Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. Revokes the certificate of Medical Assessor Bodel 17 July 2025.
2. Certifies that the degree of the claimant's permanent impairment resulting from the injuries caused by the 15 January 2023 motor accident is 7% which is not greater than 10%.

A statement setting out the Panel's reasons for the assessment is included with this certificate.

1. Abdul Merhi was involved in a motor accident on 15 January 2023. The claimant says he was standing with his friend on the footpath outside a club when a vehicle mounted the kerb and struck the claimant (and his friend).
2. The claimant says he injured spine, shoulders, right thumb and knees in the accident and he developed a psychological injury resulting from the accident. Because of those injuries, Mr Merhi made a claim for statutory benefits and then damages against Allianz, the third-party insurer of the vehicle that he says caused his accident.
3. A medical dispute about the degree of the claimant's whole person impairment (WPI) has arisen in connection with the damages claim and the claimant referred that dispute to the Personal Injury Commission (the Commission) for assessment.
4. On 17 July 2025, Medical Assessor Bodel determined that Mr Merhi had a WPI of 24%.
5. The insurer was dissatisfied with that outcome and lodged an application with the Commission seeking a review of Medical Assessor Bodel's decision. On 12 September 2025, a delegate of the President determined there was reasonable cause to suspect a material error in the assessment and has allowed the Review to proceed.
6. On 16 September 2025, the President's delegate convened this Panel to conduct the Review proceedings.
7. The Panel notes that on 16 April 2025, Medical Assessor Canaris determined that the claimant had a posttraumatic stress disorder caused by the accident which resulted in a WPI of 7%. The claimant has not sought a Review of Medical Assessor Canaris's decision.

1. Mr Merhi's claim and entitlements to compensation are governed by the provisions of the Motor Accident Injuries Act 2017 (the MAI Act).
2. Under Part 4 of the Act, an injured person can make a claim for damages for both certain types of economic (pecuniary) losses and damages for non-economic (or non-pecuniary) loss. In a claim for lump sum compensation, damages are assessed in accordance with common law principles as modified by the MAI Act.
3. Damages for non-economic loss are limited and restricted by the provisions in Division 4.3 of the MAI Act. For example, non-economic loss damages are limited to a maximum amount in accordance with s 4.13[1] and entitlement to those damages is restricted by s 4.11 to persons who have a greater than 10% WPI as a result of the injuries sustained in the accident.
4. If there is a dispute about the degree of the claimant's permanent impairment, damages for non-economic loss cannot be awarded and disputes must be referred to a Medical Assessor for determination.[2]

1. Division 7.5 of the MAI Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as Medical Assessor Bodel's, further medical assessments and the review of medical assessments by this Panel[3].
2. Applications for review of a medical assessment are made to the President of the Commission on grounds that the assessment "was incorrect in a material respect" (s 7.26(1)). If the President, or his delegate is satisfied "there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect" then the President arranges for the application to be referred to a review panel consisting of a member of the Commission and two Medical Assessors (s 7.26(2) and (2B)).
3. The review is not an appeal looking for error and is not confined to the issues raised in the application (or the reply) but is "a new assessment of all the matters with which the medical assessment is concerned" (s 7.263A).
4. Rule 128 of the Personal Injury Commission Rules (the Rules) 2021 permits the Panel to determine its own proceedings and the Panel is not bound by the rules of evidence and may inquire into relevant matters as it thinks fit.

1. Permanent impairment is assessed in accordance with Chapter 6 of the Motor Accident Guidelines (the Guidelines)[4] which are largely based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides).
2. Due to the nature of the injuries sustained by the claimant, chapter 3, the musculoskeletal chapter of the AMA 4 Guides is relevant.

1. Medical Assessor Bodel examined the claimant on 10 June 2025 and issued his certificate on 17 July 2025. The Medical Assessor confirms at [2][5] that he was asked to assess the following injuries:

(a) cervical spine - musculoligamentous injury to the cervical spine;

(b) thoracic spine - soft tissue injury to the thoracolumbar spine;

(c) lumbar spine - soft tissue injury to the lumbosacral spine;

(d) left shoulder - soft tissue injury to the left shoulder causing rupture of the acromioclavicular joint capsule and rupture of the coracoclavicular ligaments;

(e) right shoulder - soft tissue injury;

(f) right thumb - fracture of the base of the metacarpal of the right thumb causing disruption of the right thumb;

(g) left knee - nondisplaced fracture of the tibial plateau and medial meniscal tear, and

(h) right knee - impacted fracture of the head of the fibula.

1. Medical Assessor Bodel has a history from the claimant of an earlier left shoulder injury 25 years ago (at the age 13) but that, at the time of the accident he had no problem with that shoulder.
2. Medical Assessor Bodel also had a history of a car accident 17 years previously when the claimant was 21. The claimant said he received a settlement for the soft tissue injuries he received and said he had recovered from those.
3. Before the accident the claimant says he went to the gym three to five times a week lifting weights and doing cardio work.
4. The claimant gave a history of the accident. Mr Merhi says he was knocked unconscious and had minimal recall of the moments leading up to being struck. He developed neck and shoulder, mid back and lower back pain, pain in both knees and an injury to the thumb.
5. The claimant was taken to Royal Prince Alfred Hospital (RPAH) and discharged later in the day. The claimant was diagnosed with a fractured right thumb. The claimant saw his General Practitioner (GP) and had treatment but has been unable to return to work.
6. The claimant reported pain in the neck, thoracic spine between the scapulars and in the lower back. He said he also had pain in both shoulders, the left more than the right and had pain in both knees and some difficulties with the right thumb.
7. The claimant was seeing a pain specialist, Dr Mir.
8. On examination, there was a deformity of both knees with painful retropatellar crepitus, slight restriction of neck movement and a good range of movement in the thoracic spine. The claimant reported back ache with asymmetric restriction of movement. Shoulder movements were restricted in both shoulders the left more than the right (see attachment A at the end of these reasons) but no loss of motion in the other joints.
9. Dr Bodel accepted all the injuries claimed were caused by the accident and that none of the injuries had resolved. He assessed WPI at 22% as follows:

(a) lumbar spine DRE II = 5%;

(b) left shoulder 8%;

(c) right shoulder 6%;

(d) left knee 4%, and

(e) right knee 4%.

1. The Insurer takes issue with the Medical Assessor's failure to refer to:

(a) Dr Tang (the treating doctor's) opinions that the claimant was fit to work and did not need further physical treatment [1.13];

(b) Dr Malhotra's reports that the claimant was "pain focused";

(c) Medical Assessor Leaver's assessment of no restriction in the right shoulder;

(d) Dr Yeoh, shoulder surgeon who had found on examination that the claimant's right shoulder was normal, and

(e) Medical Assessor Rapaport's finding that there was no injury to the spine and referral for MRI did not relate to the accident.

