Certificate issued under s 7.26(7) of the Motor Accident Injuries Act 2017 (the Act)

1. The Review Panel confirms the certificate of Medical Assessor Ian Cameron dated

1. The Review Panel (the Panel) is constituted by the President of the Personal Injury Commission (Commission) to conduct a review of the assessment and certificate of Medical Assessor Ian Cameron dated 10 April 2025 (the review).
2. Pursuant to cl 128(1) of the Personal Injury Commission Rules 2021 (the PIC Rules), the Panel is to conduct and determine the proceedings, in accordance with procedures determined by the Panel.
3. The Panel met on 11 August 2025 to consider the following:

(a) the nature of the dispute and the matters in issue;

(b) whether any additional documents are required, and

(c) whether a re-examination is necessary.

1. On 30 July 2023, Mohamad Al Salih (the claimant) was driving along Fowler Road in Guildford on his way home. As his vehicle was traversing a roundabout at the intersection of Hawksview Street, it was hit on the passenger side by the vehicle at fault, which failed to stop at the intersection. His passenger was significantly injured. Bystanders assisted. The airbags in the claimant's car did not deploy. He reported brief amnesia. Police and ambulance officers attended. The claimant was driven home by a friend. His front seat passenger was taken by ambulance to hospital. The claimant's vehicle was written off for insurance purposes.
2. The claimant saw his general practitioner (GP) the following day with right-sided neck pain radiating to his shoulder and upper back. He has not returned to work since the accident. He had MRI investigation that showed disc pathology in the cervical region. He received physiotherapy and was commenced on prescription analgesics.
3. The claimant suffered a right knee injury some 10 months after the subject motor accident. He was in the shower and put his right hand up on the wall to stabilise himself. The arm slipped and he fell over, sustaining a rupture of the right ACL, as well as a lateral meniscus tear. The claimant's treating orthopaedic specialist questioned whether the claimant's compensatory arm was the prime cause of his slipping. There is no other evidence concerning the causes and circumstances of his fall. The insurer disputes that the claimant's right knee was injured as a result of the subject motor accident.
4. The claimant did not disclose, nor provide any medical evidence, relating to a previous worker's compensation claim in which he sustained right arm and lower back injuries whilst working as a labourer lifting heavy weights. The claimant retrained as a barber following those injuries.
5. Allianz Insurance Australia Limited (the insurer) indemnifies the owner and/or the driver of the at-fault vehicle for liability to pay the claimant any damages and/or statutory benefits under the Motor Accident Injuries Act 2017 (Act). The insurer admitted liability for the claim but denied payment of statutory benefits beyond 52 weeks on the basis that the injuries caused by the motor accident are threshold injuries for the purpose of the Act. That decision was said to be based upon medical evidence and was confirmed upon internal review.

1. As there is a dispute between the parties about whether the injury caused by the motor accident is a threshold injury under Schedule 2, cl 2(a) of the Act, the following injuries were referred by the Commission for assessment:
   • head injury - loss of consciousness at the time of the subject accident, amnesia and right sub-occipital pain;
   • cervical spine injury - C5/C6 disc bulge;
   • intermittent numbness that travels into the claimant's right hand;
   • right shoulder injury - radiculopathic pain and numbness;
   • right arm injury - radiculopathic pain and numbness;
   • thoracic spine injury - traumatic injury and right-sided pain radiating neck to upper back;
   • lumbar spine injury - L4/L5, L5/S1 disc prolapse and pain radiating down left leg, posterior left thigh and cuff to the left lateral heel, and
   • right knee injury - right ACL rupture as well as a later meniscus tear.
2. Medical Assessor Cameron certified on 10 April 2025 as follows:

The following injury caused by the motor accident:

• head injury - soft tissue injury;
• cervical spine - soft tissue injury;
• thoracic spine - soft tissue injury; and
• lumbar spine injury,

is a THRESHOLD INJURY for the purposes of the Act.

The following injuries referred to me for assessment have been assessed and determined to be not caused by the motor accident:

• right shoulder injury - radiculopathic pain and numbness;
• right arm injury - radiculopathic pain and numbness; and
• right knee injury - right ACL rupture as well as lateral meniscus tear.

A decision as to where these injuries are a THRESHOLD INJURY is not required for the purposes of the Act.

1. Medical Assessor Cameron found there is no evidence of an injury to the right shoulder or right arm. He found the right knee injury occurred approximately eight months after the subject accident and is not related to it. Medical Assessor Cameron stated, "There is not a medical explanation for symptoms from the motor accident to cause a fall with a delay of this magnitude".

1. Medical Assessor Matthew Jones certified on 19 April 2025 as follows:

• adjustment disorder with mixed anxiety and depressed mood,

is a THRESHOLD INJURY for the purposes of the Act.

The following injuries referred to me for assessment have been assessed and determined to be not caused by the motor accident:

• post-traumatic stress disorder and major depressive disorder

A decision as to whether these injuries are a threshold injury is not required for the purposes of the Act.

