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

1. Revokes the cerficate of Medical Assessor Alan Home dated 5 November 2024.
2. Certifies that the following injuries caused by the motor accident give rise to a permanent impairment of 6% and is NOT greater than 10%:
   • thoracic spine, T7 compression fracture loss of vertebral body height at T7;
   • cervical spine, soft tissue injury;
   • left shoulder, comminuted fracture to the left scapula;
   • right shoulder, musculoligamentous injury;
   • fracture of the left clavicle with associated soft tissue injury;
   • right wrist, fracture to right scaphoid trapezium and musculoligamentous injury;
   • right elbow, fracture to right radial head, and
   • left leg, soft tissue injury.
3. Certifies that the following injuries were not caused by the motor accident:
   • right hand, musculoligamentous injury, and
   • left foot, musculoligamentous injury to left foot and 4th left toe; injury to left foot impacting foot reflexes consequent upon injury to thoracic spine (pursuant to the principles in Nguyen).

1. Mr Stephen Bryant, (the claimant) is a 53-year-old male who suffered injury on

23 January 2023 as a result of a motor vehicle accident. 2. A claim was lodged upon QBE Insurance (Australia) Limited (the insurer) who is the insurer of the vehicle considered to be at fault. The insurer has a liability to pay statutory benefits and/or damages under the Motor Accident Injuries Act 2017 (MAI Act). 3. The issue in dispute between the parties is whether the "degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%."[1] 4. This is a review of a medical assessment pursuant to s 7.26 of the MAI Act. The medical assessment the subject of this review was conducted by Medical Assessor Alan Home. He issued a certificate dated 5 November 2024. The Medical Assessor certified that injuries caused by the motor accident give rise to a permanent impairment of 7% which is not greater than 10%.

1. The claimant sought a review of the medical assessment in accordance with s 7.26 of the MAI Act (review). On 18 January 2025, the President's delegate determined that there was reasonable cause to suspect the medical assessment was incorrect in a material respect. As such the review application was accepted and referred to a Review Panel (the Panel).
2. A review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).[2]
3. The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6).
4. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (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: Rule 128 of the Rules.
5. Following an initial preliminary conference, the Panel issued directions dated 26 March 2025 requiring the parties to provide further medical material.
6. Following a preliminary conference, directions were issued requiring the claimant to attend a medical examination with Medical Assessor Oates on 18 July 2025 at the Commission's medical suites. The medical examination took place as scheduled.
7. A final preliminary conference occurred with a newly constituted Review Panel (Medical Assessor Kenna being replaced by Medical Assessor Gibson) on 12 August 2025. The clinical examination findings of Medical Assessor Oates and the material provided by the parties was discussed by the Panel as a whole.

1. Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
2. The Guidelines are issued pursuant to s 10.2 of the MAI Act. The Guidelines adopt the fourth edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment (AMA 4). Where there is any difference between AMA 4 and the Guidelines, the Guidelines are definitive.[3]

1. Causation of injury is addressed from cl 1.5 of the Guidelines. Whilst the clauses are set out in respect of permanent impairment they are relevant to a dispute as to threshold injury.[4]

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

Causation means that a physical, chemical or biologic 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.

1. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'

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

1.7 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 determining the issue of causation, the Panel is to also have regard to s 5D of the Civil Liability Act 2002 (CL Act),5

(1) A determination that negligence caused particular harm comprises the following elements:

(a) that the negligence was a necessary condition of the occurrence of the harm (factual causation), and

(b) that it is appropriate for the scope of the negligent person's liability to extend to the harm so caused (scope of liability).

(2) In determining in an exceptional case, in accordance with established principles, whether negligence that cannot be established as a necessary condition of the occurrence of harm should be accepted as establishing factual causation, the court is to consider (amongst other relevant things) whether or not and why responsibility for the harm should be imposed on the negligent party.

(3) If it is relevant to the determination of factual causation to determine what the person who suffered harm would have done if the negligent person had not been negligent -

(a) the matter is to be determined subjectively in the light of all relevant circumstances, subject to paragraph (b), and

(b) any statement made by the person after suffering the harm about what he or she would have done is inadmissible except to the extent (if any) that the statement is against his or her interest.

(4) For the purpose of determining the scope of liability, the court is to consider (amongst other relevant things) whether or not and why responsibility for the harm should be imposed on the negligent party."

