MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC) under section 7.26; dispute regarding degree of permanent impairment resulting from physical injuries; lumbar spine and pelvic fractures referred for assessment; Medical Assessor certified that injuries caused by accident resulted in permanent impairment of 4%, being not greater than 10%; claimant examined; no issues of principle; Held - Review Panel satisfied claimant's injuries of lumbar spine and pelvic fractures were caused by the accident; Review Panel assessed a degree of permanent impairment resulting from those injuries to be 6% for the purposes of the Act, which is not greater than 10%; MAC revoked.

Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. revokes the certificate of Medical Assessor Alexander Woo dated 18 August 2025, and
2. certifies that the injuries of lumbar spine - soft tissue injuries and pelvis - fractures caused by the accident give rise to a permanent impairment of 6%, which is not greater than 10% for the purposes of the Motor Accident Injuries Act 2017.

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

1. On 6 February 2023, Sim Wah Lew (claimant) was involved in a motor vehicle accident where he was struck by the tailgate of a truck while at work (accident).
2. Mr Lew has made a claim for damages under the Motor Accident Injuries Act 2017 (MAI Act) on Allianz Australia Insurance Limited (insurer).
3. A dispute has arisen between Mr Lew and the insurer as to whether his physical injuries give rise to a degree of permanent impairment which is greater than 10% for the purposes of the MAI Act. This dispute has been referred to the Personal Injury Commission (Commission) for assessment.
4. On 18 August 2025, Medical Assessor Alexander Woo issued a certificate certifying that the injuries of lumbar spine - soft tissue injuries and pelvis - fractures give rise to a permanent impairment of 4%, which is not greater than 10% for the purposes of the MAI Act
5. The claimant lodged an application with the Commission seeking review of Medical Assessor Woo's decision. On 7 October 2025, a delegate of the President of the Commission was satisfied there was reasonable cause to suspect the medical assessment was incorrect in a material respect and referred the application to a review panel.
6. This review panel (Panel) has been constituted to conduct a review of Medical Assessor Woo's certificate dated 18 August 2025 (Review).

1. The claimant's claim and corresponding entitlements are governed by the MAI Act.
2. Relevantly, the claimant's entitlement to damages for non-economic loss is governed by Division 4.3. Sections 4.11 and 4.12 provide:

"4.11 No damages for non-economic loss unless permanent impairment greater than impairment threshold

No damages for non-economic loss may be awarded in respect of injury unless the degree of permanent impairment of the injured person as a result of the injury caused by a motor accident is greater than 10%.

4.12 Assessment of permanent impairment required if dispute over impairment threshold

(1) If there is a dispute about whether the degree of permanent impairment of an injured person is sufficient for an award of damages for non-economic loss, damages may not be awarded unless the degree of permanent impairment has been assessed by a medical assessor under Division 7.5.

Note - The assessment of the medical assessor is conclusive in proceedings before a court or the Commission - see section 7.23. Section 7.20 authorises a court, the Commission or party to a dispute, to refer the dispute about the degree of permanent impairment to the Commission for assessment by a medical assessor.

(a) the degree of impairment from being re-assessed under Division 7.5, or

1. Division 1.2 of the MAI Act regards interpretation and relevantly provides, in s 1.7:

"1.7 Determination of threshold degree of permanent impairment of injured person who suffers both physical and psychological/psychiatric injuries

(1) This section applies for the purposes of a determination under this Act of whether the degree of permanent impairment of an injured person as a result of an injury caused by a motor accident is greater than 10% (the impairment threshold).

(2) If an injured person receives both a physical injury and a psychological or psychiatric injury arising out of the same motor accident -

(a) the degree of permanent impairment that results from the physical injury is to be assessed separately from the degree of permanent impairment that results from the psychological or psychiatric injury (and accordingly those separate degrees of injury are not to be added together for the purposes of the impairment threshold), and

(b) the injured person is taken to have a degree of permanent impairment greater than the impairment threshold if either the degree of impairment caused by physical injuries or the degree of impairment caused by psychological or psychiatric injuries is greater than 10%.

Note - If there is more than one physical injury those injuries will still be assessed together as one injury, but separately from any psychological or psychiatric injury. Similarly, if there is more than one psychological or psychiatric injury those psychological or psychiatric injuries will be assessed together as one injury, but separately from any physical injury."

