Issued under Part 3.4 of the Motor Accidents Compensation Act 1999

1. confirms the certificate issued by Medical Assessor Bodel dated 25 July 2024, and
2. confirms that that the lumbar spine surgery performed by Dr Wong on 27 September 2021 and 22 April 2022 was reasonable and necessary in the circumstances and related to the injury caused by the motor accident on 17 September 2016 in accordance with s 58(1)(a) and (b) of the Motor Accidents Compensation Act 1999.

A statement setting out the Panel's reasons for the assessment is included with this certificate.

1. Steven Haklane was involved in a motor accident on 17 September 2016.
2. The claimant says he injured his neck, back and hand in the accident and made a claim for damages against NRMA, the third-party insurer of the vehicle that he says caused his accident. Two medical disputes have arisen in connection with this dispute.

1. On 8 December 2023 the insurer referred to the Personal Injury Commission (the Commission) a dispute about whether the claimant's lumbar spine surgeries, performed by Dr Wong in 2021 and 2022 were related to the injuries sustained in the accident and whether the surgeries were reasonable and necessary in the circumstances.
2. On 25 July 2024 Medical Assessor Bodel determined that the surgeries were related to Mr Haklane's accident caused injuries and were reasonable and necessary in the circumstances. On 26 August 2024 the insurer sought a review of that assessment.
3. On 14 October 2024, a delegate of the President determined there was reasonable cause to suspect a material error in the assessment and allowed the Review and on 2 December 2024 the President's delegate convened the current Panel to conduct the Review.

1. A medical dispute about the Mr Haklane's whole person impairment (WPI) arose in connection with his damages claim and, after an original assessment and a further assessment by Medical Assessor Truskett, the claimant was assessed as having a

15% WPI. 2. An application for review was lodged in respect of that assessment and that Panel's decision was then the subject of judicial review proceedings. On 26 May 2025 the Supreme Court ordered that the Review Panel's decision be set aside and that the dispute about WPI be remitted to the Commission to be determined by a differently constituted Panel. 3. On or about 4 June 2025 a delegate of the President convened the current Panel to conduct the Review and determine the WPI dispute.

1. The Panel determined on 9 July 2025 that it would hear and determine both Reviews together.
2. These reasons are the Panel's reasons in respect of the treatment dispute.

1. Mr Haklane's claim, and his entitlements to compensation are governed by the provisions of the Motor Accident Compensation Act 1999 (the MAC Act).
2. The MAC Act provided a scheme for the compulsory registration of motor vehicles in this state by licensed insurers up to and including 30 November 2017. The Act also provides a scheme for some limited defined benefits and lump sum compensation for person's injured in motor accidents which occurred on or before 1 December 2017.
3. Compensatory damages under the MAC Act are awarded for economic as well as

non-economic losses resulting from the injuries, disabilities and impairments caused by the motor accident.

1. Damages for economic losses are determined in accordance with common law principles and include damages for past and future treatment and care needs. There are restrictions and limitations in the Act on damages for economic losses. For example, under s 125, past and future loss of earnings are capped[1] and under s 141B damages for gratuitous domestic assistance are limited.
2. During the life of a claim, certain duties are imposed on the insurer with regards to the recovery and rehabilitation of the injured person as follows:

(a) once liability has been admitted under s 83(1), in whole or in part, the insurer has a duty to make payments for treatment, rehabilitation and care expenses "as incurred". The insurer's duty extends to payments that are reasonable and necessary in the circumstances, are properly verified and relate to the injury caused by the accident, and

(b) section 84 imposes a duty on an insurer to do all things reasonable and necessary for the rehabilitation of an injured person.

1. Any payments made by insurers pursuant to s 83(1) before judgment is obtained by the claimant are a defence to proceedings and can be deducted from the claimant's award of damages.
2. The Panel understands the claimant asked the insurer to pay for his surgery and the insurer declined. The claimant had the surgery as a private patient and has paid for it himself. Whether the claimant must repay his private insurer or whether there are expenses not covered by the insurer is not a matter for the Panel to consider although clearly the Panel's decision in the current proceedings will affect both the claimant's entitlements to damages for the treatment.

1. Section 58(1) of the MAC Act (in Part 3.3 of Chapter 3) provides for the resolution of the following "medical assessment matters" that may arise during the life of a claim:

"(a) whether the treatment provided or to be provided to the injured person was or is reasonable and necessary in the circumstances,

(b) whether any such treatment relates to the injury caused by the motor accident,

(c) (Repealed)

(d) whether the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%.

(e) (Repealed)"

1. Part 3.4 of the MAC Act provides for medical assessments including provisions relevant to an original medical assessment, further medical assessments and the review of medical assessments by this Review Panel[2].
2. Applications for review of a medical assessment under s 63 of the MAC Act are made to the President of the Commission on grounds that the assessment "was incorrect in a material respect" (sub-s (1)).
3. If the President, or his delegate is satisfied "there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect" then the President arranges to the application to be referred to a review panel consisting of a member of the Commission and two medical assessors (sub-ss (2) and (2B).
4. The review is not necessarily confined to the issues raised in the application but is "a new assessment of all the matters with which the medical assessment is concerned" (sub-s 3A).
5. Rule 128 of the Personal Injury Commission Rules (the Rules) 2021 permits the Panel to determine its own proceedings and the Panel is not bound by the rules of evidence and may inquire into relevant matters as it thinks fit.

1. Medical Assessor Bodel examined the claimant on 13 June 2024 and issued his certificate on 25 July 2024.
2. The Medical Assessor confirms at [2][3] that he was asked to assess the following treatment:

(a) a posterior lumbar interbody fusion at L4/S1 performed on 27 September 2021 performed by Dr Wong, and

(b) a laminectomy and posterior lumbar interbody fusion performed on 22 April 2022 also by Dr Wong.

1. Medical Assessor Bodel also confirms at [2] that the dispute concerned:

(a) whether the surgeries were related to the injuries caused by the accident, and

(b) whether the surgeries were reasonable and necessary in the circumstances.

1. After summarising the insurer's submissions at [3] and the claimant's submissions at [4], Medical Assessor Bodel records at [8] the claimant's history:

(a) he was born overseas and came to Australia at an early age. English is his first language, and he studied and TAFE in Electrical Engineering and IT Management;

(b) he worked as a business process analyst at the time of the accident;

(c) he had a medical history of deep vein thrombosis and iron infusions;

(d) in 2001 he had a car accident after which he developed back pain and left leg pain which he said had settled;

(e) there were multiple flare-ups of back pain after that accident, in 2011, 2014 and 2015 but that the claimant was "relatively asymptomatic at the time of the accident" in September 2016, and

(f) these flare ups occurred after dancing at a wedding, due to overwork at the gym and during renovations at home and all of these flare ups settled without surgical intervention.

1. The claimant said that he was driving his 2015 model Mercedes Benz wearing a seatbelt. It was dark but there was some daylight, it was fine and the road was dry. A car came out of a side street to the left, hitting the "A" pillar at the level of the windscreen. The car was not driveable and was towed away and then written off. Medical Assessor Bodel has a history of the claimant being "thrown around quite violently" and that he was taken to hospital and ambulance attended.
2. Medical Assessor Bodel records:

(a) the claimant felt immediate onset of neck and back pain;

(b) he had pain in his left hand and thumb due to an undisplaced fracture of the thumb;

(c) he had referred pain down the left leg, saw his GP and was referred to Dr Parkinson. The claimant was referred to Dr Yu a pain medicine physician;

(d) the claimant had scans which the insurer says show no difference from those undertaken earlier, and

(e) the claimant had physiotherapy, medication and eight weeks off work.

1. The claimant complained to Dr Bodel of a constant dull ache across the lower part of his back with referred pain into the legs but the right worse than the left. The clamant reported sharp stabbing pain in the ankle to the fourth and fifth right toes and numbness in the left leg.
2. Medical Assessor Bodel records the claimant' medication and notes the surgery was done and the claimant has improved since that surgery.
3. Medical Assessor Bodel examined the claimant and noted the scarring. The claimant had backache and evidence of L5 radiculopathy with weakness in the right great toe, diminished medial hamstring reflex and wasting of the calf.
4. Medical Assessor Bodel noted there were no reports from the treating surgeon Dr Wong, but he did have the operation report which referred to a grade 2 spondylolisthesis with worsening bilateral L5 radiculopathy. Dr Bodel noted there was no further accident or injury after the car accident and the surgery therefore was "reasonably necessary and causally related."
5. Dr Bodel confirms he did not have the radiological investigations (images) and was relying on the reports.
6. At [20] he expressed the view that the motor accident led to the progression of his pathology and the need for surgery.

Insurer's submissions - treatment dispute[4]

1. The insurer notes at [6] Medical Assessor Bodel's reasoning for causation was a deterioration of symptoms (and a grade 2 spondylolisthesis) and the absence of any other accident or injury since the current motor accident.
2. The insurer says at [8] there is doubt that the claimant has a grade 2 spondylolisthesis and at [11] that the Medical Assessor did not refer to the evidence of Dr Wong (which does not mention grade 2) or the MRI reports.
3. The insurer submits at [13] that the Medical Assessor asked himself the wrong question and did not consider "whether the [increased] pathology and symptoms were caused by the accident." The insurer says there is no change in the pathology from 2007 to 2014 to 2017 and no change in symptoms after the accident and before September 2021.
4. The insurer also submits that Medical Assessor Bodel has "reversed the onus of proof" by determining the issue of causation on the basis that there was no intervening event or accident to say that the change in pathology and symptoms must have been caused by the accident.
5. The insurer says that Medical Assessor Bodel did not have "proper regard" to various qualified reports and did not engage with a substantially articulated argument as contained in the submissions.