1. Medical Assessor Home in his certificate dated 5 November 2024 found that the following injuries caused by the motor accident give rise to a 7% WPI:
   • thoracic spine T7 compression fracture loss of vertebral body height at T7;
   • cervical spine soft tissue injury;
   • left shoulder comminuted fracture to the left scapula, and
   • fracture of the left clavicle with associated soft tissue injury.
2. On examination of the cervical spine there was no muscle spasm or guarding and the Spurling's test negative. Movement was within normal ranges and neurological examination was normal. An increased sensitivity was said to be the in lateral aspect of the left arm and forearm in a non-dermatomal pattern. A DRE Category I impairment was found.
3. In respect of the thoracic spine, examination revealed increased lumbar kyphosis in the

mid-thoracic region, and no scoliosis. Lumbosacral motion was preserved in all planes. Straight leg raising performed to 80 degrees bilaterally in a long sitting position. There was a normal neurological examination. 4. The Medical Assessor noted the T7 fracture with the latest radiology (24 November 2023) demonstrating a 15% loss of vertebral height. A 5% whole pair impairment (WPI) was found in respect of the thoracic spine. 5. Examination of the left shoulder, with consistent movement noted, found a 2% WPI. 6. In respect of the right elbow and right wrist a 0% WPI was found with the range of active movement noted as normal.

Claimant's review application submissions dated 4 December 2024

1. The claimant submits that the Medical Assessor made an "egregious error" when assessing the thoracic spine. The claimant submits that the loss of vertebral height at the T7 level is 30%, and therefore a finding that the loss of vertebral height is less than 25% is incorrect.
2. The claimant submits that the "most recent" imaging referred to be Medical Assessor Home is not in fact the most recent and the claimant refers to an MRI of the cervical and thoracic spine dated 2 May 2024 which refers to a "chronic wedging of T7 with 30% loss of height". The claimant notes that a 30% loss of height would translate to a 15% WPI finding of the thoracic spine.

Insurer's review submissions in reply dated 8 January 2025

1. The insurer agrees that Medical Assessor Home failed to refer to the entirety of the later radiological investigation in his reasoning which constitutes a material error.
2. However, the insurer contends that the Medical Assessor has primarily erred in finding a compression fracture of the T7 was caused by the accident, when the injury to the thoracic spine is wholly pre-existing. It is submitted that the Medical Assessor failed to engage with the insurer's submission as to the T7 fracture being wholly pre-existing.
3. Accordingly, the submissions regarding the loss of disc height are irrelevant where the injury was not caused by the accident.
4. The insurer submits:

"...the thoracic compression fracture and related loss of disc height was not caused in the subject accident, given the delay in complaints about the thoracic spine, the notation in the radiological report in November 2023 the age of the compression was difficult to determine, and the finding of longstanding pathology in the setting of Schmorl's nodes in the hospital records."

Claimant's further review submissions dated 23 January 2025

1. The claimant submits that it has been long held by the courts that the absence of recorded complaints in contemporaneous records in and of itself is not determinative that complaints were not in fact made. It is asserted that the absence of recorded complaint regarding the thoracic spine by ambulance staff would not be unusual as medical staff attended to the claimant's more obvious and pressing injuries such as fractures to other parts of the body.
2. In response to the insurer's submissions regarding the comment on chest CT at the hospital, regarding the fracture of the T7 being longstanding, the claimant submits that the opinion of the radiologist at the hospital was given in a complete vacuum. The claimant submits:

"She has no medical background, records, earlier scans or history to compare the CT findings with. In the absence of any context or history her comment is mere speculation and holds no weight. Indeed it ought to be noted how carefully and tentatively she expressed her opinion - 'favoured to be longstanding'. No doubt this is because she is unable to state with certainty the cause of the pathology at T7 and T9 and therefore the best she can do is to speculate based on 'the setting of Schmorl's nodes'."

