REVIEW PANEL ASSESSMENT OF TREATMENT AND CARE - CAUSATION

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

1. The Review Panel confirms the certificate dated 29 January 2025.

1. On 10 December 2022, Adolf Meyer (the claimant), was involved in a serious motor accident about 11.10am on the Central Coast highway at West Gosford. His vehicle was struck at high speed by one of two other vehicles that were drag racing. The claimant was trapped in his vehicle which rolled and came to rest on a bus shelter. Ambulance and Police Officers attended. The claimant was extricated from his vehicle and transported to John Hunter Hospital by air ambulance. The claimant sustained multiple life threatening injuries and may have sustained a mild traumatic brain injury. Both of the other drivers involved in the incident were convicted.
2. Allianz Insurance Australia Limited (the insurer) indemnifies the owner and/or the driver of the at-fault vehicle for liability to pay to the claimant any damages under the Motor Accident Injuries Act 2017 (the Act). The claimant made an application for statutory benefits. The insurer declined liability for ongoing travel reimbursements, home care services and Lite-n-Easy home delivery meal expenses, on the basis that those reimbursements were not reasonable and necessary, for the purposes of the Act. That decision was confirmed by the insurer upon internal review.

1. As there is a dispute between the parties about:
   • whether any treatment and care relate to an injury caused by the accident under Schedule 2, cl 2(b) of the Act, and
   • whether any treatment and care provided is reasonable and necessary in the circumstances under Schedule 2, cl 2(b) of the Act,

the claimant was referred to Medical Assessor Ian Cameron for assessment.

1. Medical Assessor Cameron certified on 29 January 2025 as follows:

• ongoing home care services;
• ongoing lite-n-easy meals reimbursements; and
• ongoing travel reimbursements,

RELATES TO THE INJURY caused by the motor accident.

• ongoing home care services;
• ongoing lite-n-easy meals reimbursements; and
• ongoing travel reimbursements,

IS REASONABLE AND NECESSARY in the circumstances will be determined by the Occupational Therapist appointed by the Personal Injury Commission.

1. The insurer sought a review of Medical Assessor Cameron's certificate on the basis that the assessment was incorrect, within the meaning of s 7.26 of the Act, in a material respect. The insurer brought the application within the time prescribed by s 7.26(10)(a) of the Act and cl 34 of Procedural Direction PIC 7 (28 days).

The insurer submits that there are five material errors in Medical Assessor Cameron's certificate and determination which it particularises as follows:

The insurer notes there were three disputes referred for assessment, being carer services, travel expenses for the claimant's daughter and food expenses. The insurer submits that the Medical Assessor failed to provide any path of reasoning as to how each of the disputed treatments was causally related to the accident. The insurer says that the Medical Assessor stated a conclusion that causation was established without providing an explanation for that conclusion.

The insurer submits that causation is not established or explained in relation to reimbursement for the daughter's travel to see her father. The insurer says that the Medical Assessor does not mention Emma's travel at all in his certificate. The insurer notes that the Medical Assessor acknowledged that the claimant drives regularly to the shops and the club with a 35 km radius restriction on his driver licence. Accordingly, so the insurer submits, there was no need for the daughter to provide transport for her father. The dispute was in relation to the daughter's travel. The insurer submits a daughter's choice to visit her father, who is living and driving independently, is not causally related to the accident, nor compensable. The insurer submits that the Medical Assessor provided no path of reasoning for his conclusion that the daughter's travel expenses are causally related to the accident.

In its submissions to the Medical Assessor, the insurer contended that, prior to the accident, the claimant had both a cleaner and lawn mowing services. However, the Medical Assessor obtained an inconsistent history from the claimant, that "he was completely independent prior to the motor vehicle crash". The insurer submits that the Medical Assessor failed to put that inconsistency to the claimant. The insurer says the inconsistency related directly to the treatment dispute, particularly how the provision of carer services was causally related to the accident, in circumstances where the claimant was already receiving those services. The insurer notes the Medical Assessor made no findings regarding causation of additional services, if any.

