a recycling and recovery transfer station; claimant was injured by the driver of an uninsured wheel loader; accident involved the owner and occupier of the waste management facility and with the wheel loader driven by an employee of that waste management facility/transfer station; non-CTP insurers and parties likely to be joined to the proceedings; likely that in a full hearing of all issues between all parties that there would be four independent parties involved with separate liability and quantum considerations; need for documentation to be produced under subpoena and witnesses to be compelled under subpoena to give evidence; claim likely to take several days to be heard to completion; noting the disparate interests of non-CTP participants potentially to the claim; Held – Member considered that this was not a claim that was suitable to be heard in the Personal Injury Commission and claim exempted; recommendation subsequently approved by the Division Head, as the President’s delegate.

Decision date: 30 April 2026| Member: Alexander Bolton

AAI Limited t/as AAMI v Ingram [2026] NSWPIC 269

Motor Accident Injuries Act 2017; 84 year old pedestrian struck by the insured motor vehicle whilst attempting to cross the street but failed to notice the insured vehicle was slowly reversing into a vacant parking spot; insurer submitted 20% for contributory negligence which was determined as being appropriate in the circumstances of the accident; claimant sustained fracture of the right femur and fracture of the right wrist; insurer conceded non-threshold injury and also conceded entitlement to damages for non-economic loss; claimant is retired amount proposed the non-economic loss is $220,000; Held – the proposed settlement is just, fair and reasonable; proposed settlement is approved under section 6.23 (2)(b).

Decision date: 13 May 2026| Member: David Ford

Insurance Australia Limited t/as NRMA Insurance v Sengsavang [2026] NSWPIC 272

Motor Accident Injuries Act 2017; settlement approval; claimant 27 yrs old, back seat passenger involved in an accident; sustained serious injuries to his arm, hand, and to a donor sight for skin grafts on his right thigh; claimant voluntarily entrusted control of the vehicle to a driver heavily intoxicated and impaired after drinking together at a party; claimant aware the driver was inexperienced, driving erratically and did not ask the driver to stop; contributory negligence agreed at 25%; whole person impairment conceded greater than 10%; loss of earning capacity which is productive of economic loss; Held – settlement approved in the sum of $720,000 after the 25% contributory negligence applied;  settlement just, fair and reasonable and within the range of likely potential damages assessment if the claim was to proceed to assessment taking into account the contributory negligence and age of the claimant at the time of the accident; the nature and extent of the claim, injuries, disabilities, impairments and losses.

Decision date: 15 May 2026| Member: Elyse White

Gibbons v QBE Insurance (Australia) Limited [2026] NSWPIC 287

Motor Accident Injuries Act 2017; miscellaneous claims dispute as to whether the claimant mostly at fault; sections 3.11 and 3.28; substantive dispute resolved the day prior to a scheduled assessment conference; assessment conference proceeded so Member could be addressed on costs; costs application by claimant pursuant to section 8.10(4)(b); insurer sought similar costs order; submitted exceptional circumstances existed for an award of costs in excess of the regulated amount; AAI Limited trading as GIO v Moon, San v Rumble (no 2), and Ho v Professional Services Review Committee considered; matter unusual in that NSW Police being unable to locate relevant documentation that arose from the attendance of the police officers; found that this fact resulted in additional legal work and frustrated the liability process resulting in the dispute developing longer than it otherwise would have; Held – claimant entitled to legal costs in excess of regulated amount pursuant to section 8.10(4)(b); insurer entitled to payment of legal costs in excess of the regulated amount pursuant to section 8.3(4).

Decision date: 21 May 2026| Member: Elizabeth Medland

Abbott v QBE Insurance (Australia) Limited [2026] NSWPIC 288

Motor Accident Injuries Act 2017; application for reinstatement following deemed withdrawal pursuant to section 6.26; application for reinstatement three years or more after accident; whether claimant’s explanation full and satisfactory; whether total damages likely to be awarded if claim succeeds not less than 25% of the maximum awardable for non-economic loss; claimant’s evidence is that delay attributable to solicitors; Held – claimant’s explanation full and satisfactory; total damages likely to be awarded exceeds threshold; claim reinstated

Decision date: 21 May 2026| Member: Bianca Montgomery-Hribar

AAI Limited t/as AAMI v Sessions [2026] NSWPIC 293

Motor Accident Injuries Act 2017; settlement approval; claimant was injured; claimant was working at the time of the accident; claimant is aware this approval resolves his common law damages claim; settlement complies with clause 7.37 of the Motor Accident Injuries Guidelines; Held – settlement approved in the amount of $90,000, consisting of nil non-economic loss and past economic loss of $15,000.00 and of $75,000.00 for future economic loss.

Decision date: 25 May 2026| Member: Philip Carr

Ford-Gunatilake v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPIC 301

Motor Accident Injuries Act 2017; claims assessment dispute about the amount of damages to be paid to the claimant under section 7.36 (3) and 7.36 (4); claimant was a pedestrian who was at the rear of her vehicle on the driver side with the intention to enter the driver’s door; as the claimant stepped further onto the roadway, she failed to look behind her for oncoming traffic and was struck by the insured motor vehicle; claimant suffered serious injuries; insurer admitted duty of care but alleged contributory negligence on the part of the claimant; the entire accident was recorded on insured driver’s dashcam; contributory negligence assessed at 60%; insurer conceded claimant’s whole person impairment exceeded the threshold; claim for non-economic loss, past and future economic loss; the parties agreed on quantum and requested a determination of the issue of liability; Held – claimant is entitled to damages for non-economic loss, past and future economic loss.

