1. Mr Ahmed provided a statement dated 7 September 2022 utilising the services of an Arabic interpreter.[11] Adopting the numbering used by Mr Ahmed the Panel notes the following relevant paragraphs:

"6. As my vehicle was stationary at the set of lights, a vehicle behind me ..., failed to stop and rear ended my vehicle. I was wearing my seatbelt at the time of the accident, however, the impact of the collision caused my body to thrust forward. The impact caused my head to hit the front window, my upper body slammed onto the steering wheel, and my right knee hit the dashboard.

1. I immediately began experiencing pain throughout my body, especially in the region of my neck and back. I felt pain in my right leg/knee, but I was mainly concerned about my neck and back.
2. A couple of days after consulting Dr Bumanglag, I noticed that I had pain in my right leg/knee. Very quickly this pain became extremely intense and unbearable.
3. Prior to the subject accident I was in good health. I would describe myself as being fit and healthy. I did not suffer from any pre-existing and/or medical conditions. I did not suffer from any injury, and/or pain to my right knee before the subject accident."

1. The insured driver Justin Cruise provided a statement dated 17 January 2022.[12] He described the accident as a little bump and reported the damage to his own vehicle was a crack in the plastic to the left-hand side of the bumper bar which was very minimal. He described the impact as 1 out of 10. Mr Cruise opined that the claimant's vehicle looked as if it had been damaged from a previous accident, like he had hit a pole.

1. Dr Mcintosh provided a report at the request of the insurer dated 24 November 2023.[13]
2. Photographs of the vehicles involved in the collision were included in the report of

Dr McIntosh. 3. He reported the images of the claimant's vehicle showed: * collision damage to the rear bumper system and boot lid; * the rear bumper is deformed with greatest deformation at the midline; * the bumper cover is partially detached on the offside corner; * there are contact marks on the offside corner bumper cover; * there are contact marks along the bumper cover from the offside corner to midline, and * the boot lid is not closing fully, which might reflect damage to the beaver panel or locking system. 4. The damage to the insured vehicle was reported to be: * a small area of damage on the nearside front corner lower bumper cover. The bumper is cracked. 5. Dr McIntosh concluded that the insured vehicle collided at a speed less than 13kmph into the rear of the claimant's vehicle. The change in velocity was less than 10kmph. The biomechanical forces acting through the lumbar spine, right knee and feet would have been low magnitude and tolerated without injury. The damage sustained to the rear of the claimant's vehicle was likely to be pre-existing and most likely caused by an impact with a narrow object, for example a bollard or pole.

1. On 17 June 2021 Mr Ahmed attended his GP Dr Bumanglag who recorded:

"patient driver and stopped suddenly at a traffic light

His also complains of right ear ringing."[14]

"1. Results of xray on the cervical spine and lumbar spine discussed

1. patient stated he felt pain on the right knee in the past 2 days

1. On 1 July 2021 Dr Bumanglag referred Mr Ahmed for an X-ray of the cervical and lumbar spine and an X-ray of his right knee.
2. Dr Bumanglag provided a certificate dated 1 July 2021 with the following diagnosis:

"motor vehicular accident sustaining lower back pain and right knee pain - for investigation."[16]

1. On 10 July 2021 Dr Allan Gregor recorded the claimant braked on a yellow light and was hit from the back by a speeding car at 70kmph. He reported no head injuries, no neck pain, developed right knee pain and lower back pain.[17] He referred the claimant to Dr Jayker Dave for management of his knee injury. The referral records the following history:

10 July 2021 MRI right knee radial tear medial meniscus/chondropathy."[18]

1. On 5 October 2022 Dr Dave, orthopaedic surgeon reviewed the claimant more than one year after the accident when his car was hit heavily from behind by another vehicle. He diagnosed a medial meniscus tear and chondromalacia at his patello-femoral joint. He requested approval for arthroscopic meniscal repair. [19]
2. On 28 September 2023 Dr Dave reported persisting right knee symptoms and on examination he noted tenderness around the medial joint line, McMurray's test was positive with a soft click and an increase in pain.[20] There was patellofemoral irritability and pain on squatting from the patellofemoral joint. Although arthroscopic repair had been approved

