REVIEW PANEL ASSESSMENT OF TREATMENT AND CARE - REASONABLE AND NECESSARY

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

1. The Review Panel revokes the certificate dated 18 February 2025 and issues a new certificate determining that:

(a) the following treatment and care:

• 4.5 hours weekly of personal care and support, and
• seven prepared meals per week,

IS REASONABLE AND NECESSARY in the circumstances.

(b) the following treatment and care:

• all travel reimbursement for Emma Hannan for attendances on her father (the claimant),

IS NOT REASONABLE AND NECESSARY in the circumstances

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 provided is reasonable and necessary in the circumstances under Schedule 2, cl 2(b) of the Act, the dispute was referred to Medical Assessor Lisa Middleton who certified on 18 February 2025 as follows:

• whether the request for ongoing Home Care Services is reasonable and necessary in the circumstances
• whether the request for ongoing Lite-n-Easy meals reimbursements is reasonable and necessary in the circumstances
• whether the request for ongoing travel reimbursements is reasonable and necessary in the circumstances

IS REASONABLE AND NECESSARY in the circumstances.

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

• ongoing Home Care Services
• ongoing Lite-n-Easy meals reimbursements
• ongoing travel reimbursements

RELATES TO THE INJURY caused by the motor accident.

That certificate also is before the Panel for review.

1. The insurer sought a review of Medical Assessor Middleton'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).
2. The insurer submits that there are five material errors in Medical Assessor Middleton's certificate and determination which it particularises as follows:

The insurer submitted that Medical Assessor Middleton failed to assess the number of hours of carer services that are reasonable and necessary - 1, 2, 3, 4, or 5 hours, which was the subject of the dispute.

The insurer submitted that Medical Assessor Middleton failed to assess the number of meals per week that are reasonable and necessary - 1, 2, 3, 4, 5, 6 or 7 meals per week, which was the subject of the dispute.

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.

While Medical Assessor Middleton failed to confirm the pre-accident cleaning services, the Medical Assessor certified "there is reference to some pre-MVA mild cognitive impairment (see report of Dr Falcon) however, despite his impairment, it did not impact his ability to perform his ADLs independently, and in that regard he was not receiving assistance at home". The insurer says this is an error and inconsistent with the claimant's history that he was receiving cleaning services. Medical Assessor Middleton further alleged if his physical impairments improved, he would more likely than not be able to manage "heavy housekeeping", when his pre-accident baseline was he received cleaning services for likely exactly that, being "heavy housekeeping". The insurer submits this is an error.

Medical Assessor Middleton confirmed the claimant returned to driving and drives to the shops and appointments. Medical Assessor Middleton has made an error and failed to appreciate the nature of the transport dispute, which was in relation to Emma's travel, not the claimant's travel. Medical Assessor Middleton erroneously found Emma was providing transport to the claimant to assist him with travel to appointments as needed, visit the shops, pick up groceries and coordinate services for him as appropriate. This is internally inconsistent with the finding that the claimant drives himself. The insurer submitted that Medical Assessor Middleton has erroneously assessed Emma as providing transport assistance to the claimant, which is not the dispute. The claimant is driving himself to the shops and appointment. Therefore, Medical Assessor Middleton has erroneously duplicated the same transport services. The actual dispute was in relation to Emma's travel to visit her father, not to transport her father. The insurer says this is an error and there is no path of reasoning as to why a daughter should be compensated for travelling to see her father.

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. Particularly, the President's delegate stated as follows:

(a) there does not appear to have been a history taken from the claimant/his daughter regarding a pre-accident medical history, certainly nothing is recorded to this effect in the certificate;

(b) the Medical Assessor's findings/certificate do not refer to an assessment of how many hours per week carer services would be reasonable and necessary and causally related to the motor accident;

(c) the Medical Assessor's certificate does not indicate how many pre-prepared meals per week would be reasonable and necessary and causally related to the accident;

(d) the Medical Assessor's certificate does not assess or recommend the quantity of travel services which would be reasonable and necessary to reimburse the claimant's daughter for providing travel services to the claimant;

(e) I am satisfied there is reasonable cause to suspect that the Medical Assessor may have provided inadequate reasons with respect to her findings overall and particularly with respect to causation, and

(f) I am further persuaded there is a reasonable cause to suspect that the Medical Assessor may have erred in failing to provide a pathway of reasoning to explain her findings, particularly in view of the claimant's age, pre-accident medical conditions and the fact that it was submitted by the insurer that pre-accident care/cleaning services were provided.

