MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; medical assessment of whole person impairment (WPI) by Medical Assessor (MA); claimant injured in motor accident; vehicle she was driving was hit from behind; claimant sustained injury dispute arose as to the claimant's WPI; MA determined the claimant's permanent impairment as a result of spinal injury at 19%; insurer sought a review of the assessment under section 7.26; Review Panel re-examined the claimant; Held - Review Panel confirmed certificate of MA.

Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. The Medical Review Panel affirms the certificate of Medical Assessor James Bodel dated

29 April 2025 that as a result of the fracture injury at C1, the claimant has sustained a permanent spinal canal deformity for which cervicothoracic DRE category III applies resulting in a 15% whole person impairment. 2. Further, the Panel has found consistent dysmetria in the lumbar spine, with left greater than right lateral flexion, which according to Table 6.7 of the Guidelines, gives 5% whole person impairment. 3. Further, the Panel certifies that following the combination of 15% WPI for the injury to the cervical spine and 5% whole person impairment for injury to the lumbar spine (Combined Values Charts AMA4), the claimant has a 19% whole person impairment.

1. The claimant, Holly Haaweatea Bryson (Ms Bryson), was injured in a motor vehicle accident (the accident) on 26 July 2021. The vehicle she was driving was stationary waiting to make a left-hand turn when it was hit from behind.
2. Ms Bryson submits she sustained both physical and psychiatric injury.
3. AAI Limited t/as GIO (the insurer) was the CTP insurer.
4. Pursuant to the Motor Accident Injuries Act 2017 (the Act), the statutory benefits for treatment and care cease after 26 weeks if the person's only injuries resulting from the motor accident were minor injuries.
5. On 13 August 2021, Ms Bryson submitted an Application for Personal Injury Benefits.
6. A medical dispute about the degree of Ms Bryson's whole person impairment (WPI) has arisen. This constitutes a medical assessment matter under Schedule 2, cl 2(a) of the Act.
7. A medical assessment matter is determined in accordance with Division 7.5 of the Act by a Medical Assessor: s 7.20 of the Act.
8. The dispute was referred to the Personal Injury Commission (Commission) which then assigned it to Medical Assessor James Bodel for assessment.
9. On 28 January 2025, Medical Assessor Bodel assessed Ms Bryson and on 29 April 2025, certified that the following injuries caused by the accident gave rise to a WPI of 19%:
   • cervical spine - complete C1 fracture, and
   • lumbar spine - discal damage, injury to lumbar spine.

1. The insurer sought a review of the Medical Assessment under s 7.26 of the Act (the Review).
2. On 11 June 2025, a delegate of the President of the Commission determined there was reasonable cause to suspect that the medical assessment was incorrect in a material respect and referred the matter to the Panel.
3. The review provisions provide that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission: s 7.26(5A) of the Act. Accordingly, the President's delegate has convened this Panel to conduct the review.
4. Part 5 of 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: s 41(2) of the PIC Act.
5. 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. The Review is by way of a new assessment of all matters with which the medical assessment is concerned: s 7.26(6) of the Act.
6. 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 proceedings solely based on the written application: Rule 128 of the PIC Rules.

1. Sections 5D and 5E of the Civil Liability Act 2002 (the CLA) apply to the Act: s 3B(2) of the CLA.
2. Ms Bryson's claim and entitlements to compensation are governed by the provisions of the Act. An injured person can make a claim for both economic losses and non-economic loss damages.
3. Section 4.11 of the Act provides that no damages for non-economic loss may be awarded in respect of injury unless the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%.

1. Section 7.21 of the 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. Permanent impairment is assessed in accordance with Part 6 of the Guidelines.
3. Causation of injury is addressed in cls 6.5, 6.6 and 6.7 of the Guidelines.
4. Clause 6.6 of the Guidelines notes:

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

'Causation means that a physical, chemical or 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.
2. 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."

"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. Pre-existing impairment is addressed in cls 6.31, 6.32 and 6.33 of the Guidelines.
2. The evaluation of the permanent impairment may be complicated by the presence of an impairment in the same region that existed before the relevant motor accident. If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident, then its value must be calculated and subtracted from the current WPI value. If there is no objective evidence of the pre-existing symptomatic permanent impairment, then its possible presence should be ignored: cl 6.31 of the Guidelines.
3. Clause 6.32 of the Guidelines states:

"The capacity of a medical assessor to determine a change in physical impairment will depend upon the reliability of clinical information on the pre-existing condition. To quote the AMA 4 Guides (page 10): 'For example, in apportioning a spine impairment, first the current spine impairment would be estimated, and then impairment from any pre-existing spine problem would be estimated. The estimate for the pre-existing impairment would be subtracted from that for the present impairment to account for the effects of the former. Using this approach to apportionment would require accurate information and data on both impairments.' Refer to clause 6.218 for the approach to a pre-existing psychiatric impairment."

1. Medical Assessor James Bodel examined Ms Bryson on 28 January 2025 and issued his certificate on 29 April 2025. He had the documents attached to the Application, and three additional late documents including clinical notes from Tracey Santos, psychologist, a further application with the insurer's reply submission, and the discharge referral from Byron Bay Centre Hospital dated 29 July 2021.
2. At [3]-[4] of his certificate, Medical Assessor Bodel set out the submissions made by each of the parties.
3. At [8], the Medical Assessor set out a pre-accident medical history, noting that Ms Bryson was generally very fit and healthy and she was engaged in multiple sports and an outdoor lifestyle, which she could no longer undertake. At the time of the accident, she was training for a triathlon. She was previously a snow ski instructor when she lived in Canada. She sustained a mid-thoracic injury involving T6/7 or T7/8 about 20 years ago, from which she completely recovered. She has not been able to return to her psychology, counselling and training roles, except for a few hours per week done online. She cannot concentrate and cannot sit for too long because of the physical injuries and her psychological issues.
4. Medical Assessor Bodel proceeded to set out the history of the accident at [9]. On

26 July 2021, the vehicle Ms Bryson was driving was stationary waiting to turn left when it was rear ended by another vehicle. She was pushed forward and hit her head on the steering wheel and/or head restraint. She was dazed but not rendered unconscious. Neither police nor ambulance attended. 5. He then set out Ms Bryson's history of symptoms and treatment following the accident at [10], recording that she was shocked and she had right-sided neck pain and a headache. Following the accident, she drove home and cancelled a planned meeting she had later in the day. Initially, she thought that she would be able to manage this herself. She wanted to "treat myself" but she sought some chiropractic treatment. Later, the chiropractor strongly suggested that she be seen at the local hospital, and she attended the Byron Bay Central Hospital on 29 July 2021, three days after the accident. She reported that she felt quite weak, as though her head was disconnected from her neck and that she had to "hold my head on." She stated that the airbags were not deployed. 6. Clinical findings prior to X-ray showed that she was tender in the mid-line, in the area of the upper cervical spine at C1 and C2. There was no paraspinal tenderness but there was a decreased range of motion. She was sent for imaging, including a CT scan of the spine, a CT scan of the brain, and neck angiogram. The clinical findings reported the following:

"Mildly distracted fracture of the lateral aspect of the posterior arch of C1. Approximately 2.5mm of distraction across the fracture interface. No facet joint dislocation. No spinous or transverse process fractures demonstrated. No vertebral soft tissue swelling. No occipital condylar fracture is seen."

