MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; medical assessment of whole person impairment (WPI) by Medical Assessor (MA); claimant injured in motor vehicle accident when her vehicle was hit from behind; claimant lodged Application for Personal Injury Benefits; dispute arose as to the claimant's WPI as a result of the accident; MA determined the claimant's WPI as a result of injuries sustained in the accident at 0%; claimant sought a review of the assessment under section 7.26; review panel re-examined the claimant; Held - Review Panel revoked certificate of the MA and substituted the determination of 4% WPI.

Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. The Medical Review Panel revokes the certificate of Medical Assessor Robin Alexander Mitchell dated 30 April 2025 and substitutes the determination that as a result of the following injuries caused by the accident, the claimant sustained a total permanent whole person impairment of 4%:
   • Left Shoulder, and
   • Right Shoulder
2. The Medical Review Panel determined that the following injuries caused by the accident gave rise to a permanent whole person impairment of 0%:
   • Right Ankle;
   • Cervical Spine, and
   • Lumbar Spine

1. The claimant, Leticia Druma (Ms Druma), claims to have been injured in a motor vehicle accident (the accident) on 19 November 2022. She was a passenger in her husband's car when he came to a stop to give way to traffic prior to turning left when their vehicle was hit from behind.
2. QBE Insurance (Australia) Limited (the insurer) was the CTP insurer.
3. 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 cease after 52 weeks if the person's only injuries resulting from the motor accident were minor injuries.
4. Ms Druma submitted an Application for Personal Injury Benefits dated 22 November 2022.
5. On 23 January 2024, the insurer wrote to Ms Druma advising that it had made a liability decision determining that the injuries caused to her in the accident were threshold injuries.
6. On 11 September 2024, Ms Druma's solicitor requested an Internal Review of the decision, claiming that she sustained whole person impairment (WPI) of greater than 10%.
7. On 10 December 2024, the insurer reaffirmed its decision that the injury sustained in the accident did not exceed 10% WPI.
8. A medical dispute about the degree of Ms Druma'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.
9. 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.
10. The dispute was referred to the Personal Injury Commission (Commission) which then assigned it to Medical Assessor Robin Alexander Mitchell for assessment.
11. On 16 April 2025, Medical Assessor Mitchell assessed Ms Druma and on

30 April 2025, certified that the following injuries caused by the accident gave rise to a WPI of 0%: - * Right ankle musculo-ligamentous injury * Cervical spine radiculopathy * Lumbar spine radiculopathy * Left shoulder * Right shoulder

1. Ms Druma sought a review of the Medical Assessment under s 7.26 of the Act (the Review).
2. Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A "new decision maker" is defined in cl 14A(1) of Schedule 1 of the PIC Act. As the medical assessment which is the subject of the Review was made on or after 1 March 2021, the new review provisions apply.
3. 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.
4. 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 of the medical assessment.
5. 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.
6. 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. However,

s 7.25 of the Act provides that the review of a medical assessment can be made on the basis of any agreement by the parties as to the degree of permanent impairment from a particular injury and whether a particular injury was caused by the accident, without those matters having to be the subject of assessment. 7. 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 Druma'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, 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 Robin Alexander Mitchell examined Ms Druma on 16 April 2025 and issued his certificate on 30 April 2025. He had the documents attached to the Application, and one additional late document being the report of Dr Raymond Wallace dated

13 February 2025. 2. At [2] of his certificate, Medical Assessor Mitchell noted that the following injuries had been referred to him by the Commission for Assessment: * Right ankle musculo-ligamentous injury * Cervical spine radiculopathy * Lumbar spine radiculopathy * Left shoulder * Right shoulder 3. The Medical Assessor then summarised the submissions by the parties at [3]-[4] of his certificate, noting Ms Druma claims she has sustained a WPI of greater than 10% and relies on the opinion of Dr Shahzad, whilst the insurer relies on the opinion of Dr Wallace that Ms Druma sustained a WPI of 0% 4. The Medical Assessor took a brief pre-accident history of Ms Druma at [7], noting she had a history of two previous twisting injuries to her right ankle in 2018 and 2019 that did not require treatment and subsequently resolved. 5. Medical Assessor Mitchell then took a history of the accident at [8], reporting that Ms Druma sustained a number of injuries in an accident on 19 November 2022, while the front seat passenger in a stationary vehicle, after a utility travelling behind collided with the rear of her vehicle. She was wearing her seatbelt and there was no head injury or difficulty subsequently exiting the vehicle. She attended Blacktown Hospital later that day but did not wait, apparently due to long waiting times, instead completing a telehealth consultation with her general practitioner in that afternoon whom she subsequently saw the following morning and was sent back to Blacktown Hospital where she underwent chest X-ray examination and was prescribed Panadol analgesic medication before being sent home. Two days later she saw Dr Tang again complaining of pain in her neck, both shoulders, back, and right ankle. 6. As to the history of symptoms and treatment following the accident, the Medical Assessor recorded at [9] that Ms Druma was referred to physiotherapy and hydrotherapy, and subsequently underwent a corticosteroid injection to her cervical spine, left shoulder and lumbar spine. She was referred for specialist review with Dr Kanawati, orthopaedic spinal surgeon, who initially assessed her in February 2023 and after further investigations did not recommend operative intervention. She was then referred for a specialist review with Dr Kassim, pain physician, who initially assessed her in October 2023. Dr Kassim recommended referral to a pain management program and suggested hydrotherapy. She was also referred for specialist review with Dr Vishwanathan, orthopaedic surgeon, in regard to her left shoulder condition, and surgical intervention was not recommended. She last attended physiotherapy in February 2024. 7. At [10], the Medical Assessor recorded Ms Druma's current symptoms, noting that she continued to have pain in the central lower neck, as well as the left shoulder, lumbar back, and right ankle. The back symptoms can radiate down to the tailbone and out to the right hip but no further down the leg. She has shaking of both hands which appears to occur when undertaking fine dexterous tasks with the hands. She has remained off work since the time of the accident of 19 November 2022 and she described markedly reduced current functional capacities: being able to lift no more than 2kg or stand for greater than 15 minutes. Her driving capacity is 30 minutes. She is independent with respect to her personal activities of daily living, or ADLs, but said that she has difficulty with the heavier aspects of normal household work. Medical Assessor Mitchell also noted that there had been no further injuries or conditions sustained since the accident. 8. He then discussed Ms Druma's current and proposed treatment at [11], noting that she was not currently undergoing active treatment for her injuries apart from using Panadol or Nurofen as required for pain management. 9. Medical Assessor Mitchell undertook a clinical examination of Ms Druma at [12]-[16], noting she attended the assessment unaccompanied. The Panel reproduces his findings below: -

She was overweight at 94 kg for her height of 160 cm and is right handed, and appeared comfortable while sitting during this assessment. Cervical spine (cervicothoracic) Movement in the neck was noted to be reduced, in a symmetrical manner, with ¾ of normal flexion and extension. The lateral flexion in each direction was ¾ of normal. Rotation in each direction was normal. There was no evidence of increased muscle tone, reflexes were normal bilaterally and skin sensation was normal, therefore there was no evidence of verifiable radiculopathy.

