1. The provisions of the Civil Liability Act 2002 (the CL Act) apply to the MAI Act in determining issues of causation. Particularly ss 5D and 5E of the CL Act.[10] In Raina v CIC Allianz Insurance Ltd[11] Campbell J stated:

"One may accept that a review panel is engaged in a process of dispute resolution by expert assessment of medical issues arising under the Act. However, the questions arise in a legal context and it is incumbent upon the panel, medical practitioners they may be, to correctly apply the law including the law of causation in the exercise of their powers. This includes the provisions of Division 3 of Part 1A of the Civil Liability Act 2002 (NSW), ss5D and 5E: see s 3B(2)(a) of that Act. Although it may be expected that questions about the appropriate scope of liability will arise but rarely."

1. Further, cls 6.5 to 6.7 of the Guidelines refer to causation of both injury and whether the degree of permanent impairment is caused by injury.
2. Clause 6.7 of the Guidelines provides:

"There is no simple common test of causation that is applicable in 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 the sole cause as long as it is a contributing cause, which is more than negligible."

1. The Medical Assessor noted the following body parts referred for assessment were the lumbar spine, cervical spine, thoracic spine, chest (rib fractures), right shoulder, hand, (fracture of thumb), right hip, laceration to scalp, right knee and right ankle.
2. The Medical Assessor noted that the claimant had a mildly restricted range of movement mostly with respect to loss of extension with no objective spasm or guarding and no non-verifiable radicular complaints. Neurological examination of the upper limbs was completely normal.
3. There were no symptoms pertaining to the thoracic spine and there was uniform restriction of motion within the lumbar spine.
4. Examination of the right upper extremity showed mild restriction of right shoulder movement and reduced range of motion of the right thumb.
5. Examination of the right knee showed full range of motion with tenderness along the medial and lateral aspects of the joint line and no internal ligament laxity. Examination of the right ankle was normal.
6. The Medical Assessor noted a right occipital scalp scar which was not sensitive and covered by hair, a longitudinal posterior scar from the right thumb surgery, small punctate scars from the right knee surgery and lacerations over the aspect of the right hip. Under the principle of best fit, the Medical Assessor assessed 1% whole person impairment for scarring.
7. The Medical Assessor assessed whole person impairment at 11% for the cervical spine (5%), right upper extremity (shoulder - 3% and thumb - 1%), right lower extremity (1%) based on a partial meniscal tear repair and scarring (1%). There were no other assessable impairments made by the Medical Assessor.

1. The parties filed bundle of documents for the Panel's consideration. Further material has been filed concerning the operation and recovery following right thumb surgery undertaken in February 2025.

1. A CT scan of the right knee dated 23 December 2013 showed a large joint effusion with the anterior cruciate ligament poorly defined and recommended further evaluation by an MRI scan.[12]
2. An MRI scan of the right knee dated 7 January 2014 showed a complete rupture of the anterior cruciate ligament and undisplaced fracture of the lateral tibial plateau.[13]
3. X-rays of the spine dated 7 July 2016 showed mild loss of height of the L1 vertebral body which may indicate an anterior wedge compression fracture.[14]
4. On 7 July 2016 the GP noted a recent accident causing left neck pain/lower back pain and pain from the thigh to the left foot.[15] The doctor noted a history of back pain at the age of 18 that had resolved.
5. On 11 July 2016 the GP noted the X-ray showed an L1 compression fracture with ongoing complaints of neck and back pain.[16] The GP referred the claimant for physiotherapy for the neck, bilateral shoulder and lumbar spine pain.[17]
6. In April 2017 the GP noted ongoing neck pain.[18] A CT scan of the cervical spine dated

3 April 2017 noted a clinical history of occipital headaches and showed a right posterior disc protrusion causing mild canal stenosis and probably causing C7 nerve root impingement.[19] 7. In October 2020 the GP noted ongoing pain in the neck, upper back and lower back.[20] 8. On 19 February 2021 the GP noted a history of chronic back pain for many years with occasionally referred radiculopathy.[21] The dosage of Targin was increased at that time. 9. On 12 March 2021 the claimant presented to Bankstown Hospital with left-sided neck, shoulder and upper limb pain. Examination was unremarkable with no obvious paraesthesia although there was sensory deficit in the left upper limb in the distribution of C5/6.[22] 10. On 30 October 2021 the claimant was prescribed Endone for lower back pain and wating for hernia surgery.[23]