Mr Ahmed had turned down the surgical option. Dr Dave requested physiotherapy for strengthening. 3. On 16 May 2024 Dr Dave reported Mr Ahmed continued to have symptoms in keeping with patellofemoral chondropathy as well as medial joint line symptoms.[21] He noted he had not returned to work as a concreter. He reported prominent patellofemoral symptoms with anterior knee pain when rising from a chair, going up and down stairs and when kneeling or squatting. A deeper squat caused significant pain around the medial joint line of the knee.

Dr Dave stated there was a risk of the patellofemoral symptoms deteriorating if he undergoes surgery as it will further decondition his leg, although he also noted the meniscal tear served as a barrier to ongoing rehabilitation as Mr Ahmed had painful restriction of knee flexion. He recommended a further MRI scan of the knee.

1. Mr Lau provided a report dated 6 September 2021.[22] He initially assessed Mr Ahmed on

4 September 2021. He reported complaints of right knee pain and lumbar spine pain. His examination findings included the following:

"Range of Movement: Active right knee range of motion was within normal limits, however, there was pain at end of range flexion and extension and the pain was described to be sharp and inside the knee. Active lumbar range of motion was slightly limited with flexion being 40 degrees, extension being full range, side flexion being fingertips to superior border of the patella and rotation was full range. The most painful movement was flexion and he noted that he could easily touch to floor when bending over prior to the accident. McMurray's was positive for the right knee. Squatting range was limited to 100 degrees knee flexion and required hand support to stand back up.

Muscle Power: Isometric testing revealed pain and decreased strength in both flexion and extension with pain in flexion past 90 degrees flexion and pain was described to be inside the knee. In extension the pain was at end of range and the pain was at the quadricep tendon.

Palpation: There was significant tenderness at the right quadricep tendon, lumbar spine erector spinae, quadratus lumborum and piriformis muscles. Palpation at the right side of the lumbar spine erector spinae and quadratus lumborum muscles resulted in referred pain into the right gluteal region."

1. X-ray cervical spine dated 18 June 2021 reported no fracture or dislocation. Loss of the cervical lordosis. This might be related to muscle spasm. No evidence of cervical rib. Odontoid outlines normally. No evidence of foraminal stenosis.[23]
2. X-ray lumbar spine dated 18 June 2021 reported mild scoliosis convex to the right. Loss of the lumbar lordosis. This might be related to muscle spasm. There is no fracture or dislocation. Spina bifida occulta of S1 segment. SI joints outline normally.[24]
3. X-ray right knee dated 25 June 2021 reported alignment is normal. There is no fracture or dislocation. Patella is intact. There is suggestion of minor effusion in the suprapatellar bursa.[25]
4. CT lumbar spine dated 2 July 2021 reported no evidence of fracture. At L5-S1 level, broad-based disc bulge with left lateral protrusion slightly compressing the exiting left L5 nerve in the exit foramen.[26]
5. MRI right knee dated 2 July 2021 reads:

"Alignment is normal. No evidence of fracture. Small effusion is present in the suprapatellar bursa with mild reactive synovitis. Minor oedema in the Hoffa's fat pad. Anterior cruciate and posterior cruciate ligaments are intact.

Free edge blunting of the anterior horn/body junction of the mid portion of the medial meniscus with 8.8 mm separation measured on the coronal study ...This is also seen on the sagittal study ... and the corresponding axial study ... This is consistent with a radial tear.

Posterolateral corner supporting structures including biceps femoris, fibular collateral ligament and popliteus tendons are intact.

Osteochondral effaces of the tibiofemoral joint is preserved.

Localised high-grade chondropathy of the trochlea is seen centrally with irregularity of the articular cartilage without associated minimal bone marrow oedema. There is corresponding high-grade chondromalacia patellae of the lateral facet with full-thickness irregularity, minimal fissuring and subchondral oedema.