Decision date: 27 May 2026| Member: David Ford

Workers Compensation non-Presidential Member Decisions

BVW v LL Transport Pty Ltd & Ors [2026] NSWPIC 188

Workers Compensation Act 1987; the deceased worker died on 10 November 2023; the applicant made a claim for funeral expenses payable under section 26 and for a lump sum benefit payable under section 25(1)(a); the second and third respondents made a claim for weekly compensation payable under section 25(1)(b) and lump sum benefit payable under section 25(1)(a); first respondent disputed the claims of the applicant, second respondent and third respondent; first respondent disputed the deceased worker died as a result of injury arising out of or in the course of his employment, with employment being a substantial contributing factor to injury; Held – the deceased worker died as a result of injury arising out of or in the course of his employment, with employment being a substantial contributing factor to injury; first respondent is to pay applicant’s claim for funeral expenses; first respondent is pay the second and third respondents’ claim for weekly benefits; first respondent is to pay the applicant’s claim for lump sum benefit and interest, as agreed; first respondent to pay the second and third respondents claim for lump sum, interest and fees relevant to management by the NSW Trustee, as agreed.

Decision date: 16 April 2026| Member: Jacqueline Snell

Dwyer v Tree Management Team Pty Limited [2026] NSWPIC 284

Workers Compensation Act 1987; applicant was injured while in the course of his employment; applicant suffered a lower back injury when he was struck by a tree trunk that had been cut off a tree by a colleague; claim for the cost of L4/5 posterior spinal fusion surgery, as well as related follow-up treatment; dispute about whether the proposed treatment is reasonably necessary as a result of the applicant’s accepted injury; Kooragang Cement Pty Ltd v Bates, Rose v Health Commission (NSW), Diab v NRMA Ltd, and Herborn v Spotless Services Australia Limited considered and applied; Held – proposed treatment is reasonably necessary as a result of injuries; respondent to pay for proposed surgery and follow-up treatment pursuant to section 60.

Decision date: 8 May 2026| Member: Jeffrey Gabriel

McIntosh v Secretary, Department of Education [2026] NSWPIC 285

Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); Personal Injury Commission Act 2020 (PIC Act); whether applicant required to attend an independent medico legal assessment at the request of an insurer; respondent denied liability prior to having the applicant medically examined; respondent requested orders compelling applicant attend medical appointment and claimed failure to comply with section 71 and 119 of the 1998 Act; respondent maintained denial to compel applicant to attend was a breach of procedural fairness and natural justice and contrary to the PIC Act and Personal Injury Commission Rules (PIC Rules); Held – respondent failed to comply with Mandatory Provisions found in Part 7 of the SIRA Workers Compensation Guidelines; applicant not required to attend medical assessment under section 119(4) of the 1998 Act; no discretions exist to relax the Guidelines; Principle of ‘generalia specialibus non derogant’ relevant as the 1998 Act, PIC Rules and PIC Act have no contradiction.

Decision date: 20 May 2026| Member: Diana Benk

Miljak v ComfortDelGro Australia [2026] NSWPIC 286

Workers Compensation Act 1987; claim for weekly payments and treatment expenses arising out of a motor vehicle accident on 5 November 2024 resulting in injuries to the neck, back and left knee; respondent denied liability section 4,9A, 4(b)(ii); Hancock v East Coast Timber Products Pty Ltd, Castro v State Transit Authority (NSW), Lyons v Master Builders Association of NSW Pty Ltd, Kooragang Cement Pty Ltd v Bates, Nguyen v Cosmopolitan Homes, Makita (Australia) Pty Limited v Sprowles, and Commonwealth v Muratore considered; Held – on the basis of video footage that the applicant did not suffer injury to the left knee in the manner claimed.  The applicant did sustain aggravation to a disease condition of the neck and back but such aggravation resolved as of 23 May 2025; expert reports unreliable and afforded little weight on the basis of inaccurate history given by the applicant; award for the respondent.

Decision date: 20 May 2026| Member: Diana Benk

Yap v Waverley Council [2026] NSWPIC 290

Workers Compensation Act 1987; weekly compensation; alleged lumbar spine injury said to have arisen from the nature and conditions of employment; applicant alleged she had sustained a disease-injury, either by way of onset or by aggravation of underlying pathology in the course of her employment; respondent disputed liability and alleged the applicant had given false evidence surrounding the nature of an at-home workstation from which she worked following the commencement of the COVID-19 pandemic; procedural fairness; serious matters affecting personal rights of witnesses; leave was granted to cross examine the applicant on the manner in which she alleged her injury came about and so that she may be given the opportunity to respond to the criticism made of her; Finney Pty Limited t/as Cut Price Car Rentals v Chequer, State of New South Wales v Hunt, Hancock v East Coast Timber Products Pty Limited, and AV v AW applied; applicant must discharge the onus of proving her employment was the main contributing factor to her injury, and there can be but one main contributing factor; Held – the applicant has not discharged her onus of proof in establishing her employment was the main contributing factor to her injury; award for the respondent.