That certificate is the subject of a separate review before a differently constituted Review Panel.

1. The claimant sought a review of Medical Assessor Cameron's certificate, on the grounds that the medical assessment was incorrect, within the meaning of s 7.26 of the Act, in a number of material respects. The claimant relied upon the particulars set out in the application and supporting documentation.
2. The claimant brought the application within the time prescribed by s 7.26(10) of the Act, and cl 34 of Procedural Direction PIC 7 (28 days).
3. The grounds of review upon which the insurer relied are as follows:

(a) failure to bring any inconsistencies to the claimant's attention in the course of the medical assessment so as to afford the claimant an opportunity to explain the inconsistencies, namely between the reports of Dr G Walker dated 26 March 2024 and 10 October 2024;

(b) failure to appropriately consider relevant evidence included in the claimant's application, namely the report of Dr A Aboud dated 29 August 2024, and

(c) failure to detect the presence of radiculopathy, namely in the clinical notes of Quality Medical Practice as at 30 August 2024.

1. Particulars are given in support of each ground for review. Some of those particulars are as follows:
   • the claimant submits that the failure to put inconsistencies to the claimant is critical in determining causation and nature of the injury in relation to his cervical spine, but mostly in relation to his right arm, which was a significant contributor in causing an ACL tear regarding his right knee;
   • there is nothing in the insurer's Reply which alleges that the injuries to the claimant's cervical spine and right arm were caused by his Worker's Compensation accident in about July 2020;
   • failure to appropriately consider Dr Aboud's findings is critical in determining causation and nature of the injury in relation to the cervical spine, but mostly importantly in relation to the right arm which was a significant contributor in causing an ACL tear regarding his right knee, and
   • the same submission is made in relation to the alleged failure of the Medical Assessor to properly consider the Quality Medical Practice clinical notes.
2. The claimant's review application was opposed by the insurer on various grounds. It is not necessary to deal with those submissions in detail as they were not accepted by the President's delegate. Those submissions can be summarised briefly as follows:

(a) the insurer submits there is no evidence to suggest the Medical Assessor failed to bring any inconsistencies to the claimant's attention. The insurer further submits there is no material inconsistency between Dr Walker's reports or throughout the Medical Assessor's examination;

(b) the insurer submits the Medical Assessor did consider Dr Aboud's report dated

29 August 2024 which he refers to in his report. The insurer submits there is a disclosed clear and actual path of reasoning, and

(c) in relation to the alleged failure to detect presence of radiculopathy, the insurer submits that the Medical Assessor engaged with the clinical notes of Quality Medical Practice in finding that no radiculopathy was present, in determining if the listed injuries met the definition of "threshold injuries" and/or were deemed to not be caused by the motor accident and outside the scope of the Medical Assessor's consideration.

1. President's delegate Tajan Baba issued a Determination of an Application for Review of a Medical Assessment on 13 June 2025 which stated the satisfaction of the President's delegate that there is a reasonable cause to suspect the medical assessment was incorrect in a material respect. The basis of that decision was stated to be failure to bring the inconsistencies between the reports of Dr Walker dated 26 March 2024 and 10 October 2024 to the claimant's attention. The alleged inconsistencies are not specified by the President's delegate nor by the claimant.
2. Accordingly, the review application was accepted and was referred to the Panel, which is to reassess all of the injuries referred to Medical Assessor Cameron for determination.
3. The Panel notes that the claimant bears the onus of proof to prove injury and that it is not a threshold injury: Lynch v AAI Limited[1] and Briggs v IAG Limited.[2]

1. A medical assessment matter is determined in accordance with Division 7.5 of the Act. The matter is determined at first instance by a Medical Assessor and, on review, by a Review Panel consisting of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission.
2. Part 5 of the Personal Injury Commission Act 2020 (the PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a Panel, reviewing a decision of a Medical Assessor.[3]
3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the 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 proceedings solely based on the written Application.[4]
4. The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[5]
5. All members of the Review Panel had no previous involvement with the claimant or with this matter.

1. Causation of injury is addressed in the Guidelines as follows:

"6.5 An assessment of the degree of permanent impairment is a medical assessment matter under cl 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 AMA 4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.

6.6 Causation is defined in the Glossary at page 316 of the AMA 4 Guides as follows:

Causation means that a physical, chemical or biological 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 contributed to the worsening of the impairment, which is a non-medical determination.

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

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. See Briggs v IAG Limited t/as NRMA Limited.[6] See also Insurance Australia Limited t/as NRMA Insurance v Trkulja [2023] NSWSC 956,[7] wherein his Honour Justice Wright 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 principes were intended to be applied when a medical assessment was being made in relation to causation of minor injuries."

