Review Panel Assessment of degree of permanent impairment

Replacement certificate issued under s 7.26(7) of the Motor Accident Injuries Act 2017

1. The Review Panel found the permanent impairment arising from injuries caused by the motor accident is different to that found in Medical Assessor Alexander Woo's assessment certificate dated 10 October 2024.
2. Accordingly, the Review Panel revokes that certificate and issues a new Permanent Impairment Certificate.
3. The Review Panel found that the motor accident caused the following injuries and assessed them as giving rise to 6% whole person impairment:
   • cervical spine - soft tissue injury;
   • thoracic spine - soft tissue injury;
   • lumbar spine - L1 vertebral body fracture;
   • coccyx - healed undisplaced fracture;
   • right shoulder - soft tissue injury;
   • right ankle- soft tissue injury;
   • right knee- soft tissue injury;
   • left knee- soft tissue injury, and
   • left hip- soft tissue injury.
4. The accident caused injuries with a total percentage whole person impairment not greater than 10%.

1. The claimant, Hasim Cura was injured in an accident on 5 June 2021, when he entered a roundabout on an electric bike with a car in front of him. Another car entered the roundabout from the left and slowed down, giving way to the car in front of him. Mr Cura assumed this car would also give way to him, but instead it moved on and struck his left hip and he fell to the ground.
2. He said he was knocked unconscious and a doctor on the scene rendered assistance. Ambulances attended and transported him to hospital.
3. The claimant's medical history before the accident contains lumbar spine fusion L4-5 and bilateral knee surgery resulting from his employment earlier this century.
4. The claimant alleged the accident aggravated the claimant's longstanding back problems and both knees.
5. The claimant had further spinal surgery at L4-S1 levels, after this accident, on

18 October 2022. This surgery had been planned before this accident. 6. The insurer is responsible for loss arising from the claimant's injuries from the accident on

5 June 2021 under the Motor Accident Injuries Act 2017 (MAI Act). 7. The insurer and the claimant are in a dispute about the claimant's permanent impairment from injuries caused by this accident. The claimant applied to the Personal Injury Commission (Commission) to resolve this dispute. 8. The Personal Injury Commission (Commission) referred the following injuries for assessment: * cervical spine - musculoligamentous injury and strain; * both knees - bilateral - strain and injury with aggravation of pre-existing symptoms; * spine - sacrum/coccyx/lumbar spine/thoracic spine - a small avulsion fracture of the L1 left anterior end plate together with a coccyx fracture with associated haematoma to medial gluteal region. Musculoligamentous injury and strain; * right elbow - strain and injury; * right ankle - strain and injury; * hip - strain and injury; * bilateral hands - numbness in his fourth and fifth fingers in his bilateral hands; * left thumb - numbness in his left thumb, and * bilateral shoulders - persisting median and/or ulnar nerve pathology or radiculopathy in the upper limbs. 9. On 10 October 2024 Medical Assessor Alexander Woo certified the claimant's permanent impairment at 9%. 10. The claimant applied for review on the basis the assessment was incorrect in a material respect. The insurer opposed the application. 11. On 5 December 2024 the President of the Commission's delegate constituted this Review Panel (the Panel) to review the original certificate (the Review). 12. Following rule 128(1) of the Personal Injury Commission Rules, 2021 (the PIC Rules) the Panel 'is to conduct and determine the proceedings in accordance with procedures determined by the panel'. 13. The Panel met on 7 March 2025 to discuss how this matter will proceed. The Panel considered, inter alia, the claimant's history of injury to some of the referred body parts before the accident and why the parties provided more than 2,000 pages of information, when the relevant past injuries and treatment were not disputed. 14. The Panel will only refer to past injuries in respect of the impact on the referred injuries, unless the parties' submissions refer the Panel to relevant aspects. 15. The Panel decided it was necessary to re-examine the claimant. Medical Assessors Gibson and Gray agreed to examine the claimant on behalf of the Panel on 21 March 2025.