Decision date: 21 May 2026| Member: Cameron Burge

Harrington v Corrective Services NSW [2026] NSWPIC 292

Workers Compensation Act 1987; applicant initially assessed at 15% for whole person impairment (WPI) for psychological injury in first Medical Assessment Certificate (MAC); documents not forwarded to first Medical Assessor (MA); first Appeal Panel suggested first MAC a nullity and referred matter to President; applicant directed to attend further assessment with a different MA; second MAC found impairment at 15%; brief reference to first MAC; employer appealed on one psychiatric impairment rating scale category; second Appeal Panel allowed appeal reducing WPI to 13%; applicant then contended second Appeal Panel and second MAC a nullity; observations that Member had no power to declare an Appeal Panel a nullity; applicant had not established that brief reference to first MAC and/or failure to refer to medical evidence constitute jurisdictional error resulting in a nullity of the second MAC; Held – application to declare as nullities second Appeal Panel; MAC declined.

Decision date: 22 May 2026| Principal Member: John Harris

Auddino v Secretary Department of Education [2026] NSWPIC 294

Workers Compensation Act 1987; the applicant claims weekly compensation payable under sections 36 and 37 resulting from alleged injury sustained on 5 March 2025; respondent disputed the applicant sustained injury arising out of or in the course of her employment with employment being a substantial contributing factor to injury; respondent disputed the applicant suffered an incapacity for work resulting from the injury; Held – the applicant sustained injury resulting from injury arising out of or in the course of her employment being a substantial contributing injury; applicant established she suffered an incapacity for work resulting from the injury with entitlement to weekly compensation payable under section 36 resulting from the injury; the applicant failed to establish entitlement to weekly compensation payable under section 37 resulting from the injury.

Decision date: 25 May 2026| Member: Jacqueline Snell

Egan v RK and Co Pty Ltd [2026] NSWPIC 295

Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); Personal Injury Commission Act 2020 (PIC Act); deterioration of applicant’s condition and fresh evidence due to further surgeries; application for reconsideration of the Medical Assessment Certificate and Certificate of Determination (COD) following the Appeal Decision pursuant to section 57 of the PIC Act; Samuel v Sebel Furniture Limited, Sleiman v Gadalla Pty Ltd, Lovelee v Sydney International Contained Terminals Pty Ltd, Pollard v Toll Holdings Pty Ltd, and Inner West Council v McQuade considered; whether further appeal available; whether discretion under section 329 of 1998 Act should be exercised for further medical assessment; Held – COD rescinded pursuant to section 57 of the PIC Act; further appeal and/or reconsideration available, applicant’s claim remitted to the President for referral to a medical assessor for reconsideration pursuant to section 329(1A) of the 1998 Act.

Decision date: 25 May 2026| Member: Fiona Seaton

Elias v Catholic Education Office, Diocese of Parramatta [2026] NSWPIC 296

Workers Compensation Act 1987; weekly compensation; medical expenses; workplace fall; undisputed that applicant worker injured cervical spine, right hip and right elbow; lumbar spine and right shoulder injuries disputed; worker contends injury by way of aggravation of pre-existing disease; respondent employer contends any injury temporary and resolved; weekly compensation payments ceased; worker claims symptoms of injury continue and no capacity for work under section 38; also claims consequential psychological condition from injury; lumbar spine surgery sought; all disputed by employer; Held – fall caused lumbar spine injury that continues; employer liability not established for right shoulder injury, award to respondent; no capacity for work due to injury; consequential psychological condition found to have arisen; respondent to pay weekly compensation; also to meet reasonably necessary treatment costs associated with lumbar spine surgery.

Decision date: 26 May 2026| Member: Adam Halstead

Sison v Daizli & Ors [2026] NSWPIC 297

Workers Compensation Act 1987; death claim; determination of dependency, apportionment, and payment of death benefit, interest and management fee; TNT Group 4 Pty Limited v Halioris, Kaur v Thales Underwater Systems Pty Ltd, and Wratten v Kirkpatrick & Ors considered and applied; Held – death benefit apportioned and orders for payment of benefit, interest and management fee.

Decision date: 26 May 2026| Principal Member: Glenn Capel

Everingham v State of NSW (Hunter New England Local Health District) [2026] NSWPIC 298

Workers Compensation Act 1987; claim for injury to the right hip; respondent denied liability maintaining condition is entirely due to degenerative change; claim for surgery to the right hip;   respondent denied liability maintaining injury did not materially contribute to the need for total hip replacement; claim for weekly payments for a closed period and whether suitable duties constituted a “real job”; Kooragang Cement Pty Ltd v Bates, Nguyen v Cosmopolitan Homes, AV v AW, Federal Broom Co v Semlitch, and Wollongong Nursing Home Pty Ltd v Dewar considered; Held – applicant sustained an aggravation of a disease process and employment was the main contributing factor;    respondent liable for right total hip replacement as injury ‘materially contributed’ to the need for surgery;  respondent liable for closed period weekly benefits of sections 36 and s37 on the basis that duties provided to the applicant were not suitable duties or a ‘real job’.

Decision date: 26 May 2026| Member: Diana Benk

Abarcia v Workers Educational Association [2026] NSWPIC 299

Workers Compensation Act 1987; the applicant made a claim for weekly compensation payable under section 37 and medical or related treatment expenses payable under section 60 for psychological injury sustained in the course of her employment; while the respondent did not dispute the applicant sustained injury in the course of her employment, the respondent disputed the applicant’s entitlement to compensation payable under the Act; respondent raised a defence under section 11A(1); respondent argued the applicant’s 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 performance appraisal and/or discipline; Held – the applicant’s injury was not wholly or predominantly caused by reasonable action taken or propose to be taken by or on behalf of the employer with respect to performance appraisal and/or discipline and the respondent cannot rely on section 11A(1) in defence of the applicant’s claim; applicant has entitlement to weekly compensation payable under section 37 as agreed; applicant has entitlement to medical or related treatment payable under section 60 as agreed.