Movement in the lumbar back was reduced in a symmetrical manner, with flexion and extension possible to ¾ of normal, and lateral flexion to each side also ¾ of normal range. There was no palpably increased muscle tone or abnormal reflex in either leg, and skin sensation appeared normal. There was no evidence of radiculopathy, in my opinion. However straight leg raising was markedly reduced on each side at 20° while supine on the examination couch, yet a full 90° was possible when sitting sideways on the couch indicating a degree of inconsistency in Ms Druma's responses.

Shoulder joint movement was significantly inconsistent on repeated testing and when that was pointed out to Ms Druma, she said it was because the shoulder and neck were painful at the time.

There was significant inconsistency in her responses during my physical examination, particularly during my assessment of shoulder joint movement on each side, as well as straight leg raising while supine on the examination couch but not when sitting sideways. When the inconsistency of shoulder movement was bought to her attention, she said that the cause may have been the level of pain felt at the time."

1. At [17]-[18], the Medical Assessor provided a summary of the relevant documentation and imaging upon which he relied during his assessment of Ms Druma. This is reproduced by the Panel:

Dr Wallace, orthopaedic surgeon, dated 13 February 2025

He noted a minor musculoligamentous strain of the cervical spine, which he reported had resolved. He recorded that there was no objective medical evidence to indicate a mechanism of injury with any specific trauma to her lumbar spine or right ankle "given that she was the restrained front seat passenger in a large vehicle at the time, and concluded that she was not suffering from any motor vehicle accident related disability in the cervical spine, left shoulder, lumbar back or right ankle.

Dr Shahzad, occupational physician, dated 25 November 2024

This report provided a significantly different opinion, with of an examination finding of no flexion or extension movement apparently possible at all in her neck, and all other movement reduced to 1/4 of normal, together with his opinion of a left C5 radiculopathy, for which there was no objective clinical evidence present at the time of my assessment. He found a reduction of movement in the left shoulder, as did Dr Wallace and other examiners, however reported normal movement in the right shoulder, which was reduced in other reports, and at the time of my assessment. He reported reduced movement in the lumbar spine which was almost symmetrical and also opined a left lower limb L5/S1 radiculopathy. However, at the time of my examination varied was no evidence of any objective clinical hiding to indicate a verifiable radiculopathy. There was no evidence of any loss or asymmetry of reflexes, no positive sciatic nerve root tension sign, no muscle atrophy or weakness, and no evidence of reproducible sensory loss.

Described biceps tendinitis and focal tendinosis of the supraspinatus tendon footprint.

Reported mild degenerative foraminal stenosis at L4/5 bilaterally and on the right at L5/S1 with contact of the left exiting L4 and right exiting L5 nerve roots.

Identified an annular tear at L4/5 with degenerative changes impinging on the right exiting L5 nerve root.

Found a partial thickness intrasubstance tear of the mid supraspinatus tendon, tendinosis of the infraspinatus tendon and a low-grade partial-thickness insertional tear as well as a labral tear and small para-labral cyst formation

Found degenerative cysts within the anterior aspect of the greater tuberosity and a questionable small partial thickness articular surface tear of the supraspinatus tendon.

Found degenerative changes on the right at L5/S1 as well as the right medial malleolus, with arthritis in the right subtalar joint.

1. Medical Assessor Mitchell set out his diagnosis and reasons at [19], opining the following: -
   • Right ankle musculo-ligamentous injury based on the history, the radiological investigations undertaken, and a normal range of ankle and hindfoot joint movement on my clinical examination.
   • Cervical spine soft tissue pain, based on the clinical and radiological features described
   • Lumbar spine soft tissue pain, based on the clinical and radiological features described with no evidence of radiculopathy
   • Left shoulder soft tissue pain, based on the clinical and radiological information available.
   • Right shoulder soft tissue pain, based on the clinical and radiological information
2. At [20], the Medical Assessor discussed causation and reasons, noting that the symptoms reported have a temporal relationship with the accident, however there is no current objective clinical or radiological evidence to indicate any ongoing underlying injury in the cervical spine, lumbar spine, left shoulder, or right ankle.
3. At [21], the Medical Assessor noted that the following injuries were caused by the accident: -
   • Right ankle musculo-ligamentous injury
   • Cervical spine musculo-ligamentous injury
   • Lumbar spine musculo-ligamentous injury
   • Left shoulder musculo-ligamentous injury
   • Right shoulder musculo-ligamentous injury
4. Medical Assessor Mitchell then set out his permanent impairment table at [22] which is reproduced below:

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

1. At [23]-[24], the Medical Assessor noted that there was no evidence of any relevant or significant pre-existing condition or impairment. As to apportionment, he stated that the reported symptoms have a temporal relationship with the accident, but sufficient time has elapsed for any soft tissue injury that may have been sustained at that time to have now fully resolved and there is no longer any relationship of a causal nature with respect to the ongoing reported symptoms in the accident.
2. Medical Assessor Mitchell concluded with reasons at [25] that the following injuries were caused by the accident and gave rise to a permanent impairment of 0%:
   • Right ankle with a normal range of movement in all directions is a 0% WPI
   • Cervical spine has the clinical features of a DRE 1, with no asymmetry of movement, no muscle tightness or spasm, normal neurological findings and no evidence of radiculopathy.
   • Lumbar spine has the clinical features of a DRE 1, with no asymmetry of movement, no muscle tightness or spasm, normal neurological findings and no evidence of radiculopathy
   • Left shoulder with markedly inconsistent responses on examination not allowing the range of movement method to assess impairment, and significant evidence to indicate previous significant problems radiologically.
   • Right shoulder with markedly inconsistent responses on examination not allowing the range of movement method to assess impairment, and no significant evidence to indicate recent injury.