1. The claimant submits that he paid for both his surgeries out of his own pocket as the insurer had denied liability for them.
2. The claimant says Medical Assessor Bodel was aware of the test of causation noting his reference to clauses 6.6 and 6.7 of the Motor Accident Guidelines as well as the decision of Justice Wright in Briggs v IAG Limited.
3. The claimant submits that the test of causation is that the accident must be "a contributing cause which is more than negligible."
4. The claimant submits that in addition to the grading of the spondylolisthesis and the absence of any additional incidents or accidents, Medical Assessor Bodel has considered the pre-accident symptoms, the violent nature of the accident and the immediate complaints of back pain.
5. The claimant submits the grade 1 reference occurred when Dr Wong reviewed the MRI scan but that the grade 2 reference comes from the operation report when the claimant was "open" and in theatre.
6. The claimant submits that the Medical Assessor has considered all the relevant time periods and all the relevant material in coming to his view that the claimant's clinical condition had deteriorated after the motor accident.
7. The claimant argues that the Medical Assessor referred to the absence of post-accident evidence he had also referred to the pre-accident evidence and had not reversed the onus of proof in finding causation.
8. The claimant also argues that the Medical Assessor has engaged with the insurer's evidence noting he has cited the various medical reports.

1. The Panel first issued directions in the treatment dispute matter on 11 December 2024 seeking bundles of documents from the parties which were provided.
2. On 5 February 2025 the Panel met and reported to the parties.
3. The Panels noted that the parties referred in their submissions to the Motor Accident Guidelines which only applied to motor accidents occurring after 1 December 2017. The parties had also referred in their submissions to the decision of Justice Wright in Briggs whereby the causation clauses of the Motor Accident Guidelines were applied to the issue of threshold injury in an accident that occurred after 1 December 2017 and involved a claim made under the Motor Accident Injuries Act 2017.
4. The Panel advised the parties of the re-examination date (5 March 2024) and encouraged the parties to consider settlement of the claim.
5. On 28 February 2025 the Panel advised the parties that it had decided to defer its decision about the treatment dispute until the conclusion of the Supreme Court judicial review proceedings about WPI noting there was a mutual dispute about causation in those proceedings.
6. On 4 June 2025 the Panel reported to the parties that the President had convened a Panel comprising the same members to hear the WPI Review. The Panel issued directions for a single bundle of documents from each party relevant to both disputes.
7. On 9 July 2025 the Panel met and reported to the parties the next day
8. The Panel advised the parties that it had two matters:

(a) a dispute about WPI, and

(b) a dispute about treatment

1. While the WPI dispute was lodged first, as the degree of Mr Haklane's accident-related WPI appeared to be dependent upon whether his surgery is related to the injuries caused by the accident or not, the Panel advised it would start by determining the treatment dispute and then the WPI dispute.
2. The Panel set a date for the re-examination (13 August 2025) and issued directions inviting any final submissions.
3. After the claimant attended the re-examination, and upon receipt of the clinical findings, the Panel met again to discuss the findings and finalise the decision.

1. The claimant responded to the Panel and conceded:

(a) he has no assessable impairment from his neck injury;

(b) he has no assessable impairment from his left hand and arm injury, and

(c) he is not lactose intolerant but concedes it is unlikely he has an assessable gastrointestinal impairment.

1. The claimant did not concede he has a pre-existing symptomatic impairment to his lumbar spine at the time of the accident saying he last saw a doctor about his back problems in March 2016 when he saw Dr Moses. At that time, he was able to work and perform hobbies and home duties all of which stopped after the accident.
2. The insurer made no concessions.

1. While the Panel has considered all of the material, we have, in the light of the concessions made by the claimant, documented the evidence as it relates to the issues in dispute focussing on Mr Haklane's lumbar spine injury.
2. The Panel notes that in response to requests made by the Panel, the claimant lodged additional material on 20 August 2025 being updated clinical records from the claimant's GP. In addition, on 18 September 2025, the claimant lodged records from Sydney Spine and Pelvis Physiotherapy. All of these documents the Panel has determined to allow into evidence due to the relevance of them to the matters in issue between the parties.

1. The claim form was signed as true and correct by the claimant on 7 October 2016[5]. In it Mr Haklane provides details of a 21 May 2001 accident and the claim number. He provides a consistent history of the accident, notes all emergency services attended and that both cars were towed away and written off. He records "I was taken to Canterbury Hospital with a broken hand and pain in neck, back, arms and legs."
2. At section 22 of the claim form Mr Haklane lists his injuries as:

(a) neck pain and headache;

(b) mid and lower back;

(c) hips and both legs (mostly left leg);

(d) left hand broken and nerve damage, and

(e) left arm pain, nerve damage and bruising.

1. The pain diagram completed by Mr Haklane forming part of the claim form shows neck, lower thoracic and upper lower back shaded along with the left arm at and below the wrist and the back and top of the right leg.
2. Dr Chu completed the medical certificate attached to the claim form noting the fracture of the 1st metatarsal, neck and back muscular spasm and left leg pain.

1. The claimant has provided three statements, 19 September 2019, 11 May 2023 and

15 January 2024. 2. In his first statement[6] the claimant says:

(a) he had previous neck and back injuries but led an active life working and managing his domestic tasks without difficulty [4];

(b) before the accident he was a process analyst [5] and was also an owner /builder of a home where he was building a granny flat and undertaking renovations [7];

(c) he had renovated five other homes before the accident and since 2013 and this could be physical work [8];

(d) he camped, hunted, rode a bike and played soccer with his children and did martial arts training twice a week with his son [9] - [11];

(e) he confirms his accident on 21 May 2001 and confirmed he was injured, made a workers compensation claim and was paid benefits. He said he had a few months off work and six months of restricted duties and had neck and back pain and pain down his left arm [15];

(f) after this he had flare-ups from time to time but dealt with these and exercised, had physiotherapy and took medication when necessary [16];

(g) he went to hospital in August 2009 for one of these flare ups and was referred to Dr Parkinson and Dr Darveniza and Dr Pope for a second opinion [18] and [19];

(h) in February 2016 he was referred to Dr Moses for pain radiating down the back to his left leg and after some physio these symptoms settled [20], and

(i) he says "the flare-ups of my back and neck pain which I experienced prior to 17 September 2016 were different to the frequent, severe pain I have experienced form the date of the accident to date [23].

(a) on 21 September 2001 he injured his left shoulder while skiing and had recovered from this injury [24], and

(b) in 2009 he was injured in a quad bike accident dislocating his left shoulder after which he saw Dr Goldberg, orthopaedic surgeon [25]. He said he fully recovered after physiotherapy and gym exercises [26] - [27].

1. In terms of the accident, the claimant says he was travelling through a T-intersection when another vehicle failed to give way. The claimant says he hit the driver's side door of the other car (head on). He had braked but was unable to avoid a collision [30]. Police and ambulance attended, and both vehicles were towed from the scene [31]. He says:

(a) he felt immediate pain in his left hand (a fractured thumb) [33];

(b) he experienced numbness and tingling from his neck down his left arm to the fingers of his left hand, which was more severe than previously experienced [34], tightness and numbness and pain in his lower band middle back as well as aching in his left foot and down the left leg and a painful left elbow;

(c) the back pain was "far worse" than any previously experienced pain [35];

(d) Mr Haklane was taken by ambulance with a collar on his neck and he had a scan of his neck, chest and left hand. He was dizzy [36] and [37];

(e) after discharge he had treatment from Dr Chu and had physiotherapy in Earlwood, and he has had cortisone injections in the back at the L5/S1 level [38] and [39];

(f) he was referred back to Dr Parkinson and had MRIs and he was referred to

Dr Yu pain specialist [42] and [43];

(g) he had physiotherapy and psychological treatment and considered a pain program [44];

(h) the claimant attended a Gold Cost hospital emergency department on

21 December 2017 with severe pain in the neck and tingling in his arms after visiting a theme park [45];

(i) he attended St George Emergency department on 11 October 2018 with severe headaches and neck pain which were investigated with MRIs and he was discharged and referred to Professor Halmagyi neurologist who he had not seen (because he could not afford it) [46];

(j) he had further investigation and treatment with Dr Parkinson and Dr Bolitho, neurologist and was advised to have further investigations and treatment for his left hand and elbow [48] - [50];

(k) he takes Panadol, Voltaren and Nexium daily and Gabapentin every night and Cymbalta when needed [51];

(l) the claimant says he has been told he has a fatty liver, high cholesterol and high triglycerides which Dr Lim says is a result of his medication, poor diet and inactive lifestyle since the accident. He has been referred to a dietician [52];

(m) Mr Haklane says he has neck pain which radiates into his head causing dizziness and nausea. His neck pain also radiates into both arms and fingers causing numbness and he also has pain in his left elbow and wrist [53] - [54], and

(n) he says he currently has shooting pain from his lumbar spine into both legs, numbness in both feet and his mood is low [55] - [57],

1. The remainer of the statement is dedicated to matters more relevant to Mr Haklane's damages claim.
2. In his 11 May 2023 statement, the claimant says his lower back and neck pain have worsened and his back pain is now radiating into both of his legs [2].
3. Dr Parkinson suggested surgery, but the claimant could not afford it, so he had a number of corticosteroid injections which did not help [3].
4. The claimant was referred to Dr Wong and had the surgery (L4/S1 with L5/S1 interbody fusion) on 27 September 2021 which did not help as the pain returned in November 2021 with radiation and was far worse than before the surgery [4] - [6]. He saw Dr Wong again and had revision surgery on 20 April 2022 which improved things for two months, but the pain and the numbness has returned [9] - [11].
5. Mr Haklane said he has had further treatment but his pain "continues to worsen" [16] and he has been advised to have further surgery by Dr Wong [17]. He has investigated pain management options [18] and [21].
6. The claimant says his pain is now unbearable in his lower back, legs and hips and he has numbness in his left foot. He has acupuncture and massage and medication. He is no longer having psychological counselling and has ceased Duloxetine as he did not like the side effects.
7. In his final statement dated 15 January 2024, Mr Haklane says:

(a) he refers to his 2001 accident and says he fully recovered from the injuries caused in that accident;

(b) in 2009 he was dancing at a family party when his neck pain flared up and he saw Dr Parkinson and Dr Darveniza;

(c) he had a quad bike accident in November 2009 and had physiotherapy for his shoulder and neck and he had a flare up of back pain;

(d) he had a further flare up of back pain in November 2010, November 2011;

(e) he details his treatment and exercise regime and other musculoskeletal issues;

(f) he had a further flare up in October 2015 resulting from building and renovation work and in March 2016 he saw Dr Moses;

(g) he never had cortisone injections before the accident, nor had he been advised to have surgery. He had flareups which recovered after time and physiotherapy, and

(h) at the time of the accident on 17 August 2016, he felt immediate pain in his lower back.

