MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of medical assessment; assessment of whole person impairment (WPI) and treatment; prior right shoulder injury; prior history of low back pain; prior right total knee replacement; bilateral reduction in shoulder movements; no ligamentous or tendinous injury to the left shoulder in the motor accident; WPI assessed at 8%; proposed treatment not causally related to the subject accident nor reasonable and necessary; allowance for past care relates to injuries arising from the accident, and are considered reasonable and necessary; Held - original certificate revoked; new certificate issued.

ASSESMENT OF DEGREE OF PERMANENT IMPAIRMENT AND TREATMENT - CAUSATION

Certificate issued under s 7.23 (1) of the Motor Accident Injuries Act 2017

1. The Medical Review Panel revokes the certificate of Medical Assessor Alan Home's dated

11 August 2025 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a permanent impairment of 8% and is not greater than 10%: * lumbar spine - soft tissue injury 5%, and * left shoulder - soft tissue injury 3%.

Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017

1. The following treatment and care:
   • orthopaedic surgeon consultations;
   • use of Endone;
   • Lyrica;
   • cortizone injections;
   • physiotherapy;
   • manipulation of the right shoulder;
   • pain management course;
   • GP consultations, and
   • future care,

DOES NOT RELATE TO THE INJURY caused by the motor accident, and is not reasonable and necessary as a consquence of the injury sustained in the subject motor accident.

1. The following treatment and care:
   • the past care from the date of the accident to the date of the examination,

DOES RELATE TO THE INJURY caused by the motor accident, and is reasonable and necessary as a consquence of the injury sustained in the subject motor accident.

1. Denise Walkom (the claimant) is a 79-year-old woman who was injured in a motor vehicle accident on 15 June 2016. Following the accident, the claimant lodged an application for personal injury benefit.
2. Thereafter the matter has been the subject of a number of referrals to the Personal Injury Commission (Commission) in respect to both treatment disputes and assessment of whole person impairment.
3. Most relevantly to this Panel the claimant was examined by Medical Assessor Alan Home on 4 August 2025 in respect to a referral for an assessment of whole person impairment by the claimant and an assessment of treatment - causation by the insurer. In a certificate dated 11 August 2025 Medical Assessor Home determined that the claimant suffered injuries caused by the motor accident which gave rise to a permanent impairment of 19%. He declined to assess the treatment dispute in relation to domestic assistance. He determined that the pain management treatment and three general practitioner (GP) consultations were both treatment caused by injuries arising out of the motor vehicle accident and were reasonable and necessary in the circumstances.
4. The insurer sought a review of this certificate and in a decision dated 15 October 2025 President's delegate, Ratula Gupta, decided that there is a reasonable cause to suspect that the medical assessment is incorrect in a material respect. The matter was then referred to this medical review panel.

1. Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A "new decision maker" is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
2. The new review provisions provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Commission.
3. Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
4. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application.
5. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
6. Section 17 of the Motor Accident Injuries Act 2017 (MAI Act) defines a "medical dispute" as

(a) a dispute between a claimant and an insurer about a medical assessment matter, or

(b) an issue arising about a medical assessment matter in proceedings before a court for damages or in connection with the assessment of a claim by the Commission.

1. Directions were issued to the parties on 20 October 2025 to upload all material which was before Medical Assessor Home on 4 August 2025. This material is now before the panel.
2. The panel convened on 17 December 2025 and determined that it was appropriate to conduct a further examination of the claimant. The claimant attended the rooms of Medical Assessor Margaret Gibson on 17 March 2026.

1. Ms Walkom had suffered an injury to her right shoulder in 2010 when she tripped over a dog. She said she couldn't really recall exactly how she had fallen, but she did remember it was onto concrete. She had undergone physiotherapy and hydrotherapy and she believed it had taken about 18 months before her right shoulder injury had resolved.
2. There was a prior history of low back pain with pain referral to the outer aspect of her left thigh. However, she said her back was largely asymptomatic prior to the subject accident.
3. Her surgical history had included right total knee replacement over five years ago and left total knee replacement over 10 years ago, thyroidectomy for Graves' disease over 10 years ago and hysterectomy for cervical cancer over 14 years ago. There was a medical history of gout, hypertension, hypercholesterolaemia and type 2 diabetes.

1. Ms Walkom confirmed that she had been retired at the time of the subject accident and that she hadn't worked in any paid employment since 2002. Her last job was as a security officer with Chubb Security. She said she had been in that role for about 11 years and retired due to age. She said she had worked at various locations with the company, including in the guard house of a smelter capital and patrolling Macquarie University. Prior to that she had worked as a barmaid, a cook and she had had her own car detailing business.