1. The Panel summarises the material that was available to it and upon which it relied during its assessment of Ms Druma, without duplicating material which has already been summarised by Medical Assessor Mitchell above.

Report of Dr Keller, occupational physician, dated 14 December 2023

1. Diagnosis - Ms Druma's initial reported symptoms at the hospital were of right sided thoracic middle back pain. No lasting injury to the thoracic spine has been identified. She currently reports constant left shoulder and lower back pain and intermittent daily neck pain. She states her previous right ankle pain has settled. note from the photographs provided that there was little damage to the rear of her vehicle and the accident was likely to have occurred at the low end of the force spectrum not expected to cause lasting musculoskeletal injuries. I also note that she has been extensively investigated with multiple X-rays and MRls that show longstanding multilevel degenerative changes in the cervical and lumbar spine and degenerative tendinopathy and bursitis in the left shoulder. There is evidence of longstanding past right ankle posterior tibialis tendinopathy. With careful consideration of all of the information available to me it is likely that the accident caused a temporary soft tissue strain to the thoracic spine that has now resolved. Whilst it is possible the accident temporarily exacerbated her other longstanding degenerative complaints it is not clear to me that it caused any aggravation or lasting exacerbation that persists to the present date.
2. Resolution of reported injury - In my opinion the thoracic spine soft tissue injury that occurred in November 2022 has fully resolved.
3. Comorbidities or pre-existing medical concerns - Ms Druma reports a previous motor vehicle accident, causing neck and left knee injuries resulting in left knee surgery and subsequent left saphenous nerve release. From the medical records provided I note that on 27 May 2016 she saw her doctor for left sided rib pain attributed to an injury from 10 years previously and diagnosed as erector muscle tear. She saw her doctor following a fall on 6 June 2017 and identified left shoulder pain for which she had an ultrasound. On 28 April 2017 she reported a fall causing left wrist and shoulder pain. An X-ray of the left shoulder showed osteoarthritis and acromioclavicular joint degeneration. She subsequently developed pain in the right ankle and left hip. On 8 June 2017 an ultrasound of the left shoulder revealed tendinopathy and bursitis. On 13 February 2018 a CT scan and ultrasound of the right ankle showed tibialis posterior tendinopathy and scarring of the ATFL consistent with a previous tear. She had a cortisone injection into the right ankle in February 2018. On 14 September 2006 an ultrasound of the right ankle revealed a past ATFL tear and peroneal tendinopathy. On

3 October 2020 X-rays and ultrasounds of the right wrist showed osteoarthritis and no tears. She saw her doctor on 12 December 2021 for right thumb and right foot pain that were restricting her capacity for work and for which she was referred for CT scans. From this information it is clear to me that she had right ankle problems dating back to 2006, rib pain dating back to 2016 and left shoulder pain dating back to 2017. It appears she had pain complaints in the right thumb and right foot that were restricting her capacity for work in December 2021.

Report of Dr New, orthopaedic and spinal surgeon, dated 24 October 2023

1. Diagnosis - The diagnoses are that she has cervical spondylosis, lumbar spondylosis and pain in her left shoulder as a result of the partial tears in her rotator cuff, supraspinatus, and tendinosis of the infraspinatus as well as subacromial and subdeltoid bursitis. The cause of her right lower limb discomfort is indeterminate. There is no neurological impairment.
2. Causation - It is my opinion, on the history given to me by the patient, that there is a connection between her presentation and the accident dated 19th November 2022, noting her pre-history.
3. Prognosis - Due to the significant pain presentation, her prognosis is poor.

Report of Dr Kassim, rehabilitation physician, dated 27 October 2023

1. Pain Management Plan - "Pain Management Program: We recommend the Pain Management Program. Our Pain Management Program is a Multidisciplinary Pain Program that incorporates cognitive behavioural therapy, CBT principles and active self-management strategies, the application of these principles form the foundation of effective Pain Management (Wilkinson and Whiteman 2018) and in turn formed the foundation for PainMed PMP. The patient will be required to attend 10 sessions each of Physiotherapy and Psychological therapy in addition to medical appointments. The goals of the program align closely with the agency for clinical innovations (ACI 2015) Guidelines:
   1. To improve patient's understanding of chronic pain and its effects.
   2. To improve the level of physical function and promote a return to daily living tasks.
   3. To modify the perceived level of pain, disability and suffering.
   4. To provide coping strategies for dealing with pain, disability and distress.
   5. To promote self-management.
   6. To reduce or achieve appropriate future utilisation of healthcare services related to pain.
   7. Preparation for discharge/maintenance of gains. Our team of clinicians will meet at specific intervals to review the patient's progress and to provide feedback to the insurer. Our goal is to provide the best evidence of treatment to our patients to maximise the recovery from persistent pain.
2. Medications - We aim to optimise her pain medications once we start the Pain Management Program to allow her full participation with rehabilitation.
3. Recommendations - I strongly recommend Ms Druma to be involved in Hydrotherapy Program for aquatic-based exercises and pain management and we shall request an approval for Hydrotherapy through her insurance."

