MOTOR ACCIDENTS - Motor Accidents 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 the visual impairment sustained at 5%; insurer sought a review of the assessment under section 7.26; Review Panel re-examined the claimant; Held - Review Panel confirmed MA's certificate.

1. The Medical Review Panel affirms the determination of Medical Assessor Malcolm Capon of 2 February 2025 that the claimant sustained a permanent whole person impairment of 5% as a result of the following injuries caused by the accident:
   • visual impairment - photophobia.

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 sustained injury.
3. AAI Limited t/as GIO (the insurer) was the compulsory third party (CTP) insurer.
4. Under the provision of the Motor Accident Injuries Act 2017 (the Act) in force at the time of the accident, the statutory benefits for treatment and care ceased after 26 weeks if the person's only injuries resulting from the motor accident were minor injuries.
5. Ms Bryson submitted an Application for Personal Injury Benefits (Application) dated 13 August 2021.
6. A medical dispute about the degree of Ms Bryson's whole person impairment (WPI) has arisen in connection with her claim. 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 Malcolm Capon for assessment.
9. On 28 January 2025, Medical Assessor Capon assessed Ms Bryson and on 2 February 2025, certified that the following injury caused by the accident gave rise to a WPI of 5%:
   • visual impairment.

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 Review Panel (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. The President's delegate has convened this Panel to conduct the review.
4. Part 5 of the Personal Injury Commission Act 2020 (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.

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. However, s 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 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. 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 Malcolm Capon examined Ms Bryson on 28 January 2025 and issued his certificate on 2 February 2025. He had available to him the documents attached to the Application as well as additional late documents, but he noted the late documents were not relevant to the visual system.
2. At [2] of his certificate, Medical Assessor Capon noted that the following injury was referred to him for assessment by the Commission:
   • visual Impairment.
3. Medical Assessor Capon noted the submissions made by Ms Bryson at [3] of his certificate, recording that Ms Bryson reported blurred vision, double vision, and photophobia.
4. As to pre-accident medical history, the Medical Assessor noted at [6] that Ms Bryson had previously suffered from a left nasal pterygium. He further recorded that Ms Bryson had no headaches, but her mother and sister get migraine headaches.
5. The Medical Assessor took a history of the accident at [7], noting that Ms Bryson was the driver of a car stationary at an intersection waiting to make a left-hand turn when it was hit from behind. There was no loss of consciousness and no direct head trauma. She drove the car from the site of impact to a safer area. She could not stand and she was shaking. She had pain from neck to spine. After waiting about one hour, she drove the car to her mother's house.
6. The Medical Assessor then took a history of symptoms and treatment following the accident at [8], noting that three days after accident, Ms Bryson presented to hospital with pain, photophobia, and was unable to perform tracking eye movements (so she could not read). She used a black mask to cover her eyes. She was able to read again from one year after the accident and was able to go outside in the daytime from 18 months after accident.
7. Now, every 10 to 14 days she gets episodes of photophobia, strong neck pain, migraine-like flashing lights, and can't comprehend what she is reading. These episodes can last up to three days during which she does not drive and loses depth perception.
8. Now, she also has difficulty driving when raining or at night. She gets nauseated when looking up. She can now read for up to four hours but then needs to rest, lying horizontal with her eyes closed. She prefers darkened areas and can't stand intense or flashing lights.
9. As to current symptoms, Medical Assessor Capon recorded at [10] that Ms Bryson suffers from:
   • constant photophobia (reduced from the time of the accident but unchanged for the past two years);
   • transient diplopia on upgaze (unchanged for about two years), and
   • every 10 to 14 days she gets episodes of worse photophobia, strong neck pain, migraine-like flashing lights, and can't comprehend what she is reading. These episodes can last up to three days during which she does not drive, loses depth perception. These episodes have been unchanged for the past two years.
10. Medical Assessor Capon then did a clinical examination at [12]-[13] which is reproduced by the Panel below.

Visual fields: zero loss right eye, 1% loss left eye.

Eye movements: Transient double vision on right upgaze which was associated with feeling unwell (ache in and behind eyes), so would always blink to regain single vision. Diplopia too transient to define further. Convergence to 5cm (ie normal).

Normal intraocular pressures. Left nasal pterygium. Right choroidal naevus.