1. The insurer submits that the Medical Assessor did not engage with the insurer's original submissions [2.5] which:

(a) noted no contemporaneous claim of symptoms in the spine;

(b) Medical Assessor Rapaport found no evidence of a lumbar spine injury;

(c) Dr Al-Kawaja found no radiculopathy;

(d) there was a vague reference to pain in the right shoulder but a normal MRI scan in February 2023;

(e) the claimant has wholly or largely recovered from the left shoulder, right thumb and knee injuries, and

(f) pain is not to be taken into account.

1. The insurer restated its stance in relation to the claimant's injuries:

(a) spine - there is no contemporaneous complaint of injury to the spine; Medical Assessor Rapaport found no injury to the spine; Radiological scans of the spine were normal; Dr Kahn's opinion should not be accepted, and there was no injury and no impairment.

(b) right shoulder - there is no evidence that the claimant sustained injury to the right shoulder; A February 2023 scan was normal; Dr Yeoh found it was normal, and Medical Assessor Leaver found no injury or restriction of the right shoulder, and

(c) thumb and knees - the claimant's range of motion has "increased" since Dr Khan examined the claimant in February 2024.

1. The insurer notes the Medical Assessor provided one line about the scans and radiological imaging which is "not sufficient."

1. No submissions were received in response to the application for review. The original referral for medical assessment relied on the report of Dr Khan dated 27 February 2024. The claimant identifies 10 injuries but only four impairments were found by Dr Khan. The claimant refers to reports from Dr Kassim, Dr Mir and Dr Manambrakkat which all document the claimant's various pains.
2. The claimant provided a signed statement of evidence dated 29 October 2024. In it the claimant says:

(a) he had no previous motor accident or workers compensation claims and he was otherwise participating in employment and enjoying life [5 and [6];

(b) he recounts the circumstances of the accident at [7] and [8] and suggests at [9] he "briefly lost consciousness" and only came to when Ambulance and Police arrived [9];

(c) he was unable to walk and was placed on a spine board [10];

(d) the driver did not stop or render assistance [11];

(e) the claimant lists at [12] his 10 injuries including a head injury with laceration and short-term memory loss and "psychological sequelae";

(f) he documents his treatment at [14] - [19] and his employment and business venture at [20] - [21];

(g) he says before the accident he worked out at a private gym three to four times and week, and also attended a public gym and he would go on walks and swim;

(h) he says he used to help his parents with their finances and domestic chores, and

(i) the claimant documents how his life has changed and in particular his psychological symptoms.

1. The Panel issued directions to the parties on 19 September 2025 seeking bundles of documents relevant to the review proceedings. The insurer's application for review had contained submissions only and no reply had been lodged by the claimant. The insurer was directed to lodge documents by 10 October 2025 and the claimant by 24 October 2025.
2. The insurer lodged a bundle of documents comprising 269 pages. The claimant's bundle of 228 pages was lodged with the Commission on or about 28 October 2025.
3. The Panel met on 13 November 2025 and reported to the parties on the same day. The Panel determined a re-examination would need to occur and that Medical Assessor Gorman alone would conduct the re-examination. A date was set and Mr Merhi was directed to attend, and he did attend the re-examination. The Panel met again on 12 January 2026 to discuss the re-examination findings and in order to finalise the Review proceedings.

1. Both parties have provided records and reports. Dr Bodel, the claimant's medico-legal expert and the claimant's GP refer to reports from Greenlight which the Panel understands is a rehabilitation provider. It is not clear whether this provider was arranged by the claimant or the insurer but no records or reports have been provided from Greenlight. In the light of the findings in relation to the degree of the claimant's WPI, the Panel does not propose to defer the finalisation of these reasons and request them.

1. The claimant's application for personal injury benefits (claim form) was dated 10 February 2023. The claimant referred to a motor accident about 10 years previously but denied any relevant injuries or conditions at the time of the accident.
2. The claimant notes his injuries as a broken right thumb, pain in his shoulders, both of his knees, his chest, pain in his lower back and neck and a cut to the back of his head.
3. He says he was discharged from hospital on 16 January 2023 and has not worked since the accident.

1. Ambulance records[7] indicate that personnel attended 13 minutes after a call was received. They record that police and an off-duty nurse were on the scene. The claimant was conscious but with a Glasgow Coma Scale score of 14[8] and was shocked. He repeatedly asked for his phone but was unable to move his limbs. Before he was loaded into the ambulance the claimant's GCS score was recorded as 15 and normal.
2. The ambulance report notes that the claimant identifies "pain to neck, back, left shoulder (site of previous surgery), right knee, base of right thumb, left parietal haematoma present and evidence of epistaxis (nose bleed).
3. The hospital notes[9] record a mild bruise over the left temporal lobe with a mild skin abrasion, swelling and abrasion of the left deltoid (shoulder area) and a mild laceration of the shin. There was "nil tenderness on palpation over C spine, lumbar spine and pelvis but there was tenderness in the right knee". The claimant complained of head pain, chest pain, left shoulder pain and right knee pain. The claimant was said to be amnesic to events with anterograde but no retrograde amnesia.
4. The claimant had surgery to his hand on 18 January 2023 at RPAH and there is reference to x-rays having been taken at the initial visit to emergency. The x-rays were of the chest, pelvis, left shoulder, right leg and right hand. There is reference to the claimant failing to attend a hand clinic appointment after his discharge.
5. The claimant's GP practice appears to be the Positive Health Group West Ryde. There are no pre-accident records. The notes[10] include the following:

(a) 17 January 2023 - the "discharge summary reviewed" and it was noted there was "very little information." The speed of the vehicle was said to be 50 kms pr hour. The plan was for a proper assessment. A letter from Dr Tang was sent to the emergency department of RPAH dated 17 January 2023 requesting a full trauma assessment;

(b) 23 January 2023 - the claimant had attended hand surgery and was complaining mainly of shoulder and chest discomfort with a slightly bruised right knee but no bruises on the left knee (it was aching). MRIs of both knees were recommended along with a left shoulder ultrasound;

(c) there is a certificate of fitness dated 24 January 2023 which suggests the date of the next attendance. It does not provide a diagnosis of any injury but notes the claimant had 20 drinks before the accident;

(d) 7 February 2023 - the next attendance notes the claimant had identified the driver and insurer, but he had not yet seen a physiotherapist and had ongoing right and left shoulder pain, ongoing chest pain, right and left knee pain and "experiencing back pain and neck". On this occasion a letter was written to Ms Michael seeking cognitive assessment and further requests for radiology were given, Panadeine Forte and Voltaren were prescribed.;

(e) 15 February 2023 the next attendance notes a claim number had been provided and the claimant had booked in for the MRI scans of his knees. He complained of chest pains and wanted an MRI of his chest;

(f) 1 March 2023 - MRI scans had been done, and the claimant was having ongoing pain and had no capacity to work;

(g) 13 October 2023 - Greenlight had referred the claimant to another doctor and his lawyer had recommended he see another doctor, but the claimant had returned to see Dr Tang. He also reported seeing a psychologist and pain medication specialist and was having ongoing issues with this right hand, right knee and was concerned about weight gain and memory concerns;

(h) 23 October 2023 - the claimant was said to be "finalising old work from last year, finishing off what he is able to do, last site visit was only 2 hours, he was supervising, unable to physically do much." The claimant was said to be using a friends' medicinal cannabis but was getting brain fog do did not want to get used to it. A referral to a psychologist and for nerve studies were given, and

(i) 14 November 2023 - the claimant complained of whole-body pain including his shoulders, back, knee and neck pain when he coughs. Palexia was prescribed.