1. Wright J then described the Panel's role in a medical review which is to:

"Consider whether the motor accident did cause or contribute to (the claimant's condition). This requires, not a consideration of material derived as a result of an internet search... but rather a consideration of the material referred to in 5.6 of the Guidelines, namely all the evidence available to the Panel, including all relevant findings derived from:

(1) a comprehensive, accurate history, including pre-accident history and pre-existing conditions;

(2) a review of all relevant records available at the assessment;

(3) a comprehensive description of the injured person's current symptoms;

(5) diagnostic tests available at the assessment, noting that imaging findings that are used to support the assessment should correspond with symptoms and findings on examination."

1. The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on

28 November 2022 with various amendments commencing on 1 April 2023. From that date, the MAI Amendment Act provides that a "minor injury" is known as a "threshold injury" and "minor injuries" are known as "threshold injuries". 2. The definition of what constitute a minor injury has not been amended and continues to apply to a threshold injury. 3. Any reference in these reasons to "minor injury" is a reference to a "threshold injury" and any reference to the word "minor" referring to the injury alleged to have occurred in the accident is a reference to "threshold". 4. A threshold injury is defined in s 1.6 of the Act and includes a "soft tissue injury" or "psychological or psychiatric injury that is not a recognised psychiatric illness". 5. Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the Act. The Guidelines contain the procedure for assessing whether an injury caused by the accident is a threshold injury for the purposes of the Act. 6. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:

"5.3 The assessment will determine whether the injury related to the claim is a soft-tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.

5.4 Diagnostic imaging is not considered necessary to assess threshold injury.

5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.

5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:

1. comprehensive accurate history, including pre-accident history and pre-existing conditions;
2. a review of all relevant records available at the assessment;
3. a comprehensive description of the injured person's current symptoms;
4. a careful and thorough physical and/or psychological examination;
5. diagnostic tests available at the assessment.

Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination."

1. The parties have presented their respective bundles of documents upon which they rely. The Review Panel (Panel) has read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel, or a Panel Member, has not read it, nor taken it into consideration. The same principle applies to parties not referring to, nor specifically relying upon, a document in their own bundle and submissions.
2. The fact that evidence is not referred to in these reasons does not mean it has been overlooked. It is not required that each piece of evidence be mentioned. The Panel is not required to "analyse every piece of information from every opinion contained in a document with which it was provided". The Panel has come to its own conclusions and has taken its own history.

1. The claimant relied upon the following material which the Panel has considered:

• The claimant cites the LEGISLATIVE FRAMEWORK including the statutory definition of Threshold Injury, none of which is controversial.
• The claimant then refers to various entries in the clinical records relating to physical and psychological injuries, none of which is controversial.
• The claimant then submits that, in light of the medical evidence, it is clear that his physical and psychological injuries sustained in the subject accident are non-threshold injuries for the purposes of the Act, especially in circumstances where his treating medical practitioners have addressed the nature of his injuries, addressed causation and provided diagnoses which are outside the threshold injury definition.

1. With respect to the claimant's solicitors, it seems to the Panel that the foregoing submission is little more than an attempt to pull oneself up by one's own boot straps,

Liability notice (beyond 52 weeks) and notice of cessation of statutory benefits

Claimant's request for insurer to review its decision

Correspondence from insurer maintaining its decision

1. The insurer's internal Review Specialist summarised the medical evidence and affirmed the decision that the claimant's injuries meet the definition of a "threshold injury" for the purposes of the Act:

Reports of Dr Peter Walker, treating hip and knee orthopaedic surgeon, to Dr Ashraf Aboud, treating GP

Thank you for asking me for an opinion regarding his right knee. He has a worker's compensation claim for his neck and arm. I believe he has weakness in his arm. He put his arm up in the toilet/shower one week ago and did not feel the wall properly, or he had weakness, but either way his arm slipped, and he fell over twisting his knee, sustaining a rupture of his ACL. At the time, he heard a noise. It swelled immediately and he has been in a lot of pain since then. He is currently on a single crutch.

I see him again. He still has not tested his knee properly. I really need him to see a physio because he is not able to fully straighten it and get any idea of any symptomatic instability.

His knee is giving way on him with any twisting activities. He does have increased a laxity consistent with an ACL rupture. I believe his worker's compensation claim has been disallowed. I will place him on my waiting list at Concord Hospital for an ACL reconstruction.

In a motor accident in July 2023, he was hit from the right hand side of his vehicle. He reported neck and arm pain..... He tells me secondary to this he had weakness in his arm.

He was in the shower and put his right hand up on the wall to stabilise himself. The arm slipped and he fell over, twisting his knee, sustaining a rupture of the ACL. At the time of that injury, he did hear a noise consistent with an ACL injury. It swelled immediately. Prior to this he had no knee problem. This history is consistent with an ACL rupture.

The MRI scan confirmed the ACL rupture as well as a lateral meniscus tear.... I recommended that he have an ACL reconstruction. I believe this was declined.

His history is consistent with the injury sustained. It is really just a matter of answering the question about whether or not his compensatory arm was the prime cause of him slipping."

1. The Panel notes that Dr Walker provides no diagnosis for the referenced right arm injury/weakness.

Reports of Dr A Aboud, treating general practitioner

This is a letter to the insurer relating to the claimant's downgraded working capacity.