1. At [14]-[15], Medical Assessor Capon did not provide a summary of relevant documentation that he relied upon during his assessment. He further noted that no radiological or medical imaging was brought to the assessment.
2. At [16], the Medical Assessor provided his diagnosis and reasons:

"I understand from the documentation provided that the claimant has been diagnosed with post-concussion syndrome and my view is that her photophobia, her transient diplopia and her episodic inability to read associated with seeing bright lights are part of this diagnosis. When I examined the claimant I was able to verify her photophobia and her transient diplopia but not her episodic inability to read. There is no evidence that her accident has caused any other visual impairment."

1. Medical Assessor Capon set out his causation and reasons at [17], noting that Ms Bryson's constant photophobia, her transient diplopia and her episodic inability to read associated with seeing bright lights are part of the post-concussion syndrome and were caused by the accident. He noted that the following injuries were caused by the accident:

"Her photophobia, her transient diplopia and her episodic inability to read associated with seeing bright lights are part of the post-concussion syndrome."

1. At [20], Medical Assessor Capon noted that the following injuries were also referred to his assessment but were outside of his area of expertise:
   • C1 fracture;
   • injury to lumbar spine;
   • chronic specific headaches;
   • persistent post-concussion syndrome;
   • hyperacusis, and
   • severe adjustment disorder with anxiety and depression.
2. As to permanent impairment, the Medical Assessor opined at [21] that he considered that Ms Bryson's symptoms of photophobia, her transient diplopia and her episodic inability to read associated with seeing bright lights are all permanent as they have been unchanged for the past two years.
3. He then set out his findings in the permanent impairment table at [22]:

1. At [23]-[25], the Medical Assessor noted that there was no pre-existing/subsequent impairment, no apportionment, and no effects of treatment.
2. Medical Assessor Capon concluded at [26] that the degree of permanent impairment as a result of the injuries caused by the accident was 5%.

1. The Panel summarises the material that was available to it and upon which it relied during its assessment of Ms Bryson.

Application for Personal Injury Benefits dated 13 August 2021

1. Accident Description - "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."
2. Injuries sustained - "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."

Report of Dr Alex Falcon, neuropsychologist, dated 30 April 2022

1. Motivation / Effort - there was no evidence on current assessment or interview to suggest poor or incomplete application of effort on current assessment.
2. Attention, Working Memory and Speed of cognitive processing - immediate attention span for simple auditory information was within High Average to Superior ranges for age in repeating verbally presented digits. There were no evident deficits in her ability to sustain attention and concentration over the course of interview or testing. Performances on tasks assessing working memory (i.e. ability to hold and work with information in mind) were also performed to within High Average to Superior ranges on digit reversal tasks, and to within Average ranges on digit sequencing tasks. Manipulation of dual pieces of information in mind (numbers, letters) was within Superior ranges. Overall performance on Processing Speed indexes was ranged from within Average to Superior ranges on the two tasks comprising this score.
3. Verbal learning and memory - structured and well organised material - Ms Bryson demonstrated reduced performances in immediate retention of well organised and structured verbal information with meaning (e.g. prose passages/stories) which was within Low Average ranges. She was noted to appear overwhelmed by larger chunks of information which led to difficulties initially encoding this material. The amount she was able to retain following a delay period was also reduced, though recognition of details at later time points was within normal Average ranges.
4. Less structured information - in contrast, performance in learning a list of semi-related words was within expected ranges. Overall current testing demonstrates that overall learning across repeated trials remains within Superior ranges. Her recall of a singularly presented distractor list was also within Superior ranges, and there were no difficulties noted in her independent recall of the previously learned word list following this distractor list. Delayed recall of this information was intact and within High Average ranges.
5. Visual Memory function - Ms Bryson's immediate ability to reproduce simple geometric designs that were briefly presented following immediate presentation was within Superior limits. Her independent recall of this information over time remained within High Average ranges, and recognition of the figures from distractors was intact.
6. Of note, Ms Bryson's recall of a previously copied complex visual design that she had ample time to review was intact and within Higher Average ranges for age following both immediate presentation and a 30 minute delay period. Recognition was intact.
7. Visuospatial reasoning - Ms Bryson demonstrated intact performances on tasks assessing visuospatial analysis and reconstruction on current tests. Her copy of a complex geometric figure was intact, and was performed in a reasonably organised and planned manner. Analysis and reconstruction of designs with blocks remained within High Average to Superior ranges. There was no evidence of any spatial neglect or visual inattention on current testing.
8. Language - in terms of language processing, Ms Bryson did not demonstrate any expressive or receptive language disturbances at a conversational level or throughout testing. She was able to adequately comprehend both simple and more complex task instructions. Language and expression was at all times adequate and socially appropriate.
9. Executive Abilities - Ms Bryson's ability to identify conceptual similarities between related objects was currently within Higher Average ranges for age, while nonverbal abstract reasoning skills were within Average ranges for age. Verbal generativity for phonemic categories (letters F,A,S) was reduced and within Low Average ranges for age.
10. Ms Bryson's planning and organisational approach in copying a complex geometric design was normal, commencing with global outlines and then systematically adding details in an organised manner). Performance in inhibiting automatic responses (word reading) in favour of less salient aspects of a stimulus (colour naming) was within High Average to Superior ranges for age. Divided attention on rule switching/inhibition tasks was also accurate and intact for speed.
11. Ms Bryson's speeded ability to independently switch between different lines of competing information (numbers, letters) was accurate and performed to High average ranges for speed. Novel problem solving was also intact and within High Average ranges on independent higher level problem solving tasks requiring flexibility, response maintenance, and ability to regulate performance in response to feedback.
12. Psychological function - on a self-report questionnaire regarding psychological function, Ms Bryson currently endorses symptoms suggestive of ongoing mild depression, extremely severe anxiety, and severe stress related difficulties.