1. The ambulance report noted the motor accident and injuries to the scalp, right chest, right arm including shoulder, abdomen and questioned right rib fractures.[24] The Glascow coma score (GCS) recorded at the accident site by the ambulance officer was 15.
2. The hospital notes refer to the motor vehicle accident causing a Bennett's fracture, concurrent right forearm injures, right hip lacerations and right rib fractures.[25] X-ray showed multiple right sided rib fractures including interior ribs 1 - 5 and a posterior right 10th buckle fracture.[26]
3. Clinical hospital notes refer to no cervical spine tenderness and no midline tenderness in the back. Those notes record right thumb fracture, right sided chest wall tenderness, soft non-tender abdomen and lacerations with grazes and shards of glass in the right upper limb/shoulder.[27]
4. A separate note refers to no injuries to the cervical spine and no cervical tenderness.[28]
5. The CT scan of the brain showed a large right parietal haematoma with an overlying skin laceration and tiny hyperdensities measuring up to 2 mm in size compatible with glass fragments. The scan was otherwise normal with no skull fracture or acute intracranial haemorrhage. The cervical spine scan was normal.[29]
6. The chest scan showed an irregularity of the right posterior 10th rib compatible with fracture, fractures of the anterior right 1st - 5th ribs and the possibility of a T11/12 posterior osteophyte fracture.[30]
7. The X-ray of the right wrist dated 5 February 2022 showed an acute comminuted extra articular fracture through the proximal shaft of the right thumb metacarpal with volar angulation and displacement and associated soft tissue swelling.[31]
8. The claimant first attended his GP following the motor accident on 10 February 2022 when he presented with a walking stick complaining of dizzy attacks, headache, neck pain, bilateral shoulder pain, cervical spine pain and lumbar spine pain and bilateral knee and ankle pain. The rib and thumb fractures were also noted.[32] The claimant was prescribed Endone and Targin.
9. A certificate of capacity dated 10 February 2022 referred to the motor accident causing injuries to the cervical, thoracic and lumbar spine, right shoulder, chest, multiple rib fractures on the right side, right elbow and wrist injury, bilateral knee and ankle injury.[33] Subsequent certificates recorded these injuries.[34]
10. The claimant completed an application for personal injury benefits on 9 February 2022 when he alleged that the motor accident caused injuries to the neck, right arm, right shoulder, right hand, left arm, left shoulder, left hand, chest, ribs, abdomen, back, right leg, right knee, right foot, left knee, left knee, left foot and nervous shock.[35]
11. On 21 February 2022 the GP referred the claimant for physiotherapy for the lumbosacral spine, cervical spine, dorsal spine, right shoulder, right thumb, bilateral knees and fractured ribs.[36]
12. A CT scan of the lumbar spine dated 23 February 2022 showed no evidence of fracture, disc protrusion or nerve root impingement. Disc bulges were noted at various levels.[37] An ultrasound of the right shoulder showed the rotator cuff was intact, there was no tendinosis or tear with a thickened subacromial bursa. The X-ray of the right hand showed displaced fracture at the base of the first metacarpal without distinct joint involvement.
13. A CT scan of the chest dated 28 February 2022 showed multiple healing right sided rib fractures.
14. The X-rays of the chest and right ribs dated 28 May 2022 showed no fractures.[38]
15. The X-ray of the right hand dated 30 May 2022 showed a healing fracture of the first metacarpal.[39] An ultrasound of the right elbow dated 30 May 2022 showed mild tendinosis of the common extensor tendon and a tiny surface tear of the common flexor tendon.[40]
16. The MRI scan of the cervical spine dated 30 May 2022 showed multilevel degenerative changes including broad-based disc osteophyte complexes at both C5/6 and C6/7 indicating that the changes were long-standing.[41] The MRI scan of the lumbar spine showed multilevel degenerative changes with contact/abutment of the right descending L5 nerve root.
17. The MRI scan of the right shoulder dated 31 May 2022 showed tendinosis involving the subscapularis with changes in the anterior rotator cuff interval.[42] The MRI scan of the right knee showed a linear oblique flap tear of the medial meniscus with parameniscal cystic changes.
18. On 13 July 2022 Dr Alan Nazha, pain specialist, noted that the main complaint following the motor accident were predominantly to the cervical spine, lumbar spine, right shoulder, elbow, hand, right knee and the right chest wall.[43]
19. The claimant consulted Dr Kirsh on 18 July 2022 for right shoulder and right knee pain which had settled down. The doctor noted a history of a right anterior cruciate ligament repair in 2014 which settled down with no ongoing trouble. The claimant described pain in the posterior aspect and the medial aspect of the right knee and around the patella with ongoing limping.
20. Dr Kirsh noted anterior pain inside the joint of the right shoulder with no instability and full range of movement and a positive O'Brien's test. The doctor diagnosed a strain of the acromioclavicular joint.
21. A CT scan of the right hand dated 20 October 2022 showed an old, healed fracture involving base of the first metacarpal bone with mild residual deformity.[44]
22. A CT scan of the chest dated 25 October 2022 noted complete bone union of the previously detected right rib fractures.[45]
23. Right knee surgery was permed by Dr Kirsh on 1 November 2022. The doctor noted a large medial plica and small meniscal tear and performed a partial medial meniscectomy and excision of the plica. [46]
24. On 27 March 2023 Dr Baba performed a right thumb extension osteotomy and removal of volar ganglion.[47]
25. An ultrasound of the right foot dated 18 April 2023 showed plantar fasciitis.[48]
26. An MRI scan of the cervical spine dated 7 August 2023 showed mild bulging at C5/6 with irritation of the exiting right C6 nerve and mild right narrowing at C4/5 with no features of nerve impingement. The lumbar scan showed a disc bulge at L4/5 with impingement of the descending right L5 nerve.[49]
27. On 14 August 2023, Dr McKechnie, neurosurgeon, noted neck pain radiating to the right arm and back pain with intermittent radiation through the right leg.[50] On 7 September 2023