1. An angiogram was also done and there was no sign of dissection of the vertebral artery. The abnormalities found on this scan suggested a neurosurgical review and an MRI be done subsequently. She was put into a soft collar for a reported six months.
2. The MRI scan of the cervical spine did confirm the fracture. She was then referred to

Dr Schwindack. He observed that the fracture was a stable fracture. Subsequent CT scanning two years later on 19 October 2023 showed that there was an effort for the fracture to unite, but it had not united fully. It was however stable, as indicated by Dr Schwindack, but full bony union had not occurred. 3. The stability allowed her to be mobile without the collar and she could engage in normal day-to-day activities, but should avoid high impact activities such as skiing or surfing, or any body contact sports. She found herself uncomfortable in a crowd or at a music festival. This is partly due to anxiety, but partly also due to her concern about the injury of her neck. 4. She has continued to have physiotherapy. She sought further treatment from a concussion clinic in Sydney. She had also been to a vestibular physiotherapist because of possible inner ear abnormalities associated with damage to the inner circular canals. Dr Schwindack has indicated no surgical intervention was warranted. She states that the pain was very severe and did not resolve for at least 12 - 18 months. At that time, there was a slight improvement, but resolution of symptoms has been incomplete. 5. At [11] in his certificate, Medical Assessor Bodel notes that Ms Bryson did not sustain any relevant injuries or conditions since the accident, except for a fall off a ladder injuring her right knee which had resolved. She did not re-injure her neck in the fall. 6. As to current symptoms, the Medical Assessor reported at [12] that Ms Bryson: * still has an ache in the neck, the right side worse than the left. The pain is primarily suboccipital, high in the cervical spine, underneath the occipital ridge; * has a reduced range of neck movement, the right side worse than the left, with a grossly restricted range of lateral bending and rotation to the right, with associated dysmetria and a slightly better range of rotation movement to the left. She has quite marked discomfort on palpation at the base of the neck, and * has pain in the lower part of the back, on the right side, which is aggravated by prolonged sitting or bending, twisting or lifting. 7. He then sets out Ms Bryson's current and proposed treatment at [13]: * Physiotherapy; * Nurofen; * Valium about three times a week; * CBD oil and THC, which she finds helpful; * Propranolol for the headaches; * under the care of her GP, and * she is trying to exercise but she is grossly restricted in this activity. 8. Medical Assessor Bodel then undertook a clinical examination at [14] which the Panel reproduces below:

"The claimant is anxious in her manner. She is not overweight. There is no visible sign of spinal deformity and she walks without a limp."

"There is tenderness in the trapezius muscle at the base of the neck on the right side and guarding in that area. There is dysmetria with a restricted range of lateral bending and rotation to the right, with approximately 50% of the expected range of lateral bending and rotation to the right and 70% of the expected range of lateral bending and rotation to the left. The reflexes in the upper limbs are normal. There is no measurable wasting in either arm or either forearm. There is no weakness in either arm. There is no sensory loss in a dermatomal distribution and no clinical signs of radiculopathy."

"There is a good range of lateral bending and rotation of the thoracic spine, no restriction of chest wall movement, and dysmetria or radiculopathy around the chest wall."

"There is tenderness over the lower part of the back on the right side, over the top of the right sacroiliac joint. There is some guarding in that area and slight dysmetria. There is 60% of the expected range of lateral bending to the left and 80% of expected range of lateral bending to the right. Straight leg raising is unimpaired. There is no clinical sign of reflex abnormality, sensory impairment, wasting or weakness in the lower limbs, and no clinical signs of radiculopathy."

"There is a full range of shoulder, elbow, wrist and hand movement. There are no clinical signs of localised pathology in the joints of the upper limbs."

"There is a full range of hip, knee, ankle and subtalar movement. There is no clinical sign of pathology in any of the joints of the lower limbs. Again, there is no neurological abnormality in the upper or lower limbs."

"Ms Bryson is anxious in her manner, as one would expect with the clinical symptoms that she is experiencing, associated with the psychological and physical injury. Her neck is stiff and her clinical signs are consistent with injury to the neck and the back as listed. The mechanism of the injury could have led to the clinical symptoms that she presents with."

1. At [21]-[22], Medical Assessor Bodel sets out the documentation and medical imaging that he relied upon.
2. Medical Assessor Bodel set out his diagnosis and reasons at [23], noting Ms Bryson suffered a soft tissue injury to the lower part of the back with asymmetry of back movement, and a fracture of the anterior arch of the C1 vertebral body. This is in the upper part of the cervical spine.
3. As to causation and reasons, the Medical Assessor recorded at [24] that the injuries referred to him were caused by the accident.
4. At [25], the Medical Assessor reported that the following injuries were caused by the accident:
   • cervical spine - complete C1 fracture, and
   • lumbar spine - discal damage, injury to lumbar spine.
5. Medical Assessor Bodel provided his opinion as to permanent impairment at [26]-[27] which the Panel reproduces below:

"The claimant is left with ongoing pain and stiffness in the region of the neck. She has associated headache and other issues, but from the musculoskeletal point of view, she is left with ongoing impairment in the cervical spine due to the fracture of C1 anterior arch. She has a soft tissue musculoligamentous injury to the lower part of the back with asymmetry of movement in that region, also caused by the motor vehicle accident. Both areas are now stable and static."

AMA4 Guides/ Guidelines References (chapter/ page/table)

DRE Cervicothoracic Category III Table 73, Page 3/110 of AMA4

DRE Lumbosacral Category II Table 72, Page 3/110 of AMA4

1. At [28]-[30], the Medical Assessor reported that there was no pre-existing or subsequent impairment, no apportionment, and no effects of treatment.
2. Medical Assessor Bodel concluded at [31] that the degree of WPI as a result of the injuries sustained in the accident was 19%.