Decision date: 26 May 2026| Member: Jacqueline Snell

Motor Accidents Medical Review Panel Decisions

Kim v QBE Insurance (Australia) Limited [2026] NSWPICMP 323

Motor Accident Injuries Act 2017; review of medical assessment; whether psychological injury caused by the accident is a threshold injury; original assessment found accident caused an adjustment disorder with mixed anxiety and depressed mood was a threshold injury; Review Panel found a persistent depressive disorder; evidence confirmed ongoing psychological symptomatology which contributed to family and work related stress; insurer submitted physical injuries are not substantiated such as to give rise to a psychological injury; Review Panel found the physical complaints are not without medical support and the psychological symptoms arising therefrom are genuine; evidence supports a finding of a deterioration of psychological state since the motor accident; lack of initial complaint of psychological symptoms to treatment providers does not of itself establish an absence of such symptoms; adjustment disorder may have been in the initial presentation, however, has evolved to a persistent depressive disorder; Held – claimant has suffered a psychological injury that is not a threshold injury; Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 7 May 2026| Panel Members: Member Elizabeth Medland, Dr Gerald Chew, and Dr Christopher Canaris | Injury module: Mental and Behavioural

Mikhael v Allianz Australia Insurance Limited [2026] NSWPICMP 329

Motor Accident Injuries Act 2017; review of medical assessment of dispute as to whether injuries caused by the accident give rise to a whole person impairment (WPI) greater than 10%; original assessment found a 5% WPI of the lumbar spine; remaining injuries found to be not caused by the accident; issues of causation; whether pathology identified on radiology was caused by the accident;  found the radiological findings are pre-existing degenerative changes given lack of acute ligamentous injury or haematoma; whether shoulder symptoms due to acute injury or due to referred pain from cervical spine; inconsistency in movement on examination of the shoulders; clause 6.50 of the Motor Accident Guidelines applied; discretion on the basis of the medical evidence applied in finding 0% WPI of the shoulders; Held – injuries caused by the motor accident, no bony injury and soft tissue only; WPI assessed at 0%; Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 15 May 2026| Panel Members: Member Elizabeth Medland, Dr Ian Cameron, and Dr Les Barnsley | Injury module: Spine, and Upper Limb

Liu v AAI Limited t/as AAMI [2026] NSWPICMP 337

Motor Accident Injuries Act 2017; review of medical assessment; whole person impairment (WPI); vehicle T-boned causing it to roll over; no neurological abnormalities identified; psychological injury sustained; contemporaneous evidence for neck and low back injuries; early post-accident mention of left shoulder pain; no radiculopathy or vertebral body compression to cervical spine; mild intermittent acromioclavicular joint crepitation to the left shoulder; no vertebral body compression or fracture of the lumbar spine; Held – WPI rising from the subject accident assessed at 2%; Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 18 May 2026| Panel Members: Member Hugh Macken, Dr Margaret Gibson, and Dr Sophia Lahz| Injury module: Spine, and Upper Limb

Brochtrup v AAI Limited t/as GIO [2026] NSWPICMP 348

Motor Accident Injuries Act 2017; threshold injury and degree of permanent impairment disputes; claimant was driving to work and was half-way into the roundabout when the insured vehicle entered on the left and collided with claimant’s vehicle; claimant was not taken to hospital; claimant had no problems before the accident with her back and hips; Medical Assessor (MA) found injuries to cervical spine, thoracic spine and lumbar spine are threshold injuries giving rise to a 5% whole person impairment (WPI); MA found injuries to shoulders and right hip not caused; claimant’s review application allowed on basis that MA did not provide a clear path of reasoning as to causation and why he believed the lumbar disc protrusion was a pre-existing condition; claimant re-examined by MA on behalf of the Review Panel; Review Panel accepted soft tissue injuries to cervical spine and lumbar spine are threshold injuries, with bilateral pain referred from neck; Review Panel found injury to right hip not caused; Review Panel made no finding as to thoracic spine as it was not a referred injury; Review Panel revokes the Medical Assessment Certificate (MAC) relating to threshold injury; Review Panel confirms MAC relating to WPI.

Decision date: 20 May 2026| Panel Members: Member Gary Victor Patterson, Dr Margaret Gibson, and Dr Michael Couch| Injury module: Spine, Upper Limb, and Lower Limb

Bamblett v Allianz Australia Insurance Limited [2026] NSWPICMP 378

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); treatment and care dispute; whether perineural injections (at C5/6) and cervical foraminotomy surgery (left and right at C6/7, left at C5/6) are causally related to the motor accident and reasonable and necessary; Review Panel accepted claimant sustained a cervical spine injury as a result of falling off his motorcycle in the motor accident; Review Panel re-examined and found distribution of upper limb symptoms not consistent with the dermatomal affected nerve roots claimed in the treatment and care dispute; no radicular pain found and no clinical features of radiculopathy; Review Panel found referred (non-radicular) pain; Held – Review Panel not satisfied cervical spine injections and proposed foraminotomies are reasonable and necessary; MAC revoked; new MAC issued.