The insurer submits that the Medical Assessor provided no path of reasoning as to how the provision of Lite-n-Easy meals is causally related to the accident, in circumstances where the claimant can drive and purchase pre-prepared nutritious meals of his liking.

The insurer submits that the Medical Assessor did not address the controversy regarding whether any of the treatment, and specifically the carer services, were causally related to the claimant's cognitive decline, rather than the subject accident. The insurer submits the Medical Assessor did not provide a path of reasoning as to why the accident caused the need for the treatment in dispute and not the underlying neuro-degenerative process. The insurer says the claimant's decline in cognition is in issue and that the Medical Assessor did not provide a path of reasoning as to why he concluded this was caused by the accident, when there was inconsistency from the claimant's daughter and the evidence.

1. The insurer's review application was opposed by the claimant on various grounds. It is not necessary to repeat those submissions in detail as they were not accepted by the President's delegate. The claimant is represented by his daughter Emma who has provided photographs of the accident scene, her father in hospital and lengthy commentary in relation to the matters in issue. Briefly, the colour of those submissions can be gauged from the following extract:

"Given the stress this accident has put my father through along with the severity of the accident and injuries caused to a man who previously lived independently and had never had an operation in his life, it has left me shocked in belief that again, we are going through more assessments after several OT/DR/specialist appointments and disputes if he should be receiving his little home care received - 5 hours a week from carer (equates to less than an hour a day), my weekly care visits, doctor/specialist/hydro kms paid, - which are essential since the accident and his Lite-n-Easy meals which were suggested by the original OT Assessor from Allianz. Photos share the severity of the accident, along with the injuries he suffered. I again stress prior to being hit by two drag racers at 148 km/p and his car rolling, my father had never had an operation in his 86 years prior. The extent of the multiple operations, broken back and hit to his head (shown in the images provided whilst in a coma) all documented by John Hunter Hospital, specialists and GP's is evidence alone the effect overall this has had on my father. As noted, the delirium/trauma and months of rehab along with the pain and put on antidepressants has been an incredibly hard process for my father to endure. He has lost interest in many things from living an independent man, no care prior to the accident, did own garden, cooking, cleaning - he has not had an ongoing cleaner prior to the accident. The pain from this accident he lives with daily, he has suffered since the hit to his head in the accident - this is in Dr Hall's reporting - affect to his hand mobility and strength - he can no longer use utensils as prior (photos of hand provided and noted in OT assessment). He does drive locally which gives him the freedom to cope with not being able to do much - it is as noted restricted - he is feeble of main roads since the severity of his accident understandably.

It must be noted - it was advised when I was going to and from Dad's for care, I was to submit travel expenses which has been the case given I have to go up each week to care for Dad. This is to help him over a 24 hour period. A carer to do this would be so incredibly costly that one I would not have considered asking for this and wanted to be with my father so caring for him since the accident has been 100% necessary for his support, checking in on him as he is a falls risk due to his low dynamic balance since the accident. With me caring, it also ensures he is eating as his loss of appetite has decreased significantly, loss of weight significant and his will to cook has gone.

The Lite-n-Easy has been a saviour as he went alone at lunch or dinner will go to the freezer, able to heat up the meals that are delivered and heats them up easily without any pain. It ensures he is getting the protein needed as doctors advised when discharged - build up protein. If left to Dad now to east, he will just make toasts. All desires and interest along with his loss of mobility and hand strength to cook has gone since the accident.

On the days I am there to check on Dad - I ensure I do some cooking, ran errands, attend all appointments, blood tests, drive him longer distances or when he is not able to drive due to his nerves to get behind wheel, it is also a time when I stay with him to ensure he is uplifted with games, motivation to keep going and to improve his mood not to just rely on the antidepressant provided. Given the trauma of the accident, the doctor recommended to keep him on the antidepressant medication introduced at Brisbane Waters Hospital.