1. The Panel summarises the material that was available to it and upon which it relied during its assessment of Ms Bryson, including the material available and summarised by Medical Assessor Bodel.

Discharge referral of Byron Central Hospital dated 29 July 2021

"Headache/ neck pain 4/7 BG MVA 4/7 ago - driver - rear ended - whilst stationary. Referred via chiropractor today - see letter. Did not seek medical assistance at time - pt described having to 'hold my head on' after incident. Nil air bags deployed. Pt denies LOC ? hit back of head on head rest. 'migraine' later in day & next day. Nil phx migraine. C/O nausea - dizziness & sensitivity to light since - nil vomiting. C/O sharp anterior neck pain - not particularly worse with movement. Nil numbness/ tingling in limbs. Taking nurofen PRN. Nil fever. E&D OK"

"Mildly distracted fracture of the lateral aspect of posterior arch of C1. Approximately 2.5 mm of distraction across the fracture interface No facet joint dislocation. No spinous or transverse process fractures demonstrated. No prevertebral soft tissue swelling No occipital condylar fracture is seen"

"Mildly distracted fracture of the lateral aspect of posterior arch of C1; favoured to be acute. Clinical correlation, neurosurgical review and MRI suggested No signs of acute vascular abnormality of the major visualised intracranial arteries to account for symptoms."

MRI cervical spine, five days after accident (37)

_"_Fracture of the right side of the Cl posterior arch with no associated haematoma or significant soft tissue swelling. C5/6 and C6/7 disc degeneration with minor localised ventral spinal canal encroachment."

"Mildly distracted fracture of the lateral aspect of posterior arch of C1. Approximately 2.5mm of distraction across the fracture interface. No facet joint dislocation. No spinous or transverse process fractures demonstrated. No prevertebral soft tissue swelling. No occipital condylar fracture is seen. Adequate quality CT angiogram. No dissection of vertebral artery. No pseudo aneurysm of vertebral arteries or of the internal carotid artery. Major intracranial arteries opacity normally. The distal order intracranial arteries are difficult to evaluate due to venous contamination. No signs of dural venous sinus thrombosis."

"Mildly distracted fracture of the lateral aspect of posterior arch of C1; favoured to be acute. Clinical correlation, neurosurgical review and MRI suggested. No signs of acute vascular abnormality of the major visualised intracranial arteries to account for symptoms."

CT head and cervical spine dated 20 October 2023

"No intracranial haemorrhage. No obvious area of gliosis / encephalomalacia. No mass effect or midline shift. Preserved cortical and basal ganglia attenuation. Normal ventricles. Both cerebellar tonsils are positioned above the foramen magnum. Normal orbits and visualised paranasal sinuses. No concerning osseous lesion."

"Straightening of the cervical spine but normal craniocervical junction and subaxial cervical spine alignment is maintained. Right posterolateral C1 arch fracture with corticated margin (suggesting it is an old injury) and a small 3 mm gap at the old fracture site (not united). No significant cervical spinal canal narrowing. C5-C6 uncovertebral osteophytic spurring contributing to mild bilateral C5-C6 neural foraminal stenoses. No paraspinal soft tissue abnormality. No prevertebral soft tissue swelling. Visualized upper aerodigestive tract and lung apices are clear."

"1. No acute intracranial pathology. No obvious area of gliosis / encephalomalacia seen on CT. 2. Right posterolateral C1 arch fracture with corticated margin (suggesting it is an old injury) and a small 3 mm gap at the old fracture site (not united) but normal craniocervical junction alignment is maintained. 3. C5-C6 uncovertebral osteophytic spurring contributing to mild bilateral C5-C6 neural foraminal stenoses."

Report of Dr Ron Granot dated 11 September 2023

"C1 distracted fracture Chronic persistent headache related to whiplash (vestibular migraine characteristics)"

"Migraine has a reasonable prospect of therapy responsiveness. The only caveat is ensuring her C1 fracture is now healed and does not require surgery."

"As per MAIA Guides Chapter 6, AMA IV Table 73 page 110 (as modified by MAIA Guides Table 6.7 and 6.125), the appropriate DRE of the Cervical spine is III on the assumption that imaging will show a stable healed fracture, but this will need verification as above. This equates to 15% whole person impairment, but may be higher if imaging reveals instability or non-union. In terms of a possible traumatic brain injury, as per MAIA guides: 6.164 For an assessment of mental status impairment and emotional and behavioural impairment there should be: 6.164.1 evidence of a significant impact to the head or a cerebral insult, or that the motor accident involved a high-velocity vehicle impact, and 6.164.2 one or more significant, medically verified abnormalities such as an abnormal initial post-injury Glasgow Coma Scale score, or post traumatic amnesia, or brain imaging abnormality As such, the injury in question is not assessable, due to absence of such factors. Similarly, migraine headaches are not separately assessable under MAIA guidelines as per 6.162 (in this case, it is therefore covered under the cervical spine above)."

"There is ongoing non-union, but stable alignment. On discussion with two neurosurgical colleagues, given the small gap and the satisfactory alignment, it was felt that operative intervention would not be required. A recent review article noted that: 'Occasionally, orthotic stabilization will result in non-union or continued instability, in which case surgical intervention is necessary', however, the consensus opinion was that it was not appropriate in this case. Given the stability, despite the non-union, I would maintain the previously described assessment of Whole Person Impairment unchanged."

Report of Dr John Bentivoglio dated 28 December 2023

"This lady sustained a fracture of the posterior arch of C1 on the right hand side as a result of the injury from the motor vehicle accident she described. On today's physical examination, there is no evidence of any nerve root irritation or compression. At this stage, she will (not) benefit by any aggressive modality of treatment. The fracture itself is stable. It is likely, however, she will continue to experience some degree of symptoms present in her neck, probably indefinitely. As far as her back is concerned, she states she has not had any investigation of her lumbar spine but probably has sustained some degree of discal damage. She requires CT scan taken of her lumbar spine to verify this.

On today's physical examination, there is no evidence of any nerve root irritation or compression to suggest she will benefit from aggressive modality of treatment. For her thoracic spine, all the abnormality seen on her thoracic spine are known pre-existing abnormalities. Her neurological type complaints (her hyperacusis, light sensitivity, and nausea) are not within my field of expertise and I am unsure as to what will happen with them."