Decision date: 20 May 2026| Panel Members: Member Jeremy Lum, Dr Drew Dixon, and Dr Sophia Lahz| Treatment Type: Facet Joint Injections, Surgery, Physiotherapy Treatment, and Medical Specialist Consultant

Fahim v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 355

Motor Accident Injuries Act 2017; claimant’s application for review under section 7.26 of the assessment of a threshold injury dispute; claimant pedestrian hit by car in a shopping centre car park; claimant alleged injury to 12 parts of her body including her right knee and alleged articular cartilage loss, meniscus tear, “soft tissue injury”, aggravation of degenerative changes, “orthopaedic injury” and bony contusions; Review Panel queried whether bony contusion shown on post-accident MRI was an injury to bone and therefore a non-threshold injury; neither party provided submissions in response; claimant examined and security film of accident considered; Allianz Australia Insurance Limited v Estate of the Late Summer Abawi applied; Held – MRI report accurate and showed a contusion of the right tibia; bone contusion was caused by the accident; a bone contusion is an injury to bone; an injury to bone is not a soft tissue injury and not a threshold injury; Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 21 May 2026| Panel Members: Member Belinda Cassidy, Dr Margaret Gibson, and Dr Shane Moloney| Injury module: Spine, and Lower Limb

Pudasaini v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 357

Motor Accident Injuries Act 2017; degree of whole person impairment (WPI) dispute; claimant was standing on a footpath; insured vehicle came from behind and hit his friend’s car in the rear; claimant’s left foot became partially crushed between the rear left tyre of the car and the kerb; claimant hit his head, causing multiple fractures in his forehead and nose, as well as a fractured left foot; claimant was taken to hospital and was discharged after two days; claimant had surgery on his nose and was in a moon boot for the fracture in his left foot; claimant continued to have pain symptoms following his physical injuries; claimant also started to develop symptoms such as inability to sleep; claimant was recalling the incident repeatedly; claimant’s GP said that he was suffering a stress reaction following the motor accident which should subside with time; his symptoms did not improve, he continued to have sleep issues and repeated recall of the accident; GP referred him to a psychologist for therapy;  claimant symptoms got worse and he began having nightmares related to serious motor vehicle accidents; Medical Assessor (MA) diagnosed major depressive disorder caused by the motor accident; MA assessed a WPI at 7% utilising the psychiatric impairment rating scale (PIRS); claimant’s review application allowed by the President’s delegate on basis of failure to correctly apply the PIRS with respect to social and recreational activities, and travel; claimant re-assessed remotely by both MAs; Held – Review Panel agreed on diagnosis of post-traumatic stress disorder and assessment of a 7% WPI; original Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 22 May 2026 | Panel Members: Member Gary Victor Patterson, Dr Sharon Reutens, and Dr Melissa Barrett| Injury module: Mental and Behavioural

Allianz Australia Insurance Limited v Amen [2026] NSWPICMP 358

Motor Accident Injuries Act 2017; section 1.6(3); threshold injury; psychiatric injury; post-traumatic stress disorder; pre-existing condition; persistent depressive disorder; treatment dispute; assessment of threshold injury under section 1.6(3); claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) found the claimant sustained a major depressive disorder caused by the accident, a non-threshold injury; insurer sought review; Held – claimant had a pre-existing persistent depressive disorder; Review Panel finds no evidence of exacerbation caused by the accident; no psychiatric injury caused by the accident; request for psychiatric consultation reasonable and necessary in the circumstances but it does not relate to the injury caused by the accident; original Medical Assessment Certificate (MAC) of original MA revoked; new MAC issued.

Decision date: 22 May 2026| Panel Members: Senior Member Susan McTegg, Dr Christopher Canaris, and Dr John Lam-Po-Tang| Treatment Type: Psychiatric Treatment

Elshaimy v Transport Accident Commission [2026] NSWPICMP 360

Motor Accident Injuries Act 2017; claimant’s application for review under section 7.26 of a medical assessment of whole person impairment (WPI); claimant passenger on a bus which was hit from the rear forcing claimant’s knees to impact with the back of the seat in front; injuries listed as lower back and neck, left leg inner thigh and knee region; claimant examined by one medical assessor; cervical spine assessed at 0% WPI; claimant had lower back pain and neurological symptoms in left lower limb; detailed consideration of Motor Accident Guidelines; signs of radiculopathy versus nerve injuries; lumbar spine assessed at 0% WPI; neurological signs attributed to femoral nerve injury and assessed at 6% WPI; Held – while outcome the same, WPI percentage different; Medical Assessment Certificate revoked; new MAC issued.

Decision date: 22 May 2026| Panel Members: Member Belinda Cassidy, Dr Margaret Gibson, and Dr David Gorman| Injury module: Spine, and Lower Limb

Allianz Australia Insurance Limited v El Ali [2026] NSWPICMP 366

Motor Accident Injuries Act 2017; insurer’s application for review under section 7.26 for the whole person impairment (WPI) assessment; claimant driver who sustained injuries to pelvis, ribs, head and right shoulder; claimant agreed pelvic and rib injuries resulted in no impairment; parties agreed assessment of 2% WPI for right shoulder injury; claimant diagnosed with Alzheimer’s disease after accident and alleged this was caused, aggravated, made apparent or was unmasked by the accident; claimant could not be examined due to dementia; Review Panel decided claimant’s children (who had provided statements) should be questioned; children’s evidence inconsistent with additional documents requested which revealed claimant had memory problems before the accident; Review Panel noted nature of Alzheimer’s disease was of progressive deterioration; Review Panel found claimant sustained a head injury in the accident; claimant had pre-existing symptoms and accident did not cause or unmask Alzheimer’s; current WPI assessed at 70%; effect of head injury was temporary and current impairment not caused or materially contributed to by accident; claimant may have been a little ahead of where he might have been but for the accident but this does not result in an impairment that could be considered permanent; accident is negligible contribution to the degree of the claimant’s current severe impairment; Held – Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 25 May 2026| Panel Members: Member Belinda Cassidy, Dr Sophia Lahz, and Dr Mohammed Assem| Injury module: Brain, Upper Limb, and Lower Limb