Mr Al Salih came to see me on 10.8.23 and the conditions are right upper arm and upper back pain and neck pain."

1. Dr Aboud agrees that the claimant's neck injury sustained in the subject accident (causing weakness and collapse of the right arm) has resulted in the twisting of his right knee which ultimately caused the ACL tear. Dr Aboud agrees with Dr Walker's advice but does not provide his own diagnosis.
2. The Panel notes that the clinical note made by Dr Aboud on 15 August 2023 (pages 118 to 119 of the claimant's bundle) makes no reference to the right upper arm. There is no mention of the right arm until 20.07.2024 when Dr Aboud records "right arm and neck neuropathic pain and numbness on and off." The Panel further notes that a clinical note made on 31/07/2023 by Dr Anwara Begum of Pioneer Medical Practice (page 170 of the claimant's bundle) records as follows:

"MVA yesterday. Did not have any pain after accident. No bodily injury. Came home. Paramedics advised him to go to GP. Woke up this morning with pain in right side of neck below the right ear. No bruise. No tenderness. Neck movement full range."

1. There is no mention of the right arm in the remainder of Dr Begum's clinical notes.

1. These reports are not relevant for the Panel's consideration as they do not relate to the claimant's physical injuries.

Report of Dr A Kam, treating neurosurgeon, to Dr Aboud

"This gentleman works as a barber. He was involved in a side on collision in July 2023. Since the accident, he has been suffering with ongoing neck pain and right sub-occipital pain. He describes occasional symptoms involving his right hand, with numbness which is intermittent.

The MRI scan of his cervical spine performed in October 2023 did not reveal any abnormality. There was no annular tear or discrimination. There was no compromise of the central canal or exit foramen. There was a slight reversal of lordosis.

That report references only strains of the cervical and thoracic spine. There is no mention of a right shoulder/arm injury.

That report references only strains of the cervical and thoracic spine. There is no mention of a right shoulder/arm injury.

"Mohamad wanted to clarify with me what happened during his initial injury in the shower. I did write that he slipped after he put his arm up but did not note which arm. This was his right arm which was the arm that was affected in his worker's compensation claim."

"Advised of Lyrica side-effects especially dizziness and falls and also interaction with other drugs and opiates..... Never to mix opiates or elicit drugs also it can cause epilepsy or fits also not to mix with Valium or Benzos. Tender neck muscles and also upper limbs. Neuro okay."

1. The Panel notes that the claimant has not complied with its direction, issued on 19 June 2025, to specify with particularity the entries in the clinical notes and/or other treatment records that are said to be relevant to the matters in issue.

No high grade central canal or neural exit foraminal narrowing.

No fracture. No central canal or neural exist foraminal narrowing. No nerve root impingement.

No high grade central canal or neural exit foraminal narrowing.

No acute fracture or spondylolisthesis. No high grade central canal stenosis.

No evidence of a recent fracture, subluxation or acute cervical ligamentous injury.

No significant cervical spine canal, neural foraminal stenosis or overt neural compression at any of the cervical levels.

1. Rupture of the ACL and low grade sprain of the femoral attachment of the PCL. No static anterior tibial translation.
2. Impaction relation bone contusion of the lateral femoral sulcus microtrabecular fracture of the posterolateral tibial plateau.
3. Complex displaced vertical tear of the lateral meniscus posterior horn.
4. Partial thickness tear of the anterior edge of the MCL and tear of the anterior meniscofemoral ligament associated with some subtle fissuring of the meniscus at the meniscofemoral ligament attachment.
5. Large joint effusion, posterior capsular sprain and mild capsular dehiscence.

1. The insurer relied upon the following material which the Panel has considered:

Insurer's submissions in reply to review application

(a) The insurer submits the claimed cervical spine injury meets the definition of a threshold injury for the purposes of the Act.

(b) The insurer relies upon the report of Dr Andrew Kam, neurosurgeon, dated 25 June 2024 who noted that an MRI of the cervical spine completed in October 2023 did not show any abnormality, with no presence of an annular tear or disc herniation. Reported symptoms were limited to intermittent numbness to right hand, no other clinical radicular symptoms reported.

(c) The insurer submits that, in accordance with the motor accident guidelines ("Guidelines") at cl 5.8, there needs to be two or more signs of radiculopathy for a spinal injury to be deemed beyond a soft tissue injury. The insurer further submits the available medical evidence does not support a finding of two or more clinical signs of radiculopathy, as required by the Act, in this case.

(d) The insurer submits the claimed right shoulder injury is not causally related to the subject accident.

(e) The insurer further submits that, prior to the subject accident, the claimant had a worker's compensation claim in July 2020 relating to lower back and right shoulder injuries, which the claimant failed to disclose in his Application for Personal Injury Benefits Form. The insurer says that:

"Accordingly, any self-reports by the claimant must be treated with caution".

The Panel notes that the Application for Personal Injury Benefits did not require the claimant to disclose any prior injuries arising from previous accidents.