1. Ms Walkom had been a front seat passenger in a Holden Caprice sedan being driven by her son, Tony. They had come to a stop on the Cumberland Highway when they were hit from behind by another car. There was no secondary collision. Their car sustained rear-end damage, and was towed and later repaired. The vehicle at fault was written off and she said the front grill of that vehicle had become stuck on the tow bar of their car.
2. Ms Walkom said her son was unable to get himself out of the car, but she managed to alight and had exchanged details with the other driver.
3. An ambulance arrived and Tony was conveyed to hospital. Ms Walkom said she had experienced immediate neck and low back pain together with pain over the front of her left shoulder and bruising over the chest wall from the seat belt. She said she was assessed by ambulance officers at the scene and was told to visit her own doctor the following day.
4. Ms Walkom travelled in the tow truck to the repair shop, and then the tow truck driver had given her a lift home. She recalled that at the time of the accident she was very worried about their car as it was a relatively new.
5. She attended GP, Dr Kuok in Whalan the following day, complaining of neck, low back and left shoulder pain.
6. She was referred for physiotherapy at Sydney West Physiotherapy in Penrith. She had attended approximately on a weekly basis over 12 months. She said she had then ceased treatment of her own accord as she was finding the physiotherapy unhelpful and finding she was "back to square one" immediately after each session.
7. She was then referred for hydrotherapy. She said she felt a bit better when she was in the pool but was then "back to square one" when she got out again.
8. In summary, she confirmed that neither of these measures had brought about any sustained improvement in her symptoms.
9. She had acupuncture for about four months four years ago and found this unhelpful. She was prescribed Panadeine Forte and Endone. She said the Endone was unhelpful and she stopped taking this after six months.
10. She was referred to Dr Hsu, orthopaedic surgeon. She visited him on 6 February 2018. He prescribed Lyrica. She said she had taken the Lyrica for about six months, then ceased it as she did not find it helpful either.
11. I asked her about Dr Hsu's recommendations regarding a pain management program. She said she didn't think this would be beneficial. She reasoned that she had accompanied a friend to a pain management session and had found that it was not very useful.
12. She said she had had multiple cortisone injections, several to both left and right shoulders and also to her low back. The last cortisone injection was to her low back several years ago. She found none of these cortisone injections beneficial.
13. She confirmed that the right shoulder symptoms had come on about three years after the accident and she attributed these to reliance on her right upper limb given the incapacity affecting her left upper limb.
14. She confirmed the intermittent use of analgesics, including Panadeine Forte as current treatment.

1. Ms Walkom described pain extending from the base of the neck to the back of the head. The neck pain precipitates headaches. She said that she experiences frontal headaches three to four times a week. Her neck often feels stiff. She said the pain in the neck was 6/10 severity today, and she confirmed that she had had neck pain prior to the accident, but it was only about 3/10 but had elevated to 8/10 following the accident.
2. There was no pain referral to either upper limb. In relation to the low back, pain was felt across the low back and spreads into both legs and both feet, the whole foot and whole leg being affected. She experiences severe leg cramps at times. She said the low back pain was 9/10 severity today and varies from 7/10 to 10/10 severity.
3. In relation to her left shoulder, there was pain felt all over the shoulder joint, extending posteriorly to the left shoulder blade. She said she has trouble lying on her left side. She said there is constant pain in the left shoulder region and she tends to drop items. She said she had broken several tiles at home, so was now using plastic plates and cups. She said the shoulder pain was 8/10 severity today. In relation to the right shoulder, she said it was "hopeless." Pain is felt all over the right shoulder, extending to the right shoulder blade posteriorly, rated at 10/10 severity today.
4. She added that she can't even wear a bra due to the bilateral shoulder restrictions.
5. She also described some intermittent tingling affecting the fingers of both hands involving all fingers.

1. Ms Walkom said her and her family live on the same property, she lives in the main house and her son and his wife live in the granny flat.
2. When asked about the housework, she said she doesn't do very much. Her daughter-in-law helps out with the shopping, cooking, mopping and dusting, the laundry and lifting anything heavy. Ms Walkom would purchase takeaways or frozen meals when her daughter in law doesn't cook. She said that she can stack the washing machine but can't hang the clothes outdoors, so puts them in the clothes dryer.
3. Her daughter in law also helps her get dressed and undressed and in and out of the shower.

