austlii:nsw/NSWPIC/2025/568
General information, not legal advice.
NSWPIC
2025-10-22
Original judgment source is linked above.
Insurance Australia Limited t/as NRMA Insurance v CTH [2025] NSWPIC 568
MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; settlement approval; the claimant was injured; the claimant was not working at the time of the accident; the settlement complies with clause 7.37 of the Motor Accident Injuries Guidelines (version 9.3); - the settlement is approved in the amount of $325,000.00; consisting of non-economic loss and nil past economic loss and future economic loss.
(a) a C2 hangman's fracture;
(b) a C6 right foramen transversarium fracture, and
(c) a right 5th metatarsal midshaft fracture (A10).
Dr Thomas Oh (specialist trauma surgeon) and later examined in the neurosurgery outpatient clinic by Dr Daniel Scherman (see his report below). 2. The claimant's C2 hangman's fracture, was conservatively managed with an Aspen collar for three months (A10). 3. The claimant was discharged from WH on 22 November 2022.
Dr Daniel Scherman - neurosurgery registrar WH - 12 December 2022
(a) the claimant presented for review of her progress X-rays prior to her discharge;
(b) a comparison of her X-rays with discharge X-rays noted no significant changes;
(c) there was an unremarkable neurological examination within the limits of having her cam boot on her right leg;
(d) he was "happy" with the claimant's progress and neurologically she remained well;
(e) she did not describe any motor or sensory changes in the upper or lower limbs bilaterally, and
(f) she is to continue to wear her C - spine collar until a satisfactory CT scan is obtained.
CT - chest abdomen and pelvis - 12 November 2022
(a) no pneumothorax;
(b) no pneumomediastinum;
(c) no dissection of the thoracoabdominal aorta or its major branches;
(d) no plural fluid collection;
(e) no evidence of acute hepatic, splenic, pancreatic, renal, or hollow visceral traumatic injury;
(f) minor induration of the left lower anterior abdominal wall which may represent a mild contusive injury, correlation with superficial ecchymosis suggested;
(g) appearances of the dilated biliary tree is presumably post cholecystectomy patient, however the degree is still greater than would be expected, and
(h) incidental water density cyst in the right retroperitoneum does not have the sequelae of acute injury, it is probably an incidental lymphangioma or long-standing urinoma or post-surgical seroma.
CT - cervical spine and brain - 12 November 2022
(a) no evidence of acute intrathoracic or abdominopelvic injury;
(b) minor induration of the lower left anterior abdominal wall, which may represent a mild contusion injury, and
(c) incidental water density cystic lesion in the right retroperitoneum but does not have the appearance of a sequelae of acute injury. It is probably an incidental lymphangioma or less likely a long-standing urinoma or post-surgical seroma.
(a) a subsegmental atelectasis within the left base with elevation of the left hemidiaphragm;
(b) the lungs were otherwise clear;
(c) there is no pleural effusion or pneumothorax, and
(d) there is a thoracic scoliosis convex to the right.
(a) mild greater trochanteric bursitis with gluteal tendinopathy and thinning. No definite tears are shown, and
(b) there is a dystrophic calcification in the hamstring origin with tendinopathy, but it is asymptomatic. No tears (A15 - p 113).
(a) there was a moderate subacromial bursitis, and
(b) that the rotator cuff tendons are all intact with tendinopathy of biceps, supraspinatus and subscapularis, no tears (A15 - p 111).
X-ray left elbow and forearm and ultrasound left elbow - 15 May 2025
(a) there was no avulsion fracture from the radial tuberosity;
(b) there is intact radius and ulna;
(c) normal elbow joint, DRUJ and wrist joints, and
(d) the CMC joint of the thumb demonstrates moderate OA.
(a) ruptured distal biceps tendon with tendon retraction to the level of the myotendinous junction;
(b) further elbow MRI is suggested, and
(c) there is mild common extensor origin tendinopathy with no appreciable tear (A15).
"It was a pleasure to review [CTH] in rooms today. She unfortunately had a motor vehicle accident 10 weeks ago in which she sustained multiple injuries including C2 and C6 fractures currently being managed with a hard collar. She also suffered rib fractures and a skin tear to her right forearm. She is following up with me regarding her right foot, after she was diagnosed with a metatarsal fracture and placed in a camboot, which she weaned weeks ago under the guidance of physiotherapy. She was initially admitted to Westmead Hospital, and then to the Hills Private Hospital.