1. The claimant was taken from the accident scene by ambulance. The claimant was ambulant and gave a consistent history of the accident (50kms an hour with a car coming from a side street and the claimant hitting the side of it, head on). The claimant's airbags activated, and he was wearing a seatbelt. He got out of the car on his own.
2. The claimant was said to be alert and oriented with a Glascow Coma Scale score of 15. He had swelling and pain to the left thumb, tightness and mild numbness to the left lateral neck down the left arm. His fingers were unaffected and it was recorded:

"Nil other pain. Nil shortness of breath ... Denies cervical neck pain on scene and at triage."

1. Canterbury Hospital records have been provided. The triage comment reads as follows:

"[brought in by ambulance] - [motor vehicle accident] - driver. Driving at 50 km/h T'boned into another car, airbag deployed. [Complains of] pain in lateral left neck, radiates to arm, swelling left thumb with minimal movement noted, [complains of] numbness in left thumb.

1. X-rays were done of the chest and left hand and a CT scan of the neck. The Panel notes no radiology of the lumbar spine was performed at the hospital.

1. The Panel notes there are two different medical practices in Earlwood where the claimant has attended since the accident, the Earlwood Medical Centre (EMC) and the Earlwood General Practice (EGP). The Panel had records from EGP dating back to 2014 and it appears this was the claimant's usual GP practice. Records from EMC have been provided which include a single entry before the accident on 1 April 2015 (Dr Lewis) and then after the accident there are entries on 29 November 2017 (Dr Zhang) and 19 April 2018 (Dr Lau). On 19 June 2019 the claimant attended Professor Lim for abdominal issues, and it was at this attendance that the claimant first mentioned his car accident to any of the doctors at EMC. It appears that EMC then became the practice that the claimant attended.
2. The claimant has also utilised the services of SOS physiotherapy both before and after the accident and notes have been provided by them.
3. The claimant made a claim against Allianz under the workers compensation scheme following his accident on 2001. Records in relation to this claim have not been provided and are not in the Panel's view necessary.
4. Dr Parkinson, neurosurgeon, wrote to Dr Moses (then a GP) on 1 September 2009 after his first consultation[7]. The claimant gave a history of his 2001 accident saying he had "disc herniations in both the cervical and lumbar regions." Mr Haklane had developed "acute on chronic" pain in the right side of the neck with paraesthesia and weakness in both arms. He also reported back pain running down both legs at times and there was restricted lumbar motion. Lower limb reflexes were reduced. Gait was normal. He referred the claimant to Dr Darveniza, neurologist.
5. In what is referred to as a final report to Allianz from Mr Wolak, physiotherapist dated

31 June 2010 the claimant was said to have "significant disabilities that adversely affect both his work and leisure activities." He recommended some ongoing treatment including a three-month gym membership problem and eight physiotherapy sessions as needed. 6. Dr Parkinson wrote to Dr Moses on 8 February 2012 concerning thoracic pain (T6 - T8) and lower back pain. Dr Parkinson refers to an MRI showing a central disc protrusion with cord contact and L4/5 disc height reduction with slight degenerative anterolisthesis at L5/S1. There were no neurological signs recorded, and while surgery was not contemplated, Dr Parkinsons did want to do a bilateral facet joint block at T7/8. 7. Mr Wolak, physiotherapist and exercise physiologist wrote to Allianz on 1 March and 8 May 2012 in respect of Mr Haklane's workers compensation claim. He referred in the first report to the claimant managing independently with a prescribed exercise program for a year before he experienced a flare up of back symptoms on 15 December 2011. He refers to a T7/8 disc protrusion and Dr Parkinson having suggested a facet joint injection. He refers to the claimant having "sustained an acute exacerbation of a chronic injury". The claimant had attended Pilates classes and was working on home exercises hoping to avoid corticosteroid injections. The related injury management plan refers to neck and back pain with sciatica. 8. On 3 August 2012, Mr Papas, musculoskeletal and sports physiotherapist wrote to Dr Rao at EGP referring to treatment "over the last few months for his ongoing cervical, thoracic and lumbar spine pains." It refers to compliance with an exercise program but that the claimant had "episodes of debilitating pains." Mr Papas suggested the claimant be referred to a pain physician. 9. On 8 January 2014 the claimant attended Dr Sammut of the EGP for:

(a) lower back pain with radiation down left leg for the last year;

(b) getting worse now - constant pain for the last four months;

(c) no change in sensation, no weakness;

(d) has noticed change in muscle bulk to left thigh, and

(e) the claimant's father had died of cancer and had similar lower back pain with sciatica and his cancer was missed on an MRI and found when a bone scan was done. The claimant wanted to be checked, and an MRI of his thoracic and lumbar spine was ordered.

1. On 23 April 2014 the claimant attended on Dr Hall of EGP for review of his left leg issues and again lost muscle mass in the left leg was mentioned and pain felt with exercising which was radiating down the whole left leg. Mr Haklane reported intermittent pins and needles in the left leg mainly under his toes but said he had not had any bladder or bowel dysfunction. It was reported that power was five out of five in all muscle groups of the lower limb but the claimant on examination "feels numbness in the left foot in the L5/S1 distribution". Radiology and tests ordered by another GP were referred to. There are no records from the EMC for 2014, and it is not clear to the Panel which other GP had ordered the radiology and tests.
2. The claimant attended Dr Hall of EGP again on 28 April 2024 who records worsening pain in the left hip and foot. The MRI was compared to 2012, and an injection was recommended. A referral to Dr Parkinson was given and a referral to Dr MacDessi for the leg and foot complaints.
3. Dr MacDessi, orthopaedic surgeon wrote to Dr Hall of the Earlwood practice on 23 May 2014[8] and he records a history from the claimant of "ongoing left leg sciatica radiating down to his great toe." Dr MacDessi records that the claimant was advised to have surgery by Dr Parkinson but that the claimant has "delayed any intervention on his back". The Panel notes this history is incorrect as, at this stage the medical records before the Panel indicate that Dr Parkinson had not advised the claimant to have surgery. The left leg pain was constant, and the claimant saw Dr MacDessi for left knee patella femoral pain. His opinion was:

"I feel strongly that Steven's problems are emanating from his lumbosacral spine in terms of altering his lower limb biomechanics and causing secondary muscular and patellofemoral pain issues. Ultimately I think he is best off undergoing an intervention for his L5 radiculopathy and I have suggested he sees Dr Richard Parkinson."

1. Dr MacDessi also recommended the claimant to see Dr Moses, now a sports and exercise physician (who had been the claimant's GP earlier) for the lower limb musculoskeletal issues.
2. The claimant attended at EGP on 21 August, 9 September and 4 November 2014 for unrelated issues. On 30 January, 10 March, 15 May and 21 May 2015 the claimant attended EGP for matters unrelated to his back complaints.
3. Notes from SOS physiotherapy (SOS) have been provided. These are handwritten and extensive. On 9 December 2013 the claimant reported his neck and thoracic spine were good, but he was "still getting a lot of (L) low back pain and lateral leg pain to knee" as well as knee pain. It is not clear whether he attended on 16 December 2013 but there is then a gap of almost two years to 26 October 2015 where it was reported "has noticed soreness in (L) low back and hip past month - renovating another house." There had been extreme pain going into the lateral leg to the foot over the past 3 days. The claimant attended again on 29 October,