Reports of Dr Antoun, dated 9 February 2023 and 28 February 2023

1. 9 February 2023 - "Ms Leticia Druma was involved in an incident on the 19 November 2022, with complaints of lower back and imaging confirming no acute or traumatic features only long standing chronic degenerative pathology. Correspondence with reporting radiologist, Dr Rohini Rothad confirmed that the lumbar spine pathology on MRI reported no acute or traumatic features and the L4/L5 described annular tear/fissure was long standing chronic degenerative pathology, that did not correlate with the claimed event or time frame. The MRI scan of the lumbar spine has confirmed no acute or traumatic features only long-standing degenerative pathology that is not related to or directly caused by the claimed event on the 19 November 2022. As there are no acute or traumatic features reported on the lumbar spine, Ms Druma's back symptoms are musculoligamentous in nature & expected to have resolved long ago. The reported lumbar pathology including the annular fissure, are not related to or directly caused by the claimed event on the 19 November 2022. Ms Druma's claimed symptoms are musculoligamentous in nature, with no acute or traumatic features related to the claimed event, only long-standing chronic degenerative pathology. Under the Act 2017, Ms Druma's claimed injury is deemed to be minor."
2. 28 February 2023 - "Ms Leticia Druma was Involved in an Incident on the 19 November 2022, with complaints of bilateral shoulder symptoms with imaging that was indeterminate of the relation to the claimed event. Documents reviewed noted a previous left shoulder injury in 2017 reporting a focal tendinosis noted of the footprint insertion of the supraspinatus tendon. The AHRR documented the pain in the right shoulder & right ankle being reported by Ms Druma as 10/10 compared to left shoulder of 5/10. The second AHRR, makes no comment on the left shoulder symptoms only right shoulder symptoms. Correspondence with reporting radiologist, Dr Angus Mackinnon confirmed the presence of a labral and rotator cuff tear but advised that it was difficult to determine the relationship to the incident or whether both tears were acute or pre-existing in nature, despite the bright signal of the rotator cuff tear. The MRI scan of the left shoulder has reported pathology that was deemed indeterminate in nature, with no true confirmed traumatic features related to or directly caused by the claimed event on the 19 November 2022. Previous imaging notes the presence of focal long-standing tendinosis which is a chronic condition involving deterioration of collagen (a structural protein) in the tendons. Tendinosis is caused by chronic overuse of a tendon. It can occur in any tendon, but most often occurs in the tendons of the elbow, ankle & shoulder. As the tissue degrades due to the lack of blood supply this predisposes the tendons to tear. The file documents that Ms Druma's right shoulder symptoms were worse than the left shoulder symptoms, with the left shoulder symptoms not even reported or documented in the AHRR on 1 December 2022. If the left rotator cuff or labral tear were acute & traumatic in nature, I suspect this would not have been the case and expected the left shoulder symptoms being significantly worse. Based on the discussion, described mechanism of injury and documents in the file reviewed, Ms Druma's symptoms are musculoligamentous in nature & expected to have resolved long ago. Ms Druma's claimed pathology does not appear to be consistent with documents reviewed and are more consistent to be musculoligamentous in nature, with no confirmed traumatic features related to the claimed event. Under the Act, Ms Druma's claimed injury is deemed to be minor."

Application for Personal Injury Benefits Claim Form dated 22 November 2022

1. On her claim form, Ms Druma described the accident as: "waiting in queue to exit Stanhope Parkway to turn left onto Sunnyholt Road. Moved to front of queue. We were stationary at the intersection waiting for it to be clear to proceed. The large impact from behind. We moved to a safe part of Sunnyholt Road to exchange details of the other driver." Ms Druma reported the following injuries: "Whiplash, swelling in left arm for a few hours. Then the next day pain was radiating down right arm and right side of back. On the day of accident, had pain in lower back which has persisted."

1. The Police Report recorded the crash summary details as follows:

"About 9:35am on Saturday 19th November 2022, VEH 2 was travelling down Stanhope Parkway, Stanhope Gardens where VEH 2 has intended on turning left onto Sunnyholt Road. Approaching the left turn off, DRIVER 2 has noticed that a car (description of which he could not recall). The traffic signal for the Sunnyholt Road, left turn was red and as such VEH 2 has then stopped and remained stationary. A short moment later, both DRIVER 2 and PASSENGER 2 have felt a large bang coming from the rear of their vehicle. The force of this jolted has caused a slight whiplash effect to both DRIVER 2 and PASSENGER 2. As DRIVER 2 had realised he had been in a traffic accident, both DRIVER 2 and DRIVER 1 have pulled over and safely parked to exchange particulars. All particulars for both drivers were exchanged."

1. The Panel notes the submissions of Ms Druma of 15 August 2025 and does not reproduce them as they are identical to the submissions dated 10 January 2025 which are summarised below.

1. The Panel summarises the submissions of the insurer dated 4 June 2025 by reference to paragraph numbers:

[1]-[5] The insurer sets out the background of the dispute.

[6]-[7] Section 7.26(2) of the Act provides that a review may only be made where the assessment was incorrect in a material respect and the insurer submits there is no material error in Assessor Mitchell's Certificate on this basis.

(a) failure to give full consideration to medical evidence;

(b) failure to provide adequate reasoning/apply the Motor Accident Guidelines.

[9] The insurer submits these allegations are not material errors and responds using the claimant's headings.

Alleged Error #1 - Failure to give full consideration to medical evidence

[11] The claimant alleges clear evidence of shoulder tears.

[12]-[13] The insurer notes the Medical Assessor diagnosed soft-tissue pain "based on the clinical and radiological information available," including MRIs from 20 February 2023. The insurer submits the Assessor formed an expert diagnosis based on the imaging.

[14] Alternatively, even if the diagnosis differed, the insurer submits this does not constitute a material error, and the claimant has not identified what the correct diagnosis should be.

[15]-[16] The claimant notes restricted shoulder ROM and says the Medical Assessor gave no comment on her explanation for inconsistent recordings. The insurer submits the Medical Assessor was not required to comment because the Guidelines impose a non-discretionary prohibition on using inconsistent ROM.

[17]-[19] Clause 6.50 requires ROM to be disregarded where inconsistent. The insurer submits there is no allowance to use inconsistent ROM, even if due to pain. Accordingly, the Medical Assessor was not required to explain the non-use of ROM beyond noting inconsistency.

[20] The insurer submits that no material error is demonstrated and the review application should be rejected.

[21]-[22] The claimant alleges the Medical Assessor failed to assess radiculopathy per clause 5.8. The insurer submits the Medical Assessor was not required to assess muscle weakness or atrophy where the claimant did not report these symptoms. The insurer relies on AAI Ltd t/as GIO v Amos [2024] NSWCA 65.

[23] The insurer submits the Medical Assessor was entitled to rely on symptoms actually reported and was not required to raise unreported symptoms.

[24]-[25] Citing Mandoukos v Allianz (2023), the insurer notes the parties' submissions define the issues; neither party raised muscle weakness/atrophy. Thus, the Medical Assessor was not required to assess or enquire about these symptoms.

[26]-[27] The insurer notes permanent impairment assessment is based on presentation on the day, which the Medical Assessor was entitled to rely on. The insurer submits the Medical Assessor engaged with the evidence and no material error exists.