"the degree of permanent impairment of the injured person that has resulted from the injury caused by the accident (including whether the degree of permanent impairment is greater than a particular percentage) is a medical assessment matter"

1. If there is a dispute about the degree of permanent impairment of an injured person being sufficient to award non-economic loss damages i.e. greater than 10%, then those damages may not be awarded unless the degree of permanent impairment has been assessed by a Medical Assessor under Division 7.5: s 4.12(1) MAI Act.
2. Division 7.5 of the MAI Act provides for the Commission to assess declared medical disputes including provisions relevant to an original medical assessment and for appointing Panels to review those medical assessments.[1]
3. Parties may apply to the President of the Commission for review of a medical assessment on grounds that the assessment "was incorrect in a material respect" (sub-s (1)). If the President, or his delegate is satisfied "there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect" then the President refers the application to a review panel consisting of a Member of the Commission and two Medical Assessors (sub-ss (2) and (2B)) to reassess the dispute.
4. The review is not confined to the issues raised in the application (or the reply) but is "a new assessment of all the matters with which the medical assessment is concerned" (sub-s 3A).
5. Rule 128 of the Personal Injury Commission Rules 2021 (the Rules) permits the Panel to determine its own proceedings and the rules of evidence do not bind the Panel, which may inquire into relevant matters as it thinks fit, while observing procedural fairness.
6. The method of assessing the degree of impairment is dealt with in s 7.21, which is in the following terms:

"7.21 Assessment of degree of permanent impairment

(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.

(2) Impairments that result from more than one injury arising out of the same accident are to be assessed together to assess the degree of permanent impairment of the injured person.

(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment, or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.

(4) A Medical Assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent."

1. Pre-existing impairment is addressed in cls 6.31-6.33 of the Motor Accident Guidelines (Guidelines). Clause 6.34 deals with subsequent injuries.
2. The Guidelines state as follows with respect to causation of injury:

6.5 An assessment of the degree of permanent impairment is a medical assessment matter under clause 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.

6.6 Causation is defined in the Glossary at page 316 of the AMA4 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.

6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the accident. The 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. It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed condition: Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75]. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50]. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.

1. Medical Assessor Woo recorded a history of the accident and past treatment arising from his employment as follows:
   • 9 April 2001 - right shoulder rotator cuff repair by Dr Hitchen for workers compensation;
   • 2005 - work-related back injury requiring L4/5 fusion by Dr Loefler; off work six months, returned to preinjury duties;
   • Dr Maniam - right knee arthroscopy, workers compensation;
   • 5 December 2016 - Dr SP Tan performed right knee arthroscopy, partial lateral meniscectomy;
   • 6 February 2017 - Dr SP Tan performed the same procedure on the left knee
   • 12 November 2018 - back injury at work, lumbar spine fusion L4/5 by Dr Diwan, and
   • he was planning to return to his former duties after that last surgery, but Qantas made him redundant during 2020.
2. He underwent surgery since this accident including bilateral knee arthroscopy on

3 February 2022. 3. On 18 October 2022 Dr Diwan removed the hardware from one motion segment L4 - L5 plus extension of fusion L4 - S1. 4. On 26 January 2024 he fell and landed on his bottom, but his specialist advised he did not require further treatment. 5. Medical Assessor Woo diagnosed the following conditions as caused by the accident: * cervical spine - soft tissue injury; * both knees - soft tissue injury, aggravation of pre-existing degenerative changes; * spine - L1 vertebral fracture (and coccyx fracture (undisplaced)); * right elbow - soft tissue injury; * right ankle - soft tissue injury; * left hip - soft tissue injury; * bilateral hands - soft tissue injury; * left thumb - soft tissue injury, and * bilateral shoulders - soft tissue injury. 6. He considered the pre-existing degenerative changes in both knees had been aggravated by the accident but this would have resolved after six months. 7. Bilateral knee surgery was not related to this accident. 8. He did not locate two or more of the five radiculopathy signs present in either upper limbs during this examination. 9. All injuries were assessed at 0% permanent impairment except for the L1 fracture at 5% and the right shoulder at 4%.