Mild reactive chronic tendinopathy of the quadriceps and patellar tendon.

Associated minor increased signal at the patellar tendon insertion to the patella suggestive of minor acute injury.

Calf muscles intact, there is no Baker's cyst, pes anserine tendons are normal.

Small effusion in the suprapatellar bursa and mild reactive synovitis.

Radial tear of the medial meniscus no evidence of acute cruciate ligament or collateral ligament injury. At the anterior/body junction

High grade focal chondropathy of the trochlea and corresponding high-grade chondromalacia patellae of the lateral facet."[27]

Report of Dr James Powell, orthopaedic surgeon

1. Dr Powell assessed Mr Ahmed at the request of the insurer and provided a report dated

7 April 2022. 2. He reported Mr Ahmed had whole body pain at the time and the following day he had pain throughout his back from his upper thoracic to the lumbosacral junction and in the right knee. Mr Ahmed consulted his GP and was given analgesics. He attended physiotherapy on one occasion only. 3. Dr Powell reported Mr Ahmed had constant stiffness in the back from the thoracic to the lumbar region and lumbar back pain. He also reported the pain radiated to the right lower limb every month or so. He also reported persisting pain in the right knee which can be accompanied by a clicking. 4. Dr Powell reported Mr Ahmed worked as a cement renderer but had not returned to work since the accident. 5. On examination Dr Powell found no limitation in lumbar movement, no abdominal signs and no distal neurological signs. He noted retropatellar crepitus in both knees without limitation in motion and without asymmetric soft tissue changes. 6. Dr Powell concluded Mr Ahmed had not sustained any musculoskeletal injury arising out of the accident. He concluded it was difficult to accept that Mr Ahmed had struck his knee on the dashboard as any forward progression would have been halted by the seat belt. Whilst imaging identified changes about the right knee involving the extensor mechanism, he concluded they were longstanding and indicate a degenerate aetiology.

Report of Dr Robin Mitchell, occupational physician

1. Dr Mitchell assessed the claimant and provided a report dated 3 October 2023.[28] He reported the claimant said he was stationary in traffic when his vehicle was hit from behind and apparently, he then hit his knees on the dashboard. He was wearing his seat belt, the airbags did not deploy, he did not lose consciousness and was able to exit the vehicle. Neither police nor ambulance attended.
2. Dr Mitchell reported the claimant reported ongoing pain in the neck, thoracic and lumbar back, all of a soft tissue nature with no objective clinical evidence of any current underlying injury. He reported pain in the right knee with investigations identifying a radial tear of the medial meniscus and focal chondromalacia of the lateral facet.
3. He noted the claimant reported right knee pain following the accident, which may have been due to striking the dashboard with the right knee, however, he found there was no longer any plausible relationship between the other complaints and the accident.
4. Dr Mitchell provided a supplementary report dated 13 February 2024 in which he stated he agreed with the comments of Dr Korber and stated it did not give him any reason to alter the opinion previously expressed. [29]
5. Dr Mitchell provided a report dated 26 June 2024 after reviewing the report of Dr Mcintosh, biomechanical engineer.[30] He stated it did not cause him to alter his opinion.
6. Dr Mitchell provided a further report dated 12 November 2024 in which he expressed the opinion that there was no causal relationship between the accident and the claimant's right knee condition.[31]

Report of Dr James Bodel, orthopaedic surgeon

1. Dr Bodel provided a report dated 5 October 2023.[32] Dr Bodel recorded the claimant was driving a Toyota Camry stationed behind one other vehicle at an intersection when suddenly and without warning he was hit from behind by a following motor vehicle. He reported "he was pushed forward but did not strike the vehicle in front and there were just the two vehicles involved." He reported he developed immediate onset of lower back pain, right knee pain and neck pain. He also noted he complained of pain in both feet.
2. Dr Bodel referred to the MRI scan of the right knee dated 2 July 2021, two weeks after the accident which disclosed a radial tear of the medical meniscus. He concluded the medial meniscus tear was an acute injury which occurred in the accident.
3. Dr Bodel concluded the claimant sustained a soft tissue injury to the lower part of the back and a meniscal tear in the region of the right knee caused by the accident.
4. On 5 July 2023 Dr Bodel assessed a 9% WPI based on a 5% WPI of the lumbar spine and 4% WPI for the right lower extremity.