1. Dr Yeoh, shoulder and knee surgeon wrote to Dr Coates on 28 April 2023.[11] He records the claimant having pain in the trapezial area of the right shoulder and difficulty sleeping and that there is pain in the left acromioclavicular joint. Dr Yeoh has a history of the right knee being "vaguely painful" and there was tenderness present in the left knee.
2. On examination he reports the range of motion and rotator cuff in both shoulders "is normal" and there was normal range of motion in both knees. He said the medial joint line tenderness present was consistent with a medical meniscus tear on the left.
3. Dr Yeoh reviewed the MRI scans and advised the claimant that all his injuries would heal "on their own" but recommended a cortisone injection in the left knee to minimise the symptoms with possible arthroscopic repair.
4. Dr Yeoh wrote again on 8 June 2023[12] when the claimant had not had the recommended left knee injection, and the right knee was causing more pain and collapsing. On

11 August 2023[13] Dr Teoh reported little progress and that the cortisone injection had not improved the claimant's position. His opinion was the claimant had a "non-surgical knee problem" and referred him to a sports physician. 5. Mr Calacoci, exercise physiologist wrote to Dr Coates on 18 July 2023. He notes poor compliance at the beginning "due to multiple cancellations and no shows." He says the claimant had made slight improvements but required further services. Mr Calacoci provided a final report to Dr Coates on 25 September 2023 after Mr Merhi completed 11 sessions. Mr Calacoci said there was again limited compliance with the program and gave the example that one day he turned up to the claimant's unit to find he had gone overseas without notice. 6. On 31 July 2023, Dr Mir wrote to Dr Coates with respect to managing the claimant's chronic pain. The claimant reported pain all over his body with dysesthesia and paraesthesia in his right hand after the surgery to remove the surgical wires. The claimant was taking pain killers "and uses cannabis to manage the pain." Dr Mir considered the claimant had symptoms of posttraumatic stress disorder. He recommended various scans, medication and referral to a psychiatrist. 7. An MRI of the claimant's cervical spine was performed on 23 August 2023 at the request of Dr Mir with a history given of "pai with radiation to bilateral upper limbs." There were mild disc bulges identified at C3-4 and C4-5. 8. Dr Mir wrote again to Dr Coates on 27 September 2023. He noted the report of the cervical spine MRI and referred the claimant to a neurosurgeon for further assessment. The results of the right-hand MRI raised the possibility of carpal tunnel syndrome and a referral for nerve conduction studies and neurological review was made. The bone scan results suggested a fractured right knee and an x-ray was recommended. In terms of the bilateral shoulder pain a nerve block was recommended. On 4 November 2023 Dr Mir wrote to Dr Coates advising that the claimant's pain was getting worse and Palexia was prescribed. 9. Dr Kassim, pain physician reported to Dr Coates on 27 November 2023. He has a report from the claimant that his main issue is neck pain, shoulder and thumb pain. The claimant reported "brain fog" from his brain injury with sleep issues and psychological symptoms. 10. Dr Kassim has a history of the claimant living alone with support from his parents and that he had returned to driving. The claimant was seeing a psychologist, was reluctant to trial antidepressants and was taking Palexia for pain and cannabis to help him sleep. 11. Dr Kassim diagnosed a "mild post traumatic concussion" and noted pain behaviours. He recommended the claimant see a psychologist for stress and anxiety management and that Mr Merhi be reviewed by a physiotherapist for balance and shoulder exercises. The claimant refused services at the pain clinic, preferring home visits from a local physiotherapist. He was advised to seek assistance from the traumatic brain injury clinic at Westmead. 12. Dr Al Khawaja, neurosurgeon wrote to Dr Mir on 5 February 2024 in respect of the claimant's neck and lower back pain. The claimant reported left shoulder and knee pain as well. Dr Al Khawaja says the claimant "does not have significant radiculopathy", had seen a pain clinic and was taking strong pain killers. On examination, neck movements were restricted and there was a positive Trendelenburg test on both sides, but sensation and reflexes were normal. Dr Al Khawaja reviewed the cervical MRI and the lumbar CT scan and advised injections at C3/4 and C4/5 and requested a thoracic and lumbar MRI scan. 13. The thoracic and lumbar spine MRI was performed on 13 February 2024 revealing lumbar spondylosis with disc desiccation and bulge at the L4/5 level with contact on the descending L5 nerve roots. There was also multilevel mild moderate facet joint arthropathy. 14. Dr Mir wrote to Allianz on 28 February 2024. He notes the claimant failed to attend for the nerve blocks. When asked about whether the claimant should have further exercise physiology or physiotherapy in the light of his alleged poor compliance (with attendances on Mr Calacoci) Dr Mir wrote "he has poor treatment compliance with our clinic as well." 15. Dr Mir, wrote to Dr Coates on 21 April 2024[14] at which review the claimant was complaining of neck pain radiating to the head, pain in both shoulders and referred pain in both limbs. The claimant also reported pain in both knees and right-sided hand pain. Nerve blocks were discussed and medication reviewed. 16. On 24 May 2024 Dr Kassim reported the claimant complained of persistent pain with no improvement. He reported ceasing physiotherapy because the insurer declined his therapy. He reported symptoms of brain fog, confusion, tiredness, balance problems and forgetfulness. He had seen a psychologist but not a psychiatrist or the brain injury team at Westmead. Dr Mir recommended referral to Dr Manambrakkat, psychiatrist. 17. On 30 June 2024 Dr Mir reported[15] that nerve blocks were done and had significantly improved pain and function in the left shoulder and medical branch blocks and occipital nerve blocks were recommended. Advice was also given about injections into the knees.

1. Dr Khan, general surgeon and musculoskeletal physician provided a report to the claimant's solicitors dated 27 February 2024. He has a consistent history of the accident and documents the claimant's treatment. Dr Khan reports the claimant has put on more than

10 kgs since the accident. 2. Dr Khan has a history that the claimant has not returned to work and that his mother and sister are providing him with domestic assistance. The claimant says he can only drive for short distances, cannot do housework and he does not go to the gym. 3. The claimant gave a history of a left shoulder operation 20 years before, an operation on his right fourth and fifth fingers when he punched a wall 15 years before but no previous motor accidents or workers compensation injuries. 4. The claimant's neck was examined and there is no dysmetria documented. There were no neurological deficits. Range of motion was reduced in both the right and left shoulders and there was a 10 degree lag in full flexion of the met phalangeal joint. 5. Lumbar and thoracic spine movement was restricted but there were no neurological signs. 6. Dr Khan diagnosed all of the claimant's alleged injuries (subsequently referred for assessment) and also said the claimant had developed chronic pain. 7. His impairment calculations were a combined total of 15% made up of:

(a) cervical and thoracic spine - 0%;

(b) lumbar spine - 5% (due to dysmetria);

(c) right upper limb - 5% UEI for the shoulder plus 2% UEI for the right thumb = 7% UEI which is 4% WPI;

(d) left shoulder - 4%;

(e) right knee - 0%, and

(f) left knee - 2%.