Dr Pinckney recommended a partial right L4 and L5 laminectomy.[51] 28. On 16 October 2023 Dr Baba noted evidence of healing at the osteotomy site with improved thumb pain and range of motion.[52] 29. On 20 November 2023 Dr McKechnie referred to the MRI findings which showed a large right C6/7 disc protrusion and smaller protrusion at C5/6 and noted that the claimant may eventually require an anterior C6/7 discectomy and fusion and potential treatment at C5/6.[53] 30. On 10 February 2025 the hardware in the right thumb was removed.

1. Dr James Bodel, orthopaedic surgeon, was qualified by the claimant and provided a report dated 7 August 2023.[54]
2. Dr Bodel noted current complaints of pain in the neck, right shoulder and down the right arm, lower back and right knee. The doctor opined that the claimant suffered injuries to the cervical and lumbar spine, a rotator cuff injury to the right shoulder, direct blow to the front of the right knee and soft tissue injury to the right ankle as well as multiple rib fractures which had clinically healed with no abnormality of respiratory function.
3. Dr Bodel assessed the lumbar and cervical spine at 5% each based on asymmetry of movement, 6% for the right shoulder, no assessable impairment for the ribs, and a combined assessment, based on loss of movement of 7% impairment for the right knee and ankle.
4. Dr Ristogi, psychiatrist, was qualified by the claimant and provided a report dated

14 August 2023. The doctor diagnosed that the motor accident caused a post-traumatic stress disorder and associated major depressive disorder.[55] 5. Dr Muratore was qualified by the insurer and provided a report dated 31 August 2023.[56]