1. Dr Korber provided a report dated 6 October 2023.[33] He reviewed the right knee X-ray of

25 June 2021 and the MRI scan of the right knee of 2 July 2021 (15 days after the accident). 2. He opined that most meniscal tears are degenerative although radial meniscal tears are reasonably due to high energy trauma. He stated "if the medial meniscus tear were due to trauma, I would like to see other manifestations of trauma, such as bone marrow oedema, or collateral ligament injury, or cruciate ligament injury, rather than an isolated finding, particularly as this is a high energy injury." 3. He opined that the chondromalacia patella was pre-existing. 4. Dr Korber concluded "I cannot be absolutely certain however whilst it is possible, I think on the balance of probabilities, the radial tear of the medial meniscus was not caused by the motor vehicle accident and was most likely pre-existing. The reason is the lack of other traumatic findings". 5. He also stated, "whether the claimant has aggravated a pre-existing condition is a matter for clinical determination".

1. Records produced by AAI Limited relate to an accident on 14 March 2020 which occurred at a roundabout between Park Road and Amy Street, Regents Park when a car on the claimant's left failed to give way.[34] The claimant was noted as the driver. His vehicle was deemed a total loss. Photographs of the vehicle show moderate damage to the driver's side wheel hub and extensive damage to the internal front bumper bar.

1. Records produced by NRMA relate to a previous motor accident on 19 April 2019 at Potts Hill.[35] A photograph of the claimant's vehicle depicts moderate front end damage, consistent with a relatively heavy impact. Correspondence indicated the vehicle was written off.
2. Further records produced by NRMA relate to a previous motor accident on 11 April 2019.[36] A photograph of the claimant's vehicle (BMX X5) depicts moderate driver's side door and front side panel damage, consistent with a moderate impact. Correspondence indicated the vehicle was deemed to be a total loss.

1. The insurer provided submissions dated 11 July 2025 in support of the application for review.[37]
2. The insurer notes in accepting the evidence of the claimant that he could not close his boot Medical Assessor Home has not considered the evidence of the insured driver who identified the pre-existing damage or how the damage profile is consistent with the accident noting the expert opinion of Dr McIntosh that the damage was more likely caused by an impact with a narrow object, for example a bollard or pole.
3. The insurer also noted that the photographic evidence of the rear of the claimant's vehicle shows that the boot is closed.
4. The insurer provided submissions dated 31 January 2025 in support of the application for further assessment.[38]
5. The insurer outlined the decision of the earlier Medical Review Panel and noted the following additional relevant information:
   • the opinion of Dr Mitchell as per his report dated 3 October 2023 where he noted the claimant reported right knee pain following the accident which may have been due to striking the dashboard with his right knee but there was no longer any plausible relationship between the other complaints and the accident;
   • the report of Dr Korber dated 6 October 2023 where he stated whilst he could not be certain he believed on the balance of probabilities that the radial tear of the medial meniscus was not caused by the accident and was most likely pre-existing;
   • the report of Dr McIntosh dated 24 November 2023 who concluded the damage to the claimant's vehicle was likely to be pre-existing and the biomechanical forces acting through the lumbar spine, right knee and feet would have been low magnitude and tolerated without injury;
   • the certificate of Medical Assessor Condie, physiotherapist dated 26 March 2024 who concluded the referral to Mr Dave physiotherapist was not reasonable and necessary having regard to the opinion of Dr McIntosh;
   • the claimant's involvement in other accidents on 14 March 2020, 19 April 2019, and 11 April 2019, and
   • the statement of the insured driver Mr Cruise that he felt a little bump and he described the impact as 1 out of 10 with minimal damage to his vehicle. He also asserted the damage to the claimant's vehicle looked like it had been from a previous accident.