Claimant's submissions for original application dated 11 June 2024

1. These submissions list the injuries and not reliance on the opinion of Dr Patrick who assessed a 22% WPI in his report of 29 May 2024.
2. The claimant also refutes the insurer's submission that Dr Wallace considered the fracture to be longstanding. The claimant submits that this is not true and is not an opinion expressed in his report. The claimant points out that Dr Wallace diagnosed a T7 vertebral fracture.
3. The claimant refers to the X-ray report of 24 November 2023 and that Dr Julie Arora, radiologist noted that it was difficult to determine the exact age of the compression fracture and it had developed since the previous study (referring to an X-ray of 7 August 2020 more than two years prior to the accident).
4. In respect of the records of Associate Professor Eisman, the claimant objects to the documents being part of the material before the Panel, noting it did not form part of an application to admit late documents. However, if allowed, the claimant refutes a suggestion that the doctor concluded that the T7 fracture pre-dated the accident. Instead he expressed uncertainty about the age of the fracture. The claimant notes that the Associate Professor states in his report of 21 March 2024 "...would appear to be old ie. Remote in time. He also would appear to have a Schmorl's node there, which may be confusing the picture".

Insurer's reply submissions to original application (undated)

1. The insurer refers to medical records that document pre accident issues. In this regard the records of Linfield Medical Practice are mentioned which note previous arthralgia in the joints at a consultation on 18 February 2015.
2. The insurer also notes an X-ray of the cervical and thoracic spine dated 17 July 2014 on a history of the claimant experiencing paraesthesia on the left side of the neck with the radiology revealing mild narrowing of the C4/5 and C6 disc spaces with early degenerative changes in the facet joints.
3. The insurer notes a reliance on a report of Dr Patrick by the claimant and that there is a reference to a different named person, which suggests a "cut and paste" type error in the report and therefore "...there must be considerable doubt as to the accuracy of the report and the stated findings and conclusions."
4. In respect of the cervical spine, the insurer notes an absence of recorded complaint in the ambulance report and the hospital discharge summary.
5. Similarly, in respect of the thoracic spine the insurer notes an absence of complaint in the ambulance report, hospital records or the records of Chatswood Medical & Dental Practice.
6. In respect of the thoracic spine the insurer submits:

"...the diagnosis of a T7 compression fracture, kyphosis of the mid-thoracic region of T7 and chronic compression of the T8 superior endplate with loss of vertebral height is predicated upon a comment as to the anomaly identified in an investigation report of

24 November 2023 when compared against a scan performed 7 August 2020 but which is not available.

The fact that the anomalies are no present and have appeared in the intervening period is seized upon to relate them to the sequelae of the subject accident in the absence of any further reasoning. The assessor will see that the investigation report itself stated that the age of the compression was said to be difficult to determine.

The insurer notes the absence of any complaint about the level of T7 at the time of the accident. It would be expected that if there was a blunt force injury sufficient to cause a T7 vertebral fracture together with endplate fractures at T9, such would have been extremely painful and immediately apparent. It would be expected that there would be reference to such an injury in the records of RNS Hospital.

CT Pan scan performed at RNS Hospital at the time of his admission identified the superior end plate depression of T7 and T9 however these findings were favoured to be longstanding in the setting of Schmorl's nodes.

It is significant that this was the impression of the reporting radiographer at the time the scan was performed on the day of the accident.

It is submitted this argues against the anomalies being accident related. Rather it supports a finding the anomalies were pre-existing and co-incidental."

1. The insurer submits that the claimant has recovered from the various fractures and there would be no assessable impairment. It is submitted that a finding of soft tissue injury of the cervical spine would not be made, and if a finding is made there would be no assessable impairment.
2. The insurer disputes any injury to the left lower limb beyond minor abrasions, and would not give rise to an assessable impairment.

1. The Panel issued interim directions dated 5 February 2025 requiring the parties to lodge single paginated and indexed bundles of documents relied upon. The Panel has considered the following bundles of documents in reaching its determination:

● claimant's bundle of documents relied upon - review application" consisting of

• 'Insurer's additional documents'- consisting of 18 pages lodged on

10 March 2025;

• 'Stephen Bryan-Insurer's index of additional documents - 2025.03.19' - consisting of 49 pages lodged on 19 March 2025;
• '2025.03.19 - Insurer's PIC Reply (Review Application of Certificate of Assessor Home)' consisting of 314 pages lodged on 19 March 2025;
• Application to admit late documents - claimant's bundle 'RP Paginated Bundle (Per Directions 26.3.25)' consisting of 181 pages lodged on 13 May 2025;
• Application to admit late documents - claimant's bundle 'AALD - Dr Moharami report' consisting of 6 pages lodged on 30 June 2015;
• 'Insurer's response to claimant's application to admit late documents' lodged on 10 July 2025, and
• claimant's bundle lodged on 14 July 2025 -'AALD - Link to CT Imaging (sic) from RNSH taken on 23 January 2023'.