The Panel notes that causation was not a matter for determination by Medical Assessor Middleton as it already had been accepted by Medical Assessor Cameron.

1. 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 Middleton, as previously identified. The Panel notes the parties' agreement that the treatment dispute is limited to:
   • Care-1,2,3,4 and 5 hours weekly for personal care and support;
   • Transport-all travel reimbursement to Emma Hannan for attendances upon her father, the claimant, and
   • Food-1,2,3,4,5,6 and 7 Lite-n-easy meals per week.
2. The Panel is concerned that there is some infelicity in the language of the referral. The Panel has redefined the referral to delete the words "the request for reimbursements" in each case as they imply that the Panel is to stray into areas of costs. It is not whether the request is reasonable or relates, but whether the services themselves, that are the subject of the request, are reasonable and necessary and relate to the accident. The Panel has determined that it should decide:

(a) whether ongoing homecare services are reasonable and necessary in the circumstances and relate to the injury caused by the motor accident and what services are reasonable and necessary, and

(b) whether pre-prepared meal services are reasonable and necessary and relate to the injury caused by the motor accident.

Medical Assessor Gibson is to consider the issue of causation. I am to consider the issues of reasonable and necessary and quantification. We each will make our recommendations to the Panel for its consideration and final determination.

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 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. The claimant is required to establish that the treatment and care is both "reasonable and necessary". This test differs from the worker's compensation legislation which requires a worker to establish that the treatment and care is "reasonably necessary". There is a stricter requirement under the Act because there is no moderation of the requirement that the treatment and care is "necessary".
2. When discussing the meaning of "reasonably necessary" under s 60 of the Workers Compensation Act 1987 in Clampett v WorkCover Authority of NSW,[4] Grove J stated:[5]

"22. I return to the expression 'reasonably necessary' in s 60. Dictionaries stipulate that 'necessary' as relevant definition as 'indispensable, requisite, needful, that cannot be done without' - (shorter Oxford English Dictionary, 3rd Edition) and 'that cannot be dispensed with' - Macquarie.

1. The essential issue is what effect flows from conditioning such qualities as 'reasonably'. The consequence is to moderate any sense of the absolute which might otherwise be conveyed by the word 'necessary' if it stood alone. In order to contemplate such moderation, it is apt to consider surrounding circumstances, but the question to be addressed is whether modification of a worker's home, having regard to the nature of the worker's incapacity, is reasonably necessary. In contemplation of what may be 'reasonably necessary', there is these statutory obligations specifically to have regard to the nature of the worker's incapacity. It provides emphasis towards moderating the meaning of 'necessary' in this context."
2. Similar observations have been made subsequently by the Court of Appeal on the meaning of "reasonably necessary" under other legislation.[6]
3. Factors relevant to, but not determinative of, the criteria of reasonableness in the context of the worker's compensation legislation are well-settled.[7] They include:

(a) the appropriateness of particular treatments;

(b) the availability of alternative treatments;

(c) the costs of the treatment;

(d) the actual or potential effectiveness of the treatment, and

(e) the acceptance by medical experts of the treatment as being appropriate or likely to be effective.

1. Whilst the observations in Diab were directed to the test of "reasonably necessary" in the worker's compensation legislation, we adopt it in so far as they have relevance, although not determinative, of the stricter test of "reasonable and necessary".
2. The words "in the circumstances" in the context of whether the treatment is "reasonable and necessary" must refer to the particular circumstances of the claimant. This is because Schedule 2 of the Act refers to treatment "provided or to be provided to the claimant".
3. The test of "reasonable and necessary in the circumstances" does not direct attention to the relationship between the accident and the treatment. That issue arises from consideration of whether treatment "relates to the injury caused by the accident".