Alleged Error #2 - Failure to provide adequate reasoning / apply Guidelines

[28]-[31] The claimant alleges the Medical Assessor failed to explain the non-use of reduced ROM. The insurer cites Wingfoot v Kocak (2013): decision-makers' reasons are not to be scrutinised minutely; reasons must record the actual pathway of reasoning. The insurer further relies on Ali v AAI (2016) and Insurance Australia v Milton (2016), which confirm that assessors' reasoning obligations are narrow. The insurer submits the Medical Assessor's reasoning satisfies these principles.

[32]-[33] As explained in paragraphs 16-19, the Guidelines impose a mandatory prohibition on using inconsistent ROM, so no additional reasoning was required. The insurer submits there is no failure to provide adequate reasons and no reasonable cause to suspect material error.

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

[1]-[4] The claimant provides a background of the issues in dispute.

[5]-[8] The claimant submits there is clear medical evidence of injury to both shoulders arising from the motor accident. Radiological scans support the claimant having sustained tears to both shoulders caused by the accident. The claimant submits no contemporaneous medical evidence identifies any pre-existing shoulder injury. The Medical Assessor has not found any alternative cause for the shoulder injuries.

[9]-[12] It is clear the Medical Assessor found restriction of movement in both shoulders, although not always the same range. The claimant submits she provided a valid explanation that inconsistent movement was due to pain levels and that the Medical Assessor did not state whether he accepted or rejected the claimant's explanation. She further submits all medical evidence supports bilateral shoulder injury with restricted movement, yet the Medical Assessor dismissed the evidence and, despite finding restriction, awarded no WPI percentage.

[13]-[14] The claimant submits the Medical Assessor also failed to find cervical and lumbar radiculopathy despite medical evidence supporting these injuries. Clause 5.8 of the Guidelines defines radiculopathy as impairment caused by spinal nerve root dysfunction where two or more of the following are present:

(a) loss/asymmetry of reflexes;

(b) positive sciatic nerve tension signs;

(c) muscle atrophy and/or decreased limb circumference;

(d) muscle weakness in an appropriate nerve root distribution, and

(e) reproducible sensory loss in an appropriate nerve root distribution.

[15]-[17] The claimant submits the Medical Assessor did not undertake the assessment required by clause 5.8 of the Guidelines, where identifying two or more signs would lead to a finding of radiculopathy. The claimant confirms the Medical Assessor did not measure limb circumference (5.8(c)) or discuss/test muscle weakness (5.8(d)), despite her longstanding symptoms. The claimant submits the Medical Assessor failed to consider all medical evidence and failed to apply clause 5.8, demonstrating the assessment was incorrect in a material respect.

[18] The Medical Assessor identified MRI findings showing:

• Left shoulder - partial thickness supraspinatus tear, infraspinatus tendinosis, low-grade insertional tear, labral tear and para-labral cyst;
• Right shoulder - degenerative cysts and a likely partial thickness tear of the supraspinatus.

[19]-[22] The Medical Assessor accepted both shoulder injuries were related to the motor accident. At paragraph 14, page 4, the Medical Assessor recorded findings on shoulder movement. The claimant submits it is clear she sustained bilateral shoulder injuries from the motor accident and she notes the Assessor found restricted shoulder movement.

[23] However, the claimant submits it is unknown why the Medical Assessor did not apply the recorded range of motion to assess WPI. She further submits the Medical Assessor provided no explanation for his findings or rationale, despite being required to do so.

[25] In AAI Limited v Fitzpatrick [2015] NSWSC 1108 at [29]-[30], Schmidt J held that:

• The assessor must consider clinical examination findings, opinions of treating/medico-legal practitioners, diagnostic findings and all available reports;
• Reasons must disclose the actual path of reasoning used to reach the conclusions.

[26]-[27] The claimant submits the Medical Assessor failed to provide proper reasoning or an actual path of reasoning for disregarding his own findings and the medical evidence and that given the above, the claimant submits the Medical Assessor failed to provide adequate reasoning for his determination.

1. The Panel notes the submissions of the insurer dated 13 March 2025 which call for the inclusion of the report of Dr Raymond Wallace.

1. The Panel summarises the submissions of the insurer dated 4 February 2025 by reference to paragraph numbers:

[1]-[9] The insurer sets out the background and procedural issues of the dispute.

[10]-[26] The insurer sets out an extensive history of Ms Druma's pre-accident medical history and records, noting past injuries and reported pain to her ankles and shoulders.

[27] The insurer refers to Dr Shahzad's report noting the accident caused only minor tailgate damage.

[28]-[31] A 6 December 2022 lumbar CT showed lumbar spondylosis and mild degenerative foraminal stenosis. A 31 January 2023 lumbar MRI showed an L4-L5 annular tear/fissure and degenerative changes with right L5 nerve root impingement. On 9 February 2023, radiologist Dr Rathod advised Dr Antoun that these findings were longstanding degenerative pathology unrelated to the accident. Dr Antoun opined the L4-L5 annular fissure was not related to the accident.

[32]-[33] Both doctors confirmed no acute or traumatic lumbar features and that the annular tear/fissure was chronic. Dr Antoun classified the lumbar spine injury as a "minor injury".

[34]-[36] A 20 February 2023 left shoulder MRI showed a moderate grade partial supraspinatus tear, infraspinatus tendinosis, and anterosuperior labral tear. Radiologist Dr Mackinnon advised this left shoulder pathology was indeterminate with no confirmed traumatic features caused by the accident. Dr Antoun noted longstanding tendinosis in the left shoulder tendons.

[37] A 30 August 2023 right ankle X-ray showed an intact Achilles tendon and normal plantar fascia.

[38]-[41] Dr Kassim, on 27 October 2023, diagnosed chronic lumbosacral spinal pain with no neuropathic features. Dr Ramachandran, on 9 November 2023, noted the claimant denied neuropathic features and had no pins and needles, tingling or numbness. Dr Ramachandran described her lumbosacral pain as mechanical, without neuropathic features and he also found no focal neurological deficits.

[42] The claimant relies on Dr New's 24 October 2023 report assessing the cervical spine, left shoulder, right shoulder and lumbar spine.

[43]-[45] The insurer submits Dr New made no assessment of the alleged right ankle injury. Dr New found cervical tenderness but normal neurological findings. His lumbar neurological examination found normal sensation and reflexes.