(f) The insurer refers to an MRI of the right shoulder dated 6 October 2020 which, it says, noted the claimant's sustained supraspinatus tendinosis, low grade tearing and bursitis.

(g) The insurer says the claimant was examined by Dr Anil Nair, orthopaedic surgeon, on 5 February 2021 in the worker's compensation claim. Dr Nair confirmed a diagnosis of rotator cuff tendinosis in the right shoulder.

(h) The insurer submits that, following the subject accident, the claimant did not report right shoulder pain to the GP at the initial consultation of 31 July 2023 (see previously).

(i) The insurer submits there is no evidence that the subject accident impacted the pre-existing injury to the extent of transforming it into a non-threshold injury. The insurer further submits there is no evidence the accident caused any injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage in the right shoulder.

(j) The insurer submits there is no evidence of any complaints to the right arm as a result of the subject accident. The insurer further submits there is no evidence of sufficient radicular complaints that would form a non-threshold injury to any area of the right arm. As such, the insurer submits there is no assessable injury.

(k) The insurer submits the claimed injury to the thoracic spine does not exceed the definition of a threshold injury for the purposes of the Act.

(l) In relation to the Lumbar Spine, the insurer submits the claimed injury of "L4/L5 and L5/S1 disc prolapsed with pain radiating to left leg" is not causally related to the subject accident and was pre-existing. The insurer refers to a CT of the lumbar spine dated 3 August 2020 to which Dr Nair refers.

(m) The insurer submits the claimed right knee injury is not causally related to the subject accident. The insurer says there is no complaint to the right knee noted in the Application for Personal Injury Benefits Form. There is similarly no complaint to the GP on the initial consultation of 31 July 2023.

(n) The insurer refers to Dr Peter Walker's report dated 26 March 2024 which noted the claimant experiencing arm weakness due to a worker's compensation claim for neck and arm.

There is minor tendinosis in the posterior supraspinatus with minimal interstitial delamination. Minor hyper intensity overlaying SASD bursa is noted. Remainder of rotator cuff and long head of biceps appears intact. Acromioclavicular joint appears normal. No os acromiate. Acromion appears type 1. Normal BLC and IGLLS.

• He stated that he first experienced lower back and right shoulder symptoms in July 2020. He stated that the symptoms began due to heavy lifting whilst at work. He stated that the nature and conditions of his employment was such that he was required to continually lift heavy loads.
• Absence of symptoms in the right shoulder region and the lumbar spine region prior to the subject incident on 20 July 2020.
• It is my opinion that due to the nature and conditions of his work that he has sustained lumbar disc injuries at L4/L5 and L5/S1. He has clinical evidence of rotator cuff tendinosis in the right shoulder.
• In regard to the right shoulder, I would recommend an MRI scan as he may require treatment such as cortico steroid injections.
• The impairment is solely due to the nature and conditions of his work. There are no relevant pre-existing deductions. The prognosis is guarded due to the fact that his injuries are anatomical and permanent. He is likely to continue to have symptoms and consequent disability due to his workplace injuries.

1. The report of Medical Assessor Oates is as follows:

• Head injury - loss of consciousness at the time of the subject accident, amnesia and right sub-occipital pain
• Cervical spine injury - C5/6 disc bulge, intermittent numbness that travels into the claimant's right hand
• Right shoulder injury - radiculopathic pain and numbness
• Right arm injury - radiculopathic pain and numbness
• Thoracic spine injury - traumatic injury and right-sided pain radiating neck to upper back
• Lumbar spine injury - L4/5, L5/S1 disc prolapse and pain radiating down left leg, posterior left thigh and calf to left lateral heel
• Right knee injury - right ACL rupture as well as a lateral meniscus tear

Mr Al Salih was assessed unaccompanied, but in the presence of an Arabic interpreter (NAATI No. CPN8JS05R).

Pre-accident medical history and relevant personal details

Mr Al Salih, the claimant, told me he came from Iraq in 2013. In his native country, he worked in a family mobile phone shop. He lives in a house in Australia with his wife, who is not working, and their three children.

He did form working when he came to Australia. He then changed to become a barber. He had been working as a barber for about two years prior to the subject accident.

In March 2017, there was an x-ray lumbar spine report showing low back pain, but he said there was no accident preceding this and no treatment was required.

In July 2020, whilst working as a form worker, he injured his back and right shoulder. He had Lyrica, Tramadol, physiotherapy and dry needling, and saw an orthopaedic surgeon, but had no operation. A workers compensation claim was settled. His injury prompted the change of occupation to become a barber.

He has had no operations prior to the accident and no regular medication. He did not smoke cigarettes or have alcohol.

He has had no previous problems with the right knee. He has had no previous problems with the neck.

In relation to the video imaging supplied to the Panel, from the time of the accident, the claimant told me this was filmed by his neighbour, Faisal. The claimant said he was the driver of a Toyota Camry sedan 1999 model. His friend was a front seat passenger and he was coming home from his work as a barber.