2 November 2015. On 5 November 2015 the claimant said he was a lot better, and the referred symptoms were less intense. There were several other attendances in December 2015 with the last attendance on 21 December 2015. There is then a gap in the notes until 22 September 2016. 4. The Panel notes in 2009 the claimant attended the SOS practice about 14 times, 9 times in 2010, 5 times in 2011, 22 or 23 times in 2012, 18 times in 2013, none in 2014, 8 in 2015, none in 2016 before the accident but 21 times after it. The claimant saw SOS 45 times I 2017, 35 times in 2018, 20 times in 2019 and then 8, 5 and 2 times in the next three years. 5. The claimant attended Dr Chu of the EGP on 26 February 2016 complaining of lower back pain for many years and that this pain was radiating down both the left and right leg. Mr Haklane reported no improvement with Voltaren, and the pain was radiating down the back of the leg into the toes and this pain was sharp and burning. He denied weakness or altered sensation. He was tender on examination over the L3-5 region and his slump test was positive. He wanted to see Dr Moses but not a neurosurgeon. He was prescribed Lyrica as a trial and advised to continue taking paracetamol. The Panel notes that the records of the EGP do not reveal no scripts for neuropathic or other pain were prescribed until this time. 6. Dr Moses saw the claimant on 3 March 2016 and wrote to Dr Chu at Earlwood. He has a report of "two years of lower left back pain which radiates into his left buttock and down his left leg of gradual onset." The pain was said to be mainly aching but included burning and there was paraesthesia reported in the L5 region on the left side. The thoracic scoliosis was considered to be partly to blame as was left sacroiliac joint incompetence and he suspected an L5 nerve root irritation issue on the left. Dr Moses obtained a history of a "significant" motor vehicle accident in 2001. 7. On examination, Dr Moses records "he has clear signs of left sacroiliac joint incompetence". There was tenderness in the left hip joint and right sacroiliac joint. Power and sensation were normal in the lower limb, but reflexes were absent on both sides and straight leg raise did not produce radicular pain although the slump test produced some L5 symptoms on the left. 8. Dr Moses saw the claimant again and reported on 23 March 2016. The MRI of the claimant's left hip revealed a labral tear with overlying bone marrow oedema and chondral softening. The lumbar spine MRI revealed mild bilateral neural exit foramina stenosis at L5/S1 with a 7mm anterolisthesis at L5/S1. The claimant was said to have "no significant relief from his neuropathic pain" and an increase in the Endep dose was recommended and Mr Haklane was advised to have a left L5 corticosteroid injection and left hip injection. 9. The claimant provided a small bundle of documents from Sydney Spine and Pelvis Physiotherapy (Sydney Spine and Pelvis). The claimant attended this practice on four occasions (4, 13, 27 April and 11 May 2016). At the initial consultation the physiotherapist records that the claimant has constant numbness in his toes and in the ball of the foot and left lateral leg for a few years (since 2001). Mr Haklane also appears to have advised lower back pain which was worse over the last seven to eight months). The claimant was said to be driving a lot (two to three hours a day) and was building a house. A pain diagram has the lower and mid back, left buttock and outside of the left leg highlighted. 10. The claimant attended the EGP four or five times in 2016 before the accident for conditions unrelated to this accident and with no mention of back pain recorded and no scripts for Lyrica or pain medication prescribed. 11. The claimant attended Dr Chu at EGP on 21 September 2016 four days after the accident. He referred to the accident and the fractured hand and referred to "ongoing pain in C-spine and T-spine areas" and that a C-spine X-ray was normal in hospital. On examination the thoracic spine and cervical spine were tender. There was muscle spasm in the thoracic region. There is no record of lumbar spine examination or of any lumbar spine complaint. A leaflet on "10 Exercises for your thoracic spine" was apparently provided and a referral to SOS physiotherapy given. The referral[9] refers to the car accident and the fractured thumb and "significant pain and stiffness in his neck and paravertebral muscles. There is no reference to lower back pain. 12. On 22 September 2016 the claimant attended SOS physiotherapy and referred to the car accident. He was sore in the neck (both sides) and had headache. The claimant said he had fractured his left wrist but was unsure of which bone. He also complained of "pain in low back and down (L) glutes and lateral thigh to knee." There were ongoing attendances in 2016 and early 2017 with reports of varying levels of pain in the neck and constant lower back pain. 13. The claimant saw Dr Chu on 7 October 2016 for review. She noted the claimant was seeing the fracture clinic and had seen a physiotherapist for his hand, neck and spine. The lumbar and thoracic spine were examined along with the cervical spine. There was tightness, tension and tenderness. There was restricted range of motion in some planes. Panadeine Forte was prescribed for the first time and a script for Lyrica was also provided and the CTP claim form completed. 14. Dr Chu saw the claimant again on 28 November 2016 and reviewed his hand and thumb progress. She notes lower back pain was persisting radiating down the posterior left leg to the toes with numbness. He was also experiencing daily headaches and persisting neck pain. The lumbar and thoracic spine were examined and there was muscle spasm and tightness and restricted range of lumbar spine movements, and a CT scan of the lumbar spine was ordered. The claimant returned on 9 December 2016 with ongoing lower back pain. The claimant had not trialled the Lyrica as he was worried about side effects and a further script was given at a higher dose. 15. On 15 February 2017 Dr Chu records:

(a) worsening lower back pain;

(b) he was improving with physiotherapy and analgesia;

(c) when he was at work on the Friday, he went to pick his phone up from the floor and he experienced "sudden pain in the lower back";

(d) he felt radiating pain to the outer right thigh and left outer leg to the foot;

(e) the claimant had persistent numbness previously, but it was now more intense and to the toes, and

(f) he had the sensation of wanting to defecate.

1. On 17 February 2017 Dr Yang saw the claimant at EGP and recorded lower back pain had been intermittent but that after the phone incident he had constant pain. There had been some improvement. The CT scan showed the disc protrusion at L4/5 dominating to the right and not the left. On 20 September 2017 Dr Chu had a history of the right sided sciatic pain extending, and the claimant had ongoing symptoms of needing to evacuate his bowels and he had persisting left sciatic symptoms to his foot. The claimant was given a referral to Dr Parkinson. Dr Chu spoke to the radiologist who confirmed his report and advised "previously left-sided dominance. Still left-sided neurocompression, but [now] significantly on the right side with 50% compression. Ongoing L5 pars defects bilaterally."
2. There were several other attendances early in 2017 and then on 16 May 2017 the claimant attended with ongoing troubles with lower back and leg pain. He was taking Mobic, Panadol-osteo, Lyrica and Nexium. He was working and exercising (swimming or walking in the pool).
3. Dr Parkinson wrote to Dr Millard at EGP on 18 May 2017. He was given a history of the left wrist fracture, whiplash injury and lower back ever since the accident with paraesthesia in both legs. Power, tone, reflexes and sensation were normal with a normal gait and no sign of myelopathy.
4. The claimant next attended the EGP on 29 May 2017 for sinus pain and low back pain was mentioned as "past medical history." On 31 May 2017 is a note in the SOS Physiotherapy records that the claimant had been to Dr Parkinson who had told him there was nothing operable in his lumbar spine.
5. The claimant returned to the EGP on 19 and 20 September 2017 complaining of dizziness. Lyrica was ceased on 19 September 2017, and it was noted that Cymbalta had been prescribed by someone not from the current practice.
6. On 9 January 2018 Dr Koumoulas of the EGP records increasing neck pain with radiating down both arms. Lower back pain was not mentioned. The claimant next attended on

28 September 2018 with neck pain, and it was noted "gets flare up in neck and back from time to time. Currently having flare up in neck nearly 2 months feels different to previous flare ups." The claimant returned on 5 and 11 October 2018 with ongoing review of his cervical spine pain and neck stiffness. He apparently attended hospital and had an MRI of the brain and returned to Dr O'Connor on 12 and then 18 October 2018 where Panadeine Forte was prescribed for his neck pain and headaches. There is no mention of lumbar spine pain in the records in 2018. The physiotherapy notes do mention lower back and leg symptoms throughout 2018. On 6 June 2018 the claimant was noted as being able to lift 12 kgs. 7. The claimant returned to Dr O'Connor on 29 January 2019 with more complaints about nausea but his "neck pain flare" had settled somewhat. Mobic was prescribed and Cymbalta was also mentioned but not prescribed. In March 2019 the physiotherapy notes record the claimant's neck and lower back pain increasing with constant tingling and numbness in the left arm and down both legs. 8. Dr Parkinson wrote to Dr O'Connor at Eastwood on 6 June 2019 noting Mr Haklane was now presenting with "dorsal cervical spine pain" with nighttime paraesthesia in a C6 distribution. The MRI did not reveal any C6 nerve root compression, and he recommended neurological review and nerve conduction studies but did not foreshadow surgical intervention. 9. Dr Azzi of EGP saw the claimant on 17 June 2019 primarily for gastrointestinal issues and he notes the claimant was taking non-steroidal anti-inflammatory medication with Panadol osteo and Gabapentin (from the pain specialist) due to chronic pain from neck and back injuries. There are several other attendances from 2019 concerning unrelated medical conditions. 10. On 19 June 2019 the claimant attended Professor Lim at EMC for abdominal issues but the Professor had a history of the car accident but there were no complaints of pain. 11. The claimant attended Professor Lim again on 5 July 2019. The reason for this visit was "bilateral lumbar radiculopathy. Cortisone injections in the lumbar spine were requested. On 12 August 2019 the claimant attended reporting he had the cortisone injections and there is reference to upper limb symptoms. The reason for this attendance was stated to be "Lactose intolerance." 12. Dr Bolitho, neurologist wrote to Professor Lim on 3 September 2019[10] primarily in relation to the claimant's upper limb symptoms but also referring to the claimant's reports of "whole body spasms." 13. There were also complaints during 2019 recorded in the physiotherapist's notes of the claimant's left hip locking and on 6 November 2019 the physiotherapist reported intermitted sharp pains in the ankle, weakness in the great toe, altered sensation in a L5 distribution and he was unable to elicit a knee jerk reflex. 14. Dr Yu, pain physician wrote to Dr Parkinson on 29 November 2019[11] referring to persistent lower back pain and left leg radicular pain which had increased "significantly over the last four weeks." Dr Parkinson saw the claimant on 10 December 2019 who had a report of stable back pain but worsening left side radicular pain. He reviewed the claimant's 2009 MRI and says the claimant did not have a progressive spondylolisthesis slip at L5/S1; he did have a progressive L4/5 discopathy with stenosis which might be the cause of the symptoms. He considered a bilateral L5 decompression might be needed. 15. The claimant saw Dr Parkinson four times in 2020 with Mr Haklane complaining of worsening lower limb pain. Neurologically there was "not a lot to find" in January 2020 but on 12 March 2020 the claimant reported significant left sided L5 dysesthesia. Surgery was suggested subject to Dr Bolitho's input. On 24 August 2020 after epidural injections the claimant's back pain was better but his foot pain was worse. 16. On 11 July 2020 the claimant spoke with Dr Zhang reporting dizziness and nausea, and the house was spinning. He had a CT injection into his back the day before. He was advised to go to hospital. Mr Haklane attended Dr Chen on 16 July 2020 having been discharged from hospital. The dizziness and nausea was not thought to have been triggered by the steroid injection and his back pain had improved and the claimant wanted to go back to have another one. He was prescribed Mobic. 17. On 16 September 2020 the claimant spoke with Dr Tran of EMC about his chronic back pain and the development of stomach issues. He was prescribed Celebrex. 18. Dr Parkinson saw the claimant and reported to Dr O'Connor at EGP on 8 February 2021[12]. Dr Parkinson refers to monitoring the L5/S1 spondylolisthesis for some years and that the claimant had a "two-month history of gradually increasing mechanical low back pain with some transient left buttock pain." He compared the 2017 MRI with the 2020 MRI which showed a "slightly larger" disc bulge on the right and that "foraminal crowding" was a little worse. As the claimant's pain was under control he advised against surgery at this time. 19. Dr Parkinson saw the claimant again on 27 April 2021 with the MRI from 23 December 2020. The claimant reported "some additional right L5 sciatica" and Dr Parkinson refers to a two-level fusion. The claimant was said to be "keen to get it done." 20. Mr Fengaros, chiropractor, wrote a letter dated 24 May 2021 referring to the claimant having had an "acute flare up of chronic lower back pain with lower limb referral which has been ongoing since 2016." He supported the need for surgery. 21. Dr Parkinson, neurosurgeon, wrote to NRMA on 11 August 2021 seeking approval for the surgery. He has a history of no previous back pain and unremitting back pain since the accident. He considered NRMA should be paying for the surgery. He says the claimant had "bilateral pars defects and an L5/S1 isthmic spondylolisthesis" but says this was "asymptomatic" before the motor accident. 22. The claimant attended RPAH on 27 April 2022 with positional dizziness, vertigo and vomiting and the discharge summary notes a previous episode of benign positional paroxysmal vertigo.