The carer if you look at it, is less than one hour a day. There is 24 hours in a day that he does need assistance and caring for. There are areas in his garden he is unable to now get to as it is too steep, he used to do all of the gardening himself, he had all of the necessary tools, hedges, whippersnapper to do the hedging, lawns and when it got too much.... The block is over 1,000 square metres so it was a lot to manage. He is very unstable on his legs walking, relies on his cane full-time now, he has had around five falls post-accident and regularly comments how he will never be the same, feel the same or walk the same, which gets him down a lot... He no longer has the mobility previously had to bend and make his bed and clean, etc. He also used to clean his windows, do vacuuming - he now does not have the strength.

Again, prior to the accident to confirm, there was no ongoing cleaner, no one to do his bedroom, cooking, gardening, he would do all of this and drive with no restrictions and shop/carry heavy things wherever and whenever he liked.

It is not true he was receiving care prior to the accident. Dad again was not receiving any age care package from NSW Health prior to the accident.... The insurer submits the daughter's choice to visit her father, who is living and driving independently, is not causally related to the accident nor compensable. Yes, it is my choice to visit Dad each week, it is essential and required as I care for him since the accident as he is not able to live completely independent post the accident..."

1. President's delegate, Melinda Drew, issued a Determination of an Application for Review of a Medical Assessment on 14 March 2025 which stated the satisfaction of the President's delegate there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect. The basis of that decision was stated to be the grounds for review and particulars set out in the insurer's review application. The President's delegate was satisfied there is a reasonable cause to suspect that the Medical Assessor may not have provided adequate reasons or "any path of reasoning as to how each of the disputed treatments was causally related to the accident", as he was required to do.
2. Accordingly, the review application was accepted and was referred to the Panel, which is to reassess all of the treatment disputes referred to Medical Assessor Cameron, as previously identified.

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

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

"6.5 An assessment of the degree of permanent impairment is a medical assessment matter under cl 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical Assessors must be aware of the relevant provisions of the AMA 4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.

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

Causation means that a physical, chemical or biological factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:

1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contributed to the worsening of the impairment, which is a non-medical determination.

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

6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes."

1. In Briggs v IAG Limited t/as NRMA Limited.[4] See also Insurance Australia Limited t/as NRMA Insurance v Trkulja [2023] NSWSC 956,[5] his Honour Justice Wright stated at (35):

"The question of causation of injuries was not dealt with in Part 5 of the Guidelines but causation was addressed in Part 6, which related to assessment of permanent impairment. There is no reason to think that different principes were intended to be applied when a medical assessment was being made in relation to causation of minor injuries."

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

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

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

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

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

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

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

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

(a) see paragraph 11 above;

(b) undated letter from Emma Hannan received on 11 March 2025 regarding conviction of the drivers responsible for the accident;

(c) insurer's Certificate of Determination - Internal Review dated 3 January 2025, and

(d) claimant's submissions received on 13 June 2025.

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

(a) Application for personal injury benefits dated 14 December 2012;

(b) NSW Ambulance report dated 10 December 2022;

(c) Medical records of John Hunter Hospital - various dates;

(d) John Hunter Hospital discharge referral - various dates;

(e) records from Brisbane Waters Private Hospital - various dates;

(f) Certificate of Capacity dated 21 December 2022;

(g) radiological reports of various dates;

(h) reports of Greenlight of various dates;

(i) Allied Health Recovery requests - various dates;

(j) treatment request and referrals - various dates;

(k) medical records and reports of Brisbane Waters Private Hospital - various dates;

(l) reports of Dr Helen Tongue - various dates;

(m) reports from Dr Lauren Stone - various dates;

(n) reports of Dr Jason Sharp of specialist cardiology - various dates;

(o) report of Dr Ian Nicholson, cardiothoracic surgeon dated 9 March 2023;

(p) reports of Dr Samuel Hall, neurosurgeon - various dates;

(q) reports from Sarah Bennett, occupational therapist, and Josh Breely, senior clinical exercise physiologist - various dates;

(r) report of Dr Alex Falcon, senior clinical neuropsychologist dated

2 December 2024;

(s) reports of Lisa Swan, physiotherapy dated 22 January 2024;

(t) report of Kate Cotter, consultant geriatrician dated 29 April 2024;

(u) driving assessment report dated 27 September 2023;

(v) request for internal review dated 20 December 2024, and

(w) report of Dr Margarite Thomas dated 17 December 2024.