1. Dr Malhotra provided a report to the insurer dated 15 April 2024. It appears this report consists of a document review, and the claimant was not interviewed or examined. Dr Malhotra did have a discussion with Dr Tang. The main focus of this report and discussion was the claimant's attendance at, and lack of engagement with physiotherapy and his psychological issues. Dr Malhotra considered the claimant would, long term, be unable to return to his work and he should find an alternative source of work. He recommended exercise physiology to increase cores strength and reduce pain behaviours. He also recommended psychiatric review and vocational assessment.
2. Dr Malhotra completed a further report on 5 September 2024. He again reviewed the documentation and provided an update but, on this occasion, he consulted with the clamant. The claimant confirmed injuries to the left shoulder, neck, back, both knees and right hand.
3. The claimant complained of pain in the left shoulder radiating to the neck with movement. Nothing had improved and his back was getting worse. The claimant also reported pain in the back of the neck and over his left trapezius and that all movements trigger it. Mr Merhi reported intermittent tingling and numbness in the left hand.
4. Mr Merhi said he had cortisone injections in his cervical spine which did not improve his pain and that his mid and lower back are "always twitching" and pain was getting worse.
5. The claimant reported pain in his right thumb with activity and that both knees are painful in particular when walking up and down stairs.
6. The claimant said he was not disabled but just in pain all the time. He reported mood issues, depression and this is worse than his physical symptoms.
7. The claimant reported drinking a bottle of wine one to two times a week, smoking 20 cigarettes a day (five - six before the accident) and he smoked marijuana once a week for his pain. He said he had physical pain "all the time and cannot do anything due to the pain."
8. The claimant was examined.
9. Dr Malhotra has a conversation with Dr Tang who was at that time focussing on the claimant's psychological symptoms and there was a discussion about medication. There was agreement that the claimant was demonstrating pain focussed behaviours. He considered the claimant fit to work 30 hours a week in a sedentary role.
10. Ms Thomson, Rehabilitation Counsellor provided a report dated 18 March 2025 to the insurer's solicitors in relation to Mr Merhi's education, work experience and transferrable skills for the purposes of a vocational assessment. She identified four options including a technical sales representative, civil engineering draftsperson, manufacturing production manager and customer service representative.
11. Dr Malhotra provided a supplementary report to the insurer dated 30 April 2025 commenting on the claimant's fitness to work in the four types of jobs identified by Ms Thomson.

1. Medical Assessor Rapaport certified a dispute about radiology on 21 May 2024. The radiology in dispute was the MRI for the lumbar and thoracic spines.
2. Medical Assessor Rapaport has a history of the accident and the claimant's treatment. The claimant had a poor memory of being in hospital and what investigations he had. The Medical Assessor documents the history from the notes.
3. The claimant complained of low back pain, brain fog and poor memory and psychological symptoms. He reported left AC joint pain and swelling in the left shoulder, pain in both knees and pain in the right hand and difficulty gripping.
4. The Medical Assessor notes the claimant was able to fully undress and displayed no difficulty with his thoracic and lumbar spine movement when doing so. The spine was formally examined the range of motion in the thoracic spine was normal, there was crepitus in the left shoulder and there was normal range of motion in the lumbar spine. There were no neurological deficits recorded in the upper or lower limbs.
5. Medical Assessor Rapaport determined the radiological investigations were not related to the accident because he was not satisfied the claimant injured his thoracic and lumbar spines. He says:

"It is known that when a significant traumatic spinal column injury occurs, the pain associated with that injury is at its worse in the immediate weeks or several months following injury and there is a tendency for gradual improvement of that pain as time progresses and spontaneous healing occurs.

In the case of the subject claimant, the opposite seems to have occurred. There was some early pain mentioned only sometimes following injury and not found worthy of radiological investigation and then a crescendo effect where the further away from the traumatic event, the worse the pain seemed to be manifest. The explanation for that phenomenon that is counterintuitive to causation from a traumatic injury is that any pain that worsens more than one year following pedestrian motor trauma is most likely caused by underlying chronic degenerative disease."

1. The Medical Assessor found the radiology was not reasonable and necessary due to the causation issue but also because a SPECT bone scan did not find a "hot spot" in the spine after the accident. If an injury had occurred in the spinal column there would be a hot spot presence "signalling a healing inflammatory area ... where the injury had occurred".
2. Medical Assessor Leaver determined a dispute about ongoing left shoulder physiotherapy on 18 November 2024.
3. Medical Assessor Leaver has a history of the claimant's injuries including injuries to both shoulders. He also had a history of the treatment the claimant had, and Mr Merhi had reported he was experienced with strength and conditioning training, thought the exercise physiologist was inexperienced and giving him harmful exercises and as he was not in a good state he was not motivated.
4. He records the claimant complained of pain in the neck, upper trapezius region of the left shoulder, left upper arm and wrist, pain and paraesthesia in the left fifth finger. The claimant also complained of back pain radiating to the right buttock and pain in both knees. The clamant reported daily migraine and right thumb issues. The claimant had moved in with his sister as he said he needed help but was lonely, depressed and isolated.
5. On examination the claimant's right shoulder was normal or near normal but the left shoulder was restricted. Active movements of the neck were mildly restricted. There were no neurological abnormalities in the upper limbs.
6. Medical Assessor Leaver diagnosed a chronic acromioclavicular joint injury with subacromial impingement and general referred symptoms from the cervical spine. He also suggested the claimant had a chronic pain syndrome. He found the disputed treatment related to these injuries. In terms of reasonableness and necessity, Medical Assessor Leaver noted the explanation for the non-compliance with exercise physiology and considered the claimant had not had a trial of physiotherapy and should have it.
7. On 16 April 2025, Medical Assessor Canaris certified the claimant's psychological injury (posttraumatic stress disorder) had a WPI of 7%.
8. The Medical Assessor has a history of alcohol consumption and cigarette smoking (a pack a day) but no drug (such as cannabis) habit. The Medical Assessor has a history of the accident, but the claimant said he did not remember much about it.
9. The claimant reported constant pain in his shoulders, back, neck, knees and hips. Physiotherapy made it worse and he was taking Palexia for pain. He recalled the names of his medicines and what they were for (amitriptyline, quetiapine and Mini press but says he has flashbacks, nightmares and paranoia. He has seen three different psychologists and a psychiatrist but does not like talking to anyone and wants to stay in bed.
10. Medical Assessor Canaris diagnosed a posttraumatic stress disorder and while the claimant was pain focussed, he could not determine whether there was a somatic symptom disorder.
11. The Medical Assessor discounted pain when undertaking the assessment pursuant to the psychiatric impairment rating scale (PIRS) and made no adjustment for treatment affect.

