1. The Review Panel confirms the determination of Medical Assessor Nelukshi Wijetunga dated 4 March 2025.

1. Mona Samy Ali (the claimant) is a 50-year-old woman who was injured in a motor vehicle accident which occurred on 13 March 2024. Following the accident the claimant lodged an application for Personal Injury Benefits and thereafter sought a concession from the insurer that her injuries would be considered non-threshold injuries. After a review, the insurer declined to make this concession and thereafter the claimant then lodged an Application for Assessment of Threshold Injury.
2. In respect to the claimant's physical injuries, she was assessed by Medical Assessor Nelukshi Wijetunga who, in a certificate dated 4 March 2025, certified that the injuries caused by the motor accident were threshold injuries for the purposes of the Motor Accident Injuries Act 2017 (MAI Act).
3. The claimant then sought a review of this determination and, in a decision dated

6 March 2025, President's delegate Stephanie Wigan determined that she was satisfied that there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect. Accordingly, the matter was referred to this Medical Panel. 4. Following the issuing of directions on 13 May 2025 for the parties to upload material, the Panel conveyed on 3 July 2025 to consider this matter. The Panel noted that there was a reference to the claimant being seen by a neurosurgeon, Joanne Lee, in respect to the injury she sustained. The Panel noted there was no material from Joanne Lee before it. The panel determined that it was appropriate that the claimant be re-examined. 5. 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. 6. The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission). 7. 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. 8. 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. 9. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.

1. Section 57 of the Motor Accidents Compensation Act 1999 (MAC Act) defines a "medical dispute" as a disagreement or issue to which Part 3.4 of the MAC Act applies.
2. Section 58 and s 60 of the MAC Act together with cls 1.5-1.7 of the Guidelines set out the procedures for referral to one or more Medical Assessors and the principles to be applied at such assessments.

1. The claimant was born in Iraq, was married young and migrated to Syria at the age of 17. She then migrated to New Zealand from 1997 and to Australia in 2014. In Australia she had various jobs such as cleaning and as a support worker. This was on a full-time basis. On the day of the accident, she had been driving from one client to the other.
2. In New Zealand, she had developed low back pain and was told it was a disc problem which was treated with analgesics.
3. At present she lives with her husband and prior to the accident was active walking and doing gym work.

1. The claimant was driving her car and was stationary at a pedestrian crossing when hit in the rear by another car and then hit again by the car behind which had also been rear-ended. She was wearing a seatbelt at the time, but airbags were not deployed. The ambulance or police officers did not attend the scene of the accident. She exchanged details with the other driver and drove to her next client.

HISTORY OF SYMPTOMS AND TREATMENT FOLLOWING THE MOTOR ACCIDENT

1. The claimant consulted her general practitioner (GP) the next day and stated that she had low back pain, neck pain and pain in the elbows and knees and feet. Her GP prescribed analgesics and referred her for physiotherapy.
2. Her GP referred her to a neurosurgeon, Dr Lee who organised an MRI scan and prescribed Lyrica. No surgical procedures were recommended although Dr Lee suggested cortisone injection which she declined to accept. She was also referred to a pain management practitioner, Dr Hassan, who recommended continued physiotherapy.
3. There have been no further accidents or injuries since the car accident.

1. The worst pain is in the hip region posteriorly which radiates in a global distribution to the heels bilaterally which feels like they are burning. The pain increases after sitting for half an hour when her feet become numb.
2. There is variable neck pain which increases with stress and stiffness sensation in the shoulders. There is a referral of pain down both arms in a global distribution and sharp pain in the elbows which fluctuates. There is also tenderness in the anterior chest wall centrally especially at night. Both knees give a sharp pain with increased walking. She has a poor sleep pattern due to pain and suffers from recurrent headaches.
3. The claimant is able to walk for 20 minutes and uses a walking stick when she is out of the house. She drives short distances to the shops, and her husband does most of the cooking and housework.