She reports that the pain in the foot has been gradually improving and has noticed her mobility while using a 4WW has also been improving.
Her background history includes gout, depression and bladder issues, but no major comorbidities.
On examination there is minimal swelling of her right foot. There is tenderness to palpate at the fracture site on the 5th metatarsal neck. She is neurovascularly intact.
X-rays obtained on 10 January demonstrate a 3 part fracture to the metatarsal neck with comminution. Although there is evidence of fracture healing the fracture is not completely united.
I have recommended that she continues with shoewear that is comfortable, including the use of an orthotic if she finds that easier to tolerate, or even the camboot. She will follow up with me in three months' time with an x-ray. Her physiotherapy should focus on gait retraining, calf stretching and ankle range of motion." (A13)
"I have reassured [CTH] regarding her progress. I have instructed her to remove her collar. I have instructed her that she can undertake gently physiotherapy with no restrictions. I have not made any further appointments to see her from a neurological perspective but she knows she can contact me if she runs into issues." (A14)
"I reviewed [CTH] in the Norwest clinic on 11 May 2023; she was accompanied by her daughter. [CTH] had a serious MVA approximately seven months ago. She sustained a C2 hangman's fracture and a C6 fracture which were managed for three months in a collar through the Westmead Public Neurosurgery department.
[CTH] presented today for a second opinion and management from ongoing neck pain and also hand pain and left leg and foot pain.
She describes pain that radiates from the occipital region across the back of her head over the top of her ear as well as neck stiffness. She has odd sensations and pain in the dorsal service of both her hands, particularly on the left hand side and left foot pain. The pain sometimes shoots down from her back and into her foot, but also she has independent left foot pain. I am uncertain of the aetiology.
Physical Examination: [CTH] walked quite stiffly. She had some movement in her cervical spine but was quite restricted by stiffness rather than acute pain. She had midline tenderness approximately at C6 and I also noted that her trapezius muscles were quite swollen and stiff and in spasm. She had a normal neurological exam with a Grade 5 out of 5 power in her arms and legs. There was no evidence of myelopathy when her reflexes were tested.
I am uncertain if this pain in her hands and her left foot originating from her spine. She does have a history of having had thoracic and lumbar back pain. I requested an MRI of her cervical spine and MRI of her lumbar spine and a CT of her cervical spine. I was unable to access any of the imaging from Westmead Public Hospital and they declined to send the imaging to me. [CTH]'s daughter will go and pick up her original imaging, which they will burn onto a CD. I will review [CTH] again in 2 weeks' time." (A17)
"I reviewed [CTH] today with her daughter. This consultation also included her rehabilitation expert. Miss Emily Jones. Emily was included via a telephone link.
[CTH] is still experiencing quite significant stiffness. She has pain in her shoulders but no clear radiculopathy. She has been particularly sore because when she had the MRI, she was required to lie on her back with her head supported in a cradle, and this forced extension caused significant pain.
I reviewed the imaging and report for her CT cervical spine and MRI. Her CT cervical spine shows a near complete healing of the hangman's fracture. There is no cord compression; there is some foraminal narrowing and degenerative changes, but no cord compression or any pathology requiring urgent surgery.
[CTH] has been suffering from bilateral hand and foot pain as well as numbness. She has left shin pain. I reviewed her MRI lumbar report, and I will review her imaging when I retrieve it. There is no severe canal stenosis. There is a significant amount of degenerative changes; however, nothing that would cause bilateral foot pain or bilateral paraesthesia. I did note that there was an incidental cyst associated with her right kidney.
Again I iterated with [CTH] that, given her age, these injuries can take some time to improve.
Most of the issues revolve around neck stiffness and upper body shoulder pain, and subscapular pain.
I think this will improve over time with physiotherapy at least once a week and a home exercise program. She has significant issues laying flat in her bed, even supported by pillows, and she may benefit from an ergonomic review of her bed mattress and bedroom in regards to if there is any options for an adjustable mattress.
I would suggest that she have an occupational therapist review in 3 months for assessment for driving. At this point of time, I do not think she is safe as she is so stiff in the neck she may not be able to check blind spots. Increasing her movement in her neck should now be a primary goal, as well as gait retraining; she walks quite stiffly with a slightly widened gait.
I will review [CTH] in 3 months. I suggest that she should probably have a review for that right kidney cyst, and also, in the future, she has not completed a DEXA scan to check for osteoporosis." (A 17 - p - 120 - 121)
"I reviewed [CTH] with her daughter and also Emily from rehab. [CTH] is slowly improving and has increased range of motion in her cervical spine. She has occasional headaches, and I note that you completed an MRI brain which is clear. She is now slowly building up confidence in her walking.