Discharge referral, John Hunter Hospital, expected discharge date 5 January 2023: That indicated that Mr Myer was involved in a high-speed motor vehicle accident with a rollover. He sustained two mesenteric haematomas, a liver capsular tear, left-sided rib fractures, bilateral pneumothoraxes, and an unstable extension / distraction injury to T9 / 10 involving all columns. Further issues included a haemorrhagic shock, small bowel avulsion, mesenteric haematoma, a T10-11 disco-ligamentous injury, type 2 myocardial infarction, and respiratory failure secondary to pulmonary emboli. He was referred to Brisbane Waters Private Hospital for rehabilitation. Later, an x-ray showed a right medial malleolus fracture of his right ankle, for which he was wearing a cam boot.

Dr Ian Nicholson, Cardiothoracic Surgeon, dated 09 March 2023: Dr Nicholson had been following Mr Meyer for some years for his aortic stenosis with moderate symptoms, but he had been able to do most things. He had a car accident December 2022 and a hemopneumothorax, needing a bowel resection and some orthopaedic and back surgery. He had managed to get through that and was slowly recovering. He was walking with a walking frame, whereas before the accident he was relatively mobile and in good shape. He thought that Mr Myer had deteriorated a lot since the accident and lost a lot of weight.

28 June 2023**:** Dr Hall described Mr Meyer as having a significant multi-system injury following his motor vehicle accident and a long period of rehabilitation. He had unsteadiness and hand weakness/ wasting with mild memory impairment since the trauma. During his assessment, Mr Meyer was walking with a stick and had undergone a TAVI and stent placement for cardiac issues. Regarding his thoracic spine fractures, he did not report instability type pain and had good alignment overall. But there remained some residual impairment including dizziness, being somewhat unsteady and having three falls since returning home. He had also been more forgetful since the trauma and had bilateral hand weakness, more pronounced on the left, with some associated wasting. The hand weakness was not thought to be caused by a spinal cord change and was not typical of spinal cord or root compression.

Dr Hall thought Mr Meyer certainly had a degree of overall deconditioning and muscle loss, possibly with a degree of critical illness neuropathy.

19 July 2023: An MRI of Mr Meyer's brain had showed age-associated atrophy and a small focus of haemosiderin deposition within the right central sulcus in the region of hand function. This could explain his disproportionately slow left-hand recovery. Dr Hall thought that scan showed minimal evidence of trauma, except for that "hemosiderin deposit" which indicated a prior small haemorrhage in that region, presumably related to his recent trauma. Overall, Mr Meyer's long-term function was likely to be below baseline.

Neuropsychological Assessment Report of Dr Alex Falcon, Clinical Neuropsychologist dated 02 December 2024: Dr Falcon performed a neuropsychological assessment with Mr Meyer which demonstrated overall significant declines in auditory attention aspects of working memory, learning and recall for both auditory and visual material. Otherwise, his basic expressive and receptive language functions were adequate, and he had no noted visuospatial or visual or constructional impairments. His higher level abstract concept formation was mildly reduced, though non-verbal reasoning skills were reasonable. It was noted that he approached tasks in a rigid / concrete manner and had difficulty shifting to alternate patterns of responding.

It was her opinion that Mr Meyer likely suffered a mild traumatic brain injury as a result of the accident, but the current cognitive assessments were, in her opinion, not solely reflective of possible mild traumatic brain injury. The widespread nature of those findings could point to other underlying processes. She thought it likely that those memory and cognitive changes were already occurring as a result of underlying neurodegenerative processes but were not functionally significant at the time of the accident.