1. The claimant has provided detailed submissions furnished in respect of the various medical assessment disputes arising out of the accident. Where the review is a new assessment of all matters with which the medical assessment is concerned the Panel only proposes to address those submissions dealing with the substantive dispute.
2. The claimant provided submissions dated 13 December 2021 in support of the minor (threshold) injury dispute.[39] The claimant submitted that the medical imaging proves the claimant suffered a medial meniscus tear in his right knee and that the definition of minor injury in s 1.6(2) of the MAI Act would exclude a tear of the medial meniscus meaning it is a non-minor injury.
3. The claimant provided submissions dated 29 August 2022 in response to the insurer's application for further assessment of the threshold injury dispute.[40] The claimant submits the statement of the insured driver is nothing more than an untested version of events taken by an investigator commissioned by the insurer. It is submitted this statement has no probative value. The claimant submits the records of Fairfield Chase Medical & Dental Centre confirm there was no delay in report of the right knee injury where the claimant complained of right knee pain six days after the accident. Furthermore, it is asserted injury to the right knee is confirmed by the MRI of the right knee dated 2 July 2021 which reported a small effusion and evidence of a radial tear in the medial meniscus.
4. The claimant refers to the decision of Bugat v Fox,[41] in which the Supreme Court confirmed that the presence or absence of contemporaneous evidence of injury is relevant but not determinative when considering the causation of an injury. An absence of contemporaneous evidence will not automatically remove the link of causation, and the medical examiner should be considering all the available evidence, including any further investigations the claimant undergoes. The claimant submits this principle was explored further in Norrington v QBE Insurance (Australia) Ltd[42] where the court states it is possible that causation may exist without a documented contemporaneous complaint.
5. In relation to the mechanism of the accident the claimant submitted that photographs are no more than a factor to be taken into account but are not determinative of the forces involved in the accident and nor are they determinative of the extent of any injuries sustained (El-Mohamad v Celenk ).[43]
6. The claimant provided submissions dated 5 August 2025 in response to the application for review addressing the certificate of Medical Assessor Home and the test to be determined by the President's delegate.[44]

1. Mr Ahmed was assessed by Medical Assessor Moloney by videoconference on

17 November 2025. He was unaccompanied. An interpreter B Ashqar, NAATI No. CPN 3E41ET was also present during the interview.

1. Mr Ahmed stated he had been in good health prior to the accident and was working as a cement renderer on a casual basis.
2. Medical Assessor Moloney drew the claimant's attention to earlier accidents on

14 March 2020, 19 April 2019 and 11 April 2019 referenced in records produced by the insurer. When asked what happened in those accidents, Mr Ahmed stated that he had no recollection of accidents on those dates. He then volunteered that in the past he had sustained a minor accident in a car park when another car was bumped but had no idea in what year that occurred. He also stated that there had been no previous accidents involving the car he was driving at the time of the accident.

1. Mr Ahmed stated he was in his car and was stationary at a set of lights when another car collided with the rear of his car. There was no secondary impact. He stated the other car was travelling at 70 kmph and did not slow down. When asked how he determined that speed

Mr Ahmed stated he could tell by looking in the rear vision mirror. He stated there was little damage to the offending car because it was a Volkswagen utility. 2. Mr Ahmed was able to get out of his car. He exchanged details with the other driver and then drove home. He stated he was unable to close the boot of his car after the accident, and it was subsequently declared a write-off.

History of symptoms and treatment following the accident

1. Mr Ahmed stated he initially had pain all over and with the impact he hit his knees on the dashboard.
2. He consulted his GP who prescribed analgesics and referred him for scans of his lumbar spine and right knee. He states at that time, he had pain in the lower back and right leg. His GP subsequently referred him to an orthopaedic specialist, Dr Dave. He was offered injections to the right knee but declined treatment. Physiotherapy was of slight benefit.
3. There have been no further accidents or injuries since the accident.