[46]-[47] He found no right shoulder injury apart from "discomfort". He recorded left shoulder pain over the trapezius and supraspinatus.

[48] The insurer submits Dr New failed to consider the claimant's significant pre-existing left shoulder history.

[49]-[50] The claimant relies on the report of Dr Shahzad dated 25 November 2024. He assessed the cervical spine, lumbosacral spine and left shoulder.

[51]-[52] The insurer submits Dr Shahzad did not address the right ankle or right shoulder injuries. He diagnosed cervical musculoligamentous injury with non-verifiable C5 radiculopathy; left shoulder supraspinatus tear, tendinosis, bursitis and labral tear; and lumbar pathology with alleged left S1 radiculopathy.

[53]-[54] The insurer notes his diagnosis of cervical radiculopathy was expressly "non-verifiable". The insurer submits he did not accurately assess injuries having regard to the claimant's pre-accident left shoulder history.

[55] The insurer relies on Dr Keller's 14 December 2023 report.

[56]-[61] He cited right ankle imaging showing no fractures and only degenerative tendinopathy. He found normal limb power and sensation and no objective radiculopathy. He noted extensive longstanding multilevel degenerative changes across the cervical spine, lumbar spine, left shoulder and right ankle, with no acute traumatic injuries attributable to the accident. He further reported longstanding degenerative changes and tendinopathy consistent across imaging. He observed these degenerative conditions were likely to deteriorate slowly with age. He noted the claimant reported spending 20 hours per day in bed, indicating significant deconditioning.

[62] The insurer submits Dr Keller's findings show the claimant's symptoms are degenerative, not accident related.

[63]-[64] The insurer submits that based on Dr Keller's assessment, the claimant does not exceed the 10% WPI threshold. The insurer submits the accuracy of Dr New and Dr Shahzad's AMA4/Guidelines assessments is questionable.

[65]-[66] The insurer submits Dr Shahzad failed to provide radiological support for a C5 radiculopathy diagnosis. The insurer submits there is no evidence that C5-C6 nerve impingement was caused by the accident.

[67]-[68] The insurer refers to Dr Kassim and Dr Ramachandran, both finding no neurological deficits. The insurer respectfully submits that no radiculopathy has been confirmed in the cervical or lumbar spine.

[69]-[71] Dr Keller also found no objective evidence of radiculopathy. The insurer submits any cervical nerve impingement is degenerative. The insurer supports Dr Antoun's finding that the lumbar pathology is longstanding and degenerative.

[72]-[74] The insurer submits the claimant has a longstanding right ankle history dating back to 2006. The insurer relies on Dr Antoun's reports confirming the right ankle condition is not accident related. The insurer notes neither claimant medico-legal doctor assessed the right ankle injury.

[75]-[77] The insurer relies on the findings of Dr Antoun and Dr Mackinnon. Both confirmed no traumatic features attributable to the accident. The insurer submits Dr New failed to consider the claimant's pre-existing left shoulder pathology.

[78]-[79] The insurer notes Dr New found the right shoulder normal apart from "some discomfort". The insurer relies on Dr Keller's observation of significant deconditioning affecting physical capacity.

1. The Panel summarises the submissions of Ms Druma dated 10 January 2025 by reference to paragraph numbers:

[1]-[5] The claimant sets out the issue in dispute, being the assessment of WPI.

[6]-[7] The claimant submits that on 19 November 2022 she a front-seat passenger in a rear-end motor vehicle accident. She submits she suffered non-threshold injuries to the following locations, supported by PIC Medical Assessors' notes, treating GP, physiotherapist, radiology and specialist reports:

[8] The claimant submits she continues to suffer permanent disabilities including:

• Pain, discomfort and restricted movement;
• Inability/restriction/difficulty performing household chores;
• Inability/restriction/difficulty returning to the workforce;

• Inability/restriction/difficulty performing work duties;
• Difficulties with heavy lifting;
• Reduced and restricted social activities;
• Shock, headache, insomnia, fatigue and nausea;
• Difficulties standing or sitting for prolonged periods;
• Restrictions with repetitive reaching and sustained work above shoulder height;
• Sleep disturbance;
• Depression and loss of interest;
• Interference with activities of daily living;
• Headaches/nausea;
• Shock/anxiety/depression.

[9] The claimant submits all physical injuries above relate entirely to the accident.

[10]-[11] The claimant submits they had full work capacity before the accident and that the latest certificate of capacity confirms she still suffers from all listed injuries with ongoing pain and suffering.

[12]-[13] The claimant submits her physical WPI is greater than 10% and that she is recognised by QBE Insurance as suffering a not-a-threshold injury.

1. Medical Assessor Margaret Gibson examined Ms Druma on behalf of the Panel on

10 October 2025 at the Medical Assessor's rooms. Her findings are reproduced below:

1. Ms Druma said that she was involved in a motor vehicle accident in 1986 when she sustained a whiplash injury to her neck. She said that, apart from her left knee, her injuries had recovered fully, although she was unsure how long this had taken. Her left knee had hit the steering wheel and had never fully recovered, so remains symptomatic. The claim relating to this accident was settled in 1991.
2. She had had a few falls on uneven ground in their driveway at home. She had rolled her right ankle twice in 2017 and again in 2020.

1. Ms Druma said that she hadn't worked in any capacity since the subject accident.
2. Leading up to the subject accident, she had two jobs. She was working as a full-time hearing clinic coordinator. She had commenced work there in January 2022.
3. At the same time, she was running her own online business on a part-time basis from home in 'drop shipping' and she said she had been trying to build this up.
4. Prior to working at the hearing clinic, she had as a full-time data entry operator between 2017 and December 2021. She added that during the Covid epidemic she had cut down to 20 hours per week in the office. She said it was whilst working there and during the Covid epidemic that she started her drop shipping business. Between 2011 to 2017 she was working as a full-time call centre wellness consultant
5. Over the years prior to 2011, she had mainly been working in an administrative capacity with transport and warehousing companies. She said that in the early 1990s, she and her husband set up a vertical blind business. He was installing and she was cutting and sewing.