1. Prognosis: "Prognosis remained somewhat in doubt."
2. Whole person impairment:

"Using American Medical Association Guides for Evaluation for Permanent Impairment, Fourth Edition, from page 104, the presence of an undisplaced fracture of the arch of her C1 vertebral body should have a DRE Category II impairment of her cervical spine with 5% whole person impairment. With her back, as long as investigations done of her lumbar spine indicates she does have discal damage or degenerative changes present in her lumbar spine that had become symptomatic. Then, from page 102, she would have a DRE Category II impairment of her lumbar spine and with a further 5% whole person impairment rating.

As this lady was asymptomatic prior to the motor vehicle accident, all of her ongoing symptoms relate to the injury that she sustained in the motor vehicle accident. With her thoracic spine region, all of the abnormalities seen on her investigations are preexisting and there will be no impairment rating for her known pre-existing abnormalities present in her thoracolumbar spine region."

"I saw this lady at your request on 18 December 2023 for injuries that she sustained in a motor vehicle accident on 26 July 2021. In the motor vehicle accident, she sustained a stable fracture of the C1 arch of her vertebral body. Subsequent CT scans taken of her cervical spine indicated that the fracture had not united. I reviewed an IME report by a neurologist dated 11 September 2023 and 3 February 2024. The neurologist felt that with an un-united but stable posterior arch C1 vertebral fracture, she would more accurately fit a DRE category III impairment of the cervical spine rather than DRE category II. I have carefully read pages 104 and 110 of AMA Fourth Edition. The impairment ratings are for healed fractures which is not the case for this lady. I would therefore consider that I inappropriately gave her a classification of DRE category II (which would give a 5% whole person impairment rating) and she should have a DRE category III impairment of the cervical spine (with 15% whole person impairment rating)."

1. Report of Dr John Bentivoglio dated 30 October 2025:

"I saw Ms Bryson at your request on 18 December 2023 for injuries that she sustained to her person in a motor vehicle accident on 26 July 2021. She sustained an injury to her neck. Investigation done of her cervical spine indicated that she had sustained a C1 vertebral body fracture involving the posterior aspect of her C1 vertebral body.

Unfortunately, this did not unite. Firstly, might I advise you that the C1 vertebral body is entirely different than every other vertebral body in our spinal cord. All the other vertebral bodies have an anterior body part together with spinous processes. C1 has lateral masses and essentially just a ring type structure without a vertebral body.

I consider noting that the fracture had not united should have DRE Category III impairment of cervical spine with 15% whole person impairment rating, especially noting the fracture was distracted. I have viewed the Personal Injury Commission assessment on Ms Bryson. It was done by Dr James Bodel. In his report, he noted that Ms Bryson had sustained C1 fracture as a result of the motor vehicle accident. In his statement on page 3, he indicates that from Table 6.7 on Page 104 of the Motor Accident Guidelines, a posterior element fracture with spinal canal deformity or radiculopathy, stable, healed yields a DRE Cervicothoracic Category III rating. He inappropriately indicated that there was a fracture of the arch was anterior with slight displacement. He rated her as having DRE Category III Cervicothoracic impairment rating with 15% whole person impairment. He also agreed with me that she had DRE Category II impairment of lumbar spine with further 5% whole person impairment rating.

On page 6, he correctly indicated that the CT scan of her neck showed that there was a mildly distracted fracture of the lateral aspect of the posterior arch of C1 with approximately 2.5 mm of distraction across the fracture interface. Once again on page 11 under section 22 is inappropriately indicated the fracture was to the anterior arch of C1 and not the posterior. Obviously, there is typographical error insofar as sometimes it is mentioned fracture of the arch being posteriorly and other times as being anteriorly. Definitely in the documentation, the fracture was to the posterior arch of C1.

The fact that it has not united and there is some degree of distraction present would definitely cause her to be rated as DRE Category III impairment of the cervical spine with 15% whole person impairment rating. I definitely agree that the assessor Dr Bodel should be contacted to confirm that the fracture was that of the posterior arch and not the anterior, that it did not unite and there was some degree of distraction. The distraction would cause some degree of spinal canal deformity."

Application for Personal Injury Benefits dated 13 August 2021

"Stationary, waiting for passing traffic, suddenly hit at speed from behind (rearended/hit at angle), driver was not intending to stop/slow down. I was on Coolamon Scenic Drive, intersecting hinterland way, waiting at a give way sign to turn left towards Byron Bay."

"Fractured neck - C1/Atlas, Whiplash and swelling at throat and neck, moderate to severe concussion - symptoms of dizziness, nausea, seasick feeling even when lying horizontal in dark, eyes closed, strong light sensitivity at times unbearable, headaches, brain fog, confusion intermittent double vision or unable to read/comprehend words on page at random times, shock."

1. CT cervical spine and two films dated 25 October 2021 and 19 October 2023 (from Medical Assessor Bodel's certificate):

"I have seen the CT of the cervical spine with the two sets of films dated 25 October 2021 and 19 October 2023. There is evidence of the fracture seen in the anterior arch of C1. The initial reported abnormality from the Byron Bay Hospital confirms an acute fracture. The films in October show that there is no sign of healing at that time, but the most recent films two years later in October 2023 show that there is attempted healing, but bony healing is incomplete, although the injury is 'stable'. The relevant issues in these films is that the fracture is stable from a medical point of view and that the injury does involve 'spinal canal deformity' and that the injury is now 'stable'. From Table 6.7 on Page 104, this gives a DRE Cervicothoracic Category III assessment for that reason."

1. The Panel summarises the submissions of the insurer dated 11 June 2025 by reference to paragraph numbers:

[1.1]-[1.3] The insurer sets out a background to the dispute, noting that it seeks a review of Medical Assessor Bodel's certificate alleging error on the following grounds:

(a) failing to correctly apply AMA4 and the Motor Accident Guidelines when assessing permanent impairment, and

(b) failing to provide a path of reasoning.

[2.1]-[2.13] The insurer sets out the legislation and case law upon which it relies in its submissions. The Insurer relies on the Act, Elliot v Insurance Australia t/as NRMA Insurance [2014] NSWSC 1848, and Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43.

Ground - Incorrect application of AMA4 and Motor Accident Guidelines when assessing impairment

[3.1] The insurer submits that Medical Assessor Bodel's assessment of cervical spine WPI did not comply with AMA4 or the Guidelines.

[3.2]-[3.4] Medical Assessor Bodel accepted an anterior arch fracture of C1 but assessed DRE III using Table 6.7, which applies to posterior element fractures. Table 6.7 applies only to posterior element fractures, yet the Medical Assessor diagnosed an anterior arch fracture. The insurer submits that repeated references in the certificate confirm this was not a typographical error.