Dr Muratore noted inconsistencies described by the claimant in the records, specifically that at the time of the accident he complained of severe neck and back pain and that he was an inpatient for three days. 6. Dr Muratore diagnosed a scalp laceration without a significant head injury noting the GCS score recorded by the ambulance, laceration over the right shoulder and arm with persistent right shoulder pain consistent with traumatic rotator cuff tendinitis. Other injuries included Bennett's fracture of the right thumb which required surgical correct correction, soft tissue injury to the cervical spine, tear of the right medial meniscus, right sided rib fractures, soft tissue injury to the lumbar spine and soft tissue injury to the right foot. 7. Dr Muratore opined that the claimant had not obtained maximum medical improvement with regards to the assessment of impairment of the thumb, right shoulder, right knee, cervical and lumbar spine. 8. Dr Muratore provided a further report dated 26 March 2024.[57] The doctor noted complaints of pain in the right shoulder, right thumb, neck, back, right knee and right ankle/heel. 9. Dr Muratore opined that the motor accident caused scalp laceration, right shoulder pain with no impingement and no weakness, Bennett's fracture of the right thumb with complaints of persistent symptoms which are exaggerated, soft tissue injury to the cervical spine which had ceased complicated by a chronic pain syndrome. Other injuries included a tear of the right medial meniscus treated surgically and complicated by a chronic pain syndrome, right sided rib fractures which have healed uneventfully. The doctor concluded that the soft tissue injury to the lumbar spine with pre-existing lumbar spondylosis may have been exacerbated by the motor accident, but any exacerbation has ceased and soft tissue injury to the right foot which was not diagnosed as plantar fasciitis. 10. Mr Muratore opined that he did not believe that the claimant was, despite his reported widespread symptomatology, debilitated as he stated. 11. Dr Mason, psychiatrist, was qualified by the insurer and opined that the motor accident caused a post-traumatic stress disorder and an adjustment disorder with depressed mood secondary to disability arising from ongoing pain.[58]

1. Medical Assessor Young determined that further physiotherapy sessions for the cervical spine were not reasonable and necessary.
2. The neurological examination of the cervical spine was normal with no guarding or spasm, and normal movement. The Medical Assessor concluded that the motor accident caused a soft tissue injury to the upper cervical spine with no ongoing effects. He opined that the claimant suffered a pre-existing condition to the lower cervical spine, and this was the cause of the ongoing symptoms.

Claimant's submissions dated 30 January 2024[59]

1. These submissions listed the body parts referred for assessment of permanent impairment.

Claimant's submissions dated 19 August 2024[60]

1. These submissions were filed opposing leave to review the medical assessment.
2. The claimant noted that there was a typographical error in the findings of the Medical Assessor in respect of the assessment of impairment of the right shoulder which should have been 3%. This could be corrected under the slip rule.
3. The claimant submitted that the assessment of the cervical spine was consistent with the findings on examination and that found by Dr Bodel. Whilst Dr Muratore did not make an assessment, his findings on examination were consistent with a finding of DRE category II.
4. The claimant submitted the insurer has not demonstrated that the medical assessment was incorrect in a material respect.

Insurer's submissions dated 1 December 2023[61]

1. These submissions are contained in the insurer's internal review decision.
2. The insurer referred to the ambulance report, hospital records, application for personal injury benefits, certificates of capacity provided by the GP and all relevant treatment request and referrals. Reference is also made to the pre-accident clinical records of the GP which showed neck and back pain in 2016 following a motor accident and ongoing complaints of neck pain.
3. The insurer noted the different examination findings by Dr Muratore and Dr Bodel and

Dr Muratore's opinion that further treatment was required for the right upper extremity and right lower extremity.

Insurer's submissions dated 14 February 2024[62]

1. The insurer sought leave to review the medical assessment.
2. The insurer asserted that the hospital records make no reference to the claimant sustaining a head injury. We note that this submission is difficult to accept given the obvious laceration to the scalp referenced in the notes.
3. In respect of the cervical spine injury the insurer noted the significant pre-accident history referenced in the clinical records in July 2016 and the referral for a CT scan which was reported to show pathology at C6/7. This is one of the areas commented upon by