RE-EXAMINATION FINDINGS - MEDICAL ASSESSOR GORMAN

1. Mr Merhi attended the re-examination on 12 December 2025 alone. He was pleasant throughout the re-examination but exhibited pain behaviours throughout. There was much grimacing and groaning with movement.

1. Mr Merhi is now 39 years of age. He lives with his sister and mother. He said they are looking after him.
2. He smokes 10 cigarettes per day. He hardly drinks alcohol now but there was a phase he said where he was drinking "too much" he stated.
3. He said he had an injury to his left shoulder 25 years ago and a motor vehicle accident. He said he had no ongoing problems with the left shoulder at the time of the accident.
4. At the time of the accident, he was working in medical fabric fabrication and has not been able to return to this work or any form of work.

1. Mr Merhi was struck by a motor vehicle on 15 January 2023. He said that he and his friend were on the footpath in front of an RSL Club. They were trying to book a ride share vehicle to go home. His friend had just been in an altercation with another patron at the RSL club. A man jumped in a car and drove at them to run them over.
2. Mr Merhi said he was knocked to the ground and was briefly unconscious. When he woke up the ambulance and police were already there treating him. As ambulance arrive 12 minutes after they were called and there is no suggestion Mr Merhi was unconscious for 12 minutes, it is likely he is talking about the police and off duty nurse who first attended to him.

1. Mr Merhi reported immediate neck and shoulder girdle pain (both sides), pain in the mid back and low back pain as well as pain in both knees and pain in the right thumb.
2. He was taken to RPAH and discharged home the next day. I note while there were complaints of neck and lower back symptoms to ambulance personnel there were no complaints of neck or back pain recorded in the RPAH notes.
3. Investigations at the hospital confirmed the presence of a fracture to the first metacarpal in the region of the right thumb and this was internally fixed with K wires. His hand was put into a cast and his arm in a sling. No other fractures were detected.

1. Mr Merhi reported ongoing pain and said he was referred to Dr Mir, a pain specialist who performed injections into the left shoulder. This did not improve his symptoms. Mr Merhi did not return for follow-up and further procedures proposed by Dr Mir.

1. Mr Merhi said that he is getting worse both mentally and physically. He said none of his injuries have improved or recovered and none of the treatment he has had has been beneficial.
2. His back and knees are bad he said. He gets a sharp feeling in his knees when he walks downhill and downstairs and as a result he needs to walk sideways. He said his lower back is "really, really, really bad". He says his legs feel heavy and they "tingle". He needs to lift them up and hit them when this happens.
3. He says he gets low back pain when he looks up. He reported being unable to sit for more than 10 to 20 minutes.
4. He has trouble sleeping.
5. He says he cannot put any pressure on his right hand.
6. His left shoulder is stiff and painful.
7. When asked he did not report any problems with his right shoulder and did not make any complaints of neck or thoracic spinal pain as at the date of the re-examination.

1. He has his medications in a Webster pack. He is taking the following medications -

(a) Palexia 150 mg twice daily slow release;

(b) Palexia 50 mg immediate release one to two per day;

(c) Nurofen on occasions;

(d) Duloxetine 60mg daily;

(e) Quetiapine 25mg daily, and

(f) Minipress 5mg nocte.

1. Mr Merhi says he sees a psychiatrist once a month for medication. He used to see a psychologist but did not want to talk very much so stopped seeing him.
2. Mr Merhi said he has stopped all forms of physical therapy because it made his pain worse. He does not do any exercise at all any more he said, "because I can't".
3. He has developed haemorrhoids and anal fissures and says he is booked for surgery to have these repaired.

1. Mr Merhi is 175cm tall and he weighed 108.4 kg. This suggests Mr Merhi is overweight with a body mass index (BMI) in the obese range. He looked generally depressed and deconditioned and certainly not like a gentleman who used to go to the gym and work out most days of the week (as he has reported he did).
2. Mr Merhi is right hand dominant.

1. On examination Mr Merhi complained of tenderness in the neck on palpation.
2. The range of motion in the cervical spine was measured three times. There was no dysmetria:

(a) flexion and extension were reduced by one quarter;

(b) lateral rotation was reduced by one quarter on both sides, and

(c) lateral flexion was reduced to three quarter range of motion on both sides.

1. There was no guarding or muscle spasm observed.
2. Power, sensation and reflexes in the upper limbs were normal.
3. Foraminal compression testing was negative.
4. There was no obvious atrophy or wasting of any of the muscles of the upper limbs. The measurements reproduced in the table below show a minor difference in the upper arm which is not clinically significant and is accounted for by the claimant's right-hand dominance.

1. The range of motion in the thoracic spine was observed with three repetitions:

(a) flexion and extension were normal, and

(b) rotation, both left and right were normal.

1. There was no tenderness, guarding or spasm and no complaints made of radiating symptoms or sensory change around the chest.

1. Mr Merhi indicated that where he had pain if he sat for too long over the midline of the lower back at the belt line. He said he would get low back pain if he looked up. When asked he did not describe any radiating pain or pain in his lower limbs, he described his lower limbs as feeling heavy but said they were not painful. In terms of the tingling it was a general and vague complaint and could not be localised to an appropriate nerve root distribution.
2. There was no dysmetria. Mr Merhi's range of motion was recorded as follows:

(a) flexion and extension were both reduced to three quarters of normal, and

(b) lateral flexion on both sides was reduced by one quarter.

1. There was no guarding or muscle spasm or tenderness on palpation.
2. Power, sensation and reflexes in the lower limbs was normal. Straight leg raise (sciatic stretch test) was negative.
3. There was no obvious muscle atrophy or wasting of the lower limb and the recorded measurements below indicate a small difference between left and right legs which in my view is not clinically significant.

1. There was no obvious muscle atrophy or deformity in either shoulder. There was marked restriction in shoulder movement which was variable in all units of movement across the three repetitions. The maximum range of motion I was able to elicit during the formal part of the examination is reproduced below.

1. I put to Mr Merhi that his movements were inconsistent within the examination, and he said that was because pain was variable. I put to him that the range of movement demonstrated in flexion and abduction, in particular, was much worse than recorded by other examiners such as when he saw Dr Yeoh and Medical Assessor Bodel. Mr Merhi said that this was because his shoulders were "getting worse" with time and he was experiencing more pain.
2. All Mr Merhi's movements in both elbows, wrists and in the digits of each hand were normal. When I asked where the source of the pain was in his right hand, he indicated pain over the right thenar eminence (beneath the pad between the wrist and the base of the right thumb). He was not tender over the base of the thumb which Medical Assessor Bodel had noted and where his injury occurred.