1. Section 7.21 of the MAI Act provides for the assessment of degree of permanent impairment for the purposes of the MAI Act. It states:

(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.

(2) Impairments that result from more than one injury arising out of the same motor accident are to be assessed together to assess the degree of permanent impairment of the injured person.

(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.

(4) A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent."

1. Accordingly, while Mr Lew is alleged to also have psychological injuries resulting from accident, these injuries will not be considered by the Panel in determining Mr Lew's degree of permanent impairment regarding his physical injuries.
2. The Motor Accident Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. Version 10.1 of the Guidelines is effective from 12 December 2025 and replaced version 10, except for claims arising from accidents before 1 April 2023.[1] For such accidents, such as the current accident, certain clauses do not apply, and specific clauses from version 9 of the Guidelines continue to apply.
3. Part 6 of the Guidelines is based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA4 Guides). However, cl 6.2 of the Guidelines note that Part 6 has some very significant departures from the AMA4 Guides and that Part 6 is definitive regarding the matters it addresses. Where it is silent on an issue, the AMA4 Guides should be followed.

1. Part 7 of the MAI Act regards dispute resolution. Division 7.5 regards medical assessment disputes, such as the current matter.
2. Section 7.26(5A) of the MAI Act provides that the review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission.
3. The review of the medical assessment is not limited to a review of only that aspect that is alleged to be incorrect and is to be by way of a new assessment of all matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act. The function of the Medical Assessor is to form his or her own opinion on the medical question in dispute by reflecting on the panel members' professional judgment and medical expertise; it is not to choose between competing opinions, nor to assess the correctness of such opinions.[2]
4. Part 5 of the Personal Injury Commission Act 2020 (PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a panel reviewing a decision of a Medical Assessor: s 41(2) PIC Act. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5. A review panel determines how it conducts and determines the proceedings.

1. On 13 October 2025, this Panel was constituted. On 15 October 2025, the Panel made directions for provision of a bundle of documents and written submissions from each of the parties for the purposes of the Review.
2. On 2 December 2025, the Panel met to discuss the proceedings and determined that a medical examination of the claimant was required. Mr Lew was advised of the arrangements. The Panel also directed that any further submissions regarding the lumbar spine be lodged and served by 9 December 2025, noting that pursuant to s 7.26(6) of the MAI Act, the Review is not limited to a review of only that aspect of the assessment that is alleged to be incorrect but is a new assessment of all matters with which the medical assessment is concerned.
3. On 14 January 2026, Medical Assessor Gorman examined Mr Lew on behalf of the Panel. Medical Assessor Gorman prepared a report of this examination, which was provided to Senior Medical Assessor Dixon and Member Montgomery-Hribar. Medical Assessor Gorman's medical examination report appears in full later in these reasons.
4. On 10 February 2026, the insurer confirmed that it did not wish to rely on further submissions in respect of the lumbar spine.
5. On 13 February 2026, the Panel convened for a second time to discuss the medical examination undertaken by Medical Assessor Gorman and to make its determination.

1. On 15 August 2025, Medical Assessor Woo examined Mr Lew and issued a certificate dated 18 August 2025. Medical Assessor Woo was required to assess the degree of permanent impairment arising from Mr Lew's accident caused injuries in accordance with the MAI Act.
2. Medical Assessor Woo noted that the following injuries were referred to be assessed in respect of the degree of permanent impairment:

(a) lumbar spine - aggravation of spondylosis causing left L4 and L5 radicular pain, and

(b) pelvis - sacral fracture with displacement; right iliac fracture with displacement; left iliac fracture with displacement.