Dr Kate Cotter, Consultant Geriatrician, 29 April 2024: Mr Meyer's pre-injury medical history was reported to include:

• aortic stenosis requiring TAVI procedure in April 2023
• coronary angiogram and stent placement in March 2023
• gastroesophageal reflux
• benign prostatic hypertrophy from 2016
• type 2 diabetes from 2004

Mr Meyer was taking a range of medications for those conditions, mostly non-injury related. Dr Cotter's impression was that Mr Meyer had a probable traumatic brain injury because of his motor vehicle accident. An underlying neurodegenerative disorder could not be excluded and further cognitive decline with time could support that. However, on the basis of information she had that day, she supported the traumatic brain injury.

Driving assessment report of Jacqui Henry, dated 27 September 2023: An occupational therapy driving assessment did not identify any impairment of Mr Meyer's ability to drive a C-class motor vehicle according to RMS standards. He would continue to require bi-annual senior driving tests, and his C-class licence remained without further condition or restriction. That indicated that his cognition at that time was considered adequate for him to drive safely.

Activities Daily Living Report of Carly Webb, Occupational Therapist from Greenlight HC, from email dated 27 February 2024: Meyer was receiving five hours of assistance over two days a week for cleaning tasks, laundry and shopping. Cleaning was thought to pose a challenge due to repetitive bending and lifting, while laundry was a struggle as the facilities was located downstairs. Shopping services supported him with larger items that he has difficulty with. Mr Meyer was also receiving assistance with light and easy meals, which he could access and independently heat up. He needed help with the ongoing strenuous cleaning movements involving bending and lifting.

Allied Health Recovery Request from Lisa Swan, Physiotherapist, dated 12 January 2025: In this most recent AHRR from early this year, Mr Meyer was said to be able to walk one kilometre before needing to rest. Some days he was still needing his stick due to unsteadiness because of balance issues. He was experiencing occasional back pain, and his dynamic balance was still reduced compared to pre-injury. The week before this assessment, his balance had declined and he was feeling, "wobbly". He was said to still remain a falls risk. His endurance in the pool was 30 minutes and he was very tired. That was compared to his pre-injury functioning when he was fit, could walk around the hills in Avoca, could garden on a steep, uneven block without an aid, didn't have any falls and was "independent with everything".

1. The report of Medical Assessor Margaret Gibson is as follows:

"Mr Meyer attended the Teams meeting accompanied by his daughter Emma.

Further Assessment of Treatment - Reasonable and necessary

1. The following treatment disputes were referred by the Personal Injury Commission for further assessment:
   • whether the request for ongoing homecare services relates to the injury caused by the motor accident;
   • whether the request for ongoing homecare services is reasonable and necessary in the circumstances;
   • whether the request for ongoing Lite n Easy meals reimbursements relates to the injury caused by the motor accident;
   • whether the request for ongoing Lite n Easy meals reimbursements is reasonable and necessary in the circumstances;
   • whether the request for ongoing travel reimbursements relates to the injury caused by the motor accident; and
   • whether the request for ongoing travel reimbursements is reasonable and necessary in the circumstances.

The issues of causation will be considered by me. The issues relating to reasonable and necessary will be considered by Assessor Lauren Alach. We each will make our recommendations to the Panel for its consideration and final decision.

1. Psychosocial history and pre-accident history

Prior to the motor vehicle accident on 10 December 2022, Mr Meyer was retired and living in his own two-storey home on a steeping block in Avoca Beach. From both he and his daughter, Ms Emma Hannon's reporting, he was independent with personal care and household tasks, with further information about his pre-injury performance throughout this certificate.

Ms Hannon lived in Gladesville, and they maintained frequent contact. One of his children had passed away and his other daughter lived in the USA. Mr Meyer was still capable of driving to Sydney to visit Ms Hannon and friends.

Mr Meyer's home-based hobbies were maintaining the extensive lawn and garden of his home and painting in his downstairs studios. He was socially active in his community, meeting up with friends and being involved with a German group and gardening club. He attended monthly probus meetings.

Mr Meyer had been diagnosed with Type 2 Diabetes for which he took tablets. He is also taking medication for cardiac issues and an "enlarged prostate" from which he urinates frequently.