1. The current assessment demonstrates retained expected level cognitive abilities in the majority of domains including auditory attention span, working memory (i.e ability to hold and manipulate information in mind), and cognitive processing speed. Learning and recall for unstructured auditory material, visual learning and recall, visuospatial analysis / constructional ability, expressive / receptive language, and higher-level executive functions in abstract verbal reasoning, concept formation, planning/organisation, cognitive inhibition, divided attention, and higher level novel problem solving were also within expected limits. There were some reduced performances in initially encoding lengthier pieces of auditory information, though information was suitably retained overall. These performances are also noted against ongoing self-reported psychological adjustment difficulties in mild depression, and severe anxiety and stress.
2. Ms Bryson's cognitive presentation indicates that the underlying cognitive capacities remain intact. At this point, it is likely that other additional compounding factors including pain, headaches, dizziness, sensory sensitivity and psychological factors are underlying her noted cognitive inefficiencies. This would be consistent with her level of concussion type injury without any positive imaging findings, from which a full cognitive recovery would be expected. Ms Bryson has not suffered any serious traumatic brain injury as a result of the subject accident, which is verified by no retrograde amnesia, no loss of consciousness, no post-traumatic amnesia, and no positive cerebral imaging findings. The current performances are consistent with this and would confirm that underlying cognitive faculties are intact. This was strongly reinforced to Ms Bryson.
3. The current assessment findings in addition to general practical recommendation strategies surrounding improving overall cognitive efficiencies were discussed with Ms Bryson. Pacing models towards increasing the daily window of functional recovery across every day were strongly reinforced. It is also expected that further improvements in her ongoing pain, headaches, dizziness (? possible BPPV) and other concussive type symptoms will result in improved overall cognitive efficiencies that would allow her to return to normal pre-injury roles. Similarly, improvements in depression, anxiety and stress in relation to this injury will also likely further enhance functional cognitive abilities within domestic and working environments

Report from Brain + Body Health (Sean Candler, Chiropractor) dated 19 September 2022