1. Medical Assessor Woo examined Mr Lew in the presence of an interpreter. His pre-accident medical history and personal details were noted, as was the history of the motor accident and his symptoms and treatment following the accident. It was noted that Mr Lew had occasional back pain prior to the accident but did not require any treatment, and he was asymptomatic at the time of the accident. He had no previous pelvic injury. Medical Assessor Woo's clinical examination findings have been considered and evaluated.
2. In his determination, Medical Assessor Woo noted that Mr Lew reported to have had satisfactory recovery from his injuries caused by the accident. He has some discomfort in his pelvis on prolonged walking. He has occasional lower back pain. He has no radicular complaints in his legs. He has no problem truck driving, but has ceased lifting more than 20kg.
3. On examination, it was noted by Medical Assessor Woo that there was no tenderness, spasm or guarding in the lumbar spine. Range of movement was normal. There was no dysmetria. Straight leg raising was 90 degrees on both sides. Sciatic nerve root tension signs were negative. There were no non-verifiable radicular complaints, and no muscle guarding.
4. Reflexes of both lower limbs were normal and symmetrical. There was no weakness or atrophy. There was normal sensation in both lower limbs. There were no signs of lateral cutaneous nerve of thigh compression.
5. In respect of the lower extremity, there was no leg length discrepancy. Trendelenburg sign was negative on both sides. He has normal gait including walking on tip toes and heels, there was normal alignment of the pelvis, there was minimal tenderness over the iliac crest on both sides. There was no tenderness over the pubic symphysis and sacroiliac joint on both sides. Lateral compression of the pelvis was non-tender. There was no joint line tenderness over both hips. Range of movement was normal and symmetrical in both hips. There was normal range of movement in both knees and ankles.
6. Medical Assessor Woo summarised the parties' submissions and evidence referred to therein. He also undertook a document review and summarised his pre- and post- accident medical records and radiological imaging results.
7. Medical Assessor Woo noted Dr Molnar's diagnosis of Zone 1 sacral fracture on the left side associated with a crescent to the ilium, left superior pubic ramus fracture, left inferior pubic ramus fracture, right iliac crest complex fracture, and sacroiliac joint injury. The Medical Assessor opined that this diagnosis is "most accurate and appropriate". It was noted that all the fractures in the pelvis are without displacement except the right iliac crest which is complex and displaced. Medical Assessor Woo also opined that Mr Lew had lumbar spine soft tissue injury with aggravation of pre-existing degenerative change.
8. Medical Assessor Woo opined that the injuries were caused by the accident.
9. In respect of permanent impairment, Medical Assessor Woo opined 0% due to the lumbar spine, being DRE Category II, noting a history of injury without radiculopathy or non-verifiable radicular complaints, no asymmetry of movement and no guarding. In respect of the pelvic fractures, Medical Assessor Woo opined 4% noting AMA 4 Guides, page 131, Table 3.4, opining:

(a) sacral fracture: 0% WPI, noting healed fracture without displacement on the left side associated with a crescent to the ilium;

(b) left superior pubic ramus fracture: 0% whole person impairment (WPI), noting healed fracture without displacement or residual signs;

(c) left inferior pubic ramus fracture: 0% WPI, noting healed fracture without displacement or residual signs;

(d) right iliac crest complex fracture: 2% WPI, noting healed fracture with displacement and deformity;

(e) left iliac crest facture: 2% WPI, noting healed fracture with displacement and deformity, and

(f) sacroiliac joint injury: 0% WPI, noting healed fracture without displacement or residual signs.

1. Accordingly, Medical Assessor Woo opined 4% permanent impairment caused by the accident.

1. The insurer relies on written submissions dated 23 September 2025[3] and 2 April 2025. Contrary to the Panel's directions, the insurer did not put on submissions directed to the Panel and seeks to rely on more than one set of submissions. Further, the insurer's submissions dated 23 September 2025 at paragraph 7.2 refer to reserving the right to make further submissions in respect of the lumbar spine. On 2 December 2025, the Panel directed that any further submissions in respect of the lumbar spine should be lodged and served by 9 December 2025. No further submissions were received. On 10 February 2026, the insurer confirmed that it did not wish to rely on further submissions in respect of the lumbar spine.
2. The insurer submits that it appears the claimant relies on what appears to be a typographical error where, on page 6, Medical Assessor Woo comments "All the fractures are without displacement except the right iliac crest which is complex and displaced". The insurer apprehends this should have read "All the fractures are without displacement except those to the iliac crest (both sides)". This is because, in Medical Assessor Woo's assessment of whole person impairment, he found that both the right and left iliac crest fractures had displacement and assessed each at 2%.
3. The insurer submits that the claimant underwent a pelvic manipulation under anaesthetic on 10 February 2023, where the operative findings were:

"There was no gross pelvic instability. Certainly, the sacroiliac joints appeared symmetrical. The iliac crest fracture on the right hemipelvis was also stable. His pelvic ring injury on the left side was also not mobile".