1. Ms Druma had been a front seat passenger in a Ford Territory (2013/14) which her husband was driving. They both had their seatbelts fastened. It was about 9.30am in the morning and they were heading to Castle Hill to renew his driving licence at the motor registry.
2. They had been travelling along the Stanhope Parkway and had reached the intersection with Sunnyholt Road. She said there was a sign to turn left with care, so they came to a stop waiting for the traffic to be clear. This was when she felt a bang. She said the other driver had stated he was only travelling at 20-30km/hr but she says it was more like 60-70km/hr.
3. When asked how she injured her left shoulder, she said this was due to the seat belt. She couldn't recall how she injured her right shoulder. However, she agreed that she may not have mentioned it early on, and this was because she was more concerned about her other injuries. She was unclear how she had injured her ankle, she said her neck and back injuries had come about due to the jolting of the impact.
4. She was restrained in the seat belt but noticed immediate lower lumbar pain. She said her husband was suffering with neck pain immediately as his head had been thrown back with the impact.
5. She said they both got out of the car and had taken photos and then exchanged details with the other driver.
6. No police or ambulance attended. Ms Druma said initially they hadn't thought their injuries were that significant. She said the damage to their vehicle was more severe than initially thought and the repairs had cost in the vicinity of $14,500.
7. On the day of the subject accident she had contacted her usual medical practice but they were too busy to see her. They had then driven to Blacktown Hospital, but it was too busy, so instead they visited Stanhope Park Medical Centre which was nearby. They were also busy and she was advised to return later. She was later contacted by the practice and she had a telehealth consultation with the doctor who advised that she should return for further review the following day. 1 January 2014 to 14 April 2023. There were no records on file from Stanhope Medical Centre referring to the subject accident.
8. She said she went home and started completing some paperwork online for the accident claim. She had then noticed pain in the left forearm extending from left elbow to left scaphoid region. Her left hand was puffy, her right ankle was swollen, so she rested for the remainder of the day.
9. The Personal Injury Claim Form was signed 22 November 2022, listing whiplash, swelling in left arm for a few hours. Then the next day pain was radiating down right arm plus right side of back. On the day of the accident had pain in lower back which has persisted.
10. The following day she visited a general practitioner and they referred her to Blacktown Hospital for imaging of her chest but no other regions.
11. By 28 November 2022, she started visiting Dr Danny Tang. She advised they had chosen his practice as he had managed her husband's workers' compensation claim.
12. Dr Danny Tang recorded 22 November 2022 as follows that she:

"was rear ended on 19 November 2022 went to Blacktown hospital on 20 November 2022 and had Chest X-ray. Chest X-ray was otherwise clear currently has pains in cervical spine 6/10 on the visual analogue scale and pains in her lower back of 5/10 on the visual analogue scale bilateral shoulder pains left shoulder 5/10 on the visual analogue scale and right shoulder and right ankle 10/10 on the visual analogue scale initial and now is 3/10 on the visual analogue scale bilateral knee pains 3/10 on the visual analogue scale low back pain 8/10 on the visual analogue scale."

1. She was referred to physiotherapy and acupuncture treatment at the Patrick St Medical Centre. She said this treatment had ceased in February of last year.
2. She had hydrotherapy for eight weeks. Following this she was visiting the pool herself for exercise.
3. She had a cervical spine and lumbar spine injection, two injections to the left shoulder and one injection to the right shoulder. She said these were all referred either by her general practitioner or the pain management service and performed at Rouse Hill Radiology.
4. She visited Dr Kanawati, spinal surgeon, 10 February 2023. She thinks she had only seen him once and no surgery was recommended. In his report he had concluded:

"At this stage I think Leticia should maximise all nonoperative measures. She is not an operative candidate at this stage. She should initiate some anti-inflammatory and analgesic medications. A series of corticosteroid injections may be of benefit including a left C5 selective nerve root injection as well as an L4/5 epidural steroid injection. I also want her to have an MRI of her shoulder to determine if she has any structural abnormality here which could be contributing to her discomfort. I will see Leticia after she has these investigations to determine the next most appropriate course of action which is most likely in the form of a course of physiotherapy."

1. She had visited an orthopaedic surgeon, Dr Viswanathan, on two occasions, initially on

10 April 2023, with the last appointment in 2024. She said he had told her that she had injury to her supraspinatus and infraspinatus tendons but he didn't feel surgery was indicated. 2. She attended Norwest Pain Management for an 8-week pain program. 3. Rehabilitation physician, Dr Baraa Kassim reported 27 October 2023 that:

"She reports that the pain is associated with neck movements from one side to another and it is constantly affecting her however she reports no neuropathic symptoms to the pain. She also has chronic lumbosacral spinal pain with somatic reference but no associated neuropathic features in her lower limbs and no bowel or bladder symptoms. She also describes quite significant left-sided shoulder pain and limited range of movements since the injury."

1. Ms Druma takes paracetamol or ibuprofen but rarely as she said she "puts up with the pain."
2. Ms Druma indicated central and paracentral neck pain, which is present most the time. She rated the severity as being currently 10/10. She finds it improves with rest, but she added that she "doesn't want to lay in bed."
3. There is pain across the low back which spreads to her left posterior thigh. There is some calf tightness bilaterally.
4. She said her right shoulder is constantly painful. The pain varies in intensity from 2-10/10 severity and is felt over right deltoid and right anterior shoulder. She said her left shoulder is painful constantly. She indicated the front of the shoulder, shoulder blade and lateral aspect of the shoulder.
5. There is pain over the medial aspect of the right ankle which spreads over the front of right shin as far as the knee.

1. Ms Druma lives with her husband and daughter and son-in-law in a single level house.
2. She said she avoids visiting the shops and when she does go, she would only purchase small items. She said her son-in-law does most of the shopping or else she orders online.
3. She would drive within a 20-minute radius of home. She said that apart from visits to doctors, she is at home all the time.
4. She said she doesn't hang washing on the line because it hurts too much. She said they are currently receiving cleaning assistance from the insurance company as her husband recently had surgery. She said the daughter and son-in-law clean their own bathroom. She and her husband clean the ensuite. She does the laundry, using a 9kg washer and a 10kg dryer. She makes beds with the assistance of her husband.
5. She became quite tearful when she mentioned that she can no longer attend her niece's wedding on the Central Coast because of her injuries. And she can no longer dance, whereas before she used to do character and tap.
6. She added that they have a house in Fiji but they can't go there much any longer because of her subject accident related injuries. However, they had visited last year as the daughter and sister-in-law were also going and they were able to help with the bags.