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) report 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.

Lauren Alach, Occupational Therapist visited Mr Meyer at his home at 15 Warren Street, Avoca Beach, NSW 2251 for an in-person assessment on 25 July 2025.

• Mr Adolf Meyer - Applicant
• Ms Emma Hannon - Applicant's daughter
• Lauren Alach - Occupational Therapist

My clinical examination involved observation of Mr Meyer during the assessment. I watched him as he transferred on and off chairs and his bed, moved around the house, climbed stairs and walked up and down sloping and uneven paths. Mr Meyer's lower limb strength and movements were assessed during functional movements and tasks.

Mr Meyer sat for 30 minutes at the start of the assessment. He used his hands on the arm rests of his balcony chair to stand. He took a few seconds to get his balance before he started walking with his walking stick. He showed me the lounge chair with a cushion underneath his bottom and behind his back where he sits sometimes during the day. He sat on the lounge chair and stood again with his arms for support.

Mr Meyer walked around inside of his home. He used a walking stick most of the time except when he was in the small bathroom. He said he felt more comfortable with the walking stick because of his "wobbles". That is consistent with the vertigo that he reported to Dr Gibson, and his general instability since his accident. He appeared reasonably stable most of the time when walking inside but overbalanced slightly when he was standing in his bedroom. He then regained his balance.

He walked with a reasonably symmetrical gait, taking small steps. But he was somewhat hunched over his stick and to the right side.

Mr Meyer walked down 7 steps with a rail on the right-side descending, and over a concrete paver and pebbled path down the side of his home. He took his time walking down some uneven concrete steps to the top area of his backyard, again with a rail on the right side for support. He walked over the pebbled area around the garden beds, but his balance appeared precarious at times, and he used his walking stick to remain stable.

As well as climbing shorter flights of steps as documented above, Mr Meyer climbed up and down a flight of 13 steps inside his home with a rail on the left side descending. He took his time, usually taking one step at a time rather than using a reciprocal pattern.

Mr Meyer showed me how he would bend to pick up something from the floor. He widened his feet before squatting minimally and bending forward from his hips to use his left hand. He did not appear confident in his balance and said that he prefers not to pick things up on the floor if he can help it. His daughter or a support worker often do that for him.

He could not squat or kneel on the ground, and it was obvious from my observations that he could have difficulty getting up from the ground again if he fell.

Mr Meyer no longer lifts or carries heavy items, because he cannot squat down far enough to lift safely and would have to rely on his left hand only while using his walking stick. He is also limited by his hand strength. He showed me how he carries a plate with food and a cup on it in his left hand over to the lounge or outside balcony to have a snack or lunch.

Mr Meyer lives in a two-storey home on a steeply sloping block with several garden levels. His paid gardening services are not under review so I will not describe his garden further.

He can drive to the same level as the front entrance of his home to park his car. There is then a gradually sloping bridge to access his home. His bedroom, kitchen and living area are on the entry level, so he does not need to climb steps or stairs regularly once inside his home. He does not access the lower level of his home regularly when he is alone at home.

Mr Meyer had a bed pole near his bed to support his transfers. He also had his bathroom fully modified after the accident with a walk-in shower, shower rail and hand shower. Additional rails have been installed next to steps or stairs to maximise his safe access to his home.

Based on the above, his living environment is not a major factor in his current need for care and other services under review.

Because Mr Meyer's independence with self-care tasks is not in dispute, I have not assessed his personal care abilities in detail and have not included those in the table below. But from his reporting, in a modified bathroom and when taking his time, he can toilet, shower and dress himself and perform grooming tasks, which is consistent with my observations.

He confirmed that immediately post-accident and for a period of approximately four to five months, he did received assistance and support with personal care.

Mr Meyer was independent with meal preparation. That included making his own breakfast, a light lunch when he was not out at lunchtime, and most evening meals using his stovetop, air fryer, microwave, kettle and toaster.

He ate his main meal at home most days, with occasional meals out. He was able to maintain his nutritional status and a stable weight.