I think from the perspective of returning to drive, she has a significant increase in her range of motion of her cervical spine, and I think this would be a good time for her to have a review of her driver's licence with an occupational therapist. My understanding is this is been arranged by the rehabilitation service and will occur over the next few weeks. I think she should increase her walking; she has a carer who comes twice a week, and it would be good for her to walk with her carer. I would aim to do about 400 m per walk 2-3 times per week.
She is very anxious about a new bed which has been ordered which is electronic. Emily will kindly guide [CTH] on how to use a bed safely.
Otherwise, I think by December, [CTH] should actually be able to be looking after herself very well and walking confidently. I suspect she will always have some mild neck pain, and I think that her extension of the cervical spine may be limited. At this stage, I suggest around October for her to start linking into aged care assistance if she requires it. At this stage, I have not organised any follow-up, but I am happy to see [CTH] at any time. She does not require any further progress imaging of her cervical spine." (A 17- pp 112 - 123)
Dr Peter Lam (orthopaedic foot and ankle surgeon)
"Thank you for asking me to review [CTH] who was a driver involved in a motor vehicle accident when she was hit by another car on 12th November 2020. This resulted in a neck injury and a displaced fracture of the distal 5th metatarsal. She was treated in a boot for almost 3 months, followed by physiotherapy**. X-ray of the right foot on 2nd March 2023 showed the fracture has healed.**
[CTH]'s rehab provider/Emily sat-in on the consultation via the telephone.
Examination of the left foot today reveals no foot swelling or tenderness. There is a good range of pain free 5th MP joint motion.
I have advised [CTH] that the 5th metatarsal fracture has healed well. The displacement is quite common with this type of fracture and it should not cause any long term functional problems. I am happy for [CTH] to continue with physiotherapy. She may gradually increase her walking as comfort allows. I would not expect any restrictions from her right foot 5th metatarsal fracture point of view. I have not made any arrangements for [CTH] to return for review but would be happy to see her again if required. Thank you again for asking me to review [CTH]." (A 16)
Pain in neck and shoulders - has had ultrasound guided cortisone injection in her left hip and left shoulder, to some effects;
Received ongoing physiotherapy support and treatment;
Reduced lifting capacity - limited to about 3-3.5kg of weight;
At home, her clothes line had to be lowered as she is unable to stretch high;
Mentally, remains anxious when driving - avoid driving far;
She states she has only driven three thousand kilometres in 18 months;
She remains anxious more than prior to the accident ..." (A 21)
Dr Frank Marchart - scheduled consultation - orthopaedic surgeon - 8 October 2025
Driving Assessment report - Ms Shulz occupational therapist - dated 5 October 2023
"The results of the on and off-road assessment indicates that [CTH]'s condition does not have an impact on her ability to drive to RMS standards. She has been recommended to remain on her full Class C driver's license with nil license changes recommended. No further OT driving reassessment is required.
Reassessment is to only occur if recommended by her treating doctor and/or specialists if there are any changes to [CTH]'s presentation/function. In summary the following is recommended:
• [CTH] to remain on her C Class licence with nil condition changes recommended.
• Nil further reassessment required. Future reassessment is only to occur if recommended by her treating doctor and/or specialist due to changes in her medical condition or presentation." (A18)
Rehabilitation report - Cailin Anning - Concentric Rehabilitation Centre - 23 February 2024
(a) a general assessment;
(b) communication, and
(c) "OMA tasks."
(a) word finding difficulty;
(b) reduced memory onset;
(c) difficulty remaining on task, and
(d) verbally tangential and taking more time.
Speech pathologist's report dated 6 January 2025 - Natalie James
"[CTH] presented with a new onset of slowly progressive difficulties with higher-level receptive and expressive language. [CTH] reports this coincides with memory difficulties. During the assessment [CTH] appeared distressed and concerned about the deterioration in her language and cognition."
(a) she had been diagnosed with double vision since the accident and had been prescribed new glasses;
(b) she had "difficulty explaining things, my brain is not working";
(c) she is taking a lot of pain killers for her continuing leg and neck pain;
(d) she has recently had cortisone injections for her right hip pain, that is continuing;
(e) her mobility remains challenging;
(f) she has ongoing pain in her neck and leg when standing and walking, and
(g) she can't sleep due to the pain in her right leg.