1. The Panel notes the claimant's objection to the insurer's inclusion of the file of Associate Professor Eisman, on the basis that it is not part of an application to admit late documents. However, the Panel notes that the Panel directions of 5 February 2025 called for documents relied upon which included an allowance for additional documents that were not before Medical Assessor Home. Furthermore, it is apparent that the claimant later included these documents in a subsequent bundle. Noting that the material is from a treating specialist and is relevant to the issues in dispute, the Panel has considered the documents.
2. The Panel notes the insurer's objection to the claimant relying upon the report of

Dr Moharami. The insurer submits that the report has been lodged outside the timeframe prescribed by Rule 67C of the Rules. The insurer notes that the report of Dr Korber was served in February 2025 and therefore there has been significant delay in obtaining the subject report of Dr Moharami. The Panel acknowledges the timeframe allowed for in Rule 67C of the Rules. However, the Panel considers the report of Dr Moharami as relevant to the issues in dispute and it would be in the interests of justice for the claimant to have the opportunity to respond to the report of Dr Korber, even in circumstances where there has been some delay. The Panel therefore dispenses with the requirement of Rule 67C pursuant to Rule 6(1) of the Rules. 3. The Panel has not referred to every document considered within these reasons. Some material has been referenced that is directly relevant to the findings made. However, the certificate and reasons have been provided within the context of all material having been considered.

Report of Dr John Korber, radiologist, dated 19 February 2025 - addressed to insurer

1. The doctor, within the report, analyses the radiology films. In summary he finds:

"In relation to the thoracic vertebrae, I have no doubt that there is an anterior compression of T7 (14%) and a superior endplate compression of T9 (without anterior compression). The imaging I have seen also demonstrates the scapular fracture as well as the clavicular fracture. It also demonstrates the scaphoid fracture. The hand x-ray does not confirm the triquetral fracture which would be better seen on CT."

1. In answer to a question as to whether he agrees or disagrees with the reporting radiologists the doctor answers: "without having seen the CT of the chest, it is reasonable that the T7 and T9 vertebral changes are recent." He also confirms his opinion that the pathology identified in the thoracic spine was not pre-existing. He further states "I am of the opinion that T7 and T9 are recent since the X-ray of 23 January 2023. They are clearly not present on

7 August 2020." 2. Lastly when asked whether he agreed or disagreed with Associate Professor Eisman's opinion that the thoracic fracture appeared older than the pathology noted on the left scapular, left clavicle and left anterior second rib, Dr Korber replies:

"It would appear the patient has had a significant injury given the peripheral injuries. With the limitation that the x-rays performed ten months after the injury, I do not have any reason to suggest a variation to when the fractures occurred simply based on appearance."

Dr Benham Moharami, radiologist, dated 30 June 2025 - addressed to claimant

1. Following consideration of the radiology, the doctor concludes:

"On the chest xray of 2020, pre-incident, there is no evidence of fracture and the appearance and morphology of T7 is within normal limits.

On Thoracic spine image of 2023, on my measurement (please note the measurements are different compared to the previous reports as has been used the electronic version), T6 is 22.8mm, T7 is 22.5 and T8 is 27 mm. This is almost 10% loss of vertebral body height anteriorly. However, there is central loss of body height due to superior and end-plate fracture with central vertebral body measuring 18.6mm, with T6 measuring 19.6mm and TB measuring 25.2mm, using same calculation method as previous reports, this is equal to vertebral loss of 17%. Using different method of height calculation which is comparing the anterior to the posterior height of same vertebral body (T7), the vertebral body height loss is equal to (28.6-22.5)/28.6=21.4%.

On MRI study of May 2024, when using previous method of calculating anterior body height of T6, T7 and T8, the body height loss will be equal to 23%. When using the more common method of comparing anterior and posterior column of same vertebral body, the body height loss is equal to (22.9-16.2)/22.9=29%.

Overall, when reviewing previous study, in my opinion the wedge deformity has progresses (sic) since study of 2023 to the study of 2024 and considering the common method of calculation of vertebral body height and the latest imaging (MRI) confirms that there is more than 25% (29%) loss of T7 vertebral body height."

