MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; assessment of threshold injury; assessment of degree of permanent impairment; whiplash injury to the cervical spine with C5/6 Disc bulge and non-verifiable radiculopathy; left shoulder post traumatic stiffness; rear end collision; broad-based disc protrusion with spinal canal narrowing without nerve root impingement; contemporaneous complaints of a cervical injury; limitation of shoulder movement; Nguyen v The Motor Accidents Authority of NSW & Zurich Australian Insurance Ltd applied; trapezial muscle pain; Held - whole person impairment assessed at 10%.

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

1. The Medical Review Panel revokes the certificate of Medical Assessor Adam Rapaport dated 17 June 2025 and issues a new certificate determining that the following injury caused by the motor accident:
   • cervical spine whiplash injury at C5/6 with broad based traumatic disc bulge

is not a THRESHOLD INJURY for the purposes of the Act.

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

1. The Medical Review Panel revokes the certificate of Medical Assessor Adam Rapaport dated 17 June 2025 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a permanent impairment of 10% and is not greater than 10%:
   • whiplash injury to the cervical spine with traumatic C5/6 disc bulge and with non-verifiable radulopathy 5% whole person impairment (WPI), and
   • let shoulder post-truamatic stifness with trapezial muscle pain (per Nguyen v The Motor Accidents Authority of NSW & Zurich Australian Insurance Ltd [2011] NSWSC 351 (Nguyen) 5% WPI.

1. Prudence Brennan (the claimant) is a 39-year-old woman who was injured in a motor vehicle accident on 22 March 2022. Following the accident the claimant lodged an application for personal injury benefits. Thereafter she sought a concession from Allianz Australia Insurance Limited (the insurer) that she had sustained non-threshold injuries in the motor vehicle accident and that the accident caused a degree of impairment of an excess of 10%.
2. Following a review, the insurer declined to make this concession and thereafter the claimant lodged an application for assessment of threshold injury and an application for assessment of degree of permanent impairment.
3. The claimant was assessed by Medical Assessor Adam Rapaport on 17 June 2025 and in a certificate dated 17 June 2025 he certified that the claimant sustained a cervical spine whiplash injury at C5/6 with broad-based traumatic disc bulge and this is a non-threshold injury. He further determined that the claimant had sustained a 5% whole person impairment (WPI), consequent on this injury.
4. The insurer sought of review of this certificate and, in a decision dated 20 August 2025 President's delegate Ratula Gupta decided that there was a reasonable cause to suspect that the medical assessment is incorrect in a material respect. The matter was then referred to this medical panel.
5. On 8 September 2025 directions were issued to the parties to upload the application, together with all annexures. This material is now before the panel.

1. Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A "new decision maker" is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
2. The new review provisions provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission).
3. Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
4. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application.
5. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
6. Section 17 of the Motor Accident Injuries Act 2017 (MAI Act) defines a "medical dispute" as

(a) a dispute between a claimant and an insurer about a medical assessment matter, or

(b) an issue arising about a medical assessment matter in proceedings before a court for damages or in connection with the assessment of a claim by the Commission.

1. The claimant was examined by Medical Assessor Drew Dixon at 1 Oxford Street, Darlinghurst on 30 January 2026.

1. The claimant was driving a VW Golf on her way to work at 9.00am on 26 March 2022 driving along Empire Drive, Empire Bay. She was stationary in a line of traffic waiting for a car in front to turn right into a driveway when she was rear ended from behind. She was wearing a seat belt and her airbags did not deploy. She sustained a whiplash injury to her neck and had shoulder pain on impact. She able to self-extricate and was taken by ambulance to Gosford Hospital where she had an X-ray of her cervical spine and chest. No fractures were found and she was discharged from hospital for follow up by her general practitioner (GP), Dr Raymond Fam. She took Panadol Osteo and Nurofen after the accident without significant benefit. Dr Fam ordered a CT scan of the cervical spine which showed C5/6 posterior broad based disc protrusion with spinal canal narrowing without nerve root impingement. She then had physiotherapy twice a week. She had some radicular complaint with paraesthesia radiating to her left hand and bi-temporal headache.

1. She was off work for some five months as a beauty therapist. She was offered a managerial position after the accident, working four days a week. At the same time, she was studying for her Nursing degree. She has since qualified in her Bachelor of Nursing and hopes to obtain work as an Registered Nurse (RN) in the near future, but notes she may have difficulty doing cardiopulmonary resuscitation (CPR).

1. She lives in a house with her husband and two-year-old son, her father and her uncle. Her husband does the heavy cleaning chores and her father and uncle do the yard work and her husband helps carry the heavy groceries and laundry.