Pi v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 370

Motor Accident Injuries Act 2017; threshold Injury dispute; psychological injury; claimant halted her vehicle at the intersection at Auburn Road, intending to turn right, when the insured jeep collided with the rear of the claimant’s vehicle, pushing it forward; claimant felt she had sustained a low back injury; claimant first attended her nominated treating doctor some months after the accident; claimant began to experience flashbacks, nightmares and other psychological symptoms; claimant was referred to a psychologist a few months after the accident; claimant performs light duties, administrative and reception work, at a traditional Chinese medicine clinic; Medical Assessor (MA) certified that the claimant suffered an accident-related adjustment depressive disorder which is a threshold injury; claimant’s review application allowed by President’s delegate on basis that MA failed to disclose path of reasoning for finding that claimant did not meet diagnostic criteria for PTSD; claimant re-examined remotely by both Panel MAs; Review Panel adopts different diagnosis of adjustment disorder with anxiety and depressed mood, which is a threshold injury; Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 26 May 2026| Panel Members: Member Gary Victor Patterson, Dr Christopher Canaris, and Dr Paul Friend| Injury module: Mental and Behavioural

Insurance Australia Limited t/as NRMA Insurance v Gray [2026] NSWPICMP 371

Motor Accident Injuries Act 2017; review of Medical Assessor’s (MA) determination of whole person impairment (WPI) for psychological injury under section 7.26; where the MA found that the claimant suffered from post-traumatic stress and persistent depressive disorder caused by the motor accident giving rise to a WPI of 19%; claimant re-examined by the Review Panel; where the Review Panel found that the claimant suffered from post-traumatic stress disorder caused by the motor accident which gave rise to a WPI of 8%; no apportionment for pre-existing psychological impairment; Held – Medical Assessment Certificate of the original MA revoked; new MAC issued.

Decision date: 26 May 2026| Panel Members: Member Maurice Castagnet, Dr Christopher Rikard-Bell, and Dr Himanshu Singh| Injury module: Mental and Behavioural

Gunter v AAI Limited t/as AAMI [2026] NSWPICMP 372

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); whole person impairment (WPI) dispute; claimant was proceeding in his car through an intersection when a vehicle turned in front of him causing a head on collision; claimant suffered an injury to his neck (broken C3 and torn ligament); original MAC diagnosed spinous fracture of C3 and assessed a WPI at 5%; Review Panel noted pre-existing motor accident in 1995 causing fractures at different levels at C5 and C6; previous cervical fusions at C5/6 and T1/2/3; Review Panel called for cervical CT and MRI radiological films for review; Held – Review Panel determined that there was a spinous fracture at C3 with extension into both laminae (i.e. the posterior vertebral elements) which caused residual left-sided spinal canal deformity as shown on CT films; Table 6.7 Motor Accident Guidelines and Table 73 of the Medical Association’s Guides to the Evaluation of Permanent Impairment, 4^th ed; WPI assessed as DRE III of 15%; MAC revoked; WPI greater than 10%; new MAC issued.

Decision date: 26 May 2026 | Panel Members: Member Jeremy Lum, Dr Margaret Gibson, and Dr Sophia Lahz | Injury module: Spine, Upper Limb, and Lower Limb

Yousif v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 373

Motor Accident Injuries Act 2017; review of medical assessment; whole person impairment (WPI); vehicle T-boned causing it to roll over; no neurological abnormalities identified; psychological injury sustained; contemporaneous evidence for neck and low back injuries; early post-accident mention of left shoulder pain; no radiculopathy or vertebral body compression to cervical spine; mild intermittent acromioclavicular joint crepitation to the left shoulder; no vertebral body compression or fracture of the lumbar spine; Held – WPI rising from the subject accident assessed at 2%; Medical Assessment Certificate of the original Medical Assessor confirmed.

Decision date: 26 May 2026| Panel Members: Member Hugh Macken, Dr Margaret Gibson, and Dr Les Barnsley| Injury module: Spine, and Upper Limb

Ahmed v QBE Insurance (Australia) Limited [2026] NSWPICMP 374

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); permanent impairment dispute; claimant was rear seated passenger in a sedan which was rear-ended by a large truck; alleged injuries to orbital fracture; hearing loss; lumbar spine and left shoulder; original Medical Assessor found the necessary two signs for a diagnosis of radiculopathy; lumbar spine not yet permanent as two years had not elapsed since accident and the claimant was receiving benefit from radio frequency injections; Review Panel also found lumbar spine radiculopathy; Review Panel found impairment permanent as two years had passed since accident; Radiofrequency injections only for symptom relief and unlikely to alter the underlying structural issues for which the diagnosis of radiculopathy was based; left shoulder not causally related; delay of any documented complaints; Review Panel not persuaded by claimant’s explanation of delay; Held – whole person impairment assessed at 10%; MAC revoked; new MAC issued; new combined MAC issued; WPI not greater than 10%.