1. Mr Ahmed has persistent low back pain more so on the right side with pain radiating down the right leg to the thigh. He also gets a fluctuating numbness in the dorsum of the right foot. The left leg is asymptomatic. The back pain increases with prolonged sitting although driving is okay. He tends to wake after four hours either due to anxiety or back pain. Walking is possible for about 10 minutes. There is a constant pain in the anterior portion of the right knee with no swelling, and he hears clicking sometimes.
2. At present, Mr Ahmed is single and lives with his girlfriend but does no household chores. He stated that he had been unemployed since the accident. He does some social activities outside the house such as going to the shops. He stated that he had had recent blood tests from his GP which were okay.

1. Present medication is an analgesic prescribed by his GP, but he doesn't know the name of it. He took Endone in the past, but his GP stopped this because of a worry about dependence. However, he states that he gets a few Endone tablets from a friend when the pain is bad.
2. No manual therapy is being undertaken at present.

1. Medical Assessor Moloney formed the view the claimant exaggerated the impact of the accident on the basis it was unlikely the vehicle which collided with his vehicle was travelling at 70 kmph at the time of the accident.
2. Medical Assessor Moloney also found it surprising the claimant could not recall his involvement in the three earlier accidents although the Panel notes there is no allegation of injury arising out of those accidents.

1. The claimant asserts he sustained soft tissue injury to the lumbar spine. The insurer agreed if the claimant suffered a lumbar spine injury in the accident it was a soft tissue injury.
2. The claimant reported low back pain when he consulted Dr Bumanglag on 17 June 2021 following the accident and he referenced back pain in the Application for personal injury benefits dated 24 June 2021. He underwent investigations of the lumbar spine, namely an X-ray on 18 June 2021 and a CT scan on 2 July 2021. Mr Ahmed has consistently reported ongoing lumbar spine pain including to Mr Lau, physiotherapist, and as reported by

Dr Mitchell in his report dated 3 October 2023 and Dr Bodel in his report dated 5 October 2023. Medical Assessor Moloney reported ongoing complaints of persistent low back pain. 3. The Panel is satisfied that the claimant sustained injury to the lumbar spine caused by the accident. Noting the concession of the parties the Panel finds that the claimant sustained a soft tissue injury to the lumbar spine.

1. The claimant alleges he sustained soft tissue injury to the feet caused by the accident whilst the insurer asserts the claimant did not sustain injury to either foot caused by the accident.
2. The Application for personal injury benefits dated 24 June 2021 reported the claimant had sustained foot pain in the accident. There is no record of complaint relating to either foot in the records of treatment providers although Dr Bodel noted Mr Ahmed also complained of pain in both feet. Medical Assessor Moloney reported following the accident the claimant had pain all over.
3. However, if it is accepted based on the claimant's self-report in the Application for personal injury benefits that Mr Ahmed did sustain foot pain caused by the accident the Panel finds that injury to either foot was a soft tissue injury which has now resolved. A soft tissue injury would be a threshold injury.

1. Whilst there was no report of complaint pertaining to the right knee when Mr Ahmed was assessed by his GP following the accident, he did report right knee pain on 23 June 2021, some six days after the accident. The claimant underwent an X-ray of the right knee on

25 June 2021 and an MRI on 2 July 2021 when the radial tear of the medial meniscus was demonstrated. 2. There is no dispute that the claimant was diagnosed with a radial tear of the medial meniscus following the accident. 3. Both parties agree the real dispute to be determined by the Panel is the question of causation of the radial tear of the medial meniscus of the right knee. 4. The test for causation was addressed by Wright J in Briggs v IAG Limited trading as NRMA Insurance[45] where he stated at [35]:

"The question of causation of injuries was not dealt with in Part 5 of the Guidelines but causation was addressed in Part 6, which related to assessment of permanent impairment. There is no reason to think that different principles were intended to be applied when a medical assessment was being made in relation to causation of minor injuries. Clauses 6.5 to 6.7 provided:

6.5 An assessment of the degree of permanent impairment is a medical assessment matter under clause 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues.

6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:

'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:

1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'

This, therefore, involves a medical decision and a non-medical informed judgement.

6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes."