1. Mr Merhi's gait was normal with no limp evident as he moved in and out of the examination room or around the examination room.
2. He had a range of knee movement with the best range of motion obtained as follows:

(a) on the left from 0 to 90 degrees, and

(b) on the right 0 to 110 degrees.

1. The restricted extension Medical Assessor Bodel recorded was no longer present. The variation in range of motion compared to Dr Yeoh and Dr Bodel was put to the claimant and he said this was because the level of his pain has varied and his knees have got worse.
2. There was no crepitus in either knee, no effusion and he gave no history of weakness, giving way or any recent falls. The range of motion appears inconsistent with the minor undisplaced fracture shown in the radiology.
3. There was normal range of hip, ankle and hindfoot movements on both sides.

1. During the physical examination Mr Merhi showed marked "pain behaviours" grimacing, grunting and groaning. The inconsistency and variability of knee and shoulder motion has already been noted. His assertion that none of his injuries have improved and that all are getting worse is not, in the clinical judgment of the Medical Assessors the usual pattern of injury and recovery. The extent of his complaints does not appear to be consistent with the minor pathology evident on scans and the injuries received.
2. Mr Merhi was able to get on and off the examination couch without difficulty. He was observed to walk around the examination room without a limp. He was able to sit throughout the history taking part of the examination for over 30 minutes. There were few if any objective signs of injury to his cervical, thoracic or lumbar spine.
3. The claimant said he was largely inactive and no longer attends the gym. He does not work and is helped around the house by his family. This level of inactivity and resultant deconditioning along with his weight could be the explanation for the worsening range of motion in his shoulders and knees.

(a) MRI bilateral shoulder, Medscan Imaging dated 21 February 2023, reported by Dr Ankur Srivastava. In the left shoulder there was a high-grade partial thickness rupture of the superior AC joint capsule and low-grade partial thickness rupture of the inferior AC joint capsule. Grade 2 marrow contusion in the lateral distal clavicle without discrete fracture. Grade 2 sprain of the coracoclavicular ligaments. Overall findings are in keeping with a Rockwood type 3 AC joint injury. Mild supraspinatus tendinosis with low grade intrasubstance tear in the posterior tendon. In the right shoulder there was mild subacromial subdeltoid bursitis. No rotator cuff tendon tear could be seen;

(b) MRI bilateral knees, Medscan Imaging dated 21 February 2023, reported by Dr Ankur Srivastava. In the left knee it was reported there was a small micro-trabecular fracture and low-grade marrow oedema anterolateral aspect of the tibial plateau. Horizontal oblique undersurface tear of the posterior body and posterior horn of the medial meniscus. Partial discord lateral meniscus without a discrete tear. No cruciate ligament injury. In the right knee it was noted there was a small impacted nondisplaced fracture of the fibular head. Grade 1 marrow contusion in the lateral tibiofemoral compartment and medial femoral condyle. No loose osteochondral defect. No meniscal or cruciate ligament injury.

(c) The whole-body bone scan with SPECT dated 23 August 2023 was reported by Dr Tew as showing a possible fracture in the right fibular head / neck. X-rays were recommended. Moderate activity in the right wrist and right fourth metacarpal base ? reactive ? infection. MRI was requested. Mild T1, T2 facet arthrosis. Bilateral sacroiliac joint mechanical changes.

1. The insurer has raised causation of injury as an issue, in particular with regards to the claimant's back and right shoulder injury.
2. The Panel notes the test of causation set out in cls 6.5 - 6.7 of the Guidelines requires consideration of two questions:

(a) could the accident have caused or contributed to the claimant's injuries and impairment, and

(b) did the accident in fact cause or contribute to the claimant's injuries and impairment.

1. There is very little factual material concerning the mechanics of the accident. The claimant was a pedestrian, and the insured is said to have deliberately driven at him (and his friend). The hospital notes include a history of the vehicle being driven at a speed of 50 kms per hour. It is the clinical judgment of the Medical Assessors that at a speed of 50 kms per hour a motor vehicle can inflict significant damage upon the human body and therefore Mr Merhi's accident could have caused injuries to the claimant's spine (cervical, thoracic and lumbar), his two shoulders, right thumb and both knees as alleged.
2. The question of whether the accident did in fact cause or contribute to the claimant's injuries requires a consideration of the records, in particular the contemporaneous records and the history given by the claimant. The insurer's submissions assert there is no contemporaneous evidence of any spine or right shoulder injury.
3. The Panel notes the ambulance report refers to complaints of pain in the neck, back, left shoulder, right knee, base of right thumb and an injury to the head. Hospital records have complaints of head pain, chest pain, left shoulder pain and right knee pain and various abrasions. The neck and back were examined but were not tender.
4. Mr Merhi complained to his GP on 7 February 2023 of back pain and neck pain as well as pain in both the right and left shoulder and right and left knee and radiology was requested of all these areas. The claim form completed on 10 February 2023 refers to the fractured thumb and injuries to both shoulders and knees, the chest, head, lower back and neck.
5. On the basis of these notes, and the ambulance and hospital records the Panel accepts that within four weeks of the accident the claimant was complaining of pain to the various parts of his body that he now says were injured. His GP was concerned and requested radiology of both shoulders and both knees later in February 2023. It is the clinical judgment of the Medical Assessors that radiology would only be requested by a treating practitioner if there were complaints of injury to or symptoms in those areas.
6. The Panel is therefore satisfied that the claimant sustained injuries to his:

(a) cervical spine (mentioned to ambulance);

(b) thoracic spine (while not mentioned in ambulance records radiology was performed of the thoracic spine at hospital suggesting complaints must have been made);

(c) lumbar spine (mentioned to ambulance);

(d) left shoulder (complained of in ambulance, hospital and GP records);

(e) right shoulder (referred to in first certificate of fitness);

(f) right thumb (no dispute - fractured);

(g) left knee (relatively early radiology and in claim form), and

(h) right knee (mentioned in ambulance and hospital).

What is the diagnosis of the injuries caused by the accident?

1. The Medical Assessors are of the view that the injuries caused by the motor accident are diagnosed as follows:

(a) cervical spine - soft tissue injury to the cervical spine, likely recovered due to the absence of a "hot spot" on the bone scan taken seven months after the accident;

(b) thoracic spine - soft tissue injury to the thoracolumbar spin, likely recovered due to absence of any current complaints;

(c) lumbar spine - soft tissue injury to the lumbosacral spine likely recovered due to the absence of a "hot spot" on the bone scan of August 2023;

(d) left shoulder - soft tissue injury to the left shoulder causing rupture of the acromioclavicular joint capsule and rupture of ligaments;

(e) right shoulder - soft tissue injury but no joint involvement;

(f) right thumb - fracture of the base of the metacarpal of the right thumb;

(g) left knee - undisplaced fracture of the tibial plateau and medial meniscal tear as diagnosed by the treating surgeon Dr Yeoh, and

(h) right knee - impacted fracture of the head of the fibula as diagnosed by the treating surgeon Dr Yeoh.