Decision date: 27 May 2026| Panel Members: Member Jeremy Lum, Dr Margaret Gibson, and Dr Sophia Lahz| Injury module: Brain injury, and Spine

Insurance Australia Limited t/as NRMA Insurance v CIC [2026] NSWPICMP 375

Motor Accident Injuries Act 2017; assessment of whole person impairment (WPI) for psychiatric impairment; claimant presented with pre-existing psychological conditions based on trauma, asylum seeker and depression; claimant’s history to Medical Assessors (MA) of pre-exiting condition and post-accident symptoms inconsistent with records; Review Panel did not accept uncorroborated claimant’s account; acceptance of aggravation dependent upon acceptance of claimant; Whisprun Pty Ltd v Dixon considered; history of pre-accident psychological symptoms; post-accident moving and financial activity inconsistent with claimant’s account; not seeking treatment post-accident; Review Panel not satisfied that accident caused or aggravated pre-existing psychiatric condition; no assessment of permanent impairment required; Held – original Medical Assessment Certificate revoked; new MAC issued.

Decision date: 27 May 2026 | Panel Members: Member Terence O’Riain, Dr Christopher Canaris, and Dr Surabhi Verma | Injury module: Psychological/Psychiatric

Workers Compensation Medical Appeal Panel Decisions

CAS v DIZ [2026] NSWPICMP 353

Workplace Injury Management and Workers Compensation Act 1998; psychological injury; lump sum claim; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of two of the six assessments under the psychiatric impairment rating scale categories, namely social functioning and employability; error in reference to independent medical examiner’s report and assessment of the whole person impairment (WPI); assessment in the scale of employability revoked on appeal; appellant re-examined by a medical member of the Appeal Panel; Appeal Panel made the same assessment for employability as made by the Medical Assessor;  the overall assessment of WPI remained the same; Held – Medical Assessment Certificate confirmed.

Decision date: 3 March 2026| Panel Members: Member Carolyn Rimmer, Dr John Baker, and Dr Michael Hong| Injury module: Psychological/Psychiatric

State of New South Wales (New South Wales Police Force) v Schmidt [2026] NSWPICMP 281

Workplace Injury Management and Workers Compensation Act 1998; appeal from decision of Medical Assessor (MA); whether Medical Assessment Certificate (MAC) contained a demonstrable error or was based on incorrect criteria; Held – MA’s own findings for the category of social functioning clearly fall within Class 2 impairment of the psychiatric impairment rating scale Guidelines rather than Class 3 as assessed, given the worker’s own evidence he retains close familial relationships; where was no error or use of incorrect criteria in the MA’s determination of the whole person impairment (WPI) for the category of concentration, persistence and pace; MAC assessing the worker at a 17% WPI revoked; new MAC issued assessing a 15% WPI.

Decision date: 19 May 2026| Panel Members: Member Cameron Burge, Professor Nicholas Glozier, and Dr Michael Hong| Injury module: Psychological/Psychiatric

Pollack v Lake Conjola Bowling and Recreation Club Ltd [2026] NSWPICMP 354

Workplace Injury Management and Workers Compensation Act 1998; appellant submits that the Medical Assessor (MA) erred in several respects namely: in his diagnosis; MA’s assessments of two of the categories of the psychiatric impairment rating scale (PIRS), namely social and recreational activities and employability, and in making an “Understatement of Avoidance Behaviours”; Appeal Panel found no errors; PIRS assessments consistent with the evidence; diagnosis was open to the MA; MA also dealt with the “avoidance behaviour” issue; Held – Medical Assessment Certificate confirmed.

Decision date: 20 May 2026| Panel Members: Member Deborah Moore, Dr Michael Hong, and Professor Nicholas Glozier| Injury module: Psychiatric/psychological

Carovski v Viscount Plastics Pty Limited [2026] NSWPICMP 356

Workplace Injury Management and Workers Compensation Act 1998; cervical spine; right upper extremity (shoulder, elbow and wrist); assessment of whole person impairment to the cervical spine and right upper extremity; adequacy of reasons; consideration of relevant material; obvious error; application of section 323; Held – Medical Assessor (MA) erred in adequately exposing his path of reasoning and in consideration of relevant material; MA erred in application of section 323 in consideration of the “relevant date”; appellant re-examined; Medical Assessment Certificate revoked; new MAC issued.

Decision date: 21 May 2026| Panel Members: Member Kathryn Camp, Dr Gregory McGroder, and Dr Roger Pillemer | Injury module: Cervical Spine, and Right Upper Extremity

Bartman v Bindaree Beef Pty Ltd [2026] NSWPICMP 361

Workplace Injury Management and Workers Compensation Act 1998; appeal by claimant from assessment of 15% whole person impairment for bilateral carpal tunnel condition; whether Medical Assessor (MA) had correctly applied Table 16-10 or Table 16-11 of American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed; whether MA had given adequate reasons; Held – MA misquoted Table 16-10 and different interpretations of his findings led to a re-examination as to the appropriate grade; re-examination did not reveal any assessable left wrist impairment; referral commented on as misleading and confusing, which MA stated he could not understand; certified injury date which was not relevant to his function; Haddad v The GEO Group Australia Pty Ltd considered; Medical Assessment Certificate (MAC) of original MA revoked; new MAC issued.

Decision date: 22 May 2026| Panel Members: Member John Wynyard, Dr Tommasino Mastroianni, and Dr Paul Curtin| Injury module: Right Upper Extremity, Left Upper Extremity, and Scarring (TEMSKI)

Kusiwah-Yeboah v United 4 Care Pty Ltd [2026] NSWPICMP 363

Workplace Injury Management and Workers Compensation Act 1998; appeal from 7% assessment for psychological injury; whether classifications for psychiatric impairment rating scale categories of  self-care, social and recreational activities and social functioning were correct; whether MA should have preferred opinion of claimant’s medicolegal expert; State of New South Wales (NSW Department of Education) v Kaur, and Wingfoot Australia Partners Pty Ltd v Kocak applied; Held – function of Medical Assessor (MA) discussed; no identification by claimant of mistake or misunderstanding by MA, who had noted the expert’s report without comment; with self-care, claimant’s expert assessed same rating as the MA; observations on onus in such cases for claimant to not only prove MA incorrect, but that claimant’s own expert was also incorrect; further speculative submission with no evidentiary support mischievous; Medical Assessment Certificate confirmed.