Dr McKechnie. 4. The insurer noted that there was no complaint of neck pain to the ambulance officer or in the hospital notes and there is a specific reference in the hospital records to "no cervical spine tenderness, no anterior injuries". 5. The insurer noted that the range of motion recorded by the GP on 10 April 2022 was consistent with that recorded by the GP in July 2016. It submitted that the claimant did not sustain an acute injury to the cervical spine caused by the motor accident. 6. The insurer noted that the assessment by Dr Bodel was based on asymmetry of movement without clinical signs of radiculopathy. Those findings were inconsistent with that undertaken by Dr Muratore. The insurer submitted the clinical findings satisfied DRE category I. 7. There was no complaint of thoracic spine injury to the ambulance officer, the hospital notes and Dr Bodel did not record any complaint associated with thoracic spine. 8. With respect to the lumbar spine, the insurer noted the documented pre-accident history of chronic complaints in the lumbar spine and the absence of contemporaneous complaint to the ambulance officer and in the hospital notes. 9. The insurer referred to Dr Bodel's assessment which was based on asymmetry of movement and guarding but no clinical signs of radiculopathy. The insurer referred to Dr Muratore's clinical findings which would satisfy DRE category I. 10. With respect to the right shoulder, the insurer referred to the inconsistency and the range of motion observed by Dr Bodel and Dr Muratore and noted the opinion of the latter doctor that the claimant had not attained maximum medical improvement. 11. The insurer accepted that the motor accident caused the fractured right thumb and referred to Dr Muratore's opinion that the claimant had not attained maximum medical improvement. 12. In respect of the documented rib injuries, the insurer submitted that uncomplicated rib fractures do not result in assessable impairment. 13. In respect of the alleged hip injury the insurer noted that Dr Bodel did not refer to a right hip injury and symptoms in the right hip and otherwise noted the claimant demonstrated full range of movement. 14. In respect of the right knee, the insurer referred to the differences in the assessable range of motion undertaken by Dr Bodel and Dr Muratore. 15. The insurer's submissions in respect of the right ankle were unclear noting Dr Muratore's opinion.

Insurer's submissions dated 5 August 2024[63]

1. These submissions were filed seeking leave to review the medical assessment. It asserted that it only sought leave to review the "assessment of whole person impairment".
2. The insurer submitted that the Medical Assessor did not record his range of motion findings for the cervical spine and did not comment as to how he concluded that the cervical spine injury gave rise to impairment classified as DRE category II.
3. The insurer submitted that the Medical Assessor erred as he incorrectly noted the shoulder gave rise to 2% whole person impairment when it should have been 3%.

1. Mr Akkaoui was examined by Medical Assessor Oates on 14 February 2025. The relevant findings were:
   • at the cervical spine, there is asymmetric loss of active range of motion, no guarding, no non-verifiable radicular complaints and no radiculopathy. The differentiators present indicate DRE Cervicothoracic Category II giving 5% whole person impairment;
   • at the lumbar spine, there is no asymmetric loss of range of motion, no guarding, no non-verifiable radicular complaint and no radiculopathy. This equates with a DRE Lumbosacral Category I giving 0% whole person impairment;
   • at the right knee, there has been partial meniscectomy giving 1% whole person impairment;
   • at the right shoulder, there is loss of active range of motion giving rise to assessable permanent impairment. Flexion 170° gives 1% upper extremity impairment, adduction 30° gives 1%, abduction 150° gives 1% and 60° internal rotation gives 2%. This added to 5% upper extremity impairment, equivalent to 3% whole person impairment;
   • there was no assessable loss of range of movement of the right ankle and hindfoot, and
   • the examination findings were that both the rib fractures and any thoracic spine condition had resolved.
2. Mr Akkaoui was examined by Medical Assessor Oates on 27 November 2025. The examination report is as follows:

• Head (external) - soft tissue injury, laceration to scalp
• Lumbar spine - soft tissue injury, strain, reduced range of motion
• Cervical spine - soft tissue injury, strain, reduced range of motion, radicular symptoms
• Thoracic spine - soft tissue injury, strain, reduced range of motion.
• Shoulder (right) - shoulder/arm injury, rotator cuff injury, soft tissue injury, strain, reduced range of motion and lacerations
• Hand - Bennett fracture to right thumb
• Chest wall, fribs - 9 fractures
• Hip - lacerations
• Knee (right) knee injury - soft tissue, ligament injury
• Ankle - right ankle injury, soft tissue.

He says his main problems are still the neck, back and right thumb.

The neck is 'bad'. It locks up and he can't move it again until it frees up spontaneously after 10 seconds or so and restricts turning to the left. The neck locks when he is looking down for prolonged periods, such as checking things on his phone. The pain is at the base of the neck centrally and mainly to the right shoulder, trapezius and upper arm.

The right shoulder is constantly sore. The trapezial pain comes on with the neck. Sometimes neck pain radiates to the left upper trapezius as well. There is no numbness or paraesthesia in the arms.

His low back is still a problem and has been worse since the accident. Pain is situated in the central lower back and radiates to the left paralumbar area and sometimes towards the right buttock, but no further down into the lower extremities.