1. Ms Walkom was 167cm tall and weighed 80kg. She was able to stand on toes and heels, whilst supporting herself on the side of the examination couch. And at the time she reported low back pain.
2. On examination of the neck, there was prominence of the C7 spinous process, which was not particularly tender. There was poke neck. There was thoracic kyphosis. There was tenderness over the upper less than lower cervical spine in the midline. There was right greater than left trapezial tenderness. Flexion and extension was one-third normal, rotation was one-third normal bilaterally, lateral flexion was half-normal bilaterally. There was no asymmetry, muscle spasm or guarding.
3. On examination of the upper limbs, circumferential measurements of the arms (10cm proximal to the olecranon) was 31cm on the right, 32cm on the left, forearms (10cm distal to the olecranon) measured 28cm bilaterally. Upper limb power and reflexes were normal. There were patchy sensory changes in both upper limbs which did not follow a dermatomal distribution.
4. On examination of both shoulders,

1. It is noted that the shoulder movements bilaterally were slightly more reduced in comparison to those found by the original assessor. And there was some variability when measured today. Ms Walkom maintained she did her best to move her arms and that her shoulder condition is only getting worse over time.
2. On examination of the back, there was tenderness to light pressure both centrally and paracentrally. Flexion was 1/3 normal, extension negligible, lateral flexion and rotation to 1/3 normal bilaterally. There was mild guarding with attempted extension. Straight leg raise was 70° bilaterally when seated and 10° bilaterally when lying supine with complaints of low back pain.
3. On examination of the lower limbs there were normal power and reflexes. There were some patchy sensory abnormalities which did not follow a dermatomal distribution.

1. Ms Walkom had been a front seat passenger on 15 June 2016 when the vehicle she was in was hit from behind by another car. She was able to self-extricate and whilst she was assessed by ambulance at the scene, she hadn't required any immediate medical treatment. There was contemporaneous evidence of complaints of neck, low back and left shoulder pain when she visited her GP on 27 June 2016, though there was no mention of the subject accident in the clinical notes. However a certificate completed by the GP on the panel noted there was no frank injury to the right shoulder arising from the subject accident, as there was no contemporaneous evidence and the claimant herself had confirmed her right shoulder symptoms had only commenced about three years after the subject accident and arose as a consequence of her reliance on her right upper limb due to her left upper limb issues. The Panel did not accept, that a right shoulder condition would arise in these circumstances, several years after the subject accident. Their view was that any consequential condition would have arisen in close proximity to the acute injury, and in any case would have been a temporary issue.
2. In relation to the left shoulder, the panel accepted there was a soft tissue injury to the shoulder, likely as a consequence of the seatbelt restraint. However, they were not of the opinion, given the forces involved, that there had been any ligamentous or tendinous injury to the shoulder due to the subject accident. They were of the opinion, in agreement with the previous panel, that the left shoulder injury was a soft tissue injury. And this injury had occurred against the background of her existing age related degenerative change. Of note was the significant deterioration in movements of the left shoulder, which was noted by the original assessor, Medical Assessor Home and was even more severe when examined by the Panel. The Panel were of the opinion that the most likely explanation for this degree of deterioration would be the onset of capsulitis. The Panel noted that this condition can occur spontaneously, and in particular in an older female demographic and especially in those diagnosed with diabetes. In the panel's clinical experience, whilst this condition can evolve some months after the index insult, whether trauma or surgery, it would not come on many years remote to the insult. Therefore the Panel concluded, that whilst there had been a soft tissue injury to the left shoulder, the subsequent capsulitis was unrelated. Therefore the degree of movement restriction could not be attributed to the subject accident.

1. There were complaints of pain or symptoms, but there were no clinical findings as detailed in Table 6.8, SIRA Motor Accident Guidelines. There was no radiculopathy or vertebral body compression or vertebral fracture. Therefore the cervical spine injury would be assessed at DRE Impairment Category I, thus 0% permanent WPI.

1. There were complaints of pain or symptoms, but without vertebral body compression or vertebral fracture. There were clinical findings of pain referral in the distribution of a specific nerve root i.e. non-verifiable radicular complaints, as detailed in Table 6.8, SIRA Motor Accident Guidelines. Therefore the lumbar spine injury would be assessed at DRE Impairment Category II, thus 5% permanent WPI.