1. The insurer submits that, in respect of the sacroiliac joint, there is no evidence of a fracture or displacement, and that a finding of 0% WPI is correct.
2. The insurer submits that the dispute centres around whether the undisputed fractures within the pelvis were displaced or not. The insurer further submits there is agreement that Mr Lew sustained the following fractures within the pelvis:

(a) left superior pubic ramus;

(b) left inferior pubic ramus;

(c) right iliac crest complex fracture, and

(d) sacral fracture on the left associated with a crescent to the ilium.[4]

1. The insurer submits that the claimant only refers to a CT of the pelvis dated 6 February 2023 and an X-ray dated 20 May 2023, and that they do not have regard to the totality of the scans of the pelvis.
2. The insurer's submissions summarise the radiology reports regarding the pelvis and then summarise Medical Assessor Woo's diagnoses and examination of the pelvis.
3. The insurer submits that there was no fracture of the sacroiliac joint as there is no reference to this in the radiology. The insurer refers to the X-ray dated 27 January 2024 and further submits that, in any event, given the findings that it was not displaced, the finding of 0% WPI would be correct if there was a fracture, and therefore this makes no difference.
4. In respect of the lumbar spine, the insurer submits that Medical Assessor Woo commented on the finding of Dr Kwong on page 6, that the reported clinical signs of the lumbar spine had subsided one year after Dr Kwong's assessment. The insurer submits that Medical Assessor Woo's findings that the lumbar spine give rise to 0% would be accepted.
5. The insurer further submits that, on the claimant's medical evidence, the pelvic fractures at best represent 6% WPI, therefore the finding of WPI is still not greater than 10%.

1. Mr Lew relies on written submissions dated 28 October 2025. In sum, Mr Lew submits Dr Kwong's assessment in his report dated 1 August 2024 is correct.
2. Mr Lew says he was asymptomatic at the time of the accident.
3. He says he was struck by the tailgate of a truck while at work. He fell to the ground and was unable to move with pain all over his body and back. An ambulance was called and he was taken to hospital.
4. Mr Lew submits that, at hospital, he was diagnosed with a left sacral fracture, right iliac crest fracture, superior pubic ramus fracture, inferior pubic ramus fracture, and sacroiliac joint injury. He was treated with traction.
5. Mr Lew submits that his treatment included:

(a) manipulation under general anaesthetic;

(b) attendance on Dr Kulkani, where he demonstrated back pain and numbness over the left anterior thigh in a lateral femoral cutaneous nerve distribution and buttock pain;

(c) physiotherapy and exercises, and

(d) painkillers.

(a) complaints of altered sensation in both legs in 3/23, with performance of a CT showing significant canal stenosis in the lumbar spine, and

(b) back pain with bilateral thigh numbness, which improved but did not resolve.

1. Mr Lew submits that he has returned to duties with a lifting restriction.
2. Mr Lew submits that his treating surgeon, Dr Molnar, has made the correct diagnosis, being:

(a) zone 1 sacral fracture on the left, associated with a crescent to the ilium;

(b) left superior pubic ramus fracture;

(c) left inferior pubic ramus fracture;

(d) right iliac crest complex fracture;

(e) sacroiliac joint injury, and

(f) lumbar spine soft tissue injury with aggravation of pre-existing degenerative changes.

1. Mr Lew submits that Dr Molnar's records demonstrate that he considered:

(a) the inferior ramus was minimally displaced - letter dated 10 February 2023;

(b) the pelvic ring fractures remain displaced - letter dated 2 March 2023, and

(c) that fractures remain displaced - letter dated 23 March 2023.

1. Mr Lew relies on the CT of the pelvis dated 6 February 2023, which indicates there is a displaced fracture of the right iliac wing and left posterior ilium, and the X-ray dated 20 March 2023, which shows "a moderate degree of separation" at the superior margin of the spine.
2. Mr Lew submits that, in respect of his spine, examination shows he has chronic back pain with an asymmetrical restriction in the range of movement. He submits there was no guarding present in August 2024. He further submits that a CT scan of the lumbar spine in March 2023 showed probable impingement of both L4 and L5 nerve roots and an MRI of April 2023 demonstrated compression of the cauda equina nerve roots, with moderate foraminal stenosis bilaterally abutting L4 and L5 nerve roots.