His right thumb is a little more comfortable since removal of the hardware by Dr Baba, upper limb orthopaedic surgeon, on 10/2/2025, but there is partial numbness along the radial side of the length of the right thumb. The scar is tender if he presses hard on it. The thenar eminence is swollen compared with the left and this becomes worse with activity. He has had fairly good recovery of range of movement in the thumb for gripping, but it is not full.

He still has soreness in the right heel on pressure.

The main problem is his right knee locking and clicking. There is no giving way.

He also feels pain in the back of the left knee and thinks maybe this is from taking over the extra load from favouring the right knee over a period of time.

There were no complaints in relation to the soft tissue injury to the head.

He has not worked since the accident. He is on Centrelink benefits and gives them a medical certificate three-monthly, stating he is unfit for work.

He tries gardening now and then but is limited by lower back, right knee and then his neck, and his shoulder hurts if he pulls weeds out. He is not doing any other sports or recreations now. He doesn't go to the gym anymore but attends the exercise physiologist for an exercise program once a week.

Lyrica 150mg twice a day. He has also been on anti-reflux agent for the last couple of years. He is on an anti-depressant and a hypnotic.

He sees a psychologist at Nexus, Bankstown, regularly.

He attends an exercise physiologist at Sports Fizz once a week and commenced this a couple of months after the accident.

He sees his GP, Dr Malek, Bankstown, for maintenance. He says he is not seeing any other doctors.

He remained of average muscular build with height 177cm and weight 87.8kg. I asked him about the weight loss, and he thinks it was due to stress.

He sat for the duration of the interview without visible discomfort. He transferred with some back stiffness out of a chair and on and off the couch.

He presented the history without evidence of cognitive deficit.

There was no spasm or guarding and no focal tenderness. Flexion and extension were full range. Lateral flexion was two-thirds to the right and three-quarters to the left. Rotation was three-quarters to the left and full to the right. Thus, dysmetria was present.

There were no non-verifiable radicular complaints. Reflexes and power in the upper extremities were normal. Sensation in the left upper extremity was normal and in the right upper extremity was normal, apart from partial decreased sensation to light touch and pin prick radial border of thumb, from carpometacarpal joint level distally to the tip.

Upper arm girth; right equals left equals 33cm at 10cm above the elbow crease.

Forearm girth; right equals left equals 29cm at 5cm below the elbow crease.

There was no guarding, no spasm or focal tenderness.

Thoracic rotation was full bilaterally, tested whilst the trunk was flexed to 90° at the waist. There was normal sensation over the trunk.

There was no guarding and no spasm. There was no focal tenderness.

Flexion was full with pain in the lower back on recovery to erect position. Extension full. Lateral flexion three-quarters of normal bilaterally. No dysmetria.

He walked without a limp. He could squat two-thirds limited by bilateral knee discomfort, worse on the right side. Toe walking was normal, but heel walking caused complaint of right under heel discomfort.

Reflexes were symmetrical. Plantar responses were both flexor. Power and sensation in the lower limbs were normal.

Thigh girth; right 46cm, left 47cm at 10cm above the superior patellar pole.

Leg girth; right 37cm, left 36cm at 13cm below the inferior patellar pole (maximum circumference).

Active range of movement of joints was measured with a goniometer.

Both elbows, both wrists and left hand showed full range of movement.

The right index, middle, ring and little fingers and left index, middle, ring and little fingers showed full range of movement.

Thumb range of movement measured with a goniometer is as follows:

Active range of movement of joints measured with a goniometer.

There was cracking crepitus and mild discomfort on patellar compression in the right knee. There was no crepitus nor pain on patellar compression in the left knee.

There was full range of movement of both ankles and hind feet. There was some tenderness on the undersurface of the right heel on firm palpation.

On this occasion, the claimant has his head shaved, which he says he does in the summer, and a 4cm well-healed right parieto-vertical scalp scar was clearly visible. There were no trophic changes or suture marks, and the scar was not tethered or tender.

There were well-healed arthroscopic portal scars about the right knee.

There were a number of linear, irregular, oblique, vertically running lacerations over the upper right arm which had been sutured, and showed some hypertrophic changes and colour contrast with surrounding skin, being paler. There was no adherence. There was also an irregular scar from lacerations over the dorsum of the right hand.