1. Having regard to the comments of Wright J in Briggs the Panel considers it is appropriate to apply the test as to causation set out in part 6 of the Guidelines.
2. The question is whether the accident could have caused or contributed to the medial meniscal tear of the right knee and whether it in fact did so.
3. The insurer relies upon the statement of the insured driver who reported he felt a little bump and described the impact as 1 out of 10 noting there was minimal damage to his vehicle. In his report dated 24 November 2023, Dr McIntosh, biomechanical engineer concluded that the insured vehicle collided at a speed less than 13kmph into the rear of the claimant's vehicle. In those circumstances he concluded the biomechanical forces acting through the lumbar spine, the right knee and feet would have been low magnitude and tolerated without injury. He reviewed photographs of both vehicles and whilst he noted there was collision damage to the rear bumper system and boot lid, he thought the rear bumper deformation at the midline was most likely caused by an impact with a narrow object such as a bollard or a pole.
4. The insurer also relies upon the opinion of Dr Korber, radiologist who concluded most meniscal tears are degenerative although radial meniscal tears are reasonably due to high energy trauma. He concluded that whilst he could not be absolutely certain, and it was possible, on the balance of probabilities the radial tear of the medial meniscus was not caused by the accident and was pre-existing give the lack of other traumatic findings.
5. In his statement dated 7 September 2022 Mr Ahmed reported the impact of the collision caused his body to thrust forward leading his right knee to hit the dashboard. He also stated he did not suffer from any injury and/or pain to his right knee before the accident.
6. Dr Powell considered it was difficult to accept that Mr Ahmed had struck his knee on the dashboard as any forward progression would have been halted by the seat belt. Dr Robin Mitchell initially concluded the right knee pain may have been due to striking the dashboard with the right knee although after reviewing the reports of Dr Korber and the biomechanical engineer expressed the view there was no causal relationship between the accident and the claimant's right knee condition.
7. The Panel is satisfied that the rear end collision could have caused or contributed to the medial meniscal tear of the right knee where Dr Korber found radial meniscal tears can be due to high energy trauma.
8. The next question is whether the accident did cause or contribute to the medial meniscal tear of the right knee.
9. Notwithstanding the reservations expressed by Medical Assessor Moloney as to the consistency of the claimant's evidence the Panel, likewise, does not accept the opinion of

Dr McIntosh, biomechanical engineer where his conclusion was predicated on his findings as to change in velocity at the time of the accident which in turn relied upon the statement of the insured driver and the photographs of the vehicles involved. Not only is the Panel cognisant of the need to use caution when considering photographic evidence, in El-Mohamad v Celenk the Court of Appeal reminded us that the nature of the collision was merely a factor to be taken into account and was not determinative of the extent of any personal injury sustained.[46] 10. The conclusion of Dr Powell was predicated on the basis that he did not accept that

Mr Ahmed had struck his knee on the dashboard as any forward progression would have been halted by the seat belt. However, even with effective restraint brief forward excursion, rebound or a twisting movement can occur, and there is no direct evidence of any seat-belt malfunction. The only evidence as to what actually occurred is the evidence of Mr Ahmed who has consistently maintained that he struck his right knee on the dashboard. The Panel is satisfied that it is not necessary to establish an impact at 70 kmph to establish the claimant struck his right knee on the dashboard at the time of the accident. 11. Dr Korber stated that for the medial meniscus tear to be due to trauma he would like to see other manifestations of trauma such as bone marrow oedema, collateral ligament injury or cruciate ligament injury 12. The Panel notes other manifestations of trauma were present, namely the presence of subchondral oedema, as demonstrated by the MRI of the right knee of 2 July 2021. 13. In Briggs Wright J also reminded us that the relevant legal test in relation to causation does not require scientific certainty.[47] His Honour stated at [70] - [72]:

"70. This reasoning does not accord with the relevant legal test in relation to causation, which does not require scientific certainty. In Metro North Hospital and Health Service v Pierce [2018] NSWCA 11, the Court of Appeal said, in relation to causation in a similar context, as follows at [138] (White JA, Macfarlan and Payne JJA agreeing):

'138 Whether the Hospital's negligence in not responding to the induced seizures in a timely manner materially contributed to Ms Pierce's worsened condition is not to be determined on the basis of scientific certainty, but on the balance of probabilities. As Spigelman CJ said in Seltsam Pty Ltd v McGuiness (2000) 49 NSWLR 262; [2000] NSWCA 29 at [143]:

'An inference of causation for purposes of the tort of negligence may well be drawn when a scientist, including an epidemiologist, would not draw such an inference'.'