[3.5]-[3.7] The insurer submits that the Medical Assessor diagnosed an anterior fracture based on imaging and reports and the Medical Assessor did not explain why he accepted an anterior rather than posterior fracture. It further submits that the Medical Assessor failed to adhere to the Guidelines by assessing an anterior fracture as a posterior fracture without explanation.

[3.8]-[3.11]The Guidelines and AMA4 do not contain provisions for C1 anterior fractures. The insurer submits that Clause 6.24 of the Guidelines should have been applied, requiring assessment by analogy. Clause 6.24 permits assessment by analogy where a condition is not covered, provided reasons are given. The insurer submits that the Medical Assessor failed to identify that the condition was not covered and failed to provide reasons for assessment by analogy.

[3.12]-[3.14] Table 6.7 applies to posterior fractures with spinal canal deformity or radiculopathy. The insurer submits that the Medical Assessor failed to explain both the posterior fracture assessment and the finding of spinal canal deformity. It further submits the Medical Assessor relied on slight displacement seen on CT scans as the basis for spinal canal deformity.

[3.15]-[3.18] The insurer submits that the CT scan dated 19 October 2023 expressly reported no significant spinal canal narrowing and that despite this, the Medical Assessor concluded spinal canal deformity without explaining how that conclusion was reached. It further submits that the Medical Assessor failed to provide adequate reasons for accepting spinal canal deformity and notes that the CT report explicitly stated there was no spinal canal narrowing.

[3.19]-[3.22]DRE Cervicothoracic Category III under AMA4 requires displacement that disrupts the spinal canal. This requires both displacement and disruption. The insurer submits that while slight displacement was identified, there was no explanation of canal disruption and no narrowing was reported. It further submits that the Medical Assessor failed to demonstrate a clear path of reasoning supporting canal disruption.

[3.23]-[3.24] The insurer submits that Medical Assessor Bodel's lumbar spine WPI assessment did not comply with the Guidelines. He assessed DRE category II based on asymmetry of movement.

[3.25]-[3.29] Table 6.8 requires reproducible and consistent findings across two planes of lumbar motion. The Medical Assessor recorded only one plane of lumbar motion. The insurer submits that the Medical Assessor therefore erred and failed to provide clear reasons. It further submits that the Medical Assessor failed to report whether findings were reproducible, consistent, or based on full effort, which constitutes error.

Ground - failure to demonstrate a path of reasoning

[3.30]-[3.32] The insurer submits that the Medical Assessor failed to demonstrate a path of reasoning supporting diagnosis, causation, and impairment. Under "Diagnosis and reasons", the Medical Assessor stated conclusions without explaining reasoning. Under "Causation and reasons", the Medical Assessor merely asserted causation without analysis.

[3.33] The insurer submits that no rationale was provided explaining how the accident caused the injuries, particularly in relation to the lumbar spine.

[3.34] The High Court in Wingfoot requires explanation of the actual reasoning path sufficient to expose legal error.

[3.35] In AAI Limited v Fitzpatrick [2015] NSWSC 1108, the Court confirmed that reasons must disclose the actual reasoning path.

[3.36] The insurer submits that a Medical Assessor must refer to objective evidence, competing opinions, and party submissions when addressing causation.

[3.37] A Medical Assessor must give proper reasons for causation findings (Dogon v Redmond).

[3.38] The insurer submits that parties cannot be left to fill gaps in reasoning (Sadsad v NRMA).

[3.39]-[3.41] The insurer submits that Medical Assessor Bodel failed to explain his reasoning processes. It further submits that the Medical Assessor also failed to provide adequate reasons for WPI findings as required by cl 6.122 of the Guidelines and that these failures amount to material error under s 7.26 of the Act.

[4.1]-[4.5] The insurer submits that the certificate is affected by multiple material errors such as that the Medical Assessor failed to correctly apply AMA4 and the Guidelines. It further submits that the Medical Assessor failed to provide a clear path of reasoning on impairment and causation. The insurer submits that these errors are material, as Ms Bryson may have been assessed at not greater than 10% WPI.

1. The Panel summarises the submissions of Ms Bryson dated 3 July 2025 by reference to paragraph numbers:

[1]-[4] Ms Bryson sets out a background to the dispute, noting that the insurer seeks a review of the certificate of Medical Assessor Bodel.

[5] Ms Bryson submits that the insurer's Review Application has three arguments respectively relating to the cervical spine, lumbar spine, and causation. The latter two are distractions added to bolster the application.

[6] Ms Bryson submits that determination of the cervical spine issue determines the WPI outcome, and that if the neck assessment is correct, Ms Bryson's WPI exceeds 10% regardless of the lumbar spine.

[7] She further submits that the insurer is seeking to take advantage of a typographical error in the certificate.

[8]-[9] Ms Bryson submits that the insurer argues Medical Assessor Bodel materially erred by diagnosing an anterior fracture but applying posterior fracture tables (Table 6.7), asserting the reference to "anterior" was deliberate. Ms Bryson disagrees.

[10] The question before the President's delegate is whether Medical Assessor Bodel intended to refer to an anterior or posterior fracture, and Ms Bryson submits that the evidence clearly shows the use of "anterior" was a typographical error.

[11] Medical Assessor Bodel discussed Dr Bentivoglio's finding of a posterior fracture, which Ms Bryson submits would be illogical if he believed the fracture was anterior.

[12] She further submits that the Medical Assessor's reference to "anteriorly" in describing films showing a posterior fracture demonstrates a transposition error repeated throughout the certificate.

[13] Ms Bryson submits that the 15% WPI assessment is consistent with a posterior fracture, as an anterior fracture would not attract that rating.

[14] Ms Bryson submits that hospital imaging five days post-accident identified a posterior fracture, that Medical Assessor Bodel had this evidence, and that his silence on rejecting it supports the posterior fracture conclusion.

[15] She further submits that no doctor diagnosed an anterior fracture and that all radiological and specialist evidence supported a posterior fracture.

[16] Ms Bryson claims that she was told by doctors that she fractured the back (posterior) of her neck, consistent with her symptoms.

[17] Ms Bryson submits that Medical Assessor Bodel's reference to sub-occipital pain supports a posterior fracture, as anterior fractures would not cause pain at the back of the head.

[18] Ms Bryson notes that both Dr Bentivoglio and Dr Granot diagnosed a posterior fracture and that Medical Assessor Bodel did not express disagreement.

[19] She submits that Medical Assessor Bodel expressly recorded and agreed with Dr Bentivoglio's posterior fracture finding.