1. It is now almost three years since the accident. Mr Merhi is not having any specific treatment for his physical injuries. While he is deconditioned due to inactivity and would improve with active physical therapy, the claimant has declined further treatment due to his belief it has worsened his condition not improved it. He is therefore stable and it is appropriate to assess his WPI as it is the clinical judgment of the Medical Assessors that the degree of his impairment will not change by more than 3% over the next 12 months.
2. The Panel notes that the legislation required an assessment of the impairment resulting from the injury caused by the accident. The Guidelines require the assessment of impairment to be undertaken as the claimant presents on the day of the assessment, that is the day of the re-examination by Medical Assessor Gorman.

1. Assessment of the spine requires consideration of Chapter 3 of AMA 4 Guides. The Guidelines permit only the diagnostic related estimate (DRE) method of assessment (cl 6.111).
2. The spine is divided (cl 6.131) into three regions:

(a) cervical;

(b) thoracic, and

(c) lumbar.

1. If injury to the spine is alleged, then each of the regions is assessed and the percentage impairments combined to obtain a total spinal impairment (6.131). If there are multiple impairments within one spinal region the impairments are not combined but the highest rating category is chosen (6.132)
2. There are five diagnostic related categories (DRE) and the DRE descriptors from pages 102 - 107 of the AMA 4 Guides as amended by Table 6.7 and clauses in the Guidelines apply to help determine which DRE category is the correct one. There are neurological differentiators (for example radicular symptoms versus radicular signs) and structural inclusions (for example vertebral fractures) to be considered. There is no allegation in Mr Merhi's case and no evidence of any fractures of any part of his spine.
3. The first category is DRE category I which is selected if there are symptoms which may include pain.
4. A finding of DRE II requires there to be:

(d) pain with guarding, or

(e) non-uniform range of motion (dysmetria), or

(f) non-verifiable radicular complaints defined in table 6.8 as:

(i) symptoms (shooting pain, burning sensation, tingling), which

(ii) follow the distribution of a specific nerve root, but where

(iii) there are no objective clinical findings such as loss or diminished sensation, loss or diminished power or loss or diminished reflexes

1. A finding of DRE III requires radiculopathy to be found which is defined in cl 6.138 as "the impairment caused by dysfunction of a spinal nerve root or nerve roots" and where there are two or more of five clinical signs found on examination. The signs are:

(a) loss or asymmetry of reflexes;

(b) positive sciatic nerve root tension signs;

(c) muscle atrophy and/or decreased limb circumference;

(d) muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution, and

(e) reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.

1. The Panel is satisfied the claimant's soft tissue cervical spine injury should be assessed as DRE I on the basis the claimant says he has pain in the neck and there was tenderness when examined by Medical Assessor Gorman.
2. Mr Merhi does not qualify for a DRE II assessment as there is no guarding, no dysmetria and no complaints were made of radiating radicular pain at the re-examination with Medical Assessor Gorman. He does not qualify for a DRE III assessment as he did not display any of the five signs of radiculopathy at the re-examination.

1. The Panel notes Mr Merhi did not complain to Medical Assessor Gorman of any symptoms in the mid back or thoracic spine area.
2. The Panel is of the view the claimant has no assessable impairment in this area and that any injury to the thoracic spine appears to have resolved.

1. The Panel is satisfied the claimant's soft tissue lumbar spine injury should be assessed as DRE I on the basis the claimant reports pain in the lower back.
2. Mr Merhi does not qualify for a DRE II assessment as there is no guarding, no dysmetria and no complaints were made of radiating or radicular pain at the re-examination with Medical Assessor Gorman. The complaints of tingling were general and did not follow an appropriate spinal nerve root distribution. The Panel also notes Mr Merhi does not qualify for a DRE III impairment as he did not display any of the five signs of radiculopathy at the re-examination.

1. The assessment of upper extremity impairment (UEI) is governed by Chapter 3, section 3.1 of the AMA 4 Guides. The upper extremity is divided into four regions: the shoulder, the elbow, the wrist and the hand. There are specific rules for combining certain impairments and adding others. Regional impairments such as the hand and wrist impairments are combined to obtain a total UEI which is then converted to a WPI using Table 3 on page 20 of AMA 4.
2. There are several methods of assessment:

(a) amputation (part 3.1b);

(b) sensory loss of the digits (part 3.1c);

(c) abnormal range of motion (part 3.1d);

(d) peripheral nerve disorders (part 3.1k);

(e) vascular disorders (part 3.1l), and

(f) other disorders (part 3.1m).

1. As Mr Merhi has a restriction in range of shoulder motion, the usual method of assessing shoulder impairment is in accordance with part 3.1d. This requires the measurement of six units of motion:

(a) flexion and extension;

(b) abduction and adduction, and

(c) internal and external rotation

1. Measurement of motion is done using a goniometer and only active motion (not passive) is measured. Each of the six UEI figures is added to get a total UEI percentage impairment.
2. The Guidelines note the potential difficulties with the range of motion method recognising at cl 6.50 that range of motion can be subject to variation due to pain or the lack of cooperation by the injured person. The Guidelines provide that range of motion is assessed as follows:

(a) a goniometer should be used where clinically indicated;

(b) passive range of motion may form part of the clinical examination to ascertain clinical status of the joint, but impairment should only be calculated using active range of motion measurements;

(c) if the Medical Assessor is not satisfied that the results of a measurement are reliable, active range of motion should be measured with at least three consistent repetitions;

(d) if there is inconsistency in range of motion, then it should not be used as a valid parameter of impairment evaluation (see clause 6.40 of these Guidelines), and

(e) if range of motion measurements at examination cannot be used as a valid parameter of impairment evaluation, the Medical Assessor should then use discretion in considering what weight to give other available evidence to determine if an impairment is present.

1. In Mr Merhi's case there was inconsistency observed by Medical Assessor during the course of the re-examination and a variation from the measurements obtained in previous examinations. In particular the Panel notes that the claimant had a normal range of motion in both shoulders when the claimant was examined by his treating surgeon Dr Yeoh in

April 2023. It is the Medical Assessors' views that the worsening range of motion is likely due to the claimant's inactivity, deconditioning and possibly his depressive state. While the extent of the restricted range of motion is not directly resulting from the frank injuries sustained, the consequences of the injuries to his shoulders have led to the inactive and deconditioned state. Therefore, it is the Panel's view that the injuries have had a more than negligible contribution to the development of the impairment.