1. The relevant treatment evidence is summarised in the medical examination report.

1. Dr James Bodel's report dated 20 April 2023 refers to the doctor examining the claimant three times before this accident for work related injuries. This is related to bilateral knee injuries and a lumbar spine condition.
2. Dr Bodel was appraised of the claimant's conditions before this accident, including revision of lumbar spine fusion.
3. The claimant moved slowly and unsteadily. His neck trapezius muscles were tender on the left side with guarding and reduced range of movement in all directions, as well as restricted asymmetric motion on the right.
4. His shoulders' AROM were restricted bilaterally. He had pain in the upper part of his back and at the thoracolumbar junction. He had impingement in each shoulder but no instability. There were no signs of radiculopathy or median or ulnar nerve pathology in either upper limb.
5. The earlier spinal fusion, which is unrelated to this accident was noted, and Dr Bodel did not assign any lower back impairment associated with this accident.
6. There were no radiculopathy signs or restrictions in the lower limbs.
7. Dr Bodel considered the claimant only suffered a soft tissue aggravation to his long-standing back problems, although the accident may have accelerated the urgency to re-operate on that body part even though it had been planned before this accident.
8. Dr Bodel opined the bilateral knee medial meniscectomies were related to the accident.
9. Dr Bodel opined the claimant was probably totally and permanently incapacitated for work, despite the claimant being keen to return to earning.
10. Dr Bodel assessed the following levels of impairment:
    • cervical spine - 5%;
    • bilateral shoulders - 6% each, and
    • bilateral knees - 4% each.
11. Orthopaedic surgeon Dr Murray Hyde Page examined the claimant and produced a report dated 30 May 2023 for the insurer.
12. The claimant's past medical history was noted. He presented before the specialist walking without a limp.
13. The cervical spine displayed an unrestricted range of movement. Likewise, both shoulders moved without restriction.
14. He noted the lumbar spine surgery and the claimant's recovery since the relevant surgery in 2022.
15. This specialist's hip examination found a full range of pain free movement in both hips. There was minor discomfort on the lateral side of the left hip, but it was not sufficient to justify a diagnosis of trochanteric bursitis.
16. The knees examination did not display any restrictions related to the accident, and age-related bilateral minor patellofemoral crepitus.
17. Dr Hyde Page noted the L1 fracture, which was sufficiently compressed to yield DRE category II in 5% WPI. He also noted the coccyx fracture, but it did not yield any WPI and was not symptomatic.

1. The claimant submits his impairment is greater than 10% and relies on Dr James Bodel's report dated 20 April 2023.
2. Dr Bodel opined that the claimant has soft tissue injury aggravation to his longstanding back problems and injuries to his bilateral knees and partial bilateral knee meniscectomies.
3. Dr Bodel assessed 22% WPI arising from the accident.
4. The claimant submits that Dr Bodel's opinion ought to be preferred over the insurer's instructed IME being Drs Frank Machart and Murray Hyde-Page. Dr Machart's report was not included in either bundle, and this was the only reference.
5. The claimant made further submissions when he applied for a review of Medical Assessor Alexander Woo's assessment on the following grounds:
   • cervical spine impairment assessment was incorrect, illogical and there has been a failure to demonstrate a clear path of reasoning, and
   • the bilateral shoulders impairment determination is incorrect on the face of the record and due to a lack of demonstrating a clear path of reasoning.
6. The claimant's extensive medical history before this accident does not refer to the claimant's cervical spine. However, St George Hospital investigated the claimant's cervical spine complaints after this accident.
7. Medical Assessor Woo recorded the claimant's symptoms including "he complains of neck pain. He has pain and clicking during sleep."
8. The Medical Assessor noted "there was discomfort through the range in all directions" in respect to the cervical spine.
9. The Medical Assessor referred to Drs Bodel and Hyde Page's reports. Dr Bodel assessed 5% for the cervical spine impairment. Dr Hyde Page found no cervical spine impairment.
10. The Medical Assessor diagnosed that the accident caused a cervical spine soft tissue injury. However, in assessing the cervical spine the Medical Assessor noted there were no clinical signs despite noting the claimant frequently complained to his doctors about that body part and the radiological evidence.
11. The Medical Assessor failed to provide a clear path of reasoning as to how he assessed 0% impairment. He did not explain how he came up with a different outcome to Dr Bodel.
12. The claimant also complained of bilateral shoulder pain soon after the accident. The Medical Assessor found both shoulders were injured in this accident.
13. The Medical Assessor noting the measurements differed as to flexion, abduction and internal rotation in each shoulder which was different to Dr Bodel assessing 6% in each shoulder due to a loss of motion.
14. The Medical Assessor found 4% for the right shoulder and 0% in the left shoulder.
15. The claimant submitted that the Medical Assessor erred with respect to the assessment of both shoulders because he did not demonstrate a clear path of reasoning, and he has erred in his methodology.
16. The Medical Assessor records his clinical findings as to the impairment in both shoulders. He writes "0% WPI" as to the right shoulder motion impairment but at line 80 records" converted to 4% WPI (AMA 4 page 20, table 3) and thereafter assesses 0% impairment in the left shoulder.
17. The Medical Assessor found a 0% impairment in the right shoulder but later wrote he found 4% impairment but records for the left shoulder "normal range of movement, no assessable impairment."
18. The Medical Assessor does not explain how he assessed 4% for the right shoulder when

Dr Bodel assessed 6%. 19. The Medical Assessor did not explain why he disregarded the claimant's left shoulder symptoms. His conclusion was at odds with his clinical findings.