There was a 6cm linear scar over the dorsal aspect of right thumb from the radial wrist line to the MCP joint, with keloid thickening up to 4mm wide in parts. The scar was tender to touch. There was no adherence. The scar was clearly visible to casual observation.

The claimant presented in a consistent manner during the physical examination.

1. The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[64]
2. The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[65] and Insurance Australia Ltd v Marsh.[66]
3. The Panel has met following the recent further examination conducted by Medical Assessor Oates. We adopt the examination report provided by the Medical Assessor supplemented by the following further reasons. We note that the respective examination findings of Medical Assessor Oates undertaken nine months apart were generally consistent with only minor variations.

1. The medical examination of Medical Assessor Oates show that the rib fractures and any thoracic spine injury (soft tissue) have resolved.
2. Whilst there was an obvious head injury involving lacerations to the scalp, there was no evidence of a brain injury and no basis to assess impairment based on injury to the brain.
3. The soft issue injury to the right ankle/hindfoot had resolved based on the clinical findings of Medical Assessor Oates in February and November 2025 showing no relevant symptoms and no loss of movement. The clinical symptoms of plantar fasciitis were not caused by the motor accident as there is no obvious medical basis for the motor accident to cause that condition.
4. The pre-accident clinical show a chronic lumbar spine condition for many years. The lumbar spine is protected by the seat and is not as exposed as the cervical spine is to any whiplash type injury. The findings of Medical Assessor Oates in both February and November are consistent and show no assessable impairment.
5. We are not satisfied that the motor accident caused anything other than a temporary exacerbation of lumbar spine symptoms. This conclusion is based on the chronic nature of the pre-accident symptoms, the nature of the protection to the lumbar spine from the seat, the absence of any post-accident acute pathology and the medical examination findings of Medical Assessor Oates in 2025.
6. The lumbar spine otherwise had no assessable permanent impairment.
7. The hospital records show right hand, scalp laceration and other body lacerations, right shoulder injury and Bennett's fracture. The Bennett's fracture of the thumb united, but there were ongoing complaints of pain which were treated by surgery on 10 February 2025. The operative note indicated the thumb extensor tendons were mobilised off the metal plate and hardware removed entirely, noting the osteotomy site had healed. The lacerations and right thumb injury were caused by the motor accident.
8. We are satisfied that the motor accident caused the right knee meniscal injury. This conclusion is supported by the contemporaneous complaint, the nature of the motor accident, post-accident radiology and absence of contrary submission by the insurer.
9. The claimant suffered from a pre-existing cervical spine condition. The significant high-speed accident is highly likely to have caused an aggravation of pre-existing degenerative changes given the absence of neck support and the forces exerted on the cervical region by this type of accident.
10. The insurer referred to the absence of complaint to the ambulance officer and to the hospital. We do not consider an absence of early complaint as significant because there was complaint to the GP at the initial consultation and onset of symptoms within 48 hours is not unexpected following trauma involving soft tissue and exacerbation of pre-existing degenerative pathology. Furthermore, muscle stiffness following this type of trauma will generally develop over a period of 24 - 48 hours thus explaining the absence of complaint on the day of the accident.
11. Further, the claimant would have been in significant pain at the hospital with multiple rib fractures and the thumb fracture. The absence of reference to a body part at that time is explained by the significant pain in other body parts. The analgesia for the spinal fractures would have made the claimant less aware of other body parts.
12. We do not accept the finding of Medical Assessor Young that the injury was soft tissue to the middle/higher cervical spine. That conclusion is unsupported by other records concerning the claimant's complaint of post accident cervical spine injury. Further the clinical findings of Medical Assessor Young contrast with the consistent findings of Medical Assessor Oates for the cervical spine on the two occasions in 2025.
13. There is early recorded right shoulder complaints post-accident consistent with a high-speed accident. The clinical right shoulder findings (with minor changes not medically inconsistent) by Medical Assessor Oates on both occasions are consistent with that recorded by Medical Assessor McGrath.