Decision date: 22 May 2026 | Panel Members: Member John Wynyard, Dr Graham Blom, and Professor Nicholas Glozier | Injury module: Psychiatric/psychological

Australian International Academy of Education Limited v Kaddour [2026] NSWPICMP 364

Workplace Injury Management and Workers Compensation Act 1998; appeal by employer from finding of a 41% whole person impairment (WPI) for right and left lower extremity impairments; where another Medical Assessor (MA) had assessed a 5% WPI for the lumbar spine but not qualified to assess neurological claims; where claimant presented inconsistently; whether Chapter 1.36 of the Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed, had been complied with; whether neurological deficits had been correctly calculated; Held – MA described florid and histrionic presentation and reaction to examination; MA had not referred to Chapter 1.36 and his range of motion and neurological findings were not adequately explained; claimant re-examined; no organic or physiological cause found for presentation; claimant needed assessment by a psychiatrist; Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 22 May 2026| Panel Members: Member John Wynyard, Dr Drew Dixon, and Dr John O’Neill| Injury module: Lumbar Spine, Right Lower Extremity, and Left Lower Extremity

Barber v State of New South Wales (Western Sydney Local Health District) [2026] NSWPICMP 365

Workplace Injury Management and Workers Compensation Act 1998; assessment of a primary psychiatric injury; appeal on the grounds of demonstrable error and assessment being made on the basis of incorrect criteria; appellant submitted that the assessments in the psychiatric impairment rating scales of self-care and personal hygiene and  concentration, persistence and pace were inconsistent with the evidence; Appeal Panel found error in assessment of self-care and personal hygiene and proceeded to assess Class 2 in this scale; Appeal Panel found no error in assessment of concentration, persistence and pace; Appeal Panel satisfied Medical Assessor failed to consider whether an adjustment should be made for effects of treatment; Appeal Panel satisfied an adjustment of 2% whole person impairment should be made for effects of treatment; Held – Medical Assessment Certificate (MAC) revoked; new MAC issued.

Decision date: 22 May 2026| Panel Members: Member Carolyn Rimmer, Dr Douglas Andrews, and Dr Michael Hong| Injury module: Psychiatric/psychological

Secretary Department of Education (TAFE NSW) v Venn [2026] NSWPICMP 368

Workplace Injury Management and Workers Compensation Act 1998; worker submits that Medical Assessment Certificate (MAC) contained demonstrable error and/or the application of incorrect criteria in assessment of psychiatric impairment rating scales (PIRS) category of social and recreational activities; Ballas v Department of Education considered; Held – no demonstrable error or incorrect criteria in assessment of PIRS category of social and recreational activities; MAC confirmed.

Decision date: 25 May 2026| Panel Members: Member John Isaksen, Dr John Baker, and Dr Graham Blom | Injury module: Psychiatric/psychological

Narrabri Shire Council v Cameron [2026] NSWPICMP 369

Workplace Injury Management and Workers Compensation Act 1998; appellant submits that the Medical Assessor (MA) erred in failing to make his assessments in accordance with the referral; frank injury referred for assessment; MA made comments that suggested a ‘nature and conditions’ type claim; Appeal Panel found such comments were peripheral; MA’s assessments were consistent with the evidence; Medical Assessment Certificate confirmed.

Decision date: 25 May 2026| Panel Members: Member Deborah Moore, Dr Drew Dixon, and Dr Margaret Gibson| Injury module: Cervical spine, Lumbar Spine, and Left Upper Extremity

Motor Accidents Merit Review Decisions

Singh v Youi Pty Limited [2026] NSWPICMR 19

Motor Accident Injuries Act 2017; merit review; dispute regarding calculation of pre-accident weekly earnings (PAWE); calculation under schedule 1 clause 4(1); whether earnings of company constitute earnings of director and sole shareholder; whether transfers were received by an earner as an earner; Allianz Insurance Australia Limited v Shahmiri considered and applied; Held – claimant has not established that the transfers or invoices generated by his company constitute earnings for the purposes of schedule 1 clause 4(1); no evidence of earnings received during part of relevant period; reviewable decision set aside.

Decision date: 21 May 2026| Merit Reviewer: Bianca Montgomery-Hribar

Tawanda v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMR 20

Motor Accident Injuries Act 2017; merit review; dispute about payment of weekly benefits under Division 3.3 of the Motor Accident Injuries Act 2017; pre-accident weekly earnings (PAWE); meaning of PAWE, schedule 1, clause 4(1); meaning of “earnings”; meaning of “loss of earnings”; “income from personal exertion”; schedule 1 clause 3(1); clause 3(2); clause 3(3); whether workers compensation or other statutory benefits payments are earnings received as an earner for the purpose of PAWE under clause 4; Kwak v Insurance Australia Limited t/as NRMA Insurance, Prendergast v QBE Insurance (Australia) Limited, and Khalid v Insurance Australia Limited t/as NRMA Insurance; Held – the reviewable decision is affirmed.

Decision date: 21 May 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.

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