1. The insurer refers to claimant's medical history before this accident, including a history of work-related back pain.
2. Additionally, he had had right shoulder surgery in 2001.
3. After the accident a right elbow X-ray on 5 June 2021 appeared normal.
4. A cervical spine CT scan on 5 June 2021 showed no fracture or acute injury.
5. Bilateral knee MRI scans in September 2021 showed he already had advanced grade IV medial femorotibial osteoarthritis in the left knee that predated this accident. He had a complex medial meniscus tear, and he had some patellofemoral osteoarthritic changes as well.
6. The right knee showed an anterior intrameniscal cyst of the lateral meniscus which would have been longstanding. Compared to the left knee the right knee showed longstanding degenerative changes in the medial femoral condyle. There were also degenerative changes in the right patellofemoral joint. There were some degenerative changes in the medial meniscus.
7. A lumbar spine X-ray in October 2021 showed the previous L4/5 posterior instrumental fusion. There was a fracture of the L1 vertebra where there was approximately 20% loss of anterior height.
8. A whole body bone scan in November 2021 detected a resolving L1 superior endplate fracture. There was evidence of degenerative changes in both knees but this was reasonably mild.
9. On 30 May 2023, orthopaedic surgeon Dr Murray Hyde-Page reported that the claimant moved comfortably and freely throughout his examination. He observed the claimant undressing and dressing and not appearing to be in any significant pain or discomfort. He could walk normally without a limp.
10. The insurer submits that the radiological findings did not support Dr Bodel's assessment.
11. Medical Assessor Woo's assessment identified only a 5% WPI attributable to the L1 vertebral fracture, which aligns with radiographic and clinical findings. Other assessed areas, including the knees, cervical spine, right elbow, right ankle, and shoulders, were found to have no measurable impairment, showing normal range of motion and absence of verifiable radicular symptoms.
12. Additionally, Medical Assessor Woo correctly noted that the claimant's knee degeneration and lumbar spine injuries before this accident and these did not contribute additional impairment after this accident.
13. Medical Assessor Woo interviewed the claimant in addition to reviewing the evidence provided in line with the Guidelines cl 6.18 to evaluate permanent impairment.
14. The insurer submits that Medical Assessor Woo was not obliged to refer to each and every specified record or entry.

1. Mr Cura attended unaccompanied on Medical Assessors Gibson and Gray at Medical Assessor Gibson's rooms in St Leonards on 21 March 2025. He brought some imaging studies with him to the assessment which he transported in a trolley bag. He brought along a stick but did not need to use this during the assessment.

1. In 2000, whilst employed with Qantas as a tug driver, Mr Cura sustained a work related lower back injury. Mr Cura said the pain had gradually deteriorated to the point he had consulted a specialist.
2. In 2005, he underwent L4/L5 fusion, which was performed by Dr Andreas Loefler. He said he returned to his normal duties six months following the surgery, and although there was occasional low back discomfort this was manageable.
3. In 2018 he exacerbated his low back symptoms. At this stage he visited Dr Diwan, spinal surgeon who undertook lumbar facet joint injections. Mr Cura said the doctor had advised that no surgical intervention was required at that stage, but it may be required "sooner or later" as the "gap was narrowing."
4. The surgeon recommended conservative measures, including stretching exercises and analgesia as required. On specific questioning, Mr Cura said he had no neurological complaints at that stage in either lower limb but, there was occasional episodes of low back pain with manageable discomfort.

1. Mr Cura said he had suffered with intermittent neck stiffness and pain before this accident. He attributed this to having to constantly turn his head when operating the tug at the airport. However, there were no upper limb neurological symptoms. There was pain intermittently "between the shoulders and my neck", but no upper limb paraesthesia.

1. Mr Cura had sustained a right shoulder injury at work. He said his shoulder symptoms arose due to the repetitive right upper limb movements required when steering the tug. He was also noticing some locking of the right shoulder.
2. Orthopaedic surgeon Dr Hitchen performed a right rotator cuff repair on 9 April 2001. He was able to resume his normal duties after this surgery. He said that although there was "not really" any residual stiffness, there was occasional pain, especially in cold weather, which was felt deep in the shoulder joint and continues.