1. She takes Voltaren and Thyroxine. She has had a total thyroidectomy for Grave's disease. She was referred to a neurosurgeon, Dr Mark Coghlan, who saw her initially on 22 June 2022 and she subsequently had a CT guided left C6/7 foraminal epidural injection without lasting beneficial outcome. She had ongoing pain in her left shoulder and had an ultrasound guided cortisone injection to the shoulder on 16 February 2022 and 14 February 2023 with good effect. She has not seen a shoulder surgeon for evaluation of her left shoulder brachalgia which has been consistent since the subject motor vehicle accident.
2. Dr Coughlan referred her to a pain specialist, Dr Asha Kadavil, who reviewed the claimant on 7 August 2023 and made recommendation for treatment and referred her back to the GP, Dr Fam and suggested continuation of physiotherapy. She had an independent medical examination (IME) review by Dr Charles New, orthopaedic spinal surgeon, who noted chronic pain due to pathology at the C5/6 level and that an ultrasound on 7 November 2022 had shown biceps tendonitis and supraspinatus tendinopathy and subacromial bursitis. Dr New assessed 15% WPI with respect to the claimant's cervical spine.
3. It is worth noting that Dr Mark Coughlan, in his letter to Dr Raymond Fam at the Providence Medical in Umina dated 2 November 2022, stated the claimant had a significant disruption C5/6 with the possibility of some instability as well. The C5/6 had herniated posteriorly and superiorly, elevating the posterior longitudinal ligament. He explained to the claimant that although she did not have any severe cord compression, there was significant disruption of the disc and this could account for a lot of her symptoms.
4. Pain specialist, Dr Asha Kadavil, had prescribed Palexia Sustained Release for neuropathic pain. Dr Fam, in his letter of 10 November 2022, noted the claimant had an ultrasound scan for her left shoulder that showed calcified enthesopathy involving the anterior portion of the supraspinatus tendon with subacromial bursitis and bursal impingement.

1. The post-accident ambulance records note complaints of pain to the claimant's neck and shoulders. The clinical notes from her admission to Gosford Hospital dated 26 March 2022 confirm that the claimant sustained a neck sprain.
2. Shortly after the accident the claimant was referred to a neurosurgeon Dr Coughlin. He diagnosed a traumatic disc rupture and some compression of the exiting C6 nerve root.
3. The Review Panel confirms the contemporaneous complaints of a cervical injury, the diagnosis of the claimant's treating general practitioner and neurosurgeon of a disc protrusion. The CT scan of 30 March 2022, shortly after the subject accident, confirms a disc protrusion at C5/6.
4. The claimant complained of neck and left shoulder pain at the time of her presentation to her GP on 29 March 2022. This was three days post-accident.
5. The claimant underwent an ultrasound of her left shoulder on 7 November 2022. This did not identify a rotator cuff tear. It did identify some supraspinatus tendon changes and thickening of the subacromial bursa.

1. On review today at the Hornsby rooms the claimant reported ongoing pain and stiffness in her neck with left shoulder brachalgia with trapezial muscle pain and intermittent tingling in the fingers of her left hand and altered sensation in her little finger.

1. On examination on 30 January 2026 and she was 167cm and weighed 84kg. There was stiffness of her cervical spine with flexion and extension decreased by one quarter, lateral rotation to the left decreased by one third and that to the he right by one quarter and lateral flexion to the right was decreased by one third and associated with left trapezial muscle pain and that to the right was decreased by one quarter. There was tenderness of the left supraclavicular brachial plexus. Her cervical foraminal compression test was positive as was her brachial plexus stretch test. Her upper limb reflexes required reinforcement. They were symmetrical. Her thenar power, intrinsic power and grip strength in both hands was

grade 5 of of 5. There was altered sensation of her left little finger. The Tinel's sign over the medial and ulnar nerves was negative. Her thenar power, grip strength, intrinsic power of both hands was grade 5 out of 5. There was 1cm of wasting of her left forearm measuring 24cm, 10cm below the elbow crease and 25cm on the right and 1cm of wasting of her left upper arm at 27cm, 10cm above the elbow crease on the left and 28cm on the right. 2. She had mild stiffness on elevation of her left shoulder associated with trapezial muscle pain with forward flexion 150 degrees, active abduction 130 degrees, adduction 40 degrees, internal rotation 40 degrees and external rotation 80 degrees. Should girdle power on the left was grade 4 out of 5. 3. There was full range of motion of her right shoulder, where power was grade 5 out of 5.

1. In summary this claim was rear-ended while stationary and sustained the following injuries:

(a) whiplash in due to her neck with C5/6 disc protrusion;

(b) traction injury to her neck due to a whiplash injury and has had disc disruption at C5/6 with radicular complaint without radiculopathy and has persisting radicular pain with tenderness of the supraclavicular brachial plexus, and

(c) limitation of shoulder motion as per Nguyen, due to trapezial muscle pain, where her ultrasound had shown calcific enthesopathy and subacromial bursitis with impingement as well.

1. Her impairment for the cervical spine is Diagnosis-Related Estimate (DRE) II, 5% WPI. That for the left shoulder where she has post-traumatic stiffness with trapezial muscle pain, as per Nguyen, is from Pie Charts 38, 41 and 44, 8% upper extremity impairment which equates to 5% WPI. This gives a total from the Combined Values Chart of 10% WPI. Although subsequent MRIs showed no neural compression, her radicular complaint is due to traction of the supraclavicular brachial plexus as a result of her whiplash injury when her stationary vehicle was rear ended and the post traumatic stiffness of the left shoulder was due to trapezial muscle pain, as per Nguyen.

1. The claimant has a non-threshold injury consequent on the injury she sustained to her cervical spine. The Panel has assessed WPI caused by the subject motor accident at 10%.