1. Mr Lew and the insurer have each provided a bundle of documents consisting of the evidence and submissions they rely upon for the purposes of the Review.
2. In conducting this medical review, the Panel has sought to follow and implement the words of Justice Basten in Rahman v Insurance Australia Ltd (t/as NRMA Insurance) [2022] NSWSC 1079, where his Honour noted, at [63], that the Court of Appeal has remarked on the volume of material routinely provided to medical assessors, and noted there is no general law principle requiring an assessor to refer to all the documentation to they have access.
3. Accordingly, and in endeavouring to carry out its statutory function and promote the objects of the legislation under which it operates and guiding principles, the Panel has not referenced or summarised all records relating to the claimant's symptoms or injuries.[5] If some of those medical records or reports are not referred to in the Panel's review, it should not be assumed that the Panel was unaware of that medical material or that the Panel failed to take the material into account.

1. In Mr Lew's application for personal injury benefits 1 March 2023, he describes the accident as "I was hit by the tailgate of a moving truck at work".
2. In respect of the injuries he received as a result of the accident, he notes "back, hip fracture, butt, left leg fracture".
3. Mr Lew has listed "back pain" in response to the question asking whether he was suffering an illness or injury affecting the same or similar parts of his body at the time of the accident.

1. The letter from Mr Lew's legal representatives to the insurer dated 26 September 2024 serves a copy of the report of Dr Terry Kwong dated 1 August 2024 and requests the insurer concede that Mr Lew's condition has stabilised, and that he has a permanent impairment exceeding 10%.
2. The letter from the insurer to Mr Lew dated 16 December 2024 states that the insurer does not agree his permanent impairment is greater than 10%.

1. The medical record from Ambulance NSW dated 6 February 2023 notes the final assessment as "(P) joint pain; (S) laceration".
2. It records that the ambulance attended:

"At workplace for a workplace accident ... directed to pt laying prone on ground next to truck, alert, responsive, ... bystanders and pt state that pt was standing at side of truck when a second truck with tailgate lowered revered into him at low speed, momentarily pinning him at pelvic height between the two vehicles. The second truck then moved and pt collapsed to the ground with immediate pain to the pelvic area. Pt has not rolled supine since this time".

1. The secondary survey notes "Pelvis pain described as aching; Sacral Spine altered sensation numbness; Pelvis altered sensation numbness; Left & Right hip laceration superficial; normal movement; grips strong bilaterally; speech normal".

1. The report of NSW Police dated 6 February 2023 notes police responded to a work place accident where a truck has hit a pedestrian. The narrative details continue:

"As police arrived at the location, police observed the Pat to be lying on the floor next to a truck with Ambulance officers assisting the Pat. The Pat looked as though he was in a lot of pain and was grunting each time the paramedics would move him. Police spcke with Driver 1 and stated that the Vic [sic] was initially standing at the rear of another truck that was parked next to Veh 1. Driver 1 then drove off with his tail gate down. As Driver 1 has driven away, he heard someone yell out. Driver 1 has gotten out of the truck to find the Pat lying on the floor. Driver 1 did not see anyone in his rear view mirrors when he drove off."

1. The clinical records of Westmead Hospital printed on 14 March 2024 have been considered.
2. The clinical notes record that Mr Lew was admitted on 6 February 2023 and discharged on 14 February 2023.
3. The notes record Mr Lew was standing perpendicular to truck loading bed when a second vehicle backed up to him, pinning him between two vehicles. The second vehicle was able to stop immediately. Paramedics gave morphine and secured Mr Lew's hip with compression. His pain was noted to be 4/10.
4. The presenting complaint states:

"Patient BIBA after being pinned between 2 trucks for approx 5 sec at workplace. Right truck was moving, left truck was stationary with tailgate out. Patient was pressed against the tailgate. Reports right sided pelvic pain. Nil headstrike, LOC or amnesis. Nil reported limb weakness. Nil C spine pain".

1. He was noted to present with "lateral compression type injury pelvis. CT demonstrating LEFT LC2 pelvic ring with crescent sign and comminuted right iliac crest fracture".
2. On assessment, it was noted:

"In pelvic binder, limbs tied in position of IR; right sided pelvic ring tender, no left sided or SIJ tenderness; Bilateral lower limbs NVI; No further injuries on secondary survey; XR; comminuted right iliac crest fracture; possible widening right SIJ; right root SPR fracture".

1. The Trauma Consult undertaken on 6 February 2023 notes:

"Neck - no neck tenderness, ROM intact (c spine cleared)

Chest - no chest wall tenderness / brusin g/ subcut emphysema

Abdomen - superficial abrasian epigastric region, abdomen soft non tender

UL - mild superficial abraision R elbow, no bony tenderness, ROM intact

LL - no bony tenderness, ROM intact, neurovasc intact

log roll - no midline / parapinal tenderness, perianal sensation intact, L gluteal swelling, no scapula tenderness".