1. There was no history of any injuries or conditions of elbows or hands before this accident, although on examination the Panel members noted that he had a small laceration on the left elbow from a glass cut which he then recalled was a glass cut sustained when working at home.

1. Mr Cura denied any prior conditions or injury of either hip.

1. Mr Cura said he had a number of knee injuries whilst at work. In 2005 Dr Maniam performed a right knee arthroscopy and in 2016/17 Dr Tan performed bilateral arthroscopic partial lateral meniscectomies.

1. Mr Cura had right inguinal hernia repair whilst living in Yugoslavia and sometime after this accident he had seen Dr Chu and had the procedure repeated laparoscopically. This was unsuccessful, so there was then a successful open procedure.

1. Mr Cura was born in Montenegro (ex-Yugoslavia). He is 65 years old. He completed Year 9 at school. He went on to complete his national service, serving for 13 months (this was around 1979/1980). The right inguinal hernia had occurred during this period and it was then that he had the surgical repair. He worked as a driver for some years.
2. He arrived in Australia in 1984. He married and had two children.
3. After arriving in Australia, he worked as a cleaner. He worked for BorgWarner as a process worker for 12 months, then with Glomesh/Kotex as a knitting machine operator for 12 months and then for Standard Knitting Mills in the same role for six to eight months.
4. He commenced work with Qantas in 1987 as a cleaner. After 18 months he applied to become a tug operator. He was in that job for the rest of his working life. He said Qantas offered voluntary redundancy in August 2020 during COVID-19, which he accepted and he has not worked since.
5. Mr Cura currently lives with his wife in their home. They have two adult children, a son who lives in the United States and a daughter who lives next door. His wife still works so he is not eligible for a pension.

1. Mr Cura had been riding an electric-assisted bicycle. He added that he had been riding the bike for exercise several times a week.
2. At the time of this accident he entered a roundabout, there was a car in front of him. Another car was entering the roundabout from the left and had slowed down, giving way to the car in front of him. Mr Cura assumed they would also give way to him, but instead the vehicle moved on and he was struck on his left hip and fell to the ground.
3. Mr Cura said he was unconscious for a short period. A bystander (a female doctor) assisted him at the scene.
4. The police and ambulance attended and he was conveyed to St George Hospital in a neck collar. He said at that stage his whole body was painful. He was assessed at the hospital. A CT scan demonstrated L1 vertebral avulsion fracture left anterior endplate, coccyx fracture minimally displaced. CT of his cervical spine did not show fracture. He was also noted to have a subcutaneous haematoma of his left hip. The hospital discharged him after 24 hours and since then his regular general practitioner (GP), Dr Kuzmanovski has managed his care.
5. The GP's first entry in the clinical notes about this accident was on 25 June 2021. Mr Cura had been visiting the same practice for review of his workers compensation claim. The entry before this accident on 19 May 2021 noted his WorkCover certificate was completed and the "situation remains the same."
6. The GP commented on 25 June 2021 that Mr Cura had been trying to make an appointment about this accident before then but was unable to do so because the doctor had been on holiday.
7. Mr Cura's complaints at that stage were pain in the tailbone, mid and upper thoracic area of the spine, lower back, neck, left hip, right ankle and right elbow. There were also psychological symptoms. On examining the neck, there was some restriction in movements. There were no upper limb neurological abnormalities.
8. On examining the low back, the GP noted there was restriction in spinal movements but no neurological abnormalities. There was restricted movement of left hip, left ankle, left elbow and the doctor also concluded a diagnosis of acute stress disorder according to DSM-V.
9. On 29 July 2021, at further review, the GP noted there was an X-ray confirming crush fracture L1 and apparent fracture of the coccyx. Mr Cura had been prescribed Panadeine Forte, but this was causing constipation. There was pain in both knees left worse than right and his low back felt numb. This was the first mention in the GP's notes of any knee complaint after this accident.
10. Mr Cura was referred to Dr Diwan, spinal surgeon. That doctor commented that there were degenerative changes at L3/4, the level above the fused L4/5.
11. He was referred to Dr Ivan Popoff, who performed bilateral knee arthroscopies and lateral releases on 3 February 2022 for long standing bilateral knee pain.
12. On 18 October 2022, Dr Diwan operated on Mr Cura's back, removing the hardware at L4/5 and undertaking transforaminal lumbar interbody fusion L4 to S1. Mr Cura volunteered that the insurer refused to pay for the spinal surgery due to the fact that there had been mention of degenerative changes in the spine. Therefore, he had used his private cover.
13. On 26 January 2024, Mr Cura had a fall at home whilst getting into his car. He said this had been because his right knee gave way. Following this incident there was temporary exacerbation of the back pain. He returned to Dr Diwan, but no further investigations or treatment was considered necessary.
14. Mr Cura said that over three weeks ago he had visited Dr Diwan. Then two weeks ago he had a L3/L4 corticosteroid injection.