"3.40 Effect of recovery of damages on statutory benefits
(1) If a person ('the claimant') recovers damages in respect of the death of or injury to a person caused by the fault of the owner or driver of a motor vehicle in the use or operation of the vehicle then (except to the extent that subsection (2) or (3) covers the case)
(b) the amount of any statutory benefits already paid under Division 3.3 in respect of the injury concerned is to be deducted from the damages (awarded or otherwise paid as a lump sum) and is to be paid to the person who paid the statutory benefits."
"6.23 Restrictions on settlement of claim for damages
(a) the claimant is represented in respect of the claim by an Australian legal practitioner, or
(b) the proposed settlement is approved by the Commission.
(3) The Commission is not to approve the settlement of a claim unless satisfied that the settlement complies with any applicable requirements of or made under this Act or the Motor Accident Guidelines."
(1) If a claimant, who is not represented by an Australian legal practitioner, and an insurer have agreed to a proposed damages settlement, the insurer must lodge an application for approval of a damages settlement under section 6.23 of the MAI Act, on behalf of both the claimant and the insurer, within 7 days of reaching the agreement.
"Under section 6.23(3) of the Act, before the Personal Injury Commission may approve the settlement of a claim for damages, it must be satisfied that:
(a) the proposed settlement satisfies the timing requirements in section 6.23(1) of the Act [since repealed];
(b) the proposed settlement is just, fair and reasonable and within the range of likely potential damages assessments for the claim were the matter to be assessed by the Commission, taking into account the nature and extent of the claim and the injuries, disabilities, impairments and losses sustained by the claimant, and taking into account any proposed reductions or deductions in the proposed settlement;
(c) the claimant understands that they are entitled to be represented in respect of the claim by an Australian legal practitioner, and
(d) the claimant understands the nature and effect of the proposed settlement and is willing to accept the proposed settlement."
(a) a deed of release;
(b) the amount of the proposed damages settlement, including a breakdown of the amount allowed for each head of damage and how each amount allowed has been calculated;
(c) the amount of any reductions in the proposed damages settlement including for contributory negligence or any other reduction, including brief reasons for that reduction and how any reductions have been calculated;
(d) the amount of any advance payments that the insurer has made in advance of the settlement and the dates of those advance payments, including brief reasons explaining why those advanced payments were made, and
(e) the evidence, documents and materials relevant to an assessment of the damages settlement including liability notices.
(a) of the amount of the proposed settlement and a breakdown of the amount allowed for each head of damage (A 6), and
(b) an executed settlement deed dated 25 July 2025, which identifies the total amount provided for the settlement and deductions sought to be made from the settlement (A 8).
(a) she is now residing in an aged care facility, which prevents her from making the trip to her late husband's grave on a regular basis;
(b) she has double vision, a recent development, but following the accident, in which she hit her head, she believes this arises because of the accident;
(c) she has difficulties remembering things, which she did not experience before the accident;
(d) she is taking a lot of painkillers for pain relief for her continuing leg and neck pain;
(e) mobility remains challenging for her;
(f) she has recently had cortisone injections for her right hip pain, that is continuing, and
(g) she is unable to sleep well due to the pain in her right leg.
(a) the amount of the settlement is just, fair and reasonable (appropriateness), and
(b) the claimant understands the settlement and its terms and the effect of the settlement in ending her claim for damages (the claimant's understanding).
"It is a relationship of the award to the injury and its consequences ... which is to be proportionate ... It is not a matter to be resolved by reference to some norm or standard supposedly to be derived from a consideration of amounts awarded in a number of other specific cases ... The principle to be followed ... is that the amount of damages must be fair and reasonable compensation for the injuries received and disabilities caused. It is to be proportionate to the situation of the claimant ... and not to the situation of other parties in other actions, even if some similarity between their situations may be supposed to be seen. The judgment of a Court awarding damages is not to be overborne by what other minds have judged right and proper for other situations. It may be granted that a judge who is making such assessment will be aware of and give weight to current general ideas of fairness and moderation. But this general awareness is quite a different thing ...The awareness must be a product of general experience and not formed ad hoc by a process of considering particular cases and endeavouring ... to allow for differences between the circumstances of other cases and the circumstances of the case in hand." [Planet Fisheries Pty Ltd v La Rosa (1968) 119 CLR 118 per Barwick CJ, Kitto and Menzies JJ at paragraph 11].
Insurance Australia Limited t/as NRMA Insurance
CTH [2025] NSWPIC 568;
(1968) 119 CLR 118