1. Dr Wong wrote to Professor Lim on 2 September 2021. He had conducted a telehealth conference with the claimant.
2. He notes "nil significant past medical history" other than the 2016 motor accident with lower back pain since then and lymphadenopathy. The Panel notes that Dr Wong clearly has an incorrect history.
3. Dr Wong noted the claimant had exhausted conservative treatment and despite medication "his pain still seems to be very severe". The pain was noted to be mainly down the right leg in an L5 dermatome with numbness on standing (L5 distribution). He reviewed the MRI and noted bilateral nerve root compression. He advised the claimant about surgery and scheduled a review in two weeks' time.
4. On 16 September 2021 Dr Wong saw the claimant again this time in person. The latest MRI was said to show no significant change but with grade 1 spondylolistheses due to pars defects. There was tighter compression at L5/S1 on the right compared to the left. He again advised on L5/S1 fusion surgery and decompression and that an L4 fusion may also be required later.
5. The surgery was performed on 27 September 2021. The operative report[13] says the findings were of grade 2 spondylolisthesis.
6. There are a number of reports after this noting the progression of the claimant's pain and the failure of the surgery.
7. Dr Wong reported to Professor Lim on 31 May 2022. At this time the claimant had left sided S1 numbness with pain down to the shin. There was a DVT discovered on a doppler scan of the right calf.
8. Dr Wong wrote to Professor Lim on 27 October 2022. He noted some earlier relief of pain but ongoing left S1 radicular numbness and pain radiating to the left hip becoming more constant and unbearable. There was increasing L5 radiculopathy as well. He considered the involvement of adjacent segment disease and ordered repeat scans.
9. Dr Wong referred the claimant to Dr Holford of the Pain Centre at North Shore Private on

7 March 2023 for consideration of radiofrequency ablation or other pain management strategies due to ongoing pain despite the fusion. Dr Wong also wrote to Professor Lim on this day noting "worsening right sided radiculopathy." The longstanding numbness persisted but he had increasing buttock and lumbar pain. He queried epidural scar tissue causing L5 neuro compression as he could not see any source of compression on MRI and CT scans.

1. Medical Assessor Truskett took a history from the claimant of epigastric pain weekly, relieved by Nexium and Gaviscon. This has been investigated with endoscopy and colonoscopy. The Medical Assessor records that the claimant has been advised he is lactose intolerant. Medical Assessor Truskett found the gastrointestinal symptoms were not caused by the accident-related injuries.
2. In answer to a question from the Panel, Mr Haklane's lawyers reported the claimant was not lactose intolerant and concedes it is unlikely he has an assessable gastrointestinal impairment.
3. The Panel notes:

(a) at pages 92, 99, 405 and 418 in the "history recorded" by Earlwood Medical Centre the claimant is said to have lactose intolerance diagnosed on 12 August 2019. There is a corresponding clinical note from Professor Lim (page 422) confirming lactose intolerance;

(b) at page 116 of the claimant's bundle in the admission form for the claimant's 2021 spinal surgery the claimant has indicated he has a medical reason for a special diet and that he is "lactose intolerant", and

(c) at page 445 of the claimant's bundle is a letter from Dr Kwok to Professor Lim assessing the claimant with lactose intolerance on histology and requesting he trial a lactose free diet.

1. The insurer has provided a copy of radiology from 19 October 2009 which recorded:

(a) spondylitic changes in the thoracolumbar spine with no acute fracture;

(b) no significant canal, foraminal or lateral recess stenosis;

(c) no nerve root impingement;

(d) bilateral L5 pars defect without marrow oedema, and

(e) mild grade 1 anterolisthesis

1. A lumbar X-ray was done on 1 December 2011 showing mid and lower lumbar scoliosis convex to the left with thoracic kyphosis straightened and Schmorl's nodes present.
2. The claimant had an MRI done on 9 January 2012[14] with the clinical history noted as "back pain following a non-acute MVA." There was a disc protrusion at T7/8 and a broad-based disc protrusion with foraminal stenosis and mild facet arthropathy at L4/5. L5/S1 showed anterolisthesis (grade 1) associated with bilateral pars interarticularis defects and mild foraminal stenosis."
3. On 5 February 2014 the claimant had an X-ray of his lower back and pelvis[15] due to low back and hip pain. The grade 1 anterolisthesis of L5 on S1 was measured at about 6mm secondary to pars defects and there was reduced disc height at L4/5 and L5/S1.
4. An MRI of the lumbar spine was performed on 23 April 2014 with a clinical history of "known anterolisthesis of the lumbar spine. Numbness in the left leg in the L5/S1 distribution." This was compared to the 2012 radiology, and it was said there was no significant change. The anterolisthesis was measured at 8mm.
5. Dr Moses report of the lumbar spine MRI from March 2016 revealed mild bilateral neural exit foramina stenosis at L5/S1 with a 7mm anterolisthesis at L5/S1.
6. Dr Parkinson arranged an MRI of the lumbar spine on 24 March 2017 and comparison was made with an MRI from 2009. The anterior slip was measured at 4mm which was said to be uncharged and that there were "degenerative disc protrusions at L4/5 and L5/S1 but no nerve root compression." There was minimal bilateral foraminal stenosis at L5/S1.
7. The claimant had an MRI on 31 July 2017 with a clinical history noted as "bilateral lower limb weakness". The conclusion in respect of the lumbar spine was of "bilateral L5 pars defects with grade 1 anterolisthesis of L5 on S1" which was measured at 6mm.
8. On 27 March 2019 the claimant had an MRI of his lumbosacral spine at the request of Dr Parkinson[16] which reported grade 1 anterolisthesis resulting in mild bilateral foraminal narrowing at L5/S1 with a broad based disc bulge narrowing the canal at L4/5. There was now possible contact of the descending L5 nerve roots on both sides.
9. On 21 June 2019 the claimant had a CT scan of his thoracolumbar spine due to abdominal issues and musculoskeletal pathology and an accident in 2017. There was a grade 1 anterolisthesis with canal stenosis at L/5 and partial impingement of the L5 nerve roots.
10. The CT lumbosacral spine on 25 February 2020 compared the July 2017 scan and noted the anterolisthesis and pars defects at L5 were similar. There was mild posterior L5 vertebral wedging (25%) which was stable with L5 nerve root irritation and impingement. There was diverticulitis in the colon.
11. On 23 December 2020 the claimant had an MRI of the lumbar spine due to "left sciatica". The grade 1 anterolisthesis was stable in appearance. There was intervening disc disease without significant central canal narrowing but exit canal narrowing which was similar, slightly more marked on the right, but no new descending or exiting nerve root compromise.
12. On 17 November 2021 the MRI reported noted the laminectomy and fusion but no visualised S1 nerve impingement. An MRI of 27 October 2022 reported "no visualised compression."

1. The claimant relies on four reports from Dr Peter Bentivoglio, neurosurgeon.
2. In the first report dated 2 August 2018, Dr Bentevoglio has a history of the 2001 and 2009 accidents, radiology and conservative treatment. The claimant complained of pain in his neck and back that were "slowly but surely getting worse". The neck injury was said to be the worse injury.
3. On examination there were decreased back and neck movements, but tone and power were normal with symmetrically depressed reflexes in the upper and lower limbs.
4. Dr Bentivoglio's opinion was that the claimant exacerbated pre-existing issues in his cervical and lumbar spine. He did not believe the condition was stabilised and declined to assess impairment.
5. In his second report dated 11 March 2019, the examination again revealed reduced lower back movement. Tone and power were normal but there was some mild weakness of dorsiflexion in the left foot and toes not present, in the previous examination. All reflexes were symmetrically depressed. Dr Bentevoglio again diagnosed an exacerbation of underlying cervical spondylolytic disease and spondylolytic spondylolisthesis at L5/S1 with a left nerve root compression. Dr Bentevoglio considered decompression, and fusion surgery may be necessary at L5/S1 and C5/6. He suggested if the claimant did not have the surgery there will be "ongoing gradual deterioration."
6. Dr Bentevoglio assessed WPI at:

(a) DRE II - 5% for the neck;

(b) DRE III - 10% for the lower back due to mild weakness of extension of the toes, and

(c) he has been born with the spondylolytic spondylolisthesis and has had problems dating back to 2001 and suggested a one tenth deduction of the 15% WPI for pre-existing impairment.