1. As discussed above, the Panel were not of the opinion that the current condition of shoulder capsulitis was the result of the subject accident.
2. Given this was the case, they referred to the impairment assessment of Medical Assessor Kenna on behalf of the previous Panel, who had conducted an examination prior to the onset of a subsequent and unrelated shoulder condition.
3. Based on this, they concluded 3% WPI for the left shoulder. It was also noted that there was some variability noted in shoulder movements at the panel assessment. This would in any case would prevent use of the measurements taken on the day, as cl 6.50 of the Motor Accident Guidelines states that "If there is inconsistency in range of motion then it should not be used as a valid parameter of impairment evaluation." And "If range of motion measurements at examination cannot be used as a valid parameter of impairment evaluation, the assessor should then use discretion in considering what weight to give other available evidence to determine if an impairment is present."
4. The Panel have considered other available evidence in making this determination, in particular noting the history of the subject accident, the treatment received after the accident and the imaging performed. In their clinical opinion 3% WPI was what they would expect under these circumstances.

Orthopaedic surgeon consultations from the date of the Commission's medical assessment

1. The Panel were not of the opinion that further consultations with an orthopaedic surgeon were casually related or reasonable and necessary in the context of soft tissue injuries sustained over nine years ago. In particular there was no subject accident lesions identified that would be amendable to surgical intervention.

Endone from the date of the Commission's medical assessment

1. The Panel were not of the opinion that prescription of narcotic analgesics were in the claimant's best interest due to their substantial side effects and risk of dependence. These agents are prescribed for acute pain and as a short term intervention. They are entirely inappropriate for chronic soft tissue pain. And in any case she had ceased the use of Endone on medical advice.
2. The Panel concluded that continuation of this medication was not causally related to the subject accident, nor was it reasonable and necessary under the circumstances.

Lyrica from the date of the Commission's medical assessment

1. The Panel were not of the opinion that prescription of Lyrica (pregabalin) was in the claimant's best interest due to potential side effects and risk of dependence. Lyrica (pregabalin) is an agent prescribed for neuropathic pain. The Panel were not of the opinion the claimant had ongoing neuropathic pain and in any case she had ceased the use of Lyrica on medical advice. The Panel concluded that use of this medication was not causally related to the subject accident, nor reasonable and necessary under the circumstances.

Cortisone injection left shoulder from the date of the Commission's medical assessment

1. The claimant reported having received previous cortisone injections to the left shoulder. However she indicated there was no benefit. The Panel concluded that further steroid injection was not causally related to the subject accident, nor reasonable and necessary under the circumstances.

Cortisone injection right shoulder from the date of the Commission's medical assessment

1. The Panel were not of the opinion there was a subject accident right shoulder condition and concluded steroid injection was not causally related to the subject accident, nor reasonable and necessary under the circumstances.

Cortisone injection to the lumbar spine from the date of the Commission's medical assessment

1. The claimant reported having received previous cortisone injections to her lumbar spine which she indicated were of no benefit. The Panel concluded that further steroid injection was not causally related to the subject accident, nor reasonable and necessary under the circumstances.

Physiotherapy from the date of the Commission's medical assessment

1. The claimant reported having received previous physiotherapy treatments which she indicated were of no benefit. The Panel concluded that further physiotherapy treatment was not causally related to the subject accident, nor reasonable and necessary under the circumstances.

Manipulation of the right shoulder under anaesthesia

1. The Panel were not of the opinion there was a subject accident right shoulder condition and concluded manipulation of the right shoulder under anaesthesia was not causally related to the subject accident, nor reasonable and necessary under the circumstances.

1. The referral to a pain management course relates to the injuries caused by the accident. However this recommendation was made some time ago and whilst it may relate to the subject accident it is no longer reasonable and necessary in the circumstances. This is particularly as the claimant has stated that she does not wish to engage in such a program.

GP consultations from the date of the Commission's medical assessment

1. The Panel were of the opinion that ongoing consultations for soft tissue injuries sustained over nine years ago, particularly in the context of multiple treatment measures having already been applied was now related to the subject accident, nor reasonably necessary.

Whether any care received by the claimant at between 0 and 4 hours per week, from the date of accident to the date of any Commission's assessment, was related to the accident

1. Past care relates to the accident. The claimant would have required care for her neck, left shoulder and lumbar spine conditions from the date of the subject accident to the date of the Commission's assessment

Future care from the date of the Commission's medical assessment

1. The Panel were of the opinion that ongoing care for soft tissue injuries sustained over nine years ago, nor reasonably necessary.

1. The Panel assesses the degree of impairment consequent on the injury sustained in the motor vehicle accident at 8%.
2. The Panel does not consider the treatment, other than past care from the date of the subject accident to the date of the Commission's assessment, to be causally related or reasonable and necessary as a consequence of the injuries sustained in the subject accident.