Mr Meyer makes his own breakfast. He makes toast, spreads that with butter, and has a banana. He takes his time and carries that in his left hand to the balcony to eat.

He tends to heat up soup or other food that his daughter or support worker has prepared for him, or a Light n' Easy prepared meal.

Although he has access to an air fryer and could still cook or heat some food using his stove top, Ms Hannon said that her father started to snack and not pay attention to his nutritional intake after the accident. He lost a lot of weight. He appears to have lost his motivation to cook, and his instability, reliance on a walking stick, and reduced hand strength also makes cutting up vegetables and handling pots and pans more difficult.

He has gradually put on weight since he has had access to prepared meals, which have balanced amounts of protein and other nutrients, and Ms Hannon is concerned about what would happen if he did not have access to those easy to heat, balanced, prepared meals in the future.

Although Ms Hannon agrees that there are other alternatives for pre-prepared meals that her father could get from the local shopping centre, she considers that one of the benefits of his current meals is that they can choose a variety of foods. Ms Hannon does that for him, and those meals are delivered to Mr Meyer at home. The difficulty which Mr Meyer would have buying and bringing his own meals home, even if he can access the supermarket within his driving tolerance, will be considered under shopping below.

I saw Mr Myer moving around his kitchen. He could reach for utensils and cooking equipment between knee and head height, but struggled to pick up heavier equipment because of his reduced hand strength. His hand function is not the main factor in his difficulty with meal preparation since his accident.

He used his walking stick in his right hand when walking around the kitchen and appeared unstable when standing and using his hands to reach and carry. That would likely affect his safety when moving around the kitchen to prepare meals. It could also affect his safety when using heat sources such as the stovetop. Because of his combination of impairments, he would struggle to move heavy pots between the stove, kitchen bench and the sink for draining. That is consistent with Dr Gibson's reporting that Mr Meyer struggles with significant meal preparation because of issues with his stability when standing and back pain, which limits his standing tolerance, and that his grip strength is also a factor.

Overall, Mr Meyer's ease of fatigue since the accident, physical deterioration, and mild cognitive deterioration seems to have affected his motivation to cook and maintain his nutritional status, affecting his role in meal preparation since the accident. His current performance is significantly different to his pre-accident status.

Mr Meyer could wash and dry dishes after himself and washed pans after cooking. He said that he performed all light cleaning and tidying as needed.

He still washes up after himself, including plates, cutlery and empty food containers. Because he does not cook much, he does not have to wash heavy pots and pans. Based on Mr Meyer's impairments on assessment and his current performance, he does not need injury-related help to wash and dry dishes.

Mr Meyer drove to the local shopping centre and would push a trolley or carry a basket to collect the groceries he needed.

He took those back to his home, brought them into the house and put them away, He did not receive any help with regular shopping.

He might stop past a local shop to buy something for himself when he is out, but he does not shop often.

Ms Hannon said that her father went to do some shopping after his injury. He was carrying a basket with a few items in it when he fell. She received a call from a fellow shopper to alert her to what had happened. He has not been as confident to shop for groceries himself since that fall.

Although he can still drive to the local shopping centre and could participate in shopping with help to collect and carry groceries, and that would contribute to his regular exercise, his support worker tends to go for him to pick up a few things that he needs.

Ms Hannon also does some shopping for her father when she visits and his light n' easy meals are delivered so he does not have to shop for himself regularly.

The distance restriction on Mr Meyer's licence is sufficient for him to drive to the local shopping centre. However, based on my observations of his functional balance and walking around at home with a walking stick in his right hand, and his instability at times, he is likely to be at risk of further falls if he needs to shop to meet his entire grocery needs. That includes pushing a shopping trolley or carrying a basket, to purchase his own prepared meals. His physical impairments would also make it difficult for him to bring bags with those meals into his home, even if he did multiple trips.

Therefore, having prepared meals delivered to his home, whether they are Light n' Easy or another brand, reduces the risk from Mr Meyer having to shop for those himself.

He could benefit from going shopping with a support worker to purchase other groceries and household items that he needs during the week, with that outing doubling as exercise walking over even terrain in the community.