1. In his 4 November 2022 report, Dr Bentevoglio appears to have a consistent history of the surgery and its sequelae and in particular the return of back pain with numbness in the feet. Dr Bentevoglio found no radiculopathy but neuropathic pain. Gait was normal and there was no wasting. Straight leg raising was 70 degrees on both the right and left and there was reduced back movement. Tone and power ere normal but reflexes were absent on both sides. He declined to assess impairment due to the recent surgery.
2. The final report is dated 11 August 2023. Dr Bentevoglio notes the claimant has been to the RPAH pain clinic, has been given a TENS machine and an "actipatch" neither of which have not provided much benefit. The claimant estimated his low back pain has improved by 50% since the surgery and same with the right leg pain however his left leg has been made much worse with pain and numbness.
3. On examination, gait was normal, there was no wasting, straight leg raising was to 80 degrees on both sides and he had reduction of back movements. Tone was normal, power was affected in the left great toe and there was numbness in an L5 distribution. Reflexes in the knee and ankle were absent on both sides.
4. His final diagnosis was:

"My diagnosis is still the same. He is a gentleman with discogenic low back pain secondary to L4/5 disc disease and evidence of neuropathic leg pain and evidence of L5 and S1 radiculopathy. These symptoms have been exacerbated and caused by the motor vehicle accident on 17 September 2016 when he undoubtedly exacerbated pre-existing degenerative disease as shown on MRI scans in October 2009. One can only say that the motor vehicle accident has exacerbated the back problems at L4/5 and L5/S1 which usually have settled in the past but on this occasion, it has not settled and his symptoms have slowly but surely deteriorated because of the spondylitic spondylolisthesis at L5/S1."

1. He considered the claimant was likely to require further surgery to fuse the L4/5 with L5/S1.
2. He assessed WPI at 25% from which he deducted 10% for the pre-existing degenerative disease and spondylolisthesis.

1. Dr Machart, orthopaedic surgeon, submitted a report to the insurer dated 9 January 2019. Dr Machart got a history of the car accident with the onset of lower back pain radiating to his legs, neck pain and headaches. The neck pain at that time was the worst feature and it radiated to the left shoulder.
2. Dr Machart had the history of the 2001 accident with flare-ups of back pain since with limited impact on his activities.
3. On examination there was reduced motion in the back movements, negative tension signs, reflexes were present and symmetrical in the hamstrings and knees but ankle reflexes were absent on both sides. There was diminished sensation in the left foot.
4. Relevantly to the matters in issue in this review he diagnosed a lumbar spine soft tissue sprain on the background of L5/S1 spondylolisthesis.
5. He assessed WPI at 10% (DRE II in both the cervical and lumbar spine). He deducted DRE II 5% from the lumbar spine.
6. Dr Coroneos, neurosurgeon provided a report to the insurer on 17 March 2020. He has a consistent history of previous problems in the back up to 2009/10. The claimant described pain in the neck, lower back and left thumb. The claimant reported pain in both hips and pain down the left lower limb and front of the left upper limb.
7. The claimant reported headaches, pain in the neck, front and back of the right shoulder with numbness and pins and needles in the arms. In terms of the back Mr Haklane complained of lower back pan with pins and needles and numbness in the back of both lower limbs, extreme numbness and pressure pain in the left foot and pain in the left and right leg.
8. Dr Coroneos provides great detail about the examination and test he administered. He suggests there is no evidence of any significant neurosurgical or spinal injury. He did however not have any radiological films.
9. Dr Rosenthal, occupational physician provided a report to the insurer dated 16 November 2022. The claimant's current problems were low back pain on both sides impacting around the left hip and in both legs. He reported pain and numbness. He reported pain in the big toe and arch of his left foot.
10. Dr Rosenthal details at length the medical reports and assessments.
11. On examination the neck had some reduction in movement but there were no neurological deficient and the shoulders, wrists, and hand had normal range of motion.
12. In the lower back the scar was evidence and all lumbar movements were restricted. Straight leg raise was to 50 degrees on both sides. Reflexes in the lower limbs were all dull and there was sensory loss of the left foot but no anatomically localised muscle weakness. The claimant was wearing a lumbar brace. While there was minor difference in thigh and calf measurements this was not a clinically significant difference. All hip, knee and ankle movements were full.
13. Dr Rosenthal diagnosed the fractured thumb, aggravation of degenerative changes in the cervical spine and possible temporarily exacerbation of pre-existing degenerative changes in the lumbar spine.
14. He considered the failed back surgery and pain management related to the degenerative changes and not the accident. He notes no mention in the Canterbury Hospital notes of any back symptoms.
15. Dr Mellick, neurologist provided a report to the insurer dated 27 February 2023. He has a consistent history of the accident and the immediate onset of neck, back and thumb pain.
16. The claimant reported that his back pain was increasing and the intensity of symptoms in his legs was increasing.
17. The claimant gave a history of his previous injuries and of the flare ups noting that during the flare ups he had to modify his physical activities.
18. On examination the claimant's neck movements were full and there was no abnormality in the upper limbs.
19. Dr Mellick records straight leg raising to 90 degrees on both sides, a full range of leg movements. There was no muscle atrophy and no abnormality of tone, co-ordination or sensation. Power was unimpaired and there was no abnormality of sensation. Reflexes were symmetrical but sluggish.
20. Dr Mellick had a history of no prior numbness or pain in the lower limbs before 2016.
21. His diagnosis was:

"The main complaint of back pain with referred numbness and pain is not associated with diagnostic signs of radiculopathy. There is also no muscle spasm or guarding associated with spinal movement. The appropriate diagnosis is a chronic pain syndrome of long-standing, exacerbated by the injury in question and unassociated with reproducible signs establishing radiculopathy caused by the motor vehicle accident. The fusion procedure with decompression that has been performed has, regrettably, resulted in increase in pain rather than therapeutic benefit."

1. In a supplementary report dated 9 June 2023 he noted the history he was given was contradicted by the reports of Dr Moses and that there were back and leg symptoms before the accident. Dr Mellick also noted the radiological information refers to congenital abnormality and no traumatic pathology. And he says his examination "provided no support for Mr Haklane's chronic pain being due to a spinal injury."
2. Finally, Dr Mellick noted that on 18 May 2017 it was recorded that the claimant had no neurological signs.
3. Dr Mellick expressed the view that the claimant's symptoms were caused by the first of his accident, not the current accident and he diagnosed a chronic pain syndrome.

1. Medical Assessor Truskett examined the claimant on 19 January 2024 and issued his certificate on 1 February 2024. He confirms at [2] that he was asked to assess the following injuries and symptoms:

(a) cervical spine - aggravation of degenerative disease of cervical spine;

(b) lumbar spine - aggravation of spondylolytic spondylolisthesis at L5/S1 level with left L5 nerve root compression;

(c) left metacarpal - closed fracture;

(d) left carpal tunnel syndrome and ulnar condition, and

(e) stomach - stomach/oesophagus - gastro-oesophageal reflux disease.

1. Medical Assessor Truskett took the following history at [8] - [10]:

(a) he had a medical history of elevated cholesterol;

(b) in 2001 he had a car accident after which he developed neck and back pain which resolved but flared up in 2009;

(c) he had a quad bike accident in November 2009 in which he sustained a probable brachial plexus injury which was treated by Dr Goldberg;

(d) the current accident occurred at about 50 kmph when a vehicle failed to stop at an intersection and the front of his vehicle hit the passenger side of the other vehicle. He was not knocked out, but emergency services attended, and he was taken to hospital. His vehicle was written off in the accident;

(e) the claimant said he complained at hospital of pain in the left hand, neck and lower back pain. The undisplaced fracture of the first metacarpal on his left hand was discovered and the claimant was kept overnight. Radiology of his neck demonstrated no abnormality;

(f) he attended his GP on 21 September 2016 complaining of cervical and thoracic tenderness. He was referred to and assessed by Dr Parkinson, neurosurgeon on 28 March 2017;

(g) since his previous examination with Medical Assessor Truskett he had radiating pain down both legs which had not resolved;

(h) the claimant was reviewed by Dr Parkinson on 10 December 2019 and on

27 April 2021 when he recommended a two-level decompression and fusion which was performed by Dr Wong due to an issue of affordability and private health insurance;

(i) Mr Haklane had ongoing numbness and pain in both legs with no improvement;

(j) he had further surgery on 20 April 2022 due to concern a small piece of bone graft material was in contact with the left S1 nerve root. There was some improvement in his left leg pain but three months later both his right and left sciatic pain returned and on 27 October 2022 Dr Wong suggested he might require L4/5 spinal fusion. If he has this surgery, he wants to see Dr Parkinson;

(k) the claimant was continuing with Dr Yu, pain specialist and Professor Lim, and

(l) he has continued to work full time.

1. In terms of current symptoms, Medical Assessor Truskett notes that:

(a) Mr Haklane's neck pain has resolved, and the claimant has been relatively pain-free in that part of his body for almost three years;

(b) his left arm pain has resolved but he still has "mild discomfort" of the left hand;

(c) he has constant pain in his lower back with exacerbations of worse pain which is relieved by medication and rest. He has radiating pain down his left and right left the former worse than the latter;

(d) he had epigastric pain weekly, relieved by Nexium and Gaviscon. This has been investigated with endoscopy and colonoscopy, and he has been advised he is lactose intolerant, and

(e) he also reported increased urinary frequency since the back surgery.