He was passing through a one lane roundabout when an SUV came from his left, entering the roundabout, and did not stop and hit the mid-section passenger side of his car, which pushed his car towards the centre island. The right side of his head hit against the seatbelt attachment and he reflexly drove towards the left and ended up in a road outside the roundabout. He was wearing a seatbelt. There was no secondary impact. No airbags deployed.

He thinks he was unconscious for one or two minutes and then became aware of surroundings again when passers-by opened his driver's door and he was able to get out. He was feeling dizzy. His car would not start after that and was towed away and subsequently written off, after the mid-section of the car had had to be cut off to free the passenger.

An ambulance was called by bystanders. He was checked by the paramedics whilst sitting beside the road and they asked him whether he wanted to go to hospital and he said that he felt in shock but only had a small amount of neck pain at the time. He wanted to go home so as not to worry his wife and young children. He had been given the green whistle pain medication (methoxyflurane) and was advised to see his GP the next day.

He thinks the police attended the scene, as an incident event number was issued. His passenger was taken to hospital by ambulance.

He has not returned to work as a barber since the accident because he says he can't work at this job requiring a semi-abducted shoulder posture, because of neck and right trapezial to shoulder pain.

He received insurance benefits for 52 weeks and then lived on some savings and started his own business in a small convenience store with a business partner about one year ago. He does orders by phone and does some other administrative tasks, such as paying the workers.

He filled in an APIB, which listed his neck, right shoulder and right arm and back, on 23/8/2023. I asked him why the delay and he said he was waiting to see whether the pain settled down, which it did not.

History of symptoms and treatment following the motor accident

He saw Dr Begum, GP in Merrylands, on 31/7/2023 when his usual GP was not available. He then saw his usual GP, Dr Aboud at a different medical centre, on 2/8/2023. He was complaining of pain in the neck to the right trapezius and shoulder, and numbness from the right elbow to the hand, especially involving the middle and ring fingers, along with upper back pain. He said the pre-existing low back pain condition was flared up for two or three months after the accident, then returned to its usual pre-accident status of intermittent pain after attempted lifting.

He was sent for a CT scan of the thoracic and cervical spines on 31/7/2023 and treated with Lyrica and Mobic.

Eventually, he started physiotherapy with treatment to the upper back, neck and right shoulder. He can't remember exactly when he started, but the first AHRR on file for physiotherapy was dated 3/10/2023. He thinks he attended eight sessions and then did home exercises as shown to him by the physiotherapist.

At one stage, he saw Dr Mo, whom he thinks was an independent examiner for the insurer, and an MRI scan cervical spine was ordered on 5/10/2023.

His GP referred him to Dr Kam, neurosurgeon, on 23/1/2024 but he did not get in to see him until 25/6/2024 and he was told to continue conservative treatment. He does not know why there was such a delay.

He said on or around 15/3/2024, he had been having a bad day with neck and right shoulder and arm pain and numbness, and he had been resting in the loungeroom. He got up from this rest about 6.00 - 7.00pm to pass urine. He went into the toilet, turned the light on, and went to steady himself at the toilet to urinate by putting his right hand on the wall beside the toilet, but because his hand was numb he thinks, his hand slipped down the wall and he reflexively twisted his body to the right to regain balance and heard a crack and felt immediate pain in the right knee. The right knee then swelled up. He says neither the wall nor the floor was slippery to contribute to the fall by slipping and he did not trip on anything.

He saw the GP on 16/3/2024 and was sent for MRI scan of the right knee, which showed an ACL rupture and microtrabecular fracture of the tibial plateau. He was referred to Dr Walker, orthopaedic surgeon, Leichhardt, whom he saw on 26/3/2024. Some blood was aspirated from the swollen right knee.

In regard to this report, he says he didn't have a workers compensation claim and this is an error.

The CTP insurer did not accept the knee as part of his CTP claim. He went ahead and had a right ACL reconstruction after three months when his knee didn't settle on 4/7/2024 at Macquarie Medical Centre, and he self-funded this. He said the operation helped the knee pain to some extent. Thereafter, he has been attending physiotherapy for about 12 months since the operation, which is self-funded.

He last saw Dr Wallace in early 2025. He was told to continue conservative treatment but the knee might remain unstable.

His physiotherapist said if knee pain and instability persist after a further month of treatment, he should go back for specialist review.

He has pain at the anterior aspect of right knee and a patch of numbness on the lateral side of the knee since the surgery. The knee feels unstable in an anterior direction. He stumbles but does not fall. There is no locking and no swelling.

He can feel and hear an audible clunk in the knee if he extends his knee in front of him whilst sitting. He still has intermittent pain in the neck, into the right trapezius and shoulder, and down the right arm. He has numbness in the right hand, particularly middle and ring fingers, which occurs intermittently after prolonged use of the right arm.

Lyrica (pregabalin) 150mg twice a day. Mobic (meloxicam) is taken as required when he has a flare-up of pain.

He continues under the care of his GP, Dr Aboud, Merrylands.