Dr Wallace dated 8 December 2023 addressed to the insurer

1. Following examination, the doctor stated that the claimant's injuries to his left shoulder, right elbow, right wrist and thoracic spine (including a T7 fracture) had been caused by the motor accident. He found a DRE Category II impairment in respect of the thoracic spine giving rise to a 5% WPI and a 0% WPI in respect of the balance of the injuries.

Dr Patrick dated 29 May 2024 addressed to the claimant

1. Following examination, the doctor assessed a 22% WPI. This includes a 5% WPI in respect of the cervical spine, a 5% to the thoracic spine, a 7% in respect of the right shoulder and 8% in respect of the left shoulder.

1. Below are the examination findings of Medical Assessor Oates following his assessment of the claimant on 18 July 2025 at the Commission's medical suites in Darlinghurst.

• thoracic spine: T7 compression fracture with 30% loss of vertebral height; kyphosis at the mid-thoracic region of the spine; chronic compression of T9 superior endplate with loss of vertebral height;
• cervical spine: Posterior disc protrusion at C6/7; musculoligamentous injury;
• left shoulder: Comminuted fracture of left scapula; musculoligamentous injury;
• right shoulder: musculoligamentous injury;
• left clavicle: fracture to left clavicle;
• right wrist: fracture to right scaphoid trapezium; musculoligamentous injury;
• right hand: musculoligamentous injury;
• right elbow: fracture to right radial head;
• left leg: soft tissue injury to left calf, and
• left foot: musculoligamentous injury to left foot and 4th left toe; injury to left foot impacting foot reflexes consequent upon injury to thoracic spine (pursuant to the principles in Nguyen).

Pre-accident medical history and relevant personal details including details from the file of evidence

1. The claimant is right hand dominant.
2. He was born in the UK and came to Australia in 2012. He works as a medical recruitment consultant and was a full-time employee at the time of the accident.
3. He was on no regular medications and has had no surgery. He was taking medication for ADHD (attention deficit hyperactivity disorder), which was diagnosed in adulthood.
4. In his thirties, he had a fracture of left scaphoid which was treated by immobilisation in a plaster cast and recovered.
5. In his early thirties, he had a fracture of the left elbow when he fell off a mountain bike. This recovered.
6. In 2014, he had X-ray of thoracic and cervical spine with clinical history playing piano and pins and needles and tightness in the left paracervical. This condition settled with physiotherapy. There was no radiation of symptoms to the left arm beyond the trapezius.
7. When I asked him about it, he did not recall having had a 2015 X-ray to the lumbar spine.
8. He told me that a 2017 MRI scan was done for numbness in the perineum and this settled with ergonomic adjustment of the bicycle seat.
9. At the time of the accident, he lived in a house with his wife and two children and did cycling and was a musician.

1. The claimant confirmed on 23 January 2023, he was riding a pushbike in St Ives and entered a roundabout, when his bike was hit from behind by a vehicle which entered the roundabout subsequently.
2. He was knocked off the bicycle, landing heavily on the road on his upper back and left shoulder blade area. He had a gravel rash to the lateral left lower leg from contact with the car tyre. He was not knocked out and the bicycle helmet he was wearing was not significantly damaged. He felt upper back pain and left shoulder girdle pain and the pain levels were high. An ambulance attended.
3. The ambulance record indicates 10/10 left scapular pain and an abrasion to left lower leg.
4. He was transported to Royal North Shore Hospital. The hospital investigations showed a left scapular fracture and there was also complaint of pain in the left elbow, left wrist and left mid-shaft of clavicle, with a right distal pole scaphoid fracture and trapezium fracture, and a right elbow radial head fracture.
5. A chest CT scan showed superior endplate depression of T7 and T9 which were favoured to be long-standing in the setting of Schmorl's nodes, along with a minimally displaced fracture of mid left clavicle.
6. He was discharged on 25 January 2023 after receiving analgesia.
7. Pain control was difficult at first until an anti-inflammatory, diclofenac, was added, after which pain levels became more manageable.
8. He saw Dr Papadimitriou, orthopaedic surgeon, and Dr Lawson, orthopaedic surgeon, in fracture follow-up clinic. His fractures were managed conservatively.
9. He had progress imaging. He also had an X-ray and MRI scan of cervical spine on

1 March 2023 but does not recall having any symptoms radiating from the neck into either arm. 10. He was off work for eight weeks and then returned to work on a gradual basis over one to two months, before attaining full-time work. He then resigned and started his own business in the same field, medical recruitment for specialists. His company is called MBBS Recruitment. 11. After hospital management, his general practitioner (GP) organised analgesics and physiotherapy with treatment to the upper body for strengthening using Therabands and pulleys, and then he joined a gym to continue with weight training.

