Factual background
5In June 2011, the respondent Ms Kourouche commenced an action in the District Court against the appellant Ms Frost, whose vehicle was insured by Insurance Australia Ltd trading as NRMA Insurance (NRMA). Ms Frost admits by her defence that, while driving that vehicle, she collided with Ms Kourouche, a pedestrian, and that the collision was caused by Ms Frost's negligence. Ms Kourouche claims damages for economic loss and non-economic loss; Ms Frost does not admit that any of the claimed damages were caused by the collision.
6The action was able to be commenced because Ms Kourouche's claim was certified as being exempt from assessment: see ss 92 and 108 of the Act and Emad Trolley Pty Ltd v Shigar [2003] NSWCA 231; 57 NSWLR 636. However, s 131 of the Act forbids a court from awarding damages for non-economic loss 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%. Section 131 reflects the "acknowledgement" in s 5(2)(b) of "the clear legislative intention to restrict the level of non-economic loss compensation in cases of minor injuries"; "minor injuries" are effectively identified by the 10% requirement and the restriction in such cases is complete. Ms Kourouche and Ms Frost and her insurer NRMA have been in dispute as to whether s 131 applies.
7The Act envisages that disputes of that kind are to be determined by medical assessment, rather than the ordinary processes of a court. An assessor's certificate dated 15 November 2011 certifies that Ms Kourouche's physical injuries amounted to 0% whole person impairment. There has been no challenge to that certificate.
8Ms Kourouche also claimed that she suffered psychological injury from the collision, which Assessor Prior of the Medical Assessment Service of the Motor Accidents Authority (Authority) assessed as amounting to 25% whole person impairment, by certificate dated 5 April 2012. His methodology included that Ms Kourouche has "Class 3 (11-30%)" permanent impairment for each of the categories "social and recreational activities" and "social functioning". Assessor Prior had before him reports from nine psychiatrists, one psychologist and her treating GP, and personally examined her on 5 April.
9NRMA claimed that Assessor Prior failed to have regard to all of the material before him. Section 63(1) permitted NRMA to apply to the proper officer of the Authority to refer an assessment to a review panel. Although styled a "review", in truth the panel is determining afresh the medical assessment matters referred to it. That is confirmed by s 63(3A) which provides that the review is not limited to that aspect of the assessment alleged to be incorrect, and is to be "by way of a new assessment" of all the matters.
10However, only if the proper officer was satisfied "that there is reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application" would the referral take place: s 63(3). The proper officer's decision here (and elsewhere in Part 3.4 of the Act) constitutes a "gateway" or condition precedent to the carrying out of further medical assessment, and is reviewable: Meeuwissen v Boden [2010] NSWCA 253; 78 NSWLR 143 at [23]; QBE Insurance (Australia) Ltd v Miller [2013] NSWCA 442 at [5]-[6].
11NRMA applied for a review of the assessment of psychological injury in June 2012. A copy was received by Ms Kourouche's solicitor on 14 June 2012. NRMA's application pointed to evidence from Ms Kourouche's Facebook and Twitter accounts to the effect that she had taken a holiday in April 2011, had attended a public forum in May 2011, and had a "great night with friends" in May 2011. NRMA's submission also referred to statements that she had presented a paper for International Women's Day in 2010 and had joined the Ruby Connection in March 2011. These were matters which, NRMA said, contradicted Ms Kourouche's statements to Assessor Prior and seemingly relied on by him that "she has done no public speaking", "denies speaking at conferences", "has no social activities with friends or relatives" and "is not involved in voluntary groups or community activities". NRMA submitted that although Assessor Prior had found "Class 3 (11-30%)" impairment in the "social and recreational activities" category, "the more appropriate class would have been class 1, no deficit".
12Similarly, NRMA submitted that the same material "strongly contradicts the plaintiff's evidence and when considered, Assessor Prior ought to have assessed the claimant in class 1, no deficit" in the "social functioning assessment" category. Once again, Assessor Prior had recorded and (apparently uncritically) relied on statements that "she has lost all contact with previous friends and acquaintances" and that she was "totally isolated now" to conclude Ms Kourouche had suffered "Class 3 (11-30%)" impairment in relation to his assessment of this category.
13NRMA's application made further submissions complaining of Assessor Prior's uncritical acceptance of Ms Kourouche's history in light of her statements on social media. It is not necessary to summarise them for the purposes of this appeal. NRMA's submission concluded as follows:
"The insurer submits that Assessor Prior's failure to consider the evidence before him, namely Dr Sydney-Smith, Twitter pages and Facebook pages suggesting a greater functioning than that disclosed by the plaintiff through the MAS examination would have resulted in reducing the assessment of whole person impairment to 7%, having found a median class of 2 and an aggregate score of 13.