1. The relevant principles were stated by Herron CJ, with whom Asprey and Holmes JJA agreed, in EMI (Australia) Ltd v Bes [1970] 2 NSWR 238 as follows, at 242:

'... it is not incumbent upon the applicant, upon whom the onus rests, to produce evidence from medical witnesses which proves to demonstration that the applicant's contention is correct. Medical science may say in individual cases that there is no possible connexion between the events and the death, in which case, of course, if the facts stand outside an area in which common experience can be the touchstone, then the judge cannot act as if there were a connexion. But if medical science is prepared to say that it is a possible view, then, in my opinion, the judge after examining the lay evidence may decide that it is probable. It is only when medical science denies that there is any such connexion that the judge is not entitled in such a case to act on his own intuitive reasoning. It may be, and probably is, the case that medical science will find a possibility not good enough on which to base a scientific deduction, but courts are always concerned to reach a decision on probability and it is no answer, it seems to me that no medical witness states with certainty the very issue which the judge himself has to try.'

1. Furthermore, a finding of causal connection may be open without any medical evidence at all to support it, or when the expert evidence does not rise above the opinion that a causal connection is possible: Fernandez v Tubemakers of Australia Ltd [1975] 2 NSWLR 190 at 197 (Glass JA); Metro North Hospital at [140]."
2. Noting scientific certainty is not required the Panel is satisfied, on the balance of probabilities, that the claimant did strike his right knee on the dashboard.
3. Where both Medical Assessor Berry and Dr Powell found the presence of retropatellar crepitus the Panel accepts the claimant did have pre-existing significant chondral changes between the trochlear and the lateral patella facet which were asymptomatic before the accident but became symptomatic when the claimant struck his right knee on the dashboard at the time of the accident.
4. The right knee hitting the dashboard would cause some patellofemoral pain which is verified by the sub chondral oedema noted on the MRI in the patellofemoral joint and an initial knee joint effusion. The Panel is satisfied the accident did cause or contribute to the radial tear of the medial meniscus.

1. Having determined that the claimant sustained a soft tissue injury to the lumbar spine caused by the accident the parties agree this constituted a threshold injury.
2. Having determined the claimant sustained soft tissue injury to both feet caused by the accident which has resolved, the Panel finds the soft tissue injury would be a threshold injury.
3. Having determined that the injury to the right knee was causally related to the accident the parties agree that the radial tear of the medial meniscus is not a threshold injury.

1. The Panel revokes the certificate of Medical Assessor Home dated 13 June 2025 and certifies that the following injuries caused by the accident were threshold injuries for the purpose of the MAI Act:
   • soft tissue injury to the lumbar spine, and
   • soft tissue injury to both feet (resolved).
2. The Panel certifies that the following injury caused by the accident was not a threshold injury for the purpose of the MAI Act:
   • injury to the right knee - tear of the radial meniscus.

[4] Insurer's documents p 149 and claimant's documents p 214.

[7] Insurer's documents p 2 and claimant's documents p 280.

[22] Claimant's documents p 114 and 143.

[41] Bugat v Fox [2014] NSWSC 888.

[42] Norrington v QBE Insurance (Australia) Ltd [2021] NSWSC 548.

[43] El-Mohamad V Celenk [2017] NSWCA 242 at [16].

[45] Briggs v IAG Limited Trading as NRMA Insurance [2022] NSWSC 372.

[46] Blacktown City Council v Hocking [20098] NSWCA 144; El-Mohamad v Celenk [2017] NSWCA 242.

[47] Briggs [2022] NSWSC 372.