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

1. The medical Review Panel revokes the certificate of Medical Assessor Todd Gothelf dated

8 March 2025 and issues a new certificate that, the following injuries caused by the motor accident give rise to a permanent impairment of 5% and IS NOT GREATER THAN 10%: * lumbar spine.

1. Mark Felsch (the claimant) is a 62-year-old man who was injured in a motor vehicle accident on 16 April 2022. Following the accident the claimant lodged an application for personal injury benefits and, it having been determined that he had sustained a non-threshold injury, sought a concession from the insurer that the injuries caused by the motor vehicle accident left him with a greater than 10% whole person impairment (WPI).
2. After conducting an internal review, the insurer declined to make this concession and consequently the claimant lodged an application for assessment of degree of permanent impairment.
3. The claimant was examined by Medical Assessor Gothelf on 21 February 2025, who in a certificate dated 8 March 2025, determined that the injuries caused by the motor vehicle accident gave rise to a permanent impairment of 0%.
4. The claimant sought a review of this certificate and, in a decision dated 22 May 2025 President's delegate Stephanie Wigan, determined that there was a reasonable cause to suspect that the medical assessment was incorrect in a material respect. The matter was then referred to this medical review panel.
5. The Review Panel (the panel) has been constituted by the President of the Personal Injury Commission (Commission) to conduct the Review of Medical Assessor Gothelf's assessment dated 8 March 2025 (the Review).
6. Pursuant to cl 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'.
7. The panel convened on 21 July 2025 and determined that there were records which the Panel required prior to re-examining the claimant. Once these materials are before the Panel it was determined that both Medical Assessors would examine the claimant in respect to all injuries referred to in the application for assessment of WPI.
8. The panel issue directions to the parties to upload the clinical notes of the climate hospitalisation, the clinical notes of his treating physiotherapy together with the ambulance records relating to the claimant following the motor vehicle accident. These materials have now been uploaded and were considered by the panel.
9. 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 the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
10. The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Commission.
11. Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
12. Rules 127 to 130 of the 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 matter solely based on the written application.
13. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
14. The panel determined that it was appropriate that the claimant be re-examined by both Medical Assessor Margaret Gibson and Medical Assessor Christopher Oates.
15. The claimant was examined on 24 October 2025.

PRE-ACCIDENT MEDICAL HISTORY AND RELEVANT PERSONAL DETAILS

1. The claimant had injured both his knees when he fell at work in 2020. Following this injury he was off work for eight to nine weeks. He underwent surgical debridement and partial meniscectomy of both knees, performed by Dr Broe, the right knee in October and the left in November 2020. He had subsequently had corticosteroid injections on three occasions into both knees and PRP injections on four to five occasions, that latter with Dr Nathan Gibbs. He maintained that since then his knees have been fine with no pain or stiffness.
2. He had visited his general practitioner on 4 March 2022 complaining of a painful left knee. He said this had arisen following a scuffle with an inmate.
3. He said he had been otherwise in good health prior to the subject accident.

1. The claimant said he had worked as a full-time prison officer since 6 October 1989. He said he has returned to work midway through 2022, however, it was not until August of that year that he was on a normal roster and unrestricted duties. He said when he first returned to work he had been working in the intake area which was not as physically onerous as normal duties. However, his normal duties roster was in the general jail area.
2. He said he had to pass a two-yearly fitness qualification and this came up in October 2022. He said this had involved a range of activities, including use of weapons on a firing range and using batons. He was unsuccessful on three attempts. His employer attempted to medically retire him in late 2022. He appealed this decision. However, by late 2023, he was medically retired. He has not worked in any paid employment since.
3. He said he has since lived off his superannuation and income from various property investments. He said NRMA had been paying his wages since late 2022.

1. The claimant lives alone in a single-storey five bedroom, three bathroom house in Taree. He said he had driven down yesterday for the appointment, starting his drive at 7.00am and concluding at 7.00pm, having made about five stops on the way.
2. He said he does most of his own cleaning, but has a cleaner in on a fortnightly basis for the heavier jobs. He pays someone to do his yard and they visit on a fortnightly basis. He said that he had purchased a ride-on mower as the yard is 400m², however, he finds he can no longer operate this because of his subject accident related injuries.
3. He drives an automatic car and can tolerate generally up to 40 minutes of driving before his right leg becomes numb.
4. He does his own shopping but makes multiple trips and buys only small amounts of groceries. He said the nearest supermarket is about a kilometre from home. He added that he struggles manoeuvring a trolley on uneven ground because of his low back pain.
5. He said prior to the accident he used to regularly play tennis and swim three times a week. However, since the accident, he no longer plays tennis although he has recently got back to some swimming.