Ms Hannon said that she had arranged an aged care assessment for her father before the accident because he was getting older and she wanted to be prepared for the time when he might struggle to clean his home and maintain his garden. She had been told that there was a long waiting list for those assessments. But she said that he was still lifting '20kgs bags of cement' and was fit and healthy. She was aware that he was assessed with a Level 3 Home Care Package. They had not started using those services.

Ms Hannon understands that the insurer thought that her father received paid domestic services prior to his accident but she said that was not the case. He wasn't receiving any regular help with household cleaning. They had a friend who might occasionally offer to help whippersnapper Mr Meyer's lawn but usually he did that himself. He also did all other gardening including tasks which required him to climb a ladder.

Mr Meyer was involved in a motor accident on 10 December 2022 from which he sustained significant traumatic injuries including:

• small bowel avulsion and mesenteric haematoma;
• bilateral hemopneumothorax and left 10 to 12 rib fractures;
• T10 / T11 disco ligamentous injury and unstable fracture; and
• right malleolar fracture.

Assessor Gibson, in her report prepared after her re-assessment of Mr Meyer for the review of Professor Cameron's Certificate, expanded on his thoracic fractures. She described unstable T9/T10 fracture which required multi-level T8 to T11 percutaneous pedicle screw stabilisation.

In the Discharge Summary from John Hunter Hospital, Mr Meyer was also said to suffer to Type 2 myocardial infarction, Type 1 respiratory failure secondary to pulmonary emboli, delirium and abnormal blood sugars whilst in hospital.

Mr Meyer lives alone in a split-level house in Avoca Beach. His wife had passed away in 2012 and then one of his daughters had passed away in 2014. His one surviving daughter, Emma, lives in Sydney.

Emma stated that she lives with her husband and her three boys in Sydney. She said that prior to the accident she would drive up to visit her father every few months. She added that this was because she worked full time and had her family to look after at home. She said her father would come and visit her in Sydney, as he was unrestricted with driving. However, since the subject accident, she had been coming up to visit her father on a weekly basis, as he can no longer manage to drive that distance.

When asked about reimbursement for travel expenses, she said that the insurer, Allianz, had volunteered that they would reimburse her for her mileage and she had been receiving such reimbursement since she first made an application in the period after the subject accident. She said she gets reimbursed for her mileage to and from Sydney and also her mileage when she drives her father to appointments.

Mr Meyer takes medication twice daily from a Webster-pak which he picks up himself at a local pharmacy. His daughter volunteered that she would check the pack for any missed pills when she visits, and the carer would also check the pack. For pain he takes paracetamol as required. His daughter would apply physio cream to his back.

He attends hydrotherapy twice weekly. He drives himself there. He spends 30 minutes exercising in the pool. Up until a few weeks ago, a physiotherapist was supervising his hydrotherapy but was recently ceased by the insurer. He said that he now knows what to do in the way of exercise, so he swims and moves about in the water.

A physiotherapist was attending his home on a Friday for 30 minutes, the last session was about two weeks ago.

He keeps himself active at home by walking around the house and up and down the street. He also has a stepper machine which he would use for 5 minutes a day.

He visits general practitioner, Dr Rawlings at Avoca or Terrigal Beach every 3-4 months and on those occasions, he would have some blood testing done.

He visits a cardiologist in Wahroonga for 6-monthly checks. He said his daughter drives him to the appointment. He had an endoscopy at Gosford Private 5-6 weeks ago and his daughter had driven him to the appointment. He recently had follow-up with a gastroenterologist and an endoscopy was done but no further review is required.

He wears hearing aids. He said he was wearing hearing aids prior to the subject accident but these required significant adjustment after the accident as, I understood, his hearing had deteriorated.

Mr Meyer said he drives an automatic car but that he is limited to a distance of 35km. He has a disability parking permit since the accident. He said he would drive to the supermarket, a trip taking 20 minutes. He would occasionally buy smaller items at the supermarket such as milk and coffee. He would occasionally drive himself to visit friends.