1. On examination of the neck there was no abnormality, and Mr Haklane had a normal range of wrist and finger movement. In the back there was a scar, with some loss of movement. There was some sensory loss and reduced reflexes but no wasting.
2. Medical Assessor Truskett diagnosed an aggravation of degenerative disease of the cervical and lumbar spine and a resolved left metacarpal fracture. He found the gastro-oesophageal symptoms and carpal tunnel syndrome not related to the accident.
3. WPI was assessed as follows:

(a) cervical spine DRE I = 0%

(b) lumbar spine DRE IV (20%) less DRE II (5%) = 15%

1. The DRE IV assessment was awarded because of the multilevel structural compromise in a region of the spine, that is fractures of more than one vertebra. However, the circumstances where a DRE IV is awarded "includes spinal fusion and intervertebral disc replacement" as per cl 1.145 of the Guidelines.

RE-EXAMINATION FINDINGS - THE MEDICAL ASSESSORS

1. Mr Haklane attended the re-examination on 12 August 2025 at the Commission's medical suites. Medical Assessor Gorman was present in person, with Medical Assessor Wan participating on MS Teams. The re-examination was scheduled for one hour.

1. Mr Haklane is a 52-year-old Project Manager who works full-time from his home in Earlwood.
2. Mr Haklane admitted that as it was nearly nine years since the accident, his memory of precise events and details over the last nine years is not good.
3. Mr Haklane was asked about any pre-accident medical conditions, and he disclosed that he had previous cervical spinal pain from a motor vehicle accident in 2001. He said he had sustained a cervical spinal "whiplash" and afterwards developed back and left sided leg pain. He said that after his 2001 accident he was diagnosed as having a pars defect at L5/S1 in his lower back which he was told was the likely source of his left sided leg pain. He said that the pain from his 2001 neck injury was relatively settled at the time of the 2016 accident, but on questioning he conceded there had been remissions and exacerbations since 2001. He also confirmed a shoulder problem stemming from a fall from a quad bike in or around 2009 with an exacerbation of neck pain.
4. Mr Haklane said that he developed left leg pain and pain in his lower back after the 2001 accident. Mr Haklane reported that he had "flare ups" of back pain during the period 2009 to 2016 and that most of these were associated with his "on the tools" building work. He worked his usual job full-time as well as renovating houses and building granny flats. If he had a "flare up" he would have physiotherapy and that each of his flare ups resolved with time and treatment. Mr Haklane recalls taking analgesia medication purchased over the counter and did not recall any strong prescribed pain killers or medication and did not have any spinal procedures or have any spinal procedures recommended during this time.
5. He remembers seeing Dr Moses in 2016 before the accident and that he arranged investigations and advised him regarding exercise and treatment during this period. While he had been prescribed Lyrica before the accident as a trial he did not recall taking it before the accident. He had physiotherapy at the request of Dr Moses.
6. He has been diagnosed recently as having pre-diabetes. He had a family history of diabetes with his youngest sister and older brother having diabetes. He has not started any treatment for diabetes.

1. The accident occurred on September 2016. He was wearing a seat belt, driving his car when another car came out from a side street on the left and Mr Haklane hit this car head on. His car was not drivable afterwards.
2. He was taken by ambulance to Canterbury Hospital. Mr Haklane said his main initial concern was the cervical spine pain he felt. He had a bad whiplash from his 2001 accident and he said that injury had taken a long time to get over. He had a brace placed on his neck by ambulance personnel.
3. The claimant said he had also noticed immediate sharp pain in the base of the left thumb which was diagnosed at Hospital after X-ray as an undisplaced fracture of the thumb.
4. Mr Haklane also said he had immediate aching pain in the back and thought he had numbness in both legs at this time. He conceded he did not tell Ambulance or Hospital personnel about any lower back or limb pain as he was focussed on his neck. This was his explanation for why the back pain was not recorded in either the Ambulance or the Canterbury Hospital notes.
5. The Panel notes that the EGP clinical notes were not before the Medical Assessors at the time of the re-examination and therefore the Panel was unable to put to the claimant the absence of lower back or lumbar spine pain at his first attendance after the accident.

1. Mr Haklane said his GP referred him for physiotherapy soon after the accident for his lumbar spine and hand. The clinical notes from EGP were not available at the time of the re-examination and the Medical Assessors were unable to put to the claimant that he was referred at that time only for hand and neck physiotherapy. However, the Panel has seen the physiotherapy notes, and it is quite clear the claimant was treated for neck, hand and back symptoms from 22 September 2016.
2. Mr Haklane said he was later referred to Dr Parkinson who he saw on 28 March 2017. Dr Parkinson did not suggest surgery at this stage but ongoing physiotherapy. He also saw Dr James Yu, Pain Specialist. Mr Haklane said at this time he was having fairly constant pain which was manageable and that while he understood surgical treatment was a possibility, he wanted to avoid invasive treatment including injections for as long as possible.
3. With ongoing unremitting lower back and left leg and then right leg pain, on 27 April 2021 Mr Haklane said that Dr Parkinson suggested a two-level decompression and fusion. Mr Haklane could not afford to pay for Dr Parkinson to perform the operation. His private health fund helped him find Dr Wong whose "gap" fee was less. He had a L4/S1 lumbar interbody fusion with Dr Wong on 27 September 2021. Unfortunately, his lower back and leg pain remained "agonising" after this surgery and the numbness in both Mr Haklane's legs was worse.
4. Mr Haklane went on to have a second lumbar surgery (laminectomy and revision posterior lumbar interbody fusion) which he said improved his pain for three months although it did return. He went on to be referred to Dr Brake (Pain Specialist). He has had spinal block procedures. Dr Wong also arranged a lumbar epidural injection.

1. Mr Haklane was asked about his pain levels before and after the accident. Mr Haklane conceded that he had lower back and leg pain with symptoms into his foot from time to time before the accident, but he said he always recovered from these episodes and was able to function at home, play with this children and work in his salaried job and his home renovation projects.
2. After the accident, Mr Haklane also conceded he had some good days and some periods where his back pain was manageable but overwhelmingly he said he has had near constant pain in his lower back which has worsened in intensity, spread to his right leg and which became harder to manage with physical therapies and medication.
3. He said that he agreed to have the surgery due to the progression of his pain.
4. Mr Haklane now has pain in his low back radiating to the groin and testicles on the right more than left. The pain in the right lumbar area is worse but the numbness is more severe in the left leg. On the left pain radiates to the left hamstring and then to the calf and foot. He reports intermittent sharp pain from the lower back to the hamstring and outside of the right calf.
5. His neck pain is not significant and does not bother him. His left hand can be "numb" and sore but nothing in comparison to the other pain he reported which he relates to the fracture.
6. He reports that both hips feel painful but attributes this to pain from his back.

1. He sees a physiotherapist once per week. He also sees a therapist for acupuncture, cupping and pressure point therapy. He sees Dr Brake in the RPAH Pain Clinic. The week before this assessment he performed radiofrequency medial branch blocks at L4/5 and 6 spinal cortisone injections with limited success.
2. He has ceased seeing a psychologist.
3. He continues on:

(a) Celebrex 200mg in the morning and 100mg at night

(b) Endep 10mg at night;

(c) Palexia 50mg IR and 50mg SR - around 2 per week when pain is at its worst;

(d) Panadol 2 as required;

(e) Glucosamine/Chondroitin/Krill oil/Tumeric;

(f) Voltaren gel, and

(g) Cannabis cream.

1. He was a well looking man. His height was 180cm and his weight 91.3kg - his BMI was therefore 28 (mildly overweight). GP notes reveal this has been a long-standing issue.
2. Movements of the lumbar spine were asymmetrical as follows:

(a) flexion was three quarters normal, but extension was reduced to one half (thus dysmetria), and

(b) lateral flexion was three quarters normal on both sides.

1. Wasting and atrophy - there was no significant wasting as outlined below:

1. Reflexes - knee jerk reflexes were difficult to elicit on right and left, even with reinforcement. The ankle jerks were present and equal on both sides.
2. Power - power in all muscle groups was normal (five out of five).
3. Sensation - there were subjective complaints of a reduction of sensation in the whole of the left leg. On the dorsum and lateral left foot there was more "numbness" reported on objective testing. There was also reduced sensation over the dorsum of the right foot reported. Overall, there was no consistent dermatomal loss of sensation.
4. Nerve root tension signs - the sciatic stretch testing was negative.
5. There was a depressed 9cm scar which was mildly pigmented and widened with suture marks visible over the lower lumbar spine where the claimant had his two surgeries.

1. There was a normal range of pain-free movement in all planes.
2. Power, sensation and reflexes in the upper limbs was normal. There was no wasting present and limb circumference was equal on both sides above and below the elbow. There were no signs of nerve root impingement.

1. Left and right hands were normal on examination - there was no tenderness or other abnormality in the left hand and no loss of motion in the thumb, fingers, wrists and elbows.

1. Mr Haklane has what can be described as "failed back surgery syndrome" in that he has ongoing pain despite significant interventions. There is however no residual radiculopathy as neurologically the clinical examination was normal.