Ms Hannon said that her mother passed away 12 years ago, and her father has never had regular paid cleaning assistance since then. She was not sure where the insurer got the idea that her father paid for regular cleaning services. She said that he had possibly paid for 1 spring cleaning service.

She organised the Aged Care Assessment so that they could "get onto it" if her father reached a point that he could not perform those tasks himself. She had been told that there was a waiting list for home care services, and she did not know that he had to contribute to paying for those services himself when she arranged the assessment.

Mr Meyer performed all regular home cleaning every 1-2 weeks, including vacuuming, mopping, cleaning his bathroom, dusting and wiping over appliances and surfaces in the kitchen, cleaning accessible glass doors and the balcony balustrade.

He took out rubbish to the council bins and pulled two council bins per week up the steeply sloping driveway to the road and back to the home again after they were emptied.

Mr Meyer said that because of his back pain and stiffness and instability, he does not attempt to vacuum, mop or dust, other than wiping over some surfaces within his reach. He has not attempted to squat, kneel and move into awkward positions to clean his shower recess and toilet, or to reach and bend to clean glass doors and balustrade.

He also feels too unstable to spread sheets over his bed and move around, bending and reaching, to strip and remake his bed himself. Those are the tasks that his support worker still regularly helps him with.

Ms Hannon should contribute to cleaning the downstairs area of the home where she stays when she visits.

Mr Meyer can only carry very light bags of rubbish out to the council garbage bin. His daughter or support worker take heavy rubbish bags out to the bin.

He does not have the stability, with or without his walking stick, to pull or push the council bins up the sloping driveway to the road.

Based on my physical and functional assessment detailed in this report, including Mr Meyer's ongoing back pain, stiffness and instability, more than his hand weakness, it is reasonable that he is still unable to safely perform regular heavier cleaning tasks requiring repetitive movements, stooping, squatting, bending, and working in awkward positions. That includes vacuuming, sweeping, and mopping floors, cleaning the bathroom that he uses regularly, including the shower recess and scrubbing the toilet, dusting in difficult to reach areas, and wiping over the glass doors and balustrades, at least fortnightly. He still reasonably needs paid services for that regular cleaning.

He could take out light bags of rubbish to the bins but needs help to pull the two council bins per week up the steeply sloping driveway to the road and back to the home again after they are emptied. His balance impairment means that he would be at risk by performing that task.

Because he was reported to be active and fit pre-accident, those services are still reasonable until an age where medical opinion is that he would not be able to clean throughout his home regardless of his injuries in the accident.

Mr Meyer did his own laundry, including laundering his clothes and bedding. He accessed his top loading washing machine next to his kitchen and carried his wet laundry down the side of his house to the clothesline in the area under his home.

Although Mr Meyer can still put some clothes in and out of his washing machine, he does not have the stability, with or without his walking stick in his right hand, to carry a load of washing down steps to his under-house clothesline. The support worker does his laundry, including laundering his bedding, during their regular visits.

Mr Meyer's instability when walking, and ongoing back pain and stiffness, would make it difficult for him to reach larger items, including towels and bedding, to hang and bring in from the under-house clothesline. He reasonably still needs help with those components of laundry. It would also not be safe for him to negotiate the steps and pathways with his laundry to hang it or bring it in after drying. He could hang some of his lighter clothing on a clothes airer inside his home if that was set up for him. But he would still struggle to hang his bedding and towels to dry because of his imbalance and mobility impairments.

An occupational therapist could help him to implement strategies and equipment such as clothes airers so that he could contribute to laundering lighter items of clothing. Once his clothes were dry and inside his home, he could fold them and taking his time to put them away.

Mr Meyer was independent accessing his community. On the day of the injury, he was driving to his local petrol station to fill up his tank. His daughter said that he did that regularly and was confident to drive as far as Sydney to visit her and friends.

He was safe walking around his community, including going for long walks down to the beach from his home.

Ms Hannon had no concerns about his safety when driving or during his community access.