Mr Al Salih was of average build, being right hand dominant, with height 169cm and weight 84.2kg.

There was no evidence of cognitive deficit. He was able to converse in simple terms in English, but did need the help of the interpreter with more complicated questions and explanations.

There was no muscle spasm or guarding. There was no dysmetria. There were no non-verifiable radicular complaints which followed a specific spinal nerve root distribution. There was two-thirds range of movement in flexion and extension, and in rotation and lateral flexion bilaterally.

There was full range of movement in the right and left shoulders, with pain in the right shoulder and trapezial area at the end of elevation.

Reflexes and power in the upper limbs were symmetrical. Sensation was normal in the left upper limb and in the right upper limb was intact, apart from some patchy loss which was variable on repeat testing in the right forearm, and partial loss which was consistent over the palmar and dorsal aspects of the right middle and ring fingers only. This did not follow a specific nerve root distribution.

This indicates some atrophy of the dominant right upper extremity, which is normally 0.5 - 1cm greater in girth than the non-dominant side.

Active rotation was two-thirds of normal bilaterally. There was no muscle spasm or guarding. There was no dysmetria and no non-verifiable radicular complaints.

There was no guarding or muscle spasm or focal tenderness. There were no non-verifiable radicular complaints following a specific nerve root distribution.

Flexion and extension were three-quarters of normal, lateral flexion was three-quarters of normal bilaterally.

Straight leg raise showed negative sciatic stretch test bilaterally.

Reflexes were symmetrical with plantar responses both flexor. Power was intact and sensation in the left lower extremity was normal and in the right lower extremity normal, apart from some patchy partial loss of sensation on the lateral aspect of the right knee, which he said had been present since the knee surgery. This would be an effect of surgery on local cutaneous nerves.

Range of movement: right knee -5° flexion contracture to 120° of flexion with clunk palpable and audible in the knee on active extension. Left knee 0 - 150° of flexion.

There was some instability in the right knee but no instability in the left knee. There was no patellar crepitus or pain on patellar compression.

Thigh girth; right 49cm, left 52cm indicating significant right quadriceps wasting. This is most likely due to the right knee subsequent condition.

He presented in a straightforward manner. I was able to question him closely and was satisfied with the history he gave of the mode of onset of the right knee injury.

The diagnoses have been expressed in usual medical nomenclature.

Soft tissue injury with radiating symptoms through the right upper trapezius and shoulder, into the right upper arm and forearm.

Soft tissue injury. No evidence of cognitive deficit.

Soft tissue and bony injury with rupture of ACL and low-grade sprain of the PCL; impaction related bone contusion of lateral femoral sulcus, microtrabecular fracture of the posterolateral tibial plateau; complex displaced vertical tear of the lateral meniscus; partial-thickness tear of anterior edge of MCL and tear of the anterior meniscofemoral ligament.

Soft tissue injury with temporary exacerbation of symptoms of a pre-existing known lumbar spine condition arising from previous workers compensation injury, which included lumbar radiculopathy, as documented in the file of evidence.

There was no evidence of discrete injury to the right shoulder.

The soft tissue injuries to cervical, thoracic and lumbar spines are related to the accident, as these are mentioned in the APIB dated 23/8/2023. The cervical spine is mentioned in the GP records with radiation to the right upper extremity. Thoracic spine is also mentioned in the early contemporaneous medical reports.

The head injury was mentioned on the APIB Form but not documented by the GP's and the Panel did not have access to an ambulance report.

The right knee condition is not considered to be related to the subject accident, because there were no objective examination findings of weakness (loss of power) in the right upper extremity or significant right hand numbness sufficient to cause the claimant's hand or arm to give way when leaning his hand on the wall whilst he was standing in the toilet. The history given to both the Panel Medical Assessor and Dr Peter Walker on 26/3/2024 and 10/10/2024 are indefinite about whether weakness, sensory loss or both, were implicated, however the fact remains that the proffered reasons for the fall cannot be substantiated by objective examination findings in the right upper extremity.

There was no evidence on MRI scan of disruption of an intervertebral disc fibrocartilage (annulus fibrosus). There was no evidence of cervical radiculopathy on Panel re-examination or documented in the file of evidence with two or more criteria as required by the Motor Accident Guidelines.

The radiating symptoms to the right upper extremity from the neck did not qualify as an indicator suggestive of radiculopathy, nor as non-verifiable radicular complaints, because they did not follow a specific nerve root distribution.

Although he had been previously diagnosed with a lumbar radiculopathy, this was as a result of a previous workers compensation injury and there was no evidence that the subject motor vehicle accident caused permanent aggravation, that is worsening of the pathology that was present in the lumbar spine before the accident. Lumbar radiculopathy if it had been present before the subject motor vehicle accident, was not evident from the findings of the Panel re-examination, nor was it recorded in the standard manner required under the MA Guidelines by any practitioner since the accident in the file of evidence.

This does not satisfy the definition of threshold injury, because it involves tears to ligaments."