Mr Meyer said that he is independent in dressing and undressing, toileting and showering. However, he said it takes him a very long time, approximately an hour, and at times he can't don his socks, on these occasions he would go without socks and shoes. He has an emergency pendant, but has not had to use that as yet.

He has a lot of difficulty putting on his socks and shoes. He said previously he had a bath, but since the accident he had slipped in the bath and had to call the ambulance because he couldn't get himself out. He now uses the shower exclusively. He has a railing in the shower and also next to the toilet.

He receives seven Lite n' Easy meals per week. These are ordered by his daughter. She would also prepare pre-prepared meals for his lunch and dinner when she comes up to visit. Occasionally, the carer would also pre-prepare meals. When asked what the difference was between Mr Meyer purchasing his own meals at the nearby supermarket, she said the difference is that these meals are delivered. When asked why he has issues with anything more than very simple cooking, the issues were his inability to stand in a stable way for long periods and difficulty with lifting heavy items like pots and pans.

Mr Meyer confirmed that he has a carer, Emma, from Home Instead who visits for 3 hours on a Monday and 2 hours on a Friday. She does the cleaning, makes up the bed (hospital bed) and she would occasionally do a big shop of groceries in order to carry the heavier items. She would also occasionally do some cooking in order to prepare meals in advance for Mr Meyer. She would also check his medication, serve him lunch and take him for a walk. The carer also does some laundry. Emma volunteered that he has a steep climb down stairs to the washing machine. Although, he did volunteer that he does manage to put clothes in the washing machine.

They have a gardener come in every 3 weeks as he has a very large and steep block of land. His daughter said that he used to have a lawnmower guy come in every few months but he never had a cleaner in the past. I asked him about the notes brought up by the insurer who alleged that he had reported to a social worker at BWPH that he had had a cleaner prior to the accident but he and his daughter denied this had been the case.

I asked him about the fact that he had an Aged Care Assessment in March 2023 and was assessed at Level 3 with an entitlement of 6.5 hours per week of assistance. His daughter volunteered that even though this amount of hours was allocated, they would have to pay for the service. He said he is forgetful at times such as forgetting if he has arranged an appointment to see a friend. His daughter said that the determination of 5 hours of assistance per week was grossly insufficient.

Mr Meyer makes himself some coffee and a piece of toast of a morning. He said he is very vigilant when walking around to avoid falling. His best friend would come and pick him up and take him out for coffee. When they get back they play checkers. He watches television. He would go out weekly for a meal with some German friends and they would collect him from home and drive him back. He does not have a computer. He only uses a very simple phone. He has difficulty gripping firmly using his right hand (it is noted that he has wasting of the small muscles of the hand). His daughter volunteered that even when they are eating out he always resorts to a steak knife in order to cut food.

Mr Meyer said that it is "all in the back." His back feels stiff in the morning. The back pain comes and goes throughout the day, although it is worse in the morning and improves as the day goes on.

He finds he can't lie on his side in bed. His sleep is disturbed because of the pain.

There is weakness of both hands, and in particular, as Assessor Cameron had also noted thenar wasting of his right dominant hand. He had a good range of movement of both upper limbs, as demonstrated today, with near normal range of shoulder movements.

Mr Meyer walks with the aid of a stick. He said the main reason for this is that he suffers with vertigo. Emma added that this can be quite evident when he is standing and turns his head quickly, he tends to lurch to one side. He has had five to six falls since the accident, the last was 3-4 months ago when he fell at home.

He also has urinary frequency at night so now uses a pot by his bed as it is dangerous for him to be getting up to the toilet in the middle of the night due to his instability.

Mr Meyer is an 88-year-old man who was involved in a very serious motor vehicle accident on 10 December 2022, suffering major multisystem injuries. There was a long period of rehabilitation, however he is still left with significant spinal pain, which is explicable on the basis he had sustained an unstable T9/T10 fracture which had required multilevel T8 to T11 percutaneous pedicle screw stabilisation. This would limit his endurance when standing and limit his capacity to perform any significant lifting or carrying in particular above shoulder level.