1. Mr Cura described suffering with neck stiffness and pain, the latter extending from the occiput down into the cervical spine, the trapezius and infrascapular regions bilaterally. He said he notices a click when he moves his head and neck. There were no cervical radicular symptoms.

1. The claimant had no pain in either upper limb. He did not recall injuring either hand in the motor accident. There was numbness and tingling in both thumbs which he indicated was worse at night and better if he moves the limbs around. He said the sensory symptoms arose after the accident.

1. He has right shoulder discomfort "now and again" and this is felt deep in the shoulder joint and increases with activity but it does not restrict him in his day-to-day activities. Mr Cura noted that he had experienced these same intermittent right shoulder symptoms, since the right shoulder was reconstructed. He said his left shoulder is fine.
2. There were no additional upper limb complaints.

1. Aside from some occasional infrascapular pain, there were no problems.

1. Mr Cura said there was numbness extending upwards from the upper sacral area to and around his surgical scars. He said the pain was worse over the upper third of the scar. He finds he has to lean back when seated and in bed he has to place a pillow between his knees to avoid exacerbating his back pain.
2. There were no lumbar radicular or other neurological symptoms in either lower limb.

1. His left hip is painful at times. He said he had noticed some bruising over the outer left hip after the accident and since then there has been intermittent pain over the lateral aspect of his left hip. His right hip is asymptomatic. He said the right ankle abrasion had resolved soon after the accident and there were no further ankle symptoms.

1. Mr Cura said both knees swell intermittently. There is tenderness over the anteromedial aspect of his right knee. The right knee gave way last year. Apart from intermittent swelling, his left knee is okay. He finds he needs to apply ice to both knees and he wears Velcro supports.

1. Mr Cura said he can't do much now, but he persists as he is "strong-willed", so he doesn't let his left hip symptoms restrict him. He can manage walking 20-30 minutes without a stick, but he tends to use this for longer walks or if he is carrying a bag. He uses his stick predominantly in his right hand.
2. He drives an automatic car and notices some left knee soreness and stiffness when he drives.

1. Mr Cura takes one to two Panadeine Forte tablets a day, paracetamol now and again, one Mobic per day, one Xarelto.
2. His GP continues to manage his conditions.
3. He speaks online with psychiatrist, Dr Kailas Roberts whom Mr Cura said had diagnosed post-traumatic stress disorder. He also sees a psychologist, Ms Carmen Lancu.

1. Mr Cura mobilised without the aid of his stick. He weighed 90kg and is 167cm tall. He wore Velcro knee guards on both knees. He walked without a consistent limp.
2. On examining the neck, he was tender over the lower cervical spine and the infrascapular area. Flexion and extension were to two-thirds normal, lateral flexion and rotation were to two-thirds normal. There was no asymmetry of movements, no muscle spasm or guarding. There were no cervical radicular symptoms or signs.
3. On examining the upper limbs, there was normal power, sensation and reflexes bilaterally. Circumferential measurements of arms were 32cm bilaterally (14cm above each olecranon), right forearm was 29cm and left 28.5cm. He had a small scar over the lateral aspect of his left elbow, which he said was from a glass cut at home.
4. On examining both shoulders, there was bilateral impingement, but no specific shoulder joint tenderness and no muscle wasting. There were well-healed arthroscopy portals on the right. Passive movement showed no crepitus and no irritability. Active movements as measured with a goniometer were as follows;