1. The claimant has chronic lower interscapular level pain, and he can't get that part of his mid-back comfortable when sitting in a chair, and there are intermittent mid-thoracic numbness feelings.
2. He can drive a car about one hour, then gets restless and starts moving around in his seat because of thoracic discomfort. He also gets discomfort which disturbs sleep.
3. He still rides a bicycle but for less time now, 25 - 30 minutes when he has to start adjusting his position, and he can manage one and half hour maximum. He plays the piano but for a reduced time.
4. He notices soreness in the left olecranon at the elbow when lifting barbells at the gym, and he gets occasional right scaphoid discomfort at the wrist when lifting and gripping combined with a twisting action, or if he overplays the piano.

1. The claimant attends self-funded physiotherapy about three monthly to monitor his range of movement. He goes to the gymnasium once or twice per week.
2. He stretches out his thoracic back by lying on the floor. If he is in discomfort, which stretching doesn't settle down, he will take ibuprofen +/- paracetamol but tries to avoid too much medication.

1. The claimant was of proportionate build with height 181cm and weight 82.8kg.
2. There was increased mid-thoracic kyphosis on inspection of the spine from one side.
3. There was no chest pain on springing of the ribs and no chest tenderness.

1. There was no spasm and no guarding. There were no non-verifiable radicular complaints. There was full, free range of movement in flexion, extension, lateral flexion and rotation in both directions.
2. Reflexes were all of low amplitude but symmetrical. Power and sensation in the upper limbs were normal.
3. Upper arm girth; right 31cm, left 31.5cm.
4. Forearm girth; right 29.5cm, left 29cm.

1. There was no spasm, no guarding, no non-verifiable radicular complaints.
2. There was full rotation bilaterally when tested at 90° of lumbar flexion and when tested whilst sitting to eliminate lumbar spinal rotation.
3. Sensation over the trunk was intact.

1. The claimant confirmed there was no skin mark or scarring remaining from the left leg abrasion, which had fully healed.

1. There was full range of movement in the right shoulder in flexion - 180°, extension - 50°, abduction - 180°, adduction - 50°, internal and external rotation - both 90°.
2. For the left shoulder measured with a goniometer - flexion 160°, extension 70°, abduction 160°, adduction 40°, internal rotation and external rotation both 80°.
3. The AC joint was intact.
4. There was some mild deformity of the mid-shaft of left clavicle, with no tenderness and no instability at the healed fracture site.
5. Impingement test negative bilaterally.
6. Resisted abduction and flexion strength at the shoulders was equal bilaterally.
7. Right and left elbows showed full range of movement in flexion, extension, pronation and supination measured by goniometer.
8. Right and left wrists showed the following movements by goniometer:

1. Mr Bryant presented in a straightforward consistent manner.

1. There was no additional imaging brought to the Panel re-examination. However, links to the relevant radiology has been provided and the Medical Assessors of the Panel have viewed same. This is discussed further below.

1. The above clinical examination findings were discussed by the Panel at the teleconference on 12 August 2025. The Panel after discussion, agreed with the examination findings of Medical Assessor Oates and agreed that same would be incorporated into these reasons.

1. The Panel is satisfied that on the balance of probabilities, the claimant did suffer a whiplash associated disorder musculoligamentous injury, considering the mechanics of the accident, where he was thrown off his bicycle after being hit from the rear by a motor vehicle, and landing heavily on his upper back and left scapular region, which are adjacent to the cervical spine.
2. Although he denied neck pain according to the ambulance record, and there was no neck tenderness and he was moving his neck freely according to the hospital record, he subsequently had investigations of the cervical spine on 1 March 2023 to check for the presence of a whiplash soft tissue injury or a disc injury.

1. The fractured left clavicle was related to the accident, as this is mentioned in the hospital record, within the claim form and the accompanying certificate of capacity.

1. A right elbow fracture of the radial head was caused by the accident, as is mentioned in the hospital records, the claim form and the accompanying certificate of capacity.

1. This condition is not related to the accident. It is not mentioned in the contemporaneous medical record including ambulance notes, hospital notes and GP record. The claimant confirmed that this condition had its onset after he kicked his foot on a door frame.