1. QEEG (Quantitative Electroencephalogram) - results from the brain scan demonstrated elevated activity corresponding to Alpha wave frequencies (8-12Hz) in the brain regions associated with vision and visual integration, which may be linked to impaired visual perception or spatial perception, slow reading, and blurred vision. There was also lower Gamma wave activity (35-45Hz) in the brain regions of the limbic lobe and cingulate cortex associated with body perceptions, visual imagery loss and attentional problems. More specific details are listed in the sLoreta Summary reports which have been provided. If reading reports yourself, look at the highlighted regions mapped on the brain and correlate them to the percentage deviant voxels value (less than 15% is within normal ranges).
2. Right Eyes Dynamic Vision Assessment - the dynamic vision report is attached which has specific detail about the visual and visual-motor deficits that were observed. From a visual perspective the Brainstem and higher regions associated with information processing performed above average, demonstrating healthy activity. The regions most affected were the frontal and parietal lobes involved in controlling quick jumpy saccadic eye movements and smooth tracking pursuits.
3. Balance Assessment - results from the balance assessment showed that Ms Bryson's balance age (comparison to normative data from age matched participants) was significantly higher in the testing positions with EYES OPEN, 71.2 for firm surface and 64.1 for foam surface. It was also high with EYES CLOSED on firm surface, 55.5, associated with more demand from our muscles and joints (proprioception). Specific data from these tests have been provided in the attached reports. These results suggest that vision is the largest contributor to your poor balance scores with proprioception also contributing to these scores.
4. Orthopaedic Assessment & Vestibular/Ocular Motor Screening - findings from the manual physical examination showed limited range of motion of the neck, especially in extension, looking up. Rotational movements were also limited, more so to the right hand side. When smooth and fast eye movements were combined with neck rotation, nausea and emotions were activated almost immediately. This effect was worse to the right hand side as with neck movements alone. Other dysfunctions were noted in visual motion sensitivity (visual environment moving quickly) and convergence (transitioning between far gaze and up-close gaze). The results demonstrate a disconnect and confusion by the brain when trying to integrate neck movements and eye movements together, which unfortunately is required often such as when walking, driving, shopping, etc

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 the background to the dispute, submitting that Medical Assessor Capon erred in his certificate as he failed to correctly apply the Guidelines, provide a path of reasoning, engage with relevant material, and address inconcistencies.

Threshold for establishing that the assessment was incorrect

[2.1]-[2.4] The Insurer relies on ss 7.26(10)a, 7.26(2), and 7.26(5) of the Act.

[2.5]-[2.7] The Insurer relies on Elliot v Insurance Australia t/as NRMA Insurance [2014] NSWSC 1848.

[2.8]-[2.13] The Insurer relies on s 7.23 of the Act and the decision in Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43.

Ground - Failed to correctly apply the requirements of the AMA4 and the Motor Accident Guidelines when assessing impairment

[3.1]-[3.3] The insurer submits that Medical Assessor Capon's assessment of WPI for visual impairment did not comply with the Guidelines. Clause 6.122 requires the assessor to describe how the impairment rating was calculated, with reference to relevant tables or figures. The insurer submits that the Medical Assessor failed to include any such description.

[3.4]-[3.7] Under "Determinations - Permanent Impairment" the Medical Assessor produced a table only. The insurer submits that the reference to "Chapter 8, page 209" of AMA4 is insufficient, as it contains no WPI methodology. It further submits that the Medical Assessor did not explain how impairment for photophobia was calculated and now the parties are left to decipher how 5% WPI was assessed, which is an error.

Ground - failure to demonstrate a path of reasoning

[3.8]-[3.9] The insurer submits that the Medical Assessor failed to demonstrate an actual path of reasoning supporting his WPI findings. Wingfoot requires reasons to explain the actual path of reasoning in sufficient detail to reveal legal error.

[3.10]-[3.11] In AAI Limited v Fitzpatrick [2015] NSWSC 1108, medical assessors were required to disclose the reasoning process for each conclusion. The insurer submits that medical assessors must refer to objective evidence, competing opinions and submissions when explaining conclusions.

[3.12]-[3.13] The insurer submits that parties cannot be left to fill in gaps, as stated in Sadsad v NRMA Insurance Ltd [2014] NSWSC 1216; (2014) 67 MVR 601. The insurer submits that the Medical Assessor failed to provide proper reasons for WPI as required by Clause 6.22.

[3.14]-[3.15] The insurer submits that the Medical Assessor failed to explain his reasoning process for WPI and that this failure constitutes a material error under s 7.26.

Ground - failure to engage with relevant material

[3.16]-[3.18] The insurer submits that there is reasonable cause to suspect error in the Medical Assessor's engagement with the material as the Medical Assessor recorded that he considered the documents provided and noted "There was no reply". It submits that this is incorrect, as the insurer's Reply was sealed on 15 July 2024 and should have been before him.

[3.19]-[3.21] The insurer submits that the Medical Assessor did not consider the Reply or any documents, including the claimant's application and that the Medical Assessor recorded "Nil" under "Summary of relevant documentation". It submits there is no explanation for disregarding the documents or accepting subjective history despite objective inconsistency.