1. Present medication is Lyrica 25 mg in the morning and 75 mg at night and an occasional Panadol. Physiotherapy ceased three months ago and there is no other treatment plan at present.

1. The claimant walked into the rooms with a walking stick in the right hand which she relies on when out of the house since the accident. She stated she is right-handed; height was measured at 166cm and weight of 75kg.

1. On palpation there was generalised tenderness to light touch, but no guarding or spasm noted in the cervical musculature. On testing range of movement, flexion/extension was 80% of expected range and side bending and rotation were 70% of expected range with no asymmetry.
2. On neurological examination of the upper limb, reflexes were of low amplitude but equal with normal power and no sensory changes noted. No muscle wasting was apparent with the circumference of the upper arms 32 cm bilaterally (10 cm above the olecranon process) and in the upper forearm 26 cm bilaterally (5 cm below the olecranon process).

1. The claimant walked with a slow shuffling gait without the walking stick and had difficulty standing on her heel or toes.
2. On palpation there was tenderness over the entire lumbar spine region to light touch, but no guarding or spasm was noted in lumbar musculature. On testing range of movement, flexion/extension was 20% of expected range and side bending was 30% of expected range bilaterally as was rotation with no asymmetry. Straight leg raise when lying was 20° bilaterally limited by pain in the hamstrings and hips. When seated straight leg raise was 80° bilaterally with negative sciatic nerve root tension signs.
3. On neurological examination of the lower limbs, reflexes were of low amplitude but equal. There was normal power and a global decrease in sensation to light touch in the entire left leg which was not dermatomal. No muscle wasting was apparent the circumference of the lower thighs 52 cm bilaterally (10 cm above the superior patella pole and at the maximum circumference of the calves 36 cm bilaterally).
4. There has been no two signs of radiculopathy recorded by the treating doctors or physiotherapist that conformed to the Guidelines. At the time of the examination by Dr Lee, a treating neurosurgeon, she recorded a normal neurological examination of the lower limbs except for some slight hip restriction due to pain. Dr Hassan, a pain specialist, recorded radicular pain with tingling and numbness in the right foot but this alone does not qualify for radiculopathy under the Guidelines. Therefore, the Panel does not consider that there was radiculopathy prior to our examination.

1. On inspection, no muscle wasting of the shoulders was apparent and on palpation there was generalised tenderness over the entire shoulder joint region. With passive movement no crepitus was detected and on active movement no referral from the cervical spine. Active movements are measured using a goniometer and repeated. Impingement tests were negative.

1. The claimant stated that she could not improve on the measured range of movement due to global shoulder pain bilaterally with no referral of pain from the cervical spine.

1. On palpation there was a global tenderness of both elbows and on passive movement no crepitus was detected. Active measurements were made using a goniometer.

1. On inspection no effusions were noted, and no ligament laxity was recorded on testing. There was no crepitus on passive movement.

1. No radiological studies were available for inspection.

1. There is documentation by the treating doctor in his clinical notes and certificate of capacity that the claimant sustained a soft tissue injury to her cervical and lumbar spine. There are no signs of radiculopathy, dysmetria or non-verifiable radicular complaints in the spine. These injuries are threshold injuries for the purposes of the MAI Act.

1. The treating GP, Dr Khoo reported bilateral shoulder pain two days after the accident and the Panel accepts that there has been a soft tissue injury to the shoulders sustained in the subject accident. The shoulders are also a threshold injury for the purposes of the MAI Act.

1. The treating GP recorded pain at the bilateral medial regions of both elbows without bruising at the time of his initial examination and the Panel accepts that there has been a soft tissue injury to the elbows due to the subject accident. The elbows are also threshold injury for the purposes of the MAI Act.

1. The treating GP recorded pain in bilateral knee without bruising at the first examination with tenderness on palpation. The Panel accepts that the claimant may have had a soft tissue injury to her knees in the subject accident. The knees are also threshold injury for the purposes of the MAI Act.

1. The Panel is satisfied that the injuries sustained by the claimant in the motor accident are threshold injuries.