1. Ms Druma was 160cm tall. She weighed 86kg. She volunteered that she gained between 10 and 20kg since the accident.
2. When she initially came into the consultation room, she refused to sit down and it was some time before she felt her spine was comfortable enough to sit.
3. On examination of the neck, there was tenderness over the lower cervical spine and extending into the trapezius regions bilaterally, with recoiling to even light touch. Flexion and extension were to two-thirds normal, lateral flexion was to two-thirds normal bilaterally and rotation two-thirds normal bilaterally. There was no asymmetry, muscle spasm or guarding.
4. On examination of the upper limbs, circumferential measurements were consistent with right hand dominance, arms measuring 33cm bilaterally, 10cm proximal from the olecranon process. Right forearm measured 28cm and left forearm 27cm, both 10cm distal to the olecranon process.
5. Upper limb reflexes, power and sensation were normal bilaterally.
6. On examination of both shoulders:

1. There was recoiling to light palpation over the lateral aspect of the shoulders. When asked about consistency of shoulder movements, she said that she did not feel there was a very big difference. She said at the onset that she can only lift her left arm to 90° although greater range was then measured When advised that measured movements were different to the previous assessor, she said that may have related to how much rest she had prior to the appointment. It was noted that Medical Assessor Mitchell had also identified inconsistencies in measured shoulder movements. She was advised that the Panel would consider the implications of the variability in shoulder movements and so may not be able to use the measured readings for calculation of impairment.
2. On examination of the back, flexion and extension were to one third normal, lateral flexion was to three-quarters normal bilaterally, rotation was to three-quarters normal bilaterally. There was tenderness over the mid thoracic spine and lower lumbar spine. There was no asymmetry, muscle spasm or guarding with movements of either the thoracic or lumbar spine.
3. On examination of the lower limbs, circumferential measurements were equivalent, thighs measuring 45cm, 10cm from the upper pole of the patella and maximal calf girth was 38cm bilaterally.
4. Lower limb reflexes, power and sensation were normal and symmetrical. Ankle and foot movements were as follows and there was no swelling or crepitus:

1. Ms Druma brought no imaging studies with her for the assessment. The following were on file:
2. Left shoulder ultrasound performed 8 June 2017 showed biceps tendonitis, focal tenderness noted at the footprint insertion of the supraspinatus tendon. There was localised cortical irregularity noted in the greater tuberosity, subacromial bursitis present.
3. CT scan lumbosacral spine performed 6 December 2022 showed lumbar spondylosis with mild degenerative neural foraminal stenosis at bilateral L4/L5 and right L5/S1. There is contact of the left exiting L4 and the right exiting L5 nerve roots. No significant spinal canal stenosis. Multilevel facet joint arthrosis most marked at L5/S1.
4. MRI sacrum and coccyx performed 7 February 2023, no significant abnormality demonstrated.
5. MRI scan left shoulder performed 20 February 2023 showed moderate grade partial thickness intrasubstance tear mid supraspinatus tendon, tendinosis of the infraspinatus tendon and low-grade partial thickness insertional tear anteriorly, small SA/SD bursal effusion, anterior superior labral tear and small paralabral cyst formation measuring 3mm.
6. MRI scan cervical spine performed 2 February 2023 showed "No evidence of recent cervical spine injury. Moderate cervical spondylosis with multilevel neural foraminal stenosis as described. There is impingement of the left C5 and right C6 nerve roots. Mild spinal canal stenosis at C5-C6 and C6-C7. No evidence of myelopathic change."
7. SPECT CT performed 31 May 2023 showed mild facet joint arthritis at L5/S1 on the right, no significant degenerative change in the discovertebral junctions, normal appearance to the coccyx bone, bony trauma involving the right medial malleolus and presumed post-traumatic arthritis of the right subtalar joint.
8. MRI and x-ray right ankle performed 30 August 2023. There were no significant findings with preservation of joint spaces. No discrete tears.

1. Ms Druma is 61 years of age and right hand dominant. She was involved in the subject accident on 19 November 2022. There were early complaints of neck, low back, right ankle and bilateral shoulder symptoms. Dr Danny Tang had recorded complaints in all these regions on 22 November 2022.
2. The Panel concluded she had sustained soft tissue injuries to her neck, low back, right ankle and both shoulders.

1. 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 zero percent permanent WPI.

1. There were complaints of pain or symptoms, but without vertebral body compression or vertebral fracture. There were no clinical findings as detailed in Table 6.8, SIRA Motor Accident Guidelines. Therefore the lumbar spine injury would be assessed at DRE Impairment Category I, thus zero percent permanent WPI.

1. Shoulder movements were variably restricted when measured at assessment today and also when examined by the original assessor. Clause 6.50 of the MAA Impairment Guidelines states that "If there is inconsistency in range of motion then it should not be used as a valid parameter of impairment evaluation." And "If range of motion measurements at examination cannot be used as a valid parameter of impairment evaluation, the assessor should then use discretion in considering what weight to give other available evidence to determine if an impairment is present."
2. The Guidelines advise that the assessor use clinical judgement in determining an appropriate impairment rating.
3. Clause 6.24 of the MAA Guidelines does permit assessment to be completed by analogy. The subject accident-related shoulder impairment may be considered analogous to mild intermittent acromioclavicular joint crepitation. In reference to Table 18, acromioclavicular joint crepitation gives rise to 15% WPI. Then, in reference to Table 19 mild inconstant severity is 10% joint impairment. Thus 10% of 15% gives 1.5% WPI and rounding this to the next closest integer, gives 2% WPI.
4. It was the panel's opinion that there was 2% WPI for each shoulder.

1. Foot and ankle movements assessed with reference to Tables 42, 43, 44 [Chapter 3, AMA 4, p78] gave rise to 0% WPI. There were no diagnosis based estimates applicable [Chapter 3, AMA 4, Table 64, p85].

1. The Medical Review Panel revokes the certificate of Medical Assessor Robin Alexander Mitchell dated 30 April 2025 and substitutes the determination that as a result of the following injuries caused by the accident, the claimant sustained a total permanent whole person impairment of 4%:
   • Left Shoulder, and
   • Right Shoulder
2. The Medical Review Panel determined that the following injuries caused by the accident gave rise to a permanent whole person impairment of 0%:
   • Right Ankle;
   • Cervical Spine, and
   • Lumbar Spine