Ground - Failure to address inconsistencies between evidence and examination

[3.22] The insurer submits that the Medical Assessor accepted subjective assertions contradicting objective evidence without inquiry.

[3.23]-[3.25] The Medical Assessor recorded the claimant's history of severe visual limitation for 18 months post-accident. The Medical Assessor recorded the claimant's history as "Consistent". The insurer submits that this history was contradicted by objective evidence of daytime activities, travel, driving, swimming and camping.

[3.26]-[3.27] The insurer refers to the Brain and Body Health records which showed exercise, outdoor activity and travel during the relevant period. The insurer submits that physiotherapy records demonstrated repeated daytime driving, walking, beach activity, camping and ocean swimming.

[3.28]-[3.29] Further, the insurer submits that GP records showed travel to Sydney and participation in significant social events. It submits that the Medical Assessor failed to engage with this material or explain acceptance of the claimant's history.

[3.30]-[3.33] The insurer submits that the Medical Assessor did not comment on the inconsistencies and that the Medical Assessor uncritically accepted the claimant's explanation. The insurer submits that this failure to question inconsistencies breaches Clause 6.41 of the Guidelines. It further submits that the Medical Assessor failed to explain why inconsistent histories were adopted.

[3.34]-[3.36] Wingfoot confirms that failure to disclose the reasoning path is itself an error of law. The insurer submits that the Medical Assessor failed to apply his own medical expertise and instead accepted self-reporting and that the assessment does not disclose the reasoning path for accepting inconsistent evidence.

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

[1] The claimant accepts that the certificate of Medical Assessor Capon appears to have been completed without reference to the insurer's reply.

[2] However, the claimant submits that the Medical Assessor's path of reasoning is clear: the claimant developed photophobia and related problems due to the motor vehicle accident. His assessment of WPI for this injury was 5%, which of itself does not entitle the claimant to non-economic loss damages.

[3] The claimant submits that the combined certificate includes Medical Assessor Capon's 5% WPI, which is added to Assessor Bodel's 19% for spinal injuries. The insurer disputes Assessor Bodel's original certificate, and the claimant has provided submissions. Shortly put, it appears Medical Assessor Bodel made a typographical error by transposing "anterior" and "posterior".

[4] The claimant submits that this is a typographical error which Medical Assessor Bodel should be asked to confirm or deny. If confirmed as a posterior fracture, the claimant's neck injury was correctly assessed at 15% WPI, placing her well above the 10% threshold.

[5] The claimant submits that, if so, reviewing Medical Assessor Capon's decision would have no impact on her entitlement to non-economic loss damages.

[6] Accordingly, the claimant submits that the application concerning Medical Assessor Capon's reasons should be held in abeyance until Medical Assessor Bodel confirms or corrects his certificate.

[7] The claimant submits that referring the matter back to Medical Assessor Bodel to confirm or correct the certificate is simple. If the typographical error is confirmed, both insurer applications will fall away, saving time and cost.

[8] Accordingly, the claimant submits that no action should be taken on the insurer's application regarding Medical Assessor Capon until Assessor Bodel addresses the asserted typographical error.

1. Medical Assessor Kerrie Meades examined Ms Bryson on behalf of the Panel on Tuesday, 11 November 2025 at Level 2, 35 York Street Sydney. The following injury was referred by the Commission for assessment:
   • visual impairment.
2. Medical Assessor Meades substantially altered her views of diagnosis and causation after consultation following the examination.

Summary of submissions by Medical Assessor Meades

1. Medical Assessor Malcolm Capon's path of reasoning is clear. Holly Bryson developed photophobia and similar problems because of the injuries suffered in the motor vehicle accident. His assessment of WPI for this injury was only 5%. Of itself that is not, of course, sufficient to entitle her to damages for non-economic loss.
2. Matthew Seisun from Sparke Helmore, the lawyers for the insurer, claimed that Medical Assessor Capon failed to apply the requirements of the Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4) and the Guidelines when assessing impairment. They claim there is no assessment for WPI on page 209 Chapter 8 of AMA 4
3. They also claim Medical Assessor Capon accepted Ms Bryson's assertion that she did not go outside until after 26 January 2023 despite recorded contradictory evidence