In these circumstances, the insurer submits the correction of these errors are capable of altering the outcome of the assessment as the whole person impairment assessment is capable of being less than 10%."
14The Authority's Medical Assessment Guidelines (as to which see further below) provide for a party to reply in writing to an application for a review of an assessment. Ms Kourouche's reply was not tendered in the court below. When the appeal was heard, the Court was told, without objection, that Ms Kourouche's lawyers had supplied a reply. That statement from the Bar table is consistent with the reasons of the review panel recording that it had before it Ms Kourouche's "reply form and attached documents".
15I would infer, in light of the terms of NRMA's application as summarised above, that Ms Kourouche and her lawyers were aware that NRMA was contending that (a) her history as given to Assessor Prior was inconsistent with her social media postings, (b) the latter were to be preferred, and (c) NRMA sought a replacement assessment of whole person impairment of less than 10%, which would, if it issued, prevent the District Court from awarding her any damages for non-economic loss. To anticipate the language of the authorities referred to below, those were all matters "obviously open on the known material".
16The proper officer formed the state of satisfaction required by s 63(3) and referred NRMA's application to a panel of three assessors. No challenge has been made to that decision. Assessors Newlyn, Rose and Virgona reviewed the documentary material before them and determined that it was necessary for them to re-examine Ms Kourouche. The examination occurred on 26 September 2012. When she was notified of the examination by the three assessors, it must have been plain to Ms Kourouche and her lawyers that the review panel had formed the view that they could not carry out their function on the papers. It must also have been plain that one purpose of the re-examination was to test the veracity of Ms Kourouche's history.
17The review panel's certificate, dated 4 October 2012, records the history that Ms Kourouche gave to the panel, and the questions she was asked. By way of example, the certificate records:
"When it was put to her that the [Twitter and Facebook] accounts indicate that she had read books, attended events, had gone out with friends and had gone away, she denied all of it, stating that she was 'delusional, making it up, I'm out of body, the voices were so relentless'. She stated that the insurance company caused her 'so much trauma, caused the voices telling me to kill myself, it was relentless.'"
18No part of Ms Kourouche's complaint was that the panel failed to confront her with the material which might be used to draw an adverse inference, and so it is not necessary to provide any further examples of the way in which that process (so far as it is disclosed by the panel's reasons) took place.
19The concluding section of the panel's reasons included the following passages:
"C. Panel Deliberations
The claimant was in a minor traffic accident. It has been determined that she suffered minor injuries and she had a 0% WPI as a result of the physical injuries. Despite this she has ongoing complaints of pain and disability associated with it. Her descriptions of her pain and the impacts on her body are exaggerated and bizarre.
The Panel's major difficulty with this case was the claimant's unreliability as a historian. The Panel was at pains to put the inconsistencies to her, she would often react with anger or outrage to this and her subsequent explanations shed little light on matters, as follows:
...
Regarding the Twitter/Facebook entries: Her explanation for the Twitter and Facebook entries, as being 'made up', was not considered credible by the Panel. There is also ample evidence, provided by her treating psychiatrist and others, that she has reported performing a range of activities in the time since the accident, including socializing, going out with friends, travelling interstate, giving a paper at a conference.
...
Regarding her ongoing psychological symptoms: the description of these is exaggerated and bizarre, and symptoms are dramatically embellished, if not fabricated, for example, feeling cars on top of her, adopting the persona of the driver and 'killing souls', seeing ancestors, hearing voices when driving, etc. The symptom profile was not consistent with any recognized psychiatric disorder.
...
In conclusion, the three panellists agreed that the claimant's presentation was characterized by gross exaggeration if not fabrication, to the point where much of the history and presentation is in question. The Panel has found it impossible to determine, with any degree of confidence, the presence of a specific psychiatric disorder as a result of the accident. It appears that she suffered soft tissue injuries that have resolved, that she has developed a Chronic Pain Disorder and that, if she had a psychiatric reaction as a result of the accident, it was probably mild and comprised mixed anxiety and depressive symptoms. It is compelling that her treating psychiatrist noted that, in 2010, she 'only becomes upset and agitated when she talks about the accident. If she "pushes it away" she can function normally for a time'. Although there may be persisting mild anxiety and depressive symptoms, associated with her chronic pain disorder, her history is so unreliable that an accurate diagnosis cannot be made. Similarly, an accurate assessment of WPI is impossible due to the distortions.
In summary, the Panel found that there is no diagnosis attributable to the subject motor accident, therefore an assessment of whole person impairment is not indicated.
4. Panel Decision
The Review Panel found that the accident WAS a cause of the following claimed psychiatric injuries:
· Nil psychiatric disorder related to the motor accident."
20The review panel accordingly revoked Assessor Prior's certificate and replaced it with a certificate of nil psychiatric disorder related to the motor accident.