Furthermore he has generalised debility, arising from accident related muscle loss and deconditioning. Particularly, considering his age, it was the Panel's opinion that he will not regain his pre-subject accident physical capacity.

Based on available evidence, he was independent in self-care and household chores, including meal preparation, prior to the accident. Whilst there was an ACAT assessment performed, it would seem, based upon all available evidence, that he had not utilised this level of assistance at any stage prior to the subject accident. He said that the only support he had been receiving prior to the subject accident was with the lawn mowing.

Prior to the subject accident he reports being able to drive down to Sydney to visit his daughter. He is now restricted in the distance he can drive a car. Therefore, his daughter is having to travel up to see him on a weekly basis.

Currently, he is unstable when walking, requiring a stick to assist with his mobility. He has limited tolerance for prolonged standing or lifting of any heavy weights.

He advised that he struggles with any significant meal preparation because of issues with stability when standing and back pain which limits his tolerance to standing. Furthermore reduced grip strength limits his ability to safely lift and manipulate pots and pans and other household items.

The Panel noted that the applicant had contended there was some cognitive decline even prior to the subject accident. However, there were no documented pre- subject accident clinical records that provide any objective confirmation of any neurodegenerative condition prior to the subject accident. This is against the clear evidence of accident related TBI. This in keeping of the opinion of Dr Kate Cotter (29 April 2024). And whilst IME, Dr Alex Falcon hypothesises that there was a widespread neurodegenerative process prior to the subject accident, with changes evident on a cerebral MRI scan, there was no MRI scan prior to the subject accident and, no objective neurocognitive testing.

Request for ongoing home care service relates to the injury and it is reasonable and necessary under the circumstances. The request for pre-prepared meals relates to the injury, although supply of a particular type of meal brand is not reasonable or necessary. However, some form of pre-prepared meals is necessary.

In relation to ongoing travel reimbursements, his daughter is travelling up there on a weekly basis. She assists him with his medications. She does cooking, takes him to appointments and out for walks.

Whether ongoing travel services provided to the claimant are reasonable and necessary is not the subject of this dispute but is arguable. For example, does he need someone to drive him beyond the 30 kms radius currently imposed upon him? If he needs someone to drive him to visit friends and relatives in the Southern Highlands beyond that radius, and he cannot do that, could be a form of attendant care service and therefore the cost would be claimable.

However, the cost of his daughter's travel to and from the claimant's home to stay overnight and help him is not a treatment expense claimable under section 3.24 (1) (a), (b) or (c) of the Act, because the claimant is not doing the travelling. The claimant's daughter is providing treatment (attendant care services) free of charge. The cost of the daughter's travel may be allowable as the reasonable cost of the provision of the attendant care services."

1. The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[6] The Panel adopts the examination findings and reasons of Medical Assessor Gibson with which Medical Assessor Alach agrees.
2. The Panel is not required to choose between medical opinions and is required to form its own opinions.[7]
3. The Panel finds that, based upon the evidence:
   • the request for ongoing homecare services;
   • the request for ongoing meals reimbursements, and
   • the request for ongoing travel reimbursements,

relates to the injury caused by the motor accident, as a matter of medical determination, and as a matter of non-medical informed judgment. The only alternative possible cause suggested by the insurer is the claimant's cognitive decline, which the Panel has considered and rejected, for the reasons stated.

1. The Panel finds no evidence to support the insurer's contention that the disputed care and treatment requests arise from the claimant's cognitive decline rather than the admittedly serious injuries he sustained in the motor accident. The Panel is satisfied that the claimant has discharged his evidentiary onus of proof.
2. The Panel met on 12 May 2025 to consider the following:

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

(b) whether any additional documents were required, and

(c) whether a re-examination was necessary.

The Panel reconvened on 14 August 2025 to consider its findings and finalise its determination.

1. The Panel has explained its reasons for finding that the referred treatment and care relates to the injury caused by the accident.

1. For the above reasons, the Panel concludes the certificate dated 29 January 2025 should be confirmed.

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

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

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