Summary of documents reviewed by Medical Assessor Meades

• Commission review of medical assessment, Terence Stern, 24 September 2025;
• review of medical assessment, Terence Stern, 30 September 2025;
• determination of an Application for Review of a Medical Assessment, Stephanie Wigan, 21 July 2025;
• motor accident reply;
• claimant's Commission submission in reply;
• motor accidents division claims, Elizabeth Medland;
• review of medical assessment;
• insurers application submission, 11 June 2025;
• certificate of Medical Assessor Malcolm Capon, 2 February 2025;
• Combined Certificate of Medical Assessor James Bodel. 14 May 2025;
• medical assessment, Robert Payten, 24 February 2025;
• medical assessment, Robin Fitzsimon, 11 December 2024;
• medical assessment, James Bodel, 29 April 2025;
• determination of an Application for Review of s Medical Assessment, Medical Assessor Kumar, 30 January 2025, and
• medical assessment permanent impairment, Mukesh Kumar, 22 November 2024.

Additional late documents considered by Medical Assessor Meades

• Application to Admit Late Documents, 12 September 2024, Tajan Baba;
• review of medical assessment, 20 October 2025, Terence Stern, and
• Medical Assessor Meades explained to Holly Bryson that this is an assessment for the Commission and although she was an ophthalmologist, she could not give Ms Bryson any advice or management.

Pre-accident medical history and relevant personal details taken by Medical Assessor Meades

1. Ms Bryson was born in Sydney and studied psychology for two years. She did her final year in New Zealand (Batchelor of Science). She came back to Sydney and then travelled to the USA studying nature-based psychotherapy treating combat veterans, addicts etc. She came back to Sydney in 2012 to work with community organisation in Waterloo working with Aboriginal rehab, drugs and alcohol etc.
2. She started her own business when she had the accident. She went back to work in 2022 for one hour and now is working two and half hours in the morning four days a week, mainly online.
3. Ms Bryson is single with no children. Her hobbies include surfing, training for triathlon, dancing, sculpting (lime stone carving) and tennis in high school.
4. Ms Bryson has coeliac disease. She has had her gall bladder removed. She has no allergies and her parents wore glasses. Her medications include Valium, CBD (medicinal cannabis), THC mariposa flower for pain, Apo-Prochlorperazine for motion sickness, Nurofen and Panadol.

1. Ms Bryson was waiting for a truck to pass when her vehicle was hit from behind, whilst her head was turned to the right. The airbags were not deployed, and she was wearing a seatbelt. She became shaky and had pain in the top of her head, right side more than left. She could not stand however she drove to her mother's house and went to bed. She cancelled her case meeting session at work. She became irritable and was getting worse. She could not understand words, could not read and her mother suggested a chiropractor, where she was unable to make out forms and was transferred to Byron Hospital. There was no direct injury to her eyes and she hit the back of her head on the headrest
2. She was based in Hawaii but has stayed with her mother since the accident. She has been seeing a physiotherapist about eye tracking movements

1. She had a CT scan which showed a fracture of C1. She was transferred to Tweed Heads Hospital for an MRI. She was put in a soft collar and booked to see a neurosurgeon in three months.
2. She saw the general practitioner (GP) with difficulty with light and head pain behind the eyes and was sent to Tweed Heads Hospital for intravenous (IVI) medication similar to migraine.
3. She wore her neck brace for 18 months at night and 12 months during the day. In this period she did not drive a car but had her mother drive her to appointments. She bought a car after 18 months and retains her car licence and she went camping. She also would stay with her dad and catch a taxi to appointments. She was unable to drive with the collar on. She occasionally went swimming and was advised to swim in the ocean as a pool may hit her head. It was only in calm water. She wore a hat and sunglasses for the first 12 months.
4. She has had no injuries or conditions since the motor vehicle accident.