1. The Medical Assessors are satisfied that Mr Merhi sustained an injury to the left shoulder causing rupture of the acromioclavicular joint capsule and rupture of the coracoclavicular capsule and ligaments and that he had a normal range of motion in April 2023 when examined by Dr Yeoh. The claimant's range of motion was more restricted when examined by Medical Assessor Gorman than when he was examined by Medical Assessors Leaver and Bodel. Medical Assessor Gorman noted the range of shoulder motion was variable within the assessment which the claimant said was due to pain. The Medical Assessors also note there was no evidence of muscle atrophy in or around the shoulders which would be expected with long term restriction of motion to the extent demonstrated at the re-examination.
2. Due to this inconsistency, it is therefore the Panel's decision that the range of motion method cannot be used for impairment assessment in Mr Merhi's case.
3. The injury to the acromioclavicular joint is noted. The acromioclavicular joint contributes, in accordance with Table 18 at page 58 of the AMA 4 Guides, 25% of the upper extremity function. A condition that is analogous to the claimant's ruptured capsule and ligaments would produce constant crepitations during active range of motion. The Panel therefore proposes to assess impairment based on this analogous condition and accepts the claimant has a 20% impairment to the joint (see Table 19 at page 59) which results in an UEI of 5% which translates to a 3% WPI using Table 3 at page 20 of AMA 4.

1. Mr Merhi's range of motion was better than on the left but was also variable at re-examination and differed from previous assessments. Dr Yeoh reported a full and complete range of motion in April 2023 and Medical Assessor Leaver found a near full range of motion in the right shoulder.
2. Because of the inconsistency and variation, as with the left shoulder the Panel is of the view the range of motion method cannot therefore be used.
3. A condition that is analogous to the claimant's soft tissue shoulder injury would produce some crepitation during active range of motion. The Panel therefore proposes to assess impairment based on this analogous and mild condition and accepts the claimant has a 10% impairment to the joint (see Table 19 at page 59) which results in an UEI of 2.5% which is rounded up to 3% UEI which translates to a 2% WPI using Table 3 at page 20 of AMA 4.

1. The claimant sustained a fracture of the base of the metacarpal of the right thumb. Three days after the accident he had surgery and wires were inserted to fix the fracture. These wires have been removed.
2. It is the clinical judgment of the Medical Assessors that range of motion is the most appropriate method of assessment for this injury.
3. At the re-examination by Medical Assessor Gorman there was a normal range of motion in both thumbs (and all of his fingers) and no tenderness over the base of the thumb at the site of the fracture (although there was tenderness elsewhere in the right hand).
4. It appears the claimant has fully recovered from the right thumb injury and the Panel is satisfied there is a 0% WPI resulting from the right thumb fracture.

1. The assessment of lower extremity impairment is governed by Chapter 3, section 3.2 of the AMA 4 Guides. There are 13 methods of assessment provided for as follows:

(a) limb length discrepancy (3.2a);

(b) gait derangement (3.2b);

(c) muscle atrophy (3.2c);

(d) manual muscle-testing (3.2d);

(e) range of motion (3.3e);

(f) joint ankylosis (3.2f);

(g) arthritis (3.2g);

(h) amputations (3.2h);

(i) diagnosis-based estimates (3.2i);

(j) skin loss (3.2j);

(k) peripheral nerve injuries (3.2.k);

(l) causalgia and reflex sympathetic dystrophy (3.2l), and

(m) vascular disorder (3.2m).

1. Each limb is assessed and each injury (if there are multiple injuries in each limb) is assessed separately. Clause 6.70 and table 6.5 of the Guidelines states which of the above methods can and cannot be combined and table 6.6 provides guidance is selecting the most appropriate method. The Guidelines at cls 6.76 to 6.110 provides specific interpretation and guidance on the various methods of assessment.
2. Mr Merhi has had injury to his knees (as diagnosed by Dr Yeoh) and has discomfort in his knees.

1. The claimant sustained an undisplaced fracture of the left tibial plateau and a medial meniscal tear. The undisplaced tibial plateau fracture attracts a 2% WPI as set out the Diagnostic Related Estimates (DRE) in Table 64 on page 85 of AMA4.
2. The range of left knee flexion demonstrated to Medical Assessor Gorman (0 - 90 degrees) was less than Medical Assessor Bodel recorded (flexion to 120 degrees) and the normal range of motion recorded by Dr Yeoh. The loss of left knee flexion to 90 degrees is considered a mild impairment according to table 41 and attracts a 4% impairment. This impairment cannot be combined with the DRE assessment of 2% (see cl 6.74 and Table 6.5 of the Guidelines) and the highest rating of the two should ordinarily be chosen (see cl 6.70 of the Guidelines).
3. The claimant exhibited many pain behaviours throughout the re-examination and said his range of motion varies because of his pain which is getting worse. Clause 6.38 provides that a separate allowance for permanent impairment due to pain cannot be included in an assessment. It is the Medical Assessor's view that the claimant's deterioration in range of motion in the knee is not directly resulting from the injury caused by the accident but is a result of his likely depressive state, inactivity and associated stiffness. Clause 6.84 in respect of the lower limb is similar to cl 6.50 for the upper limb. The Panel is not satisfied therefore that the range of motion is a reliable measure of the claimant's impairment and that the 4% figure should not be accepted.
4. The Panel is satisfied that the claimant has an impairment and that the degree of the impairment is 2% associated with the DRE for an undisplaced tibial plateau fracture.

1. The claimant sustained an impacted fracture of the head of the right fibula. There is no prescribed impairment for such a diagnosed fracture in the list of diagnosed disorders in Table 64.
2. As the claimant is able to flex up to 110 degrees (the same degree achieved when examined by Dr Khan) and has no reduction in extension, there is therefore no assessable impairment under the range of motion model.
3. It is the clinical judgment of the Medical Assessors that there is no other method of impairment assessment that would result in a percentage impairment.
4. The Panel is satisfied that while the claimant did injure his right knee, he has no assessable impairment today.

1. The claimant's impairment in relation to the alleged injuries is as follows:

(a) Cervical spine - DRE I = 0%;

(b) Thoracic spine - no assessable impairment;

(c) Lumbar spine - DRE I = 0%;

(d) Left shoulder - 3% (by analogy);

(e) Right shoulder - 2% (by analogy);

(f) Right thumb - 0%;

(g) Right knee - no assessable impairment, and

(h) Left knee - DRE 2%.

1. The total WPI is 7% which is not greater than 10%. If the range of motion in the left knee impairment (4%) was to be adopted instead of the DRE impairment (2%) then as the greater of the two would have to be used the claimant's WPI would be 9% and not 7% which would still be a WPI of not greater than 10%.
2. As the Panel has come to a different conclusion to the original Medical Assessor, it follows therefore that Medical Assessor Bodel's certificate must be revoked.

Attachment A: Shoulder range of motion comparison

[1] The current maximum as of October 2025 is $691,000.

[4] Section 7.21. The current version of the Guidelines is Version 10.1.

[5] The numbers in square brackets are a reference to the section number in the Medical Assessor's reasons.

[6] The numbers in square brackets are a reference to the paragraph number in the submissions.

[8] Normal is 15. The GCS is a neurological tool that indicates a person's level of consciousness,