1. On or about 29 January 2026, the following message was sent to the parties by the Case Officer at the request of the Panel:

"In its submissions dated 6 November 2025, the insurer restates its concerns about the claimant's reports, including the failure to disclose a prior worker's compensation claim relating to right shoulder injury which was not referenced in the APAB. The insurer then submits that any self-reports by the claimant must be treated with caution. In response, the claimant says "there is nothing in the Reply which alleges that the injuries to the claimant's cervical spine and right arm were caused by his worker's compensation accident in about July 2020."

Notwithstanding that he bears the onus of proving a non-threshold injury, the claimant does not directly address the causation issue, impliedly raised by the insurer and implicitly by Dr Walker in his report dated 10 October 2024. There is no medical evidence from the claimant as to the nature of the right arm injury he suffered at work. The Panel has only the insurer's report by Dr Anil Nair dated 05/02/2021. He diagnosed right shoulder cuff tendonitis. Neither Dr Walker nor Dr Aboud provide a diagnosis of the alleged right shoulder injury caused by the accident. The claimant did not respond to the insurer's challenge to his credibility based upon failure to disclose relevant information. The claimant does not particularise the alleged inconsistencies between the reports of Dr Walker dated 26 March 2024 and 10 October 2024. Dr Walker confirms the claimant's right arm was the subject of his previous worker's compensation claim (page 100). There appears to be no mention of radiculopathy in the Quality Medical Practice clinical notes, as of 30 August, contrary to the claimant's submission. There is no mention of a right arm injury in the clinical notes of Dr Begum of Quality Medical Practice. There is no mention of the right arm in Dr Aboud's Pioneer Medical Practice clinical notes until 20/07/2024, when he records "right arm and neck radiculopathic pain and numbness on and off". The claimant may make further submissions addressing these apparent inconsistencies within the next fifteen (15) working days. Please confirm that, depending upon the claimant's responses, the insurer will be invited to make further submissions in reply."

1. On or about 30 January 2026, the Panel caused the Case Officer to send the following additional message to the parties:

"Please also inform the parties that the Panel wishes to know if the claimant was experiencing dizziness and falls before the occasion that he allegedly fell whilst standing at the toilet to urinate , injuring his knee, and also what other drugs and opioids he was ingesting at that time, in addition to his prescribed Lyrica."

The claimant has not responded to those messages, nor made any further submissions. Whilst the Panel could infer that any such response by the claimant would not advance his case, the Panel refrains from doing so and is content to make its determination based upon the presently available evidence.

1. The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[8] It is not the role of the Panel to correct error in the decision of the original Medical Assessor.
2. The Panel is not required to choose between competing medical opinions and is required to form its own opinions.[9] The Panel adopts the findings and opinions of Medical Assessor Oates with which Medical Assessor Gorman concurs.
3. The Panel met on 11 August 2025 to consider the following:

(a) the nature of the dispute and the matters in issue;

(b) whether any additional documents are required, and

(c) whether a re-examination is necessary.

The claimant failed to attend the original re-examination appointment on 23 October 2025 and the post-examination conference set down for 18 November 2025 was cancelled.

The claimant was examined by Medical Assessor Oates on 27 November 2025 at the PIC Medical Suites, Sydney.

1. The Panel reconvened on 24 February 2026 to consider its findings and to finalise its decision.
2. The Panel is concerned about the lack of evidence from the claimant concerning his previous worker's compensation claim in which he sustained an injury to his right arm (insurer's report by Dr Anil Nair dated 5/02/2021).
3. As noted previously, the claimant bears the onus to prove injury and that it is not a threshold injury.[10]
4. Having regard to all of the evidence, the Panel is not satisfied, as a matter of medical determination and as a matter of factual non-medical judgment, that the motor accident could have caused, and did cause weakness and collapse of the claimant's right arm, as a consequence of his accident-related soft tissue neck injury, leading to his sustaining an injury to his right knee, when he fell over in the bathroom some ten months after the subject motor accident. In coming to those conclusions, the Panel has had regard to the general principles prescribed by section 5D of the Civil Liability Act 2002.
5. The Panel notes the claimant's video footage of the accident scene and its aftermath. The Panel also notes the parties' submissions in relation to that material. Other than indicating that, based upon the number of emergency services personnel in attendance, the accident was significant, the Panel does not find any of that material to be of much assistance, or relevance, to its determination of the matters in issue.

1. For the above reasons, the Panel confirms the certificates of Medical Assessor Ian Cameron dated 10 April 2025.

[1] Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6.

[2] Briggs v IAG Limited t/as NRMA Insurance [2022] NSWSC 372.

[6] Briggs v IAG Limited t/as NRMA Insurance [2022] NSWSC 372.

[7] Insurance Australia Limited t/as NRMA Insurance v Trkulja [2023] NSWSC 956.

[9] Insurance Australia Group Limited v Keen [2021] NSWCA 287 and Insurance Australia Group Limited v Marsh [2021] NSWCA 31.