1. At present, big gestures are difficult to process so her sessions at work with more than 30 people she got another person to cover the session. She does not like flashing lights and she is unable to pay attention to what is being said. The eyes improved a lot in the first two years however going in and outdoors the adjustment to light is difficult. The physio session made her vomit due to neck movements and eye movements

1. Ms Bryson was given glasses by an optometrist for stretched ligaments. She wore them for 12 months but then found them no help and no longer wears them. She uses drops for a pterygium in her left eye

1. She had 6/4.8 vision in both eyes without correction and N4 reading with no correction. Her pupils extraocular muscles, intraocular pressures and retinal exam were all normal. She had a minimal refractive error. Her anterior segment showed a small pinguecula in the nasal area of the left eye and a small pterygium in the nasal part of her right eye

1. It appeared to Medical Assessor Meades on her initial examination of Ms Bryson that there was no injury to the visual system causing photophobia. Note that Medical Assessor Meades altered her views on injury to the visual system and photophobia after post-examination consultation.

Summary of relevant documentation and imaging set out by Medical Assessor Meades

1. Medical Assessor Malcolm Capon's examination is on 28 January 2025 is consistent with the Panel's and is basically normal. He did give 5% for photophobia which is consistent with par 3 page 209 from AMA 4. "The Physician may combine 5% impairment with the impaired visual function of the involved eye."
2. However, there was no impairment in either eye and the photophobia is not related to media opacities, corneal or lens opacities etc. Normally this 5% in one eye would be combined with the impairment in both eyes Table 7 p 8/219 and converted in WPI Table 6 p 8/218.
3. In Medical Assessor Meades' assessment on 11 November 2025, she was initially of the opinion that no value would be given for injury to the visual system for the photophobia as, in her initial view, photophobia was not related to an abnormality of the visual system. She subsequently after consultation with Medical Assessor Steiner changed this view.
4. Medical Assessor Capon also mentions that she is able to go outside in the daytime from 18 months after the motor vehicle accident.
5. Evidence from her visits, Brain and Body Health mentioned she was walking, swimming, stationary bike etc. In her visit on 18(?19) September 2022 and 8 October 2022, she mentioned she struggled while in Sydney, continued to adopt daily habits such as morning sunlight and other sleep hygiene habits, and continued sub-thresholds physical exercise.
6. At her visits to Physio Plus and Bangalow Physiotherapy, the following was recorded:
   • 21(24?) January 2022 started driving small distances;
   • on 31 January 2022 drove to consult;
   • 7 February drove to consult;
   • 21 February 2022 drove to consult beach walking/talking couples therapy concentration and bush walking;
   • 7 March 2022 bush walking;
   • 11 April 2022 hearing (heading) to Sydney next week;
   • from 16 June 2022, 23 July 2022, 18 July 2022, 1 August 2022, 15 August 2022, 29 August 2022 to 5 October 2022, driving confidence improving, and
   • 5 December 2022, 19 December 2022 and 9 January camping and swimming in surf.
7. Ocean Shores medical practice was noted. On 9 June 2022 back from Sydney, increased general movement around home and beach. On 16 November 2022 involved in sister's wedding.
8. Medical Assessor Meades noted Ms Bryson's visit to Bangalow Physio on 6 June 2022. She was returning to northern rivers next week. Found the plane trip terrible and was now driving to this consult.
9. At her consult with Dr Alex Falcon, a neuropsychologist on 30 April 2022, Ms Bryson reported that she returned to driving without concerns in January 2022.
10. When this discrepancy was pointed out to Ms Bryson, she said she did not drive with her neck brace on (18 months at night and 12 months during the day). She made these appointments by her mother driving her or staying at her father's house and catching a taxi. She occasionally went swimming and was advised to swim in the ocean as in a pool she may hit her head. It was only in calm water.
11. Humphrey visual fields were normal in both eyes. The Optical Coherence Tomography (OCT) of macula and optic nerves were normal.
12. At the end of the consultation, Ms Bryson started to vomit. Medical Assessor Meades sat her down in the waiting room, gave her a glass of water and vomit bags. She advised her to go to casualty via taxi. Ms Bryson wanted to go to her father's house or her

brother-in-law's. A taxi was ordered, and she was accompanied to the taxi and she went to her brother-in-law's house. Both her father and brother-in-law were contacted by phone. In Medical Assessor Meades' opinion, this vomiting needs further investigation. She showed no sign of photophobia during this episode.