1. The Theatre Procedure undertaken on 10 February 2023 notes no fixation hardware was seen on the three images provided. The X-ray of the pelvis undertaken on 6 February 2023 notes "Both hip joints good alignment. Comminuted fracture right ilium. Linear fractures proximal left superior pubic ramus".
2. The CT abdomen pelvis with contrast undertaken on 6 February 2023 concludes "comminuted slightly displaced fractures right iliac wing. Adjacent haematoma. Comminuted fracture left superior pubic ramus. Comminuted minimally displaced fracture left posterior ilium. Right sided retroperitoneal haematoma".
3. The X-ray chest undertaken on 6 February 2023 and X-ray pelvis undertaken on 6 February 2023 notes a comminuted right iliac wing fracture, with no further fracture or dislocation identified. Proximal right and left femora appear normal. Pelvic bowel gas pattern appears unremarkable. The cardiomediastinal contour is within normal limits. Lungs are clear. No supine pneumothorax.
4. The issues are noted to be "Pelvic ring crush injury. Right iliac wing fracture, left superior pubic ramus fracture, left posterior ilium fracture; stable, managed with MUA; pain is well controlled pre and post operatively; for follow up with XRs at 2 weeks".
5. The operation report created on 6 February 2023 notes the planned procedure to be " (a) Intermittent back pain

(b) Intermittent pain and numbness radiating from his back to his left leg;

(c) Pelvic and buttock pain with lifting;

(d) Sitting tolerance of one hour;

(e) Standing tolerance of 30 minutes, and

(f) Walking is not restricted at his own pace.

1. Current medications were noted to be Panadol on an as necessary basis.
2. On examination, it was noted his gait was normal. His cervical spine had a good range of movement. The joints of the upper limbs were normal. His lumbar spine flexion was 60º and extension was 10º. Lateral flexion was 10º to the left and 12º to the right. He was tender over his left lumbar paraspinal muscles and there was increased resting muscular tension. Straight leg raising was negative. There was no focal neurological deficits in his lower limbs. The diameter of both thighs was 45cm. The diameter of both calves was 36cm. Both hips had good range of motion. Both knees had range of motion of 0º to 130º. There was no effusion in either knee. Both ankles had good range of motion. The power, tone and reflexes were normal. His general examination was normal. His heart sounds were dual. His chest was clear. His abdomen was soft and non-tender.
3. The radiology reports and medical records were reviewed by Dr Kwong.
4. Dr Kwong diagnosed the following:

(a) sacral fracture;

(b) right iliac wing fracture;

(c) left superior pubic ramus fracture;

(d) left posterior ilium fracture;

(e) aggravation of spondylolisthesis causing left L4 and L5 radicular pain;

(f) retroperitoneal haematoma-this is outside my area of expertise;

(g) right iliac haematoma, and

(h) left gluteal haematoma.

1. Dr Kwong noted Mr Lew's prognosis is reasonable. Dr Kwong opined that the injuries diagnosed were caused by the accident. Dr Kwong opined Mr Lew is fit for his current duties and hours. It is opined that no surgery is proposed or required.
2. In respect of permanent impairment, Dr Kwong opined 5% in respect of the lumbar spine, noting this is based on DRE method as there was a history of injury. Dr Kwong opined Mr Lew fulfils DRE lumbosacral category II, noting chronic back pain with asymmetrical restriction in range of motion. He has localised tenderness and increased resting muscular tension in his left lumbar paraspinal muscle consistent with guarding. He has left L4 and L5 radicular pain. He does not fulfil the criteria for radiculopathy to qualify for DRE III. He is independent with self care but has restriction with household and recreational activities. He had underlying degenerative spondylolisthesis but he was asymptomatic and was able to work full time in a physically demanding job as a truck driver. Dr Kwong opined no deductible proportion.
3. In respect of permanent impairment arising from the pelvic fractures, it was noted that this assessment was based on Table 3.4 of the AMA4 Guides. Dr Kwong opined 6%WPI consisting of:

(a) 2% WPI based on the sacral fracture with displacement of
(b) 2% WPI based on the right iliac fracture with displacement of