1. There is no contemporaneous medical evidence of an independent injury to the right hand, although there is clear evidence of a right wrist injury. On the balance of probabilities, the Panel is not satisfied that the claimant suffered an injury to the right hand caused by the motor accident.

1. There was a soft tissue injury abrasion to the left calf from contact with the tyre of the car which hit him. This injury is mentioned in the ambulance records. The Panel is satisfied that the claimant suffered an injury to his left leg caused by the accident.

1. The Panel is satisfied on the balance of probabilities that the claimant suffered a comminuted fracture of left scapula caused by the accident. The ambulance record indicated he hit the concrete with his left scapula adjacent to thoracic spine, and this injury is mentioned in the hospital record, the claim form and the accompanying certificate of capacity.

1. The T7 compression fracture is an acute fracture according to expert radiological evidence and was not present on a previous X-ray taken prior to the motor vehicle accident, therefore the Panel is satisfied, on the balance of probabilities, that the accident is a cause of T7 compression fracture and a T9 superior endplate compression. The Panel considers the motor accident mechanism to be consistent with such injury.
2. The Panel notes the comments of the radiologist at the Royal North Shore Hospital. Having considered the entirety of the medical evidence, including from the expert radiologists,

Dr Korber and Dr Moharami, the Panel is satisfied that the mechanism of the motor accident is capable to giving rise to a compression fracture. Secondly, on the balance of probabilities, the Panel is satisfied that the compression fracture was caused by the motor accident. It is also noted that Dr Wallace similarly expressed his opinion that the fracture was caused by the motor accident.

1. There was a scaphoid and trapezium fracture of which the accident is a cause, as this injury is referred to in the hospital record, the claim form and the accompanying certificate of capacity.

1. This is a musculoligamentous injury, and the Panel is satisfied that that the accident was a material cause of this injury, noting the claimant's complaints recorded in the hospital file.