Mr Meyer said that he is confident driving within the 30-kilometre radius from his home which he is allowed to drive under his restricted licence. That means he can drive to visit friends who live on the Central Coast, to his GP, the pharmacy, and to his Probus meetings. He said that being able to drive contributes greatly to his quality of life.

Ms Hannon said that although she worries about him driving, she has driven with him and is confident that he drives safely to familiar locations. There are a few scratches and bumps on his car, but he has not had any more serious accidents. She understands that having his licence contributes greatly to her father's sense of independence.

He was driving himself to local physiotherapy and exercise appointments, but those have not continued. He can drive to the local pool to do his self-managed hydrotherapy.

The main reason why Ms Hannon chooses to accompany her father to appointments is because he is no longer a good historian, as reported previously. But that access to injury-related appointments is not the subject of this review assessment.

Ms Hannon said that her father could visit her previously, so she did not need to travel to his home as regularly, incurring excess travel costs. She also now provides some of his care gratuitously, so travelling to his home is a necessary part of that care provision and she expects that the insurer would help to pay for those costs as they have been since her father's injury. That includes weekly trips from Gladesville to Avoca Beach, return.

As part of the review assessment, the parties were asked to refine the issues in dispute and to be reviewed. The need for "ongoing travel reimbursements" was refined to be "travel for Ms Hannon for attendance upon her father, the claimant". That means travel for Ms Hannon from her home to her father's home to provide gratuitous care.

During the assessment, I informed Ms Hannon that under the Motor Accidents Compensation Act and the Motor Accidents Injury Act, no statutory benefits are payable for gratuitous attendant care services such as she provides. The only travel/transport costs which are claimable relate to the claimant travelling to and from injury-related medical and rehabilitation appointments or someone helping the claimant to do so. Because her travel to and from her father's home is not to a medical or rehabilitation appointment, that is not a treatment expense which is claimable under the Act. She understood that, although she still did not think it was fair. She could see why that travel is unlikely to be considered reasonable and necessary as part of this review.

Mr Meyer sat for about 30 minutes at the start of the assessment and then moved around his home and outside. His presentation was consistent with his and his daughter's reporting of the symptoms that he continues to experience since his accident, as well as other aspects of my physical assessment.

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 because 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. Treatment and Care - reasonable and necessary

Following review of the evidence, Assessor Gibson's medical assessment and my examination, the following care is considered reasonable and necessary to meet

Mr Meyer's current injury-related needs. Given that he is 88 years old, regular medical monitoring and assessment is needed to determine when age-related and non-injury related factors are the main cause of his need for that care, above his injuries in the accident.

My in-person assessment conducted at Mr Meyer's home was consistent with the medical evidence available about the physical impairments that he continues to experience since his accident. It was also consistent with Dr Margaret Gibson's assessment as part of her review of Professor Cameron's certificate.

I considered the Insurer's submissions, including their reference to the 'medical controversy' about Mr Meyer having a paid cleaner prior to his injury. On detailed investigation, it seems that Mr Meyer had only received a one-off spring cleaning service. Although he had an aged care assessment, which is referred to in other sections of this report, I saw no other mention in the medical reports or other documents available that he received a more regular paid cleaning service. He and his daughter have also consistently told all assessors the same information about his pre-injury independence with domestic tasks.

Mr Meyer's reduced hand function could also be a factor in his need for support, which Dr Hall thought could be trauma related as indicated by the MRI findings of a 'hemosiderin deposit' in the region of Mr Meyer's brain related to hand function. As could his cognitive changes, which evidence indicates could be due to a combination of injury and non-injury related factors, but was sufficient for him to maintain his driver's licence. However, Mr Meyer's instability and pain seem to be the main factors in his ongoing need for the below services.

Therefore, based on my findings on assessment, and Mr Meyer's residual back pain, stiffness and his instability, for which he relies on a walking stick for mobility and safety, he has not returned to being able to perform all the physical components of regular cleaning, laundry, meal preparation and shopping tasks.