1. On examining both elbows and hands, there was a normal range of motion and no sensory changes. Upper limb power and reflexes were symmetrical and normal.
2. On examining the back, there was upper and mid thoracic central tenderness over the spinous processes with some extension to the left infrascapular region, but no paravertebral tenderness or guarding. He was tender over the lower back, in particular L5 spinous process. There was tenderness generally over the sacral and coccygeal areas, with no localising tenderness and no deformity of the sacrum or coccyx.
3. There was dysaesthesia between the lumbar spinal scars. There were three well healed, longitudinal operative scars with negligible contour defect, minimal colour contrast and no visible suture marks. The central scar measured 11cm, there was a 9cm scar to the right and a 10cm on the left.
4. There were normal movements of the thoracic spine with no dysmetria. In the lumbar spine, two-thirds normal flexion, extension one-fifth, lateral flexion two-thirds, rotations two-thirds demonstrating lumbar dysmetria.
5. On examining the lower limbs, there was normal power, sensation and reflexes bilaterally. Right thigh circumference was 46.5cm and left 46cm, both 10cm above upper pole of each patella. Calves measured 39.5cm bilaterally at maximal girth.
6. There was left trochanteric tenderness without affecting gait. Active hip movements were as follows:

1. On examining both knees, there was no swelling. Both knees were stable. There was posterolateral joint line tenderness and patellofemoral crepitus on examining the right knee, with 135° flexion and 0° extension. There was anteromedial joint line tenderness, but no patellofemoral crepitus on examining the left knee, with 140° flexion and 0°extension.
2. On examining both ankles and feet the Panel found active movements were as follows:

1. Soft tissue injury. There were complaints of pain or symptoms, but there were no clinical findings as detailed in Table 6.8, SIRA Motor Accident Guidelines. There was no radiculopathy or vertebral body compression or vertebral fracture. Therefore, the cervical spine injury would be assessed at DRE Impairment Category I, thus 0% WPI.

1. Soft tissue injury. There were complaints of pain or symptoms, but there were no clinical findings as detailed in Table 6.8, Guidelines. Thus, the thoracic spine injury would be assessed at DRE Impairment Category I, thus 0% WPI.

1. Fracture L1 vertebral body. There was a prior spinal fusion L4/5 and the claimant had remained symptomatic. Therefore prior to this accident this would rate DRE Category IV, thus 20%WPI, as there was no radiculopathy (Table 6.7, SIRA Motor Accident Guidelines). Following the accident there was a spinal fusion L4/5/S1, this would also rate DRE Category IV, thus 20%WPI. Thus 20% - 20% = 0% net impairment regarding lumbar surgery.
2. However, there was an endplate spinal fracture with less than 25% compression.
3. The panel measured maximal vertebral compression on the plain X-ray images dated

28 July 2021 showingT12 (3.1cm), L1 (3cm), L2 (3.3cm). 4. The measurements of the two unaffected vertebrae were added and then an average obtained 3.1 + 3.3 = 6.4/2 = 3.2. 5. The measurement from the compressed vertebra was then subtracted from the average of the two adjacent vertebrae: 3.2 - 3 = 0.2. 6. The resulting figure (0.2) was divided by the average of the two unaffected vertebrae and turned into a percentage: 0.2/3.2 x 100 = 6% compression (rounded) equals 5% WPI (DRE category II, 3/102 AMA 4). 7. Therefore 5% WPI, due to the accident.

1. The Panel reviewed the available imaging and confirmed there were no displaced fractures. On examination there was no localising tenderness and no deformity of the sacro-coccygeal region; any fracture in the coccyx had healed as shown on the bone scan performed 2 November 2021. Therefore, based on s 3.4 AMA 4 there was 0% WPI.

1. Soft tissue injury. Movements were measured. Right upper extremity impairment (1%) was calculated with reference to Chapter 3, Fig 38, 41, 44, AMA 4 and then converted to 1% WPI using Table 3, p 20, AMA 4.

1. Soft tissue injury. Movements were measured. Left upper extremity impairment (0%) was calculated with reference to Chapter 3, Fig 38, 41, 44, AMA 4. Left shoulder asymptomatic and any soft tissue injury resolved.

1. Soft tissue injury. Movements were measured and normal, equivalent to the left elbow. Right elbow asymptomatic and any right elbow soft tissue injury resolved.

1. The claimant reported to the Medical Assessors that he did not injure either hand in the accident, but he later developed intermittent sensory symptoms in both thumbs. This was unrelated to the subject accident, due to the time of onset and the absence of any subject accident related injuries that would produce these symptoms.
2. However, when the Panel assessed the hands there was normal and symmetrical range of movement of both hands and thumbs and no objective sensory or motor loss at the thumbs, hands or upper limbs.