1. At the cervical spine, there is dysmetria of active range of motion. There is no guarding, no non-verifiable radicular complaints and no radiculopathy. These findings are consistent with the earlier examination findings in February 2025. The cervical spine is assessed at DRE cervicothoracic category II is assessed giving 5% whole person impairment (WPI).
2. At the right knee, there has been partial meniscectomy giving 1% whole person impairment (see Table 64 of AMA 4, p 85 diagnosis-based estimate).
3. The claimant has multiple scars caused by the motor accident which are assessed together. With reference to TEMSKI, the claimant is conscious of the scars, particularly the scar on the thumb and scars on the right upper arm. There is noticeable colour contrast of scars on the thumb and on the arm with surrounding skin.
4. The claimant is able to easily locate the scars. There are trophic changes in the thumb scar evident to touch. Suture marks are clearly visible in the thumb scar. The anatomical location of the thumb scar is usually visible with usual clothing and hairstyle.
5. The scalp scar is now visible whilst his head is shaved during summer months but normally would not be visible with usual hairstyle. The upper arm scars would not be visible with usual clothing.
6. There was no contour defect visible. There are no limitations of performance of activities of daily living. There is no requirement for treatment and no adherence.
7. We have considered all factors under Table 6.18 of the Guidelines[67] when assessing best fit for the scars. The best fit under TEMSKI, now that the thumb scar is considered, is 2% WPI.
8. With respect to right thumb impairment, abduction 55° gives no assessable impairment, IP flexion of 0° gives 1% of the thumb and 65° flexion gives 1% of the thumb. Opposition 4cm gives 9% of the thumb. Adduction 3cm gives 3% of the thumb. MCP flexion to 40° gives 2% of the thumb. Adding these gives 16% of the thumb.
9. For the left thumb, 70° abduction gives zero impairment, 75° flexion of IP joint gives zero impairment. 6cm opposition gives 3% of the thumb. 2cm adduction gives 1% of the thumb. Adding these gives 4% of the left thumb.
10. The net impairment of the right thumb using the left thumb as a baseline, which is uninjured, is 16 minus 4 gives 12% of the thumb, which equates to 5% of the hand and 5% of the upper extremity.
11. The nature of the right thumb restriction is entirely consistent with the significant fracture, post-operative treatment and subsequent recovery.
12. There is assessable impairment arising from loss of active range of motion of the right shoulder. Flexion 160 gives 1% UEI (upper extremity impairment), adduction 30 gives 1% UEI, abduction 150 gives 1% UEI, internal rotation 60 gives 2% UEI. Adding these gives 5% UEI.
13. Combining 5% UEI (right thumb) with 5% UEI (right shoulder) gives 10% UEI of the right upper limb which is converted to 6% WPI.
14. Based on the clinical findings, there is no other assessable impairment of any other body part such as the right hip.
15. The combined WPI is 6% by 5% by 2% by 1% totalling 14% WPI.
16. We are not satisfied that there is "objective evidence" of pre-existing impairment of the cervical spine within the meaning of cl 6.31 of the Guidelines. There is evidence of cervical spine symptoms pre-dating the motor accident but no objective evidence of pre-existing impairment assessable under the Guidelines.
17. There is no basis to make any deduction for a pre-existing condition to the other assessable body parts.
18. We are satisfied that the impairment is permanent within the meaning of cls 6.19 and 6.20 of the Guidelines because the various injuries condition (save as to the right thumb) are well stabilised with little change in the condition since the examination of the previous assessment of Medical Assessor Oates. The claimant does not require further surgery and does not require treatment that will impact on permanent impairment in the foreseeable future.
19. With respect to the assessment of the right thumb, there has been a significant period since the February 2025 surgery and no further improvement in movement is expected.

1. We revoke the original medical assessment. A new medical assessment is attached at the commencement of these Reasons.

[2] See Division 7.5 and Schedule 2, cl 2 of the MAI Act.

[3] Allianz Australia Insurance Ltd v Akkaoui [2025] NSWPICMP 152 (previous Panel decision).

[6] Section 7.26(5) of the MAI Act; claimant's bundle, page 303.

[10] See s 3B(2) of the Civil Liability Act 2002.

[11] [2021] NSWSC 13 (Raina) at [65].

[47] Insurer's bundle, p 330 and p 334.

[65] [2021] NSWCA 287 at [40], [41] and [45].

[66] [2022] NSWCA 31 at [11], [21], [64].