1. At this Medical Examination, Medical Assessor Meades performed what she considered to be a normal ocular examination and she was then of the view that there was no explanation for photophobia. At that time, she was of the view that there was no evidence of an injury to the visual system from the accident.
2. Medical Assessor Meades subsequently, after discussing the case with Medical Assessor Steiner, modified her opinions on injury and causation and arrived at the view that Ms Bryson had indeed as a result of the accident suffered from photophobia.
3. The inconsistensies in the history she gave to Medical Assessor Capon and the evidence in the recorded visits to Brain and Body Health, Physio Plus and Bangalow Physiotherapy, Ocean Shores medical practise and Dr Alex Falcon, a neuropsychologist comment on 30 April 2022 that she had restarted driving without concerns were not fully explained by Ms Bryson when Medical Assessor Meades questioned her about this.

1. Initially, Medical Assessor Meades was of the view that there were no injuries to the visual system which were caused by the motor vehicle accident.
2. Initially, Medical Assessor Meades was of the view that the photophobia had not been caused by the accident and was not related to the visual system. Subsequently, after consultation with Medical Assessor Steiner, she came to a different view on diagnosis of photophobia and causation as a result of post-concussive syndrome.

1. The Members of the Panel discussed the findings of Medical Assessor Meades via an email discussion and further teleconference. The Panel notes that Medical Assessor Meades initially was of the opinion that the photophobia was not caused by the accident. This opinion was, however, changed upon further deliberation by the Panel including input from Medical Assessor Steiner AM.
2. The Panel discussed the findings and opinion of Medical Assessor Meades. She provided her comments on her meeting with Ms Bryson on Tuesday, 18 November 2025 at 12.53pm.
3. On 18 November 2025, Medical Assessor Michael Steiner AM relayed his view to the members of the Panel that in his opinion, Ms Bryson had a post-concussive syndrome which would explain the photophobia even with no ocular cause.
4. Initially, Medical Assessor Meades was of a different opinion to that of Medical Assessor Steiner AM, namely that there was no photophobia.
5. At 3.00pm on 24 November 2025, the members of the Panel met via audio-visual link to discuss the case.
6. At this meeting, Medical Assessor Steiner articulated his view that the accident had caused a post-concussive syndrome which had resulted in photophobia.
7. On Tuesday, 25 November 2025 at 4.30pm, Medical Assessor Steiner confirmed his opinion that Ms Bryson had a 5% impairment of the visual system which, using Table 3, equated to 5% WPI.
8. Medical Assessor Steiner, referring to paragraph 3, page 8/209 of the AMA 4, confirmed that a WPI between 5%-10% could be applied. He noted that both specialists who assessed Ms Bryson's photophobia made the clinical assessment that her impairment was at the lower end and felt that 5% WPI for each eye was appropriate.
9. He then referred to paragraph 3, page 8/209 of AMA 4, which he quoted as clearly stating there was an allowance of 5% for photophobia which must then be added to visual loss and converted to WPI (pursuant to Table 7 and Table 6) which would be 5%.
10. On Tuesday, 25 November 2025 at 7.30pm, Medical Assessor Meades confirmed to Medical Assessor Steiner and Member Stern that she agreed with Medical Assessor Steiner's assessment.
11. She noted that photophobia is usually related to a condition of the eye like corneal opacities, but she was happy to accept the causation being concussion as opined by Medical Assessor Steiner.
12. Since the meeting on 25 November 2025 to the date of this certificate, Medical Assessor Meades has adhered to Medical Assessor Steiner's view that there was a 5% WPI due to photophobia caused by the post-concussive syndrome. The whole of the Panel was in agreement with this opinion.

"[3.2] Clause 6.122 of the Guidelines states: The Medical Assessor must include in the report a description of how the impairment rating was calculated, with reference to the relevant tables and/or figures used."

1. The Panel has given a description of how the impairment rating was calculated with reference to the relevant tables.
2. In respect of [3.9] of the submissions, the Panel has explained how the impairment for photophobia was calculated.
3. The Panel has considered all of the documents of relevance, and most of them were referred to or summarised in these reasons.
4. The Panel considered that Ms Bryson's account was consistent and that consistency was not damaged by the fact that Ms Bryson may have travelled by motor vehicle on odd occasion.
5. In the broader picture, the Panel was satisfied that Ms Bryson did have a post-concussive syndrome which had resulted in photophobia.

1. The Panel affirms the determination of Medical Assessor Malcolm Capon of 2 February 2025 that the claimant sustained a permanent WPI of 5% as a result of the following injury caused by the accident:
   • visual impairment - photophobia.