1. There was no gait derangement (Chapter 3 AMA 4, Table 36, p76). No muscle atrophy [Chapter 3 AMA 4, Table 37, p77]. No unilateral muscle weakness (Chapter 3 AMA 4, Table 38 and 39, p77). Knee movements were assessed with reference to Table 41 (Chapter 3, AMA 4, p78) resulting in 0% WPI. Hip movements were assessed with reference to Table 40 (Chapter 3, AMA 4, p78) gave rise to 0% WPI. Foot and ankle movements assessed with reference to Tables 42, 43, 44 (Chapter 3, AMA 4, p78) gave rise to 0% WPI.
2. Ankle and hindfoot movements were symmetrical. As per cl 6.72 of the Guides "If the contralateral uninjured joint has a less than average mobility, the impairment value(s) corresponding with the uninjured joint can serve as a baseline and are subtracted from the calculated impairment for the injured joint, only if there is a reasonable expectation that the injured joint would have had similar findings to the uninjured joint before injury. The rationale for this decision must be explained in the impairment evaluation report."
3. Although ankle plantar flexion was reduced, this was the case on both sides so whilst the right ankle restriction would give rise to 3% WPI, being the injured side, this was the same range of motion as the uninjured side, also 3%, so subtracting the impairment on the uninjured side from the impairment on the injured side (3% - 3%) yielding a net impairment of 0% WPI.
4. There was right patellofemoral crepitus. In the Panel's clinical judgment this was explicable given the advanced degenerative changes demonstrated in the pre-accident MRI scan dated 27 July 2020.

1. There was no gait derangement (Chapter 3 AMA 4, Table 36, p76). No muscle atrophy (Chapter 3 AMA 4, Table 37, p77). No unilateral muscle weakness (Chapter 3 AMA 4, Table 38 and 39, p77). Knee movements were assessed with reference to Table 41 (Chapter 3, AMA 4, p78) resulting in 0% WPI. Hip movements were assessed with reference to Table 40 (Chapter 3, AMA 4, p78) gave rise to 0% WPI.
2. There was no left patellofemoral crepitus (Table 62, Chapter 3, AMA 4, p83) giving rise to 0% WPI. There was left sided trochanteric bursal tenderness which doesn't rate any impairment in the absence of gait derangement.
3. Combining all the above impairments - 5%WPI for lumbar spine, 1%WPI for right shoulder, yielding 6% WPI due to the accident.

1. The determination as to permanent impairment is made in accordance with the American Medical Association's Guides to the Evaluation of Permanent Impairment (Fourth Edition) (AMA4 Guides) and the Guidelines version 9.3. Permanent impairment is defined in the AMA4 Guides (p 315) as follows:

"Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment. A permanent impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment."

1. It is now over four years since the accident, but his revision lumbar spine surgery was on

18 October 2022, almost two and a half years ago. His injuries are stable so his permanent whole person impairment is considered to be unlikely to change substantially by more than 3% in the next year with or without medical treatment.

1. The following injuries WERE caused by the accident:
   • cervical spine - soft tissue injury;
   • thoracic spine-soft tissue injury;
   • lumbar spine - L1 vertebral body fracture;
   • coccyx - healed undisplaced fracture;
   • right shoulder - soft tissue injury;
   • right ankle - soft tissue injury;;
   • right knee- soft tissue injury;
   • left knee- soft tissue injury; and
   • left hip- soft tissue injury.

• right elbow - soft tissue injury;
• left shoulder - soft tissue injury, and
• right hip - soft tissue injury.

1. The following injuries were not caused by the accident:
   • bilateral hands including left thumb.

Chapter 3, Page 110,

1. All of the calculated impairment is the outcome of the accident.

1. The Panel adopted the Medical Assessors' examination and permanent impairment assessment.

1. The Panel found the permanent impairment arising from injuries caused by this accident is different to that found in Medical Assessor Alexander Woo's assessment certificate dated 10 October 2024.
2. Accordingly, the Review Panel revokes that certificate and issues a new Permanent Impairment Certificate.
3. The Review Panel found that the motor accident caused the following injuries and assessed them as giving rise to 6% whole person impairment:
   • cervical spine - soft tissue injury;
   • thoracic spine-soft tissue injury;
   • lumbar spine - L1 body fracture;
   • coccyx - fracture;
   • right shoulder - soft tissue
   • left shoulder - resolved soft tissue;
   • right lower limb, and
   • left lower limb.
4. The accident caused injuries with a total percentage WPI not greater than 10%.