1. In the cervical spine, there are intermittent symptoms but no guarding, no spasm, no non-verifiable radicular complaints, and no radiculopathy as prescribed by the Guidelines. The descriptors place him in DRE Cervicothoracic Category I giving 0% WPI.
2. The left clavicle and left scapula are assessed by means of range of movement at the left shoulder. Flexion 160° gives 1% upper extremity impairment and abduction 160° gives 1%. Adding these gives 2% upper extremity impairment, equivalent to 1% WPI.
3. The right elbow showed full range of movement in flexion, extension, pronation and supination, hence 0% WPI.
4. The left leg abrasion soft tissue injury has healed, resulting in 0% WPI.
5. The right wrist showed full range of movement, hence no assessable permanent impairment.
6. The right shoulder showed full range of movement, hence no assessable permanent impairment.
7. He had ongoing interscapular pain from the time of the accident and measurements have revealed he has lost 2cm in height, with development of a mid-thoracic kyphosis. Before the accident he was 183cm and now is 181cm.
8. On 24 November 2023, he saw his GP after he had put down a barbell at the gym and got sudden onset of right intercostal pain radiating to the thoracic spine. He was sent for a bone scan to check the ribs and the status of T7 +/- a Schmorl's node.
9. An X-ray of the chest and thoracic spine on even date showed mild T7 superior endplate compression with 15% loss of vertebral body height. This was reported to have developed since the previous study of 7 August 2020, although it was difficult to determine the age of the compression fracture of T7. There was no rib fracture.
10. He had a bone mineral densitometry DEXA scan showing a mix of osteoporosis and osteopaenia.
11. He was referred to Associate Professor Eisman, endocrinologist, after the DEXA scan. He had a nuclear bone scan on 1 December 2023 showing fractures of left scapula and left clavicle, undisplaced fracture of anterior right second rib and T7 mild compression fracture, which was said to be old or remote.
12. Associate Professor Eisman, after further investigation, diagnosed hypercalciuria, meaning his kidneys were leaking calcium into the urine, with the calcium then being leached out of the bones. He initiated treatment with Dithiazide 25mg per day from October 2024 and as a result of treatment, he is no longer leaking calcium into the urine.
13. He is to have a repeat DEXA scan in February 2026 to check on the status of his bone density.
14. He was referred to a neurologist for "moving toe" syndrome of the left foot, which is unrelated to the motor vehicle accident. He recalls this came on after he kicked his left foot on a doorframe.
15. Dr Korber, radiologist, on 19 February 2025, referred to an anterior compression of T7 vertebral body of 14% and superior endplate compression of T9 vertebra without anterior vertebral body compression. Both of these vertebral changes are recent, as they were not present on the X-ray of 7 August 2020.
16. Dr Moharami, radiologist, on 30 June 2025 noted 17% vertebral body height loss at T7, or 21.4% when comparing the anterior and posterior vertebral body height on X-ray.
17. An MRI scan of 2 May 2024 using the method of comparing anterior body height resulted in 23% compression of T7 against adjacent vertebra, and if measuring anterior and posterior heights of the T7 vertebra gave 29% loss of T7 vertebral body height.
18. Note: cl 6.148 of the Guidelines, prescribes the preferred method of assessing the amount of compression in a vertebral fracture is to use a lateral X-ray of the spinal region with the beam parallel to the disc spaces, or a CT scan if the former is not available. The area of maximum compression is measured in the vertebra with the compression fracture. The same area of the vertebrae directly above and below the affected vertebra is measured and an average obtained.
19. The measurement from the compressed vertebra is then subtracted from the average of the two adjacent vertebrae and the resulting figure is divided by the average of the two unaffected vertebrae and turned into a percentage. If there are not two adjacent normal vertebrae, then the next vertebra that is normal and one adjacent to (above or below) the affected vertebra is used. The calculations must be documented in the impairment evaluation report.
20. In the case of this claimant, the superior endplate compression of T9, which does not involve anterior compression, is assessed as DRE Category II because there is no measurable compression of the vertebral body (cl 6150 of the Guidelines).
21. For this claimant, both independent expert radiologists (Drs Moharami and Korber) confirm less than 25% T7 anterior vertebral body height loss, when using the preferred assessment method set out at cl 6.148 of the Guidelines. The "more common method" of assessment of vertebral body height loss, comparing the anterior and posterior columns of the same vertebral body as referenced by Dr Moharami in his report of 30 June 2025, is not the method prescribed by the Guidelines. It is therefore rejected by the Panel. His assessment of 29% loss of T7 vertebral body height based on the MRI study of 2 May 2024, uses this invalid assessment method, whereas when the method prescribed by the Guidelines is used, his assessment is 23% loss of T7 vertebral body height. The Panel notes that cl 6.148 states that lateral x-ray is to be preferred for this assessment, or if unavailable, a CT scan can be used. The Guidelines are silent on the use of an MRI scan for assessment purposes, however, it cautions that the error rate will be significant unless the Medical Assessor is able to magnify the images electronically.
22. The Medical Assessors of the Panel made their assessment based on the magnified CT images dated 24 January 2024, and using the preferred method of assessment as stipulated by cl 6.148 of the Guidelines. Both Medical Assessor Oates, and Medical Assessor Gibson calculated a 21% loss of height in this regard, utilising the method prescribed by the Guidelines.
23. Whilst the Guidelines stipulate the use of lateral x-ray or CT scan, for the sake of completeness, the Panel recently requested a link to the MRI study of 2 May 2024 which was promptly provided. Both Medical Assessors have viewed same and when utilising the method of assessment prescribed by cl 6.148 of the Guidelines, agree on a calculation of 23% loss of height. It is to be noted that this accords with the findings of Dr Moharami when he utilised the Guidelines prescribed method of assessment.
24. The Panel notes that Dr Korber did not have access to the MRI study of May 2024.
25. Less than 25% compression of a vertebral body is DRE Thoracolumbar Category II giving 5% WPI.
26. The thoracic spine has a T7 compression fracture with 25% or less loss of vertebral body height when calculated according to the method prescribed in the Guidelines.
27. There is also compression of the T9 superior endplate without compression of the vertebra. This endplate compression, whether single or multiple, results in DRE Category II. A compression fracture of less than 25% of the vertebral body in the thoracic spine also results in DRE Thoracolumbar Category II giving 5% WPI.
28. The combined impairment is 5% (thoracolumbar spine) by 1% (left clavicle and left scapula) giving 6% WPI.

1. As the findings of the Panel differ from Medical Assessor Home the certificate of

5 November 2024 is revoked and a new certificate is provided at the beginning of these reasons.

[4] See Briggs v IAG Limited t/as NRMA Insurance [2022] NSWSC 372 at [35].