1. The claimant alleges he injured his lumbar spine in the accident and that this injury materially contributed to the need for the lumbar spine surgeries that occurred in 2021 and 2022. The insurer notes that the claimant had a long-standing history of lower back complaints before the accident and that whatever lumbar spine injury the claimant may have sustained in the accident, it did not materially contribute to the need for the surgery.
2. Causation of injury involves determining whether the motor accident could have caused or materially contributed to the injury (a medical matter) and whether the insurer did in fact cause or contribute to the injury (a factual matter).
3. The Medical Assessors have considered the circumstances of the accident. The claimant's vehicle t-boned another car that had failed to give way at the not insignificant speed of 50kms per hour. The claimant's car was not drivable, and was written off (as was the other car). The forces involved were sufficient to cause a fracture (albeit undisplaced) in the left thumb and immediate symptoms of a whiplash injury in the neck. The Medical Assessors are satisfied that the circumstances of this motor accident could have caused a lumbar spine injury particularly in someone with an already injured and vulnerable spine such as the claimant.
4. The question remains whether the accident did in fact cause or materially contribute to the injury. It is not disputed that the claimant had a pre-existing lumbar spine condition. His bilateral pars intra-articularis defects at L5 are reported in radiology from October 2009. These defects allowed a spondylolisthesis (slipping forward of the L5 vertebra on top of the S1 vertebra) to occur. When first reported, this was described as a mild grade 1 slippage. In addition, the claimant had a broad-based disc protrusion at L4/5 identified in January 2012. In February 2014 the claimant's L4/5 and L5/S1 discs were compressed when scanned. In April 2014 and March 2016 scans showed foraminal stenosis at L5/S1 on both sides.
5. There is also no disputing that the claimant had episodes of lower back pain between 2009 and the date of the accident in September 2016 which were investigated by specialists, and which were the subject of treatment.
6. Mr Haklane said that in the four months leading up to the accident his lower back was not symptomatic, and he was not having treatment. There is certainly no evidence of lower back complaints in the GP notes after May 2016 and there are no attendances on his usual physiotherapist (SOS physiotherapy) from December 2015 until after the accident. Sydney Spine and Pelvis notes confirm four attendances in April and May 2016. While there is no record of the claimant complaining of lower back symptoms to ambulance, hospital or his GP within the first week of the accident, the claimant says he had pain, and he did have treatment for low back symptoms from his usual physiotherapist from 22 September 2016.
7. At the attendance on his GP on 5 October 2016 and in his claim form, the claimant reported back complaints.
8. The Panel accepts the explanation from the claimant that he was focused on his neck pain in the period immediately after the accident and that Mr Haklane was not concerned with the development of lower back complaints in the light of his previous history. The Panel is satisfied that the claimant did sustain an injury to his lower back in the motor accident.

What is the diagnosis of the claimant's lower back injury?

1. It is the clinical judgment of the Medical Assessors on the Panel that the claimant's lower back injury is an aggravation of a pre-existing L5/S1 spondylolisthesis with the development of worsening lower back and radicular pain.
2. The spondylolisthesis means that the L5 vertebrae was not securely attached to the S1 and was vulnerable to further injury (and further slippage) from both minor and major events.
3. The spondylolisthesis was present before the accident. The Medical Assessors are of the view that the totality of the previous records indicate that this condition was symptomatic but intermittently so. There were certainly flare ups, but between these flare ups, the claimant says there was no treatment and this is supported by the records.
4. The Medical Assessors have carefully considered whether the accident caused a temporary worsening of pain which, in medical terms, would usually be described as an exacerbation of an injury or whether the accident caused a permanent worsening of pain and disability which in medical terms is known as an aggravation injury. Noting the claimant's history, the physiotherapy notes, GP clinical notes and specialist records (and the prescription of medication after the accident), the Medical Assessors are, in their clinical judgment, of the view that the spondylolistheses has become more constantly symptomatic since the accident and that Mr Haklane has experienced an aggravation rather than an exacerbation as a result of the accident.

Was the surgery related to the injury caused by the accident?

1. The insurer is not under a duty to pay for the treatment in dispute if it does "not relate to the injury resulting from the motor accident". Proceedings concerning treatment disputes do not concern the assessment of whole person impairment therefore the provisions about causation of impairment in the AMA4 Guides and the Motor Accident Permanent Impairment Guidelines (the Guidelines) do not determine the issue currently before the Panel.
2. The Panel notes the decision of AAI Limited t/as AAMI v Phillips[17] where the test of causation of surgical treatment was determined in a MAC Act matter where the claimant had three motor accidents. The court said:

"[28] The requirement in s 58(1)(b) is to determine whether the treatment relates to the injury caused by the accident. If the injury that existed at the time of the Panel's assessment was not the injury caused by the accident (the mild soft tissue injuries superimposed on the chronic degenerative changes) but, rather, simply the continuation of those pre-existing degenerative changes, then the treatment cannot relate to "the injury caused by the motor accident".

[29] I accept the plaintiffs' submission that for any of the three motor accidents to have been causative of the need for the suggested surgery, the accident would have to have made at least a material contribution to the need for surgery[18]. Further, the Panel should have considered whether the proposed surgery would not have arisen but for the occurrence of one or more of the accidents being considered." [emphasis added]

1. The Panel notes that the insurer has argued that there was no change in the pathology shown on the radiology from before the accident to the radiology undertaken in March 2017.
2. Firstly, the Medical Assessors note that the measurement of the spondylolisthesis or slippage reported in the radiological reports has varied over time. It was 6mm in February 2014, 8mm in April 2014, 7mm in March 2016 and 4mm in March 2017. These measurements are heavily dependent on the operator and the radiologist. Experts and treating doctors have commented that there has been no change in the degree of slippage.
3. The change in grading from grade 1 in radiology before the surgery to Dr Wong's operation note suggesting a grade 2 spondylolisthesis is not of great significance to the Medical Assessors. Grade 1 means a slip of less than 25% in the width of the vertebrae and grade 2 a 25-50% slip. Dr Wong's assessment in his operation report may or may not have been correct but in the clinical judgment of the Medical Assessors, he could only have been certain if he did lateral X-rays intraoperatively and there is no evidence of that.
4. In any event, the grade of slippage alone is not determinative of the need for the operation. The operation was performed for ongoing pain and radicular symptoms in the presence of a spondylolisthesis (slippage).
5. Secondly the Medical Assessors note that the insurer has argued that Dr Parkinson recorded no neurological signs of radiculopathy in his report of 18 May 2017. It is the clinical judgment of the Medical Assessors that surgery such as that performed on the claimant's spine is appropriate treatment to alleviate unremitting lumbar and radicular pain. Radicular or radiating pain is not a sign of radiculopathy (as per the Permanent Impairment Guidelines) but is a sign or symptoms of nerve root compromise and injury.
6. It was the aggravation of the claimant's spondylolisthesis that led to a permanent worsening of the claimant's lower back and leg pain. It is the clinical judgment of the Medical Assessors that it was this worsening that led to the need for surgery.
7. The Panel is therefore satisfied that the claimant's 2016 motor accident was a material contribution to the 2021 surgery and also the 2022 surgery (which was required to address ongoing issues likely caused by the first surgery).
8. The Medical Assessors note that pars intra-articularis defects and spondylolisthesis are not uncommon and do not always lead to symptoms severe enough for surgery. The Medical Assessors are of the view that if no other injuries, accidents or incidents had occurred, that "but for the accident" Mr Haklane would not have necessarily proceeded to surgery in 2021 and 2022. The Panel does note however the active lifestyle that Mr Haklane led and his building and renovation work. If this level of activity had continued the Medical Assessors are of the view that this could have led to further exacerbations or aggravations which might then have resulted in a need for the surgery.

Was the surgery reasonable and necessary in the circumstances?

1. In Diab v NRMA Ltd[19] at [88] the following factors were found to be relevant to, but not determinative of the criteria of reasonableness in the workers compensation scheme:

(a) the appropriateness of the treatment in dispute;

(b) the availability of alternative treatment;

(c) the cost effectiveness of the treatment;

(d) the actual or potential effectiveness of the treatment, and

(e) the acceptance by medical experts of the appropriateness of the treatment.

1. While related to a different scheme and another test (in workers compensation the test is whether treatment is "reasonably necessary"), the Panel considers these criteria are relevant to our decision of whether Mr Haklane's surgery is "reasonable and necessary".
2. The words "in the circumstances" in the context of whether the treatment is "reasonable and necessary" must refer to the particular circumstances of the claimant in the proceedings before the Panel.
3. The claimant had exhausted conservative measures including medication, physiotherapy and injections. It is the clinical judgment of the Medical Assessors that in the presence of ongoing constant pain the surgical treatment recommended by Dr Parkinson and performed by Dr Wong was appropriate. At the time the surgery was proposed its potential effectiveness was to reduce or eliminate pain. Its actual effectiveness has led to a reduction in some symptoms but no reduction in others. The treatment was certainly cost effective (for the motor accident insurer) because the claimant's private health insurer paid for it.
4. The Panel is therefore of the view that the surgical treatment in 2021 was reasonable and necessary in the circumstances. The revision surgery in 2022 was also reasonable and necessary in the circumstances, that is the presence of ongoing burning pain and the likelihood this was caused by scarring from the first surgery.

1. In summary it is the finding of the Panel that:

(a) Mr Haklane injured his lumbar spine in the September 2016 accident;

(b) he sustained an aggravation injury of pre-existing spondylolisthesis;

(c) unremitting pain from this aggravation caused the need for surgery;

(d) the surgery is related to the accident and but for the accident would not have been needed, and

(e) the surgery is reasonable and necessary treatment for unremitting radicular back pain.

1. As the Panel has come to the same conclusion as Medical Assessor Bodel it follows therefore that his certificate should be confirmed.

[1] The currently net weekly amount is $5,998.

[2] Sections 61, 62 and 63 of the MAC Act.

[3] The numbers in square brackets are a reference to the section number in the Medical Assessor's reasons.

[4] The numbers in square brackets are a reference to the paragraph number in the submissions.

[5] It is found at page 140 of the insurer's additional bundle filed on 21 August 2025.

[6] Page 33 of the claimant's joint bundle.

[7] Dr Parkin's letters and reports are found at pages 266 - 285 of the claimant's joint bundle.

[9] Page 187 of the insurer's 21 August 2025 bundle.

[10] Page 223 of the claimant's 21 August 2025 bundle.

[11] Page 74 of the claimant's 21 August 2025 bundle

[12] Page 65 of the claimant's 21 August 2025 bundle.

[13] Page 216 and 314 of the claimant's bundle.

[14] Page 285 of the claimant's bundle.

[15] Page 166 of the insurer's 21 August 2025 bundle.

[16] Page 275 of the claimant's bundle.

[17] [2018] NSWSC 1710.

[19] [2014] NSWWCCPD 72 (Diab).