1. The claimant had been driving a Silverado with his seat belt fastened when another vehicle came from a cross street on the left and collided with the left corner of his car. It appears his car had then collided with a fence. He said both he and the other car were travelling at 100kmph. He said his air bags had deployed, approximately 16 in number.
2. His vehicle was towed and later written off.
3. He said he had developed significant swelling over his anterior chest wall due to the seat belt. He said the accident involved such force his phone became wedged into the side of the console. He said he had "hit my head somewhere." He still has a depressed scar over the left forehead, but there was no loss of consciousness. He said there was onset of right shoulder and low back discomfort within an hour of the accident.
4. He was asked about the Personal Injury Claim Form completed on 9 May 2022 which had not mentioned the low back. He said at that stage his ribs were the main issue. It was also noted that early after the accident he visited his general practitioner, however, his back injury was not mentioned until July 2022. He said that initially, although the physio realised that he had back pain, because of the severity of the chest pain and the rib and sternal fracture, he was unable to treat the back. He did however have some treatment of his right shoulder.
5. He was referred to orthopaedic surgeon, Dr Richard Matthews and he had visited him on two or three occasions. He said he was referred to surgeon, Dr Reddy regarding his back and was told he had disc bulges.
6. He was sent to Dr Champion, a pain physician, who advised nerve blocks and in fact he had one nerve block to his low back. He said his symptoms had improved, in particular the leg pain had stopped for six to seven weeks after the injections.
7. The claimant made reference to visiting an IME, Dr Stephen Rimmer, and was quite scathing about his interaction with this doctor and added that he (Mr Felsch) had recorded the conversation on his phone.
8. He said physiotherapy treatment was ceased in April/May 2023 by the insurer. He subsequently had fortnightly physiotherapy which he then paid for himself.
9. More recently he was visiting a physiotherapist in Yamba, Mr Simon Wording for about two to three weeks for treatment of his cervical, thoracic and lumbar spine. However, he has not visited him since he moved to Taree in September this year.
10. The claimant said he is to commence exercise physiology with a therapist, at the Mayo Private Hospital.
11. He continues to visit general practitioner Dr Tilmann Rust at the Eastgardens Medical Centre. He had last seen the doctor three months ago. He visits the doctor every three months for certification and generally comes down to Sydney by plane. He said he is concerned about changing doctors because he is worried this would be interpreted poorly by the insurer.

1. The claimant takes Mersyndol Forte tablets as required at night. He estimates he would have five tablets a week. He takes paracetamol as required.
2. He has been taking 40mg telmisartan for hypertension over the last four years.

There were no subsequent injuries or new medical problems.

1. The claimant said that his neck is stiff and "clicky" at times.
2. There are frequent spasms in the low back. These are felt in the midline and spread across the back. There is pain from the low back which spreads to right buttock, side of right thigh, side of right calf and whole right foot where there are pins and needles. He said pushing a shopping trolley or prolonged sitting or bending aggravates the discomfort and brings on the spasms. He said as a result he uses a long-handled device to access items from the ground.
3. There is "pinching" stiffness in the upper back and he stretches at times to relieve the spasm. He said this discomfort can be precipitated by activities such as sliding a door and then he develops sharp pain between his shoulder blades.
4. There is a constant right shoulder blade/trapezius discomfort which he described as being an "ache" or a "knot". He said when seated in the car with his arms at 90 degrees holding the steering wheel, his whole right upper limb becomes numb and painful. He said this symptom settles down if he shakes the arm. He added that he has had nerve conduction studies and was advised that he may have some carpal tunnel syndrome.

1. The claimant brought no imaging with him to the assessment.

1. Following his report of his injuries to his general practitioner, the claimant was referred to Clinical Physio Solutions where he received treatment from Mitchell Stamatellis. In a pictograph dated 20 May 2022 the notes highlighted the areas in which the claimant was complaining of pain. These included the left chest area, the left thigh area, the right knee and the left and central lumbar spinal area. The note on the pictogram states:

1. The panel is satisfied that this early contemporaneous report confirms a complaint of a lumbar spinal injury to a health practitioner, shortly after the subject accident occurred.

1. The claimant was 183cm tall. He weighed 102kg. He was right hand dominant.
2. There was tenderness over the right lateral ribs and xiphisternum without any visible deformity.
3. On examination of the neck, there was diffuse tenderness. Flexion and extension were to half normal. Lateral flexion was to half normal bilaterally. Rotation was to two thirds normal bilaterally. There was no asymmetry, muscle spasm or guarding. There were no reported NVRC's (non-verifiable radicular complaints).
4. On examination of the upper limbs, right arm circumference measured 33cm and left arm 32.5cm, 10cm from the olecranon process. Forearms measured equally at 26.5cm, both 10cm distal to the olecranon process.
5. There were normal upper limb reflexes and power. There was no radicular sensory loss over either upper limb.
6. On examination of the shoulders, active movements, repeated to check for consistency and measured with a goniometer, were as follows:

1. With shoulder movements, he reported upper scapular trapezial and scapular thoracic discomfort with movements of the right shoulder and left shoulder blade area lower thoracic region and rib cage pain on movements of the left shoulder. There was no neck discomfort reported with shoulder movements.
2. On examination of both elbows, both wrists and both hands there was a normal range of movement bilaterally, apart from there being fixed flexion deformity of the left little finger PIP joint.
3. On examination of the upper and lower back, there was tenderness L4/L5/S1 centrally and over right sacroiliac joint. There was no muscle guarding. Flexion was half normal. Extension was one third normal. Lateral flexion was to half normal bilaterally. Rotation was to one third normal bilaterally. Asymmetry was present.
4. On examination of the lower limbs there was reduced sensory appreciation in an S1 distribution over the left leg, calf and lateral aspect of the foot. Reflexes were normal and symmetrical. There was variable weakness of eversion of the right foot, not to a sustained degree on repetition. Straight leg raise on the left 70°, on the right 60°, with complaints of back pain. Neurotension signs were negative.
5. On examination of both knees, there was no instability or crepitus. Right knee flexion was to 130°, left knee flexion 140°. There was normal extension bilaterally.
6. Thighs measured 47cm on the right and 46.5cm on the left, both 10cm from the upper pole of patella, right calf maximal girth measured 39.5cm, and left calf 39cm.
7. There was no pelvic tenderness. There was some reported back pain on pelvic compression but no specific signs of any ongoing pelvic injury.
8. Following the re-examination by the Medical Assessors, the Panel reconvened and jointly made the following decisions.

1. The claimant is a 62-year-old right handed driver who was involved in a high speed accident on 16 April 2022 and sustained multiple injuries. The Panel Medical Assessors accepted the claimant's explanation for late recording of the right shoulder and lumbar spine conditions on the basis that the focus of attention was on the fractures and the pain arising there from prevented early treatment of these soft tissue injuries.
2. The right sternoclavicular joint injury and sternal and rib fractures were caused by the subject accident have resolved.
3. When asked about the listed right wrist fracture, he told the panel that he did not have a right wrist fracture in the subject accident but had fractured his right wrist (scaphoid and hamate bones) when skiing in 1994. The panel concluded this injury was not related to the subject accident.
4. When asked about the listed left-hand injury, he told the panel he had fractured left little finger many years ago, and this was unrelated to the accident. The panel concluded this injury was not related to the subject accident.
5. The panel concluded there had been a soft tissue injury to the pelvis, as there had been some bruising noted after the accident. However, there was no persisting pelvic symptoms and no objective findings on examination. The panel concluded the soft tissue injury to the pelvis had resolved.
6. When asked about the listed left knee injury, he told the panel that this was not injured in the subject accident. The panel concluded this injury was not related to the subject accident.
7. In relation to the right knee, he advised this had been swollen following the accident. However, his right knee symptoms had settled after a few months. The panel concluded the soft tissue injury to the right knee had resolved.
8. The panel concluded he had sustained a soft tissue injury to the right shoulder girdle, but not a discrete right shoulder joint injury and there was ongoing symptoms, referred from the adjacent thoracic spine and restriction of movements.
9. The panel concluded he had sustained a soft tissue injury to the cervical spine and there were ongoing symptoms and restriction of movements.
10. The panel concluded he had sustained a soft tissue injury to the thoracic spine and there were ongoing symptoms and restriction of movements.
11. The panel concluded he had sustained a soft tissue injury to the lumbar spine and there was ongoing symptoms and restriction of movements.

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 0% 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 6.7, MAA Guidelines. Thus in reference to MAA Guidelines the thoracic spine injury would be assessed at DRE Impairment Category I, thus 0% permanent WPI.

1. There were complaints of pain or symptoms, but without vertebral body compression or vertebral fracture. There were clinical findings of pain referral in the distribution of a specific nerve root i.e. non-verifiable radicular complaints, as detailed in Table 6.8, SIRA Motor Accident Guidelines. Therefore the lumbar spine injury would be assessed at DRE Impairment Category II, thus 5% permanent WPI.

1. Movements were measured. Total upper extremity impairment (UEI) (8%) was calculated with reference to Chapter 3, Fig 38, 41, 44, AMA 4.
2. However, there was also restriction of the uninjured left shoulder. Total UEI (8%) was calculated with reference to Chapter 3, Fig 38, 41, 44, AMA 4.
3. The Guidelines state at s 6.51 that,

"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."

"When using clause 6.51 (above), the medical assessor must subtract the total upper extremity impairment (UEI) for the uninjured joint from the total UEI for the injured joint. The resulting percentage UEI is then converted to WPI. Where more than one joint in the upper limb is injured and clause 6.51 is used, clause 6.51 must be applied to each joint."

1. Thus subtracting 8% - 8% gives 0% UEI, and with reference to Table 3, p 20, AMA 4, 0% WPI for the right shoulder.
2. The Nguyen decision did not apply, as the restriction in movements of the shoulders was not related to his cervical spine.

1. The panel determines that the claimant has suffered a 5% WPI arising from the injuries sustained in the subject accident.