Further information and analysis to support my assessment is in the Activities of Daily Living Status section of this report

I have determined that Mr Meyer reasonably requires the following hours of home care assistance based on his current status:

• 2.0 hours per week - For regular cleaning assistance of the main level of his home which Mr Meyer uses regularly.

Twice weekly: Spot mopping and vacuuming to clean up spills twice a week

Weekly: Taking the full council bins out to the road and bringing them back again.

Fortnightly: Vacuuming / sweeping and mopping throughout the main level, washing glass doors and the balcony balustrade, scrubbing the shower recess and bath, cleaning the toilet, wiping over some surfaces in the kitchen, dusting, cleaning skirting boards and other areas outside of his reach,

• 1.0 hour per week - To strip and remake Mr Meyer's bed and launder his bedding, hang heavier clothes and bedding to dry, and to bring in laundry from the clothesline.
• 1.5 hours per week - To encourage and accompany Mr Meyer to the local shops to pick up food items for breakfast and lunch meals and to practice walking on level ground.

Total: 4.5 hours per week of paid domestic assistance for the above home care tasks.

There could be other care that Mr Meyer would benefit from to help him to continue living safely, based on his current impairments. That could include encouragement and help to participate in his exercise program more regularly for physical maintenance, and monitoring to ensure he takes his medication daily and does not miss any tablets. But his need for that support should be assessed separately and medical opinion would be needed as to whether that care is injury related.

From my assessment, the issue of whether Mr Meyer benefits from having meals delivered is not just related to his ability to shop safely to purchase prepared meals himself. Overall, Mr Meyer's ease of fatigue since the accident, physical deterioration, and mild cognitive deterioration seems to have affected his motivation to choose meals and cook, and therefore his ability to maintain his weight and nutritional status and perform his role in meal preparation. His current performance is still significantly different to his pre-accident status. That seems reasonable given his long hospitalisation and period of recovery from his severe injuries and his residual impairments.

From my assessment, Mr Meyer has benefited from having nutritious meals delivered for ease of heating and eating, weight gain and health maintenance. His current Lite n' Easy meals seem to be meeting those aims. I saw no clear change in his status over time to alter that need, especially as he has not returned to safely cooking main meals himself.

Therefore, he reasonably still needs the delivery of one main meal per day, seven meals per week, consistent with Dr. Margaret Gibson's opinion in her certificate. The specific meal type is not the main issue, if he is provided with a nutritionally balanced range, but the need for a pre-prepared nutritious meal remains.

Transport for Ms Hannon to Attend Upon Mr Meyer:

While Mr Meyer is eligible for reimbursement of his travel costs for treatment and care under Section 3.24(1)(2) of the Motor Accidents Injury Act 2017, that does not include reimbursement of the transport costs for someone providing gratuitous care. Although Ms Hannon feels the need to visit her father more regularly since his accident to contribute to his care gratuitously, no statutory benefits are payable for her travel costs to and from her father's home.

Therefore, reimbursement for Ms Hannon's travel to and from Mr Meyer's home is not considered reasonable or necessary under the Motor Accidents Injury Act 2017."

1. The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[8] The Panel adopts the examination findings and reasons of Medical Assessor Alach with which Medical Assessor Gibson concurs.
2. The Panel is not required to choose between medical opinions and is required to form its own opinions.[9]
3. The Panel met on 22 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 conclude 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 and what treatment and care is reasonable and necessary in the circumstances of this case.
2. Further to the final comment made by Medical Assessor Alach in her examination report (above), the cost of the daughter's travel cannot be a subject of this determination, as it is beyond the scope of the referred dispute, as defined by the parties (Mandoukis).

1. For the above reasons, the Panel concludes the certificate dated 18 February 2025 should be revoked. The certificate appears at the commencement of these reasons.

[4] [2003] NSWCA 52.

[5] Clampett at (22) - (23), Meagher and Santow JJA agreeing.

[6] See ING Bank (Australia) Limited v O'Shea [2010] NSWCA 71 at (48); Moorebank Recyclers Pty Limited v Tanlane Pty Limited [2012] NSWCA 445 at (113).

[7] See Diab v NRMA Limited [2014] NSWWCCPD 2 at (88).

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