[20] Ms Bryson submits that the insurer is alone in asserting an anterior fracture and relies on a typographical error, noting that:

(a) no medical evidence supports an anterior fracture;

(b) all radiological evidence identifies a posterior C1 fracture;

(c) the insurer initially relied only on submissions and treating evidence;

(d) a report from Dr Gothelf has not been served;

(e) it is reasonable to infer Dr Gothelf diagnosed a posterior fracture, and

(f) bringing the application in these circumstances is contrary to the scheme's ethos.

[21]-[23] Ms Bryson submits that the reference to an anterior fracture is an obvious error requiring clarification by Medical Assessor Bodel and that the President's delegate's task is simply to determine whether a typographical error was made. She further submits that the most obvious course is to contact Medical Assessor Bodel for clarification, and if confirmed as posterior, the review application should be dismissed.

[24]-[25] Ms Bryson submits that the insurer's criticism of the lumbar spine assessment is irrelevant and that even if there were an error, it does not affect the outcome because the cervical spine assessment alone exceeds the 10% WPI threshold.

[26]-[27] Ms Bryson submits that the insurer alleges a failure to provide reasoning on causation, relying on a brief statement under "Causation and Reasons". She further submits that Medical Assessor Bodel had already explained causation elsewhere in the certificate, specifically on pages 2 and 3.

[28]-[29] The Medical Assessor addressed pre-existing degeneration, symptoms, stability, healing, and imaging findings in detail, demonstrating clear reasoning. Ms Bryson submits that if the fracture is posterior, the AMA IV Guides mandate a 15% WPI rating.

[30] Ms Bryson notes that there was no evidence of pre-existing symptomatic spinal injury and submits that Medical Assessor Bodel addressed this issue logically.

[31]-[35] Ms Bryson submits that the evidence strongly supports a typographical error and that the certificate should be referred back to Medical Assessor Bodel for clarification. She submits that she is a credible witness who sustained a posterior C1 fracture as a result of the accident and that there is no evidence of a pre-existing symptomatic spinal condition.

Claimant's further submissions dated 9 September 2025

1. The Panel summarises the submissions of Ms Bryson dated 9 September 2025 by reference to paragraph numbers:

[1]-[2] Ms Bryson submits that the President delegate's Decision contains a judicial error and that, if the Review application is successful, instructions will be sought to commence judicial review proceedings in the Supreme Court of NSW.

[3] Ms Bryson submits that the President's delegate appears not to have read

Ms Bryson's reply submissions dated 3 July 2025, as the Decision does not refer to Ms Bryson's reasoning and is silent on the key issue of whether Medical Assessor Bodel made a typographical error in his certificate dated

[4] Ms Bryson asks that the Review Panel read her submissions dated

3 July 2025 and the original submissions before Medical Assessor Bodel.

[5] Ms Bryson submits that the issue before the Review Panel is straightforward and concerns the cervical spine injury only, and that the insurer has attempted to distract the Panel by raising issues relating to other body parts. The central question is whether Medical Assessor Bodel made a typographical error by referring to an "anterior" rather than a "posterior" fracture, and that if so, there is no basis for the insurer's review application and the certificate should be affirmed with that correction.

[7] Ms Bryson submits that there is no doubt she sustained a posterior fracture, that there is no evidence of an anterior fracture, and that a diagnosis of an anterior fracture would be inconsistent with the radiological and medical evidence.

[8] Ms Bryson submits that the Review Panel can determine the application on the papers and that a reassessment is unnecessary.

[9] Ms Bryson submits that the reference to an anterior fracture is a typographical error and that the Review Panel should first approach Medical Assessor Bodel for clarification, noting there is no dispute that a posterior fracture attracts a 15% WPI rating.

[10] She further submits that if a posterior fracture attracts 15% WPI, she meets the "greater than 10%" threshold for NEL damages, and that even if other errors exist (which are not conceded), the evidence establishes a posterior fracture.

[11] Ms Bryson submits that this matter has had a significant personal impact, outlining that she has undergone multiple medical assessments since June 2024 and waited several months for the Combined Certificate.

[12] Ms Bryson submits that the insurer's review application seeks to take advantage of a typographical error, as a finding of an anterior fracture would be inconsistent with all radiological, treating, and medico-legal evidence.

[13] Ms Bryson submits that she is a well-educated health professional and is certain that she sustained a posterior fracture.

[14] Ms Bryson submits that the accident occurred approximately four years ago, that she has consistently been told she sustained a posterior fracture, and that the process has been extremely taxing.

[15] Ms Bryson claims that the insurer is withholding a report from Dr Todd Gothelf, orthopaedic surgeon, which examined her at the insurer's request, and that the report has not been provided to the Commission.

[16] Ms Bryson submits that while she does not know Dr Gothelf's opinion, it is reasonable to assume he diagnosed a posterior fracture, as an anterior fracture diagnosis would assist the insurer's case.

[17] Ms Bryson submits that if the insurer possesses a report diagnosing a posterior fracture yet proceeds with this application, this may amount to a departure from model litigant obligations, and she is considering a complaint to SIRA.

[18] She further submits that the insurer's review application should not have been accepted and that had the President's delegate contacted Medical Assessor Bodel for clarification, he would likely have confirmed a posterior fracture.

(a) contact Medical Assessor Bodel to confirm he intended to diagnose a posterior fracture, and

(b) direct the insurer to provide any evidence of an anterior fracture other than the certificate.

[20] Ms Bryson submits that even if the above steps are not taken, the Review Panel should find that she sustained a posterior fracture caused by the accident, attracting a 15% WPI assessment.

Insurer's reply submissions dated 23 September 2025

1. The Panel summarises the submissions of the insurer dated 23 September 2025 by reference to paragraph numbers:

[1]-[2] The insurer refers to Ms Bryson's further submissions dated

9 September 2025 and submits that she takes issue with the President's delegate's decision to accept the insurer's Review Application.

[3]-[4] The insurer submits that whether judicial review of the President's delegate's decision is sought is not a matter for the Review Panel. It further submits that Ms Bryson incorrectly confines the application to one issue, whether an anterior or posterior cervical fracture was sustained, and ignores other grounds of review.

[5] The insurer's submissions dated 11 June 2025 identified multiple errors in Medical Assessor Bodel's certificate, including:

(a) inadequate reasons for diagnosing an anterior rather than posterior fracture;

(b) inadequate reasons for accepting "spinal canal deformity";

(c) non-compliance with the Guidelines in assessing the lumbar spine, and

(d) failure to provide a clear path of reasoning on diagnosis, causation, examination findings, and permanent impairment.

[6] The insurer submits that while Ms Bryson argues the matter can be determined on the papers, the Review Panel must examine Ms Bryson because it must reassess all injuries referred to Medical Assessor Bodel and is not limited to the original grounds of review, as noted by the President's delegate.

[7]-[8] The insurer disagrees with Ms Bryson's submission that a posterior fracture is automatically assessed at 15% WPI, which is incorrect. It submits that assessment as DRE III under Table 6.7 of the Guidelines requires a posterior element fracture with spinal canal deformity or radiculopathy, stable and healed.

[9]-[10] The insurer submits that Medical Assessor Bodel did not explain how he found a "spinal canal deformity." The insurer's submissions of 11 June 2025 addressed the evidence on this issue at paragraphs 3.12-3.22.

[11]-[12] The insurer relies on its submissions dated 11 June 2025, which detail multiple grounds of error and submits that it will be necessary for the Review Panel to re-examine Ms Bryson.

1. Medical Assessor Sophia Lahz and Medical Assessor Les Barnsley jointly examined

Ms Bryson on 7 November 2025. Their findings are reproduced below. 2. Ms Bryson is aged 41 and right-handed, working part-time (10 hours per week) as a psychotherapist. 3. At the commencement of the assessment, Medical Assessor Barnsley explained the non-confidential nature of the appointment, that the Medical Assessors were unable to provide her with any treatment advice and that the examination would only include the cervical and lumbar spine, as opposed the post-concussive symptoms for which she has received considerable treatment.

1. Prior to the motor accident on 26 July 2021, Ms Bryson reported that she had been fit and well, having spent the previous seven years living in Hawaii. She had been very physically active, enjoying surfing and triathlons.
2. Ms Bryson has no significant medical history aside from T7-8 compression fractures at age 15 due to a competitive (freestyle) skiing injury. She recovered and was able to resume competition without problems.
3. Specifically, there was no past history of any neck or lower back problems.
4. Ms Bryson confirmed the accident of 26 July 2021. She was the restrained driver of an Audi waiting to turn left with her head turned hard right when the vehicle was rear-ended without warning.
5. She does not remember any part of her body striking the cabin interior aside from head going backwards into the headrest. There was no loss of consciousness. She remembers her head forcibly rotating.
6. There was immediate pain in the top right side of the neck and left lower back. She was in shock and felt unable to continue standing. There were no visual or hearing symptoms. She recalls shaking of the upper and lower limbs at the scene during the immediate aftermath.
7. There was damage to the rear of her vehicle and also (relatively more) damage to the at-fault vehicle.
8. After speaking with the other driver, Ms Bryson was able to drive the car a short distance to her mother's home whence she was later conveyed to Byron Bay Hospital. A CT scan of the cervical spine showed a fracture of the C1 right-sided posterior arch. Despite low back pain, a scan of the lumbar spine was not done, Ms Bryson was reportedly informed that she could only have a scan of two sections of the spine. Given the previous thoracic spine injury, she says that she made the "wrong" decision to have the (asymptomatic, previously injured) thoracic spine checked instead of the sore lower back.
9. A hard collar was applied to the neck following the identification of the C1 fracture and she was then transferred to Tweed Hospital where an MRI and CT angiogram of the cervical spine was done for exclusion of (vertebral) artery bleeding (negative). Post-MRI, she said that a "soft" (actually a Philadelphia) collar was applied which she wore for some weeks on neurosurgical (hospital) advice.
10. Ms Bryson went to her mother's house where she said that she tried to "sleep off" the injury. Her head felt heavy and she had the sense that things were "upside down". She also noticed changes in her spatial perception and difficulty lifting her arms.
11. She saw a neurosurgeon, Dr Schwindack, three months later.
12. A progress MRI in July 2021 showed 2.5 mm of distraction at the right C1 posterior arch. In September 2021, there was another appointment in which Dr Schwindack's correspondence referred to an MRI as not showing any ligament injury. He encouraged gentle neck mobilization and removal of the collar whilst in bed. He did not anticipate any structural issues at the neck and recommended further review in November 2021 at which stage, he would advise her re weaning the collar.
13. A subsequent brain MRI showed no evidence of traumatic brain injury/diffuse axonal injury. At review in November 2021, Dr Schwindack provided Ms Bryson with much reassurance that the neck was stable and that she should not be fearful of moving it. However,

Ms Bryson was anxious whilst also concerned by cognitive changes and there were other significant concussive symptoms for which Dr Schwindack referred her to the North Coast Brain Injury Service. Ms Bryson later attended the Sydney Concussion Clinic regarding the post concussive symptoms. 14. Ms Bryson received extensive treatment for multiple symptoms of post-concussive syndrome inclusive of changes in vision, balance, light/noise sensitivity and dizziness, although these were not the focus of today's Panel assessment. 15. Ongoing, there has been pain in the neck and lower back as well as the abovementioned post concussive symptoms. 16. Ms Bryson has consulted a neurologist who prescribed Beta blockers for headaches. She could not tolerate the latter medication which caused significant fatigue. 17. The most recent cervical spine imaging occurred on 19 October 2023, a CT brain and cervical spine demonstrating right posterolateral C1 arch fracture with corticated margin suggestive of an injury with 3 mm gap at the fracture site consistent with non-union. 18. Ms Bryson currently has an upcoming neurology review for a second opinion. 19. Although there has been serial imaging of the neck C1 fracture, there has never been any imaging undertaken of the lumbar spine since the accident. 20. Ms Bryson continues physiotherapy although she is uncertain of whether treatment helps or not given that she often vomits afterwards. Both neck and lower back are treated during the physiotherapy sessions. 21. Ms Bryson's current medications are Stemetil prn, Nurofen, Valium, Melatonin and CBD/THC oil. 22. Ms Bryson is working part-time hours in her vocation as a psychotherapist (just 4x2.5 hours per week).

1. Her neck remains stiff and painful at the uppermost right in the suboccipital region corresponding with the site of the ununited C1 fracture.
2. The pain also spreads down the sides of the neck and to bilateral temporal regions.
3. Ms Bryson dislikes neck movement as well as others touching her neck because the latter gives rise to feelings of nausea and dysequilibrium. Similarly, requests to move her eyes can cause both nausea and imbalance.
4. There is no sensory alteration perceived at the upper neck or else the occipital regions.
5. Neck pain is worse at night and often wakes her up. There are intermittent generalised pins and needles affecting the right upper limb.
6. There are difficulties with neck movement, being worse for extension than flexion and more difficult towards the left than the right.
7. She also has problems sustaining upper limb elevation due to neck pain.

1. Ms Bryson complains of constant non-radiating pain at the left side of the lower back in the PSIS (posterior superior iliac spine) region. Back pain is made worse by prolonged sitting whilst the lower limbs are asymptomatic.

1. Ms Bryson presented in a straightforward manner. Her height was 157 cm and weight 70 kg.
2. She could briefly balance on heels and then on toes. Gait was normal.
3. There was normal neck posture although the Medical Assessors noted allodynia in the right upper cervical region. Active neck movements were extension 25% normal range, flexion 50% normal range, right lateral flexion 40% normal range, left lateral flexion 30% normal range and rotation 25% normal range to either side. Dysmetria was present in two planes (flexion/extension and lateral flexion). There was no muscle guarding or spasm. There were no upper limb non-verifiable radicular complaints (the reported generalized paraesthesia in the right upper limb are not within the distribution of a single dermatome and thus not a non-verifiable radicular symptom).
4. Upper limb reflexes were present and symmetrical and there were normal upper limb sensation and power although right arm movement induced some neck pain.
5. There was no wasting of the arms (32 cm) or forearms 25 cm at corresponding points.
6. On examination of the lower back, there was normal lumbar lordosis with tenderness over the left PSIS but with no muscle spasm or guarding. Flexion and extension were 2/3 normal range. With lateral flexion, fingertips reached 10 cm from the floor on the left and 12 cm from the floor on the right representing dysmetria in this plane. There were no non-verifiable lower limb symptomatic complaints. There were normal lower limb power and normal sensation. There was no wasting present at thighs (10 cm above superior patellar pole) 52 cm or calves 41 cm at maximal mid-calf girth. Lower limb reflexes were present and symmetrical. SLR was 80 degrees bilaterally with negative stretch testing.

1. Ms Bryson brought images of a CT scan of the cervical spine performed on 19 October 2023 showing non-union of the right posterolateral C1 arch fracture. Of note, the images showed a visible step as well as a 3 mm gap between the fracture ends. There was also visible asymmetry with eccentric placement of the peg within spinal canal with greater distance on the right of the peg compared with left.

1. The Panel found no evidence of either cervical or else lumbar radiculopathy.
2. The Panel notes that the vertebrae below C1 have distinct anterior components, specifically vertebral bodies, and have posterior elements including the facet joints, lamina and spinous processes. The anterior components provide significant structural integrity to the vertebra even in the presence of a posterior element fracture.
3. By contrast, C1 is a ring structure without any anterior support, so a fracture of any component in the ring compromises the structural integrity of the entire ring structure.
4. The Panel considered that the best fit for this injury was a posterior element fracture other than a transverse or spinous process fracture. The Panel considered that this was best represented by the structural inclusions outlined on page 104 of the guidelines and is best reflected in a DRE category III classification. The Panel also noted that the posterior C1 arch fracture had not healed although Ms Bryson did not meet the structural inclusion criteria for cervicothoracic DRE category IV (page 104 AMA4).
5. In the alternative if the injury is taken to be a fracture of posterior elements, the Panel notes that there is dispute over whether the observed step in the C1 vertebra after the accident is a disruption of the spinal canal.
6. Importantly, the Panel has viewed the CT images taken on 19 October 2023 which show ongoing non-union of the C1 posterior arch fracture with 3 mm gap. The films also show a definite step between the fragments. The peg is no longer centered in the spinal canal with greater distance to the right compared with the left of the peg.
7. It is clear that the original assessor was in error by multiple references to an "anterior" cervical spine fracture. The fracture which Ms Bryson sustained is one involving the C1 posterior arch. Referring to the criteria for cervicothoracic DRE category III on page 104 of AMA4, there has undoubtedly been a fracture of the posterior elements i.e. the arch which is not a fracture of a transverse or else spinous process. Further, the above C1 posterior arch fracture has disrupted the spinal canal by virtue of the 3 mm gap, the visible step between the fracture fragments, and finally the (now) asymmetric position of the peg within the spinal canal.
8. The Panel has determined that the abovementioned findings are consistent with a spinal canal deformity for which cervicothoracic DRE category III or else 15% WPI ought to be accorded.
9. There are three aspects to the "spinal canal deformity"; the discontinuity of the ring structure (see [119]), a step between the ununited fragments causing small alteration in the canal configuration, and finally, the peg structure which is normally centred in the canal is no longer, with an increased gap to the right of the peg compared with the left. The latter also constitutes a change in configuration of the spinal canal.
10. Regarding the lumbar spine, the Panel has found consistent dysmetria with L>R lateral flexion which according to Table 6.7 of the guidelines page 103, attracts 5% WPI.
11. Following combination of 15% WPI for the cervical spine with 5% WPI for the lumbar spine there is 19% WPI (Combined Values Chart AMA4).
12. There is no deductible proportion from either the cervical spine or else the lumbar spine.

1. The insurer submitted at [7]-[8] that the submission that a posterior fracture is automatically assessed at 15% WPI is incorrect. It submits that the assessment as DRE category III on Table 6.7 of the Guidelines requires a posterior element fracture with spinal canal deformity or radiculopathy stable and healed.
2. The Panel referred to the following evidence at [88]:

"A CT scan of the cervical spine showed a fracture of the C1 right-sided posterior arch."

1. At [92], the Panel noted that a progress MRI in July 2021 showed 2.5mm of distraction at the right C1 posterior arch.
2. At [116], the Panel noted that the CT scan of 19 October 2023 showed non-union of the right posterolateral C1 arch fracture.
3. The Panel noted that the images showed a visible step as well as a 3mm gap between the fracture ends. There was visible asymmetry with eccentric placement of the peg within the spinal canal with greater distance on the right of the peg compared with the left.
4. The Panel again points out that C1 is a ring structure without any anterior support so that the fracture of any component in the ring compromises the structural integrity of the entire area of anatomy.

1. The Medical Review Panel affirms the certificate of Medical Assessor James Bodel dated

29 April 2025 that as a result of the fracture injury at C1, Ms Bryson has sustained a permanent spinal canal deformity for which cervicothoracic DRE category III applies resulting in a 15% WPI. 2. Further, the Panel has found consistent dysmetria in the lumbar spine, with left greater than right lateral flexion, which according to Table 6.7 of the Guidelines, gives 5% WPI. 3. Further, the Panel certifies that following the combination of 15% WPI for the injury to the cervical spine and 5% WPI for injury to the lumbar spine (Combined Values Charts AMA4), Ms Bryson has a 19% WPI. 4. Further, the Panel certifies that there is no deductible proportion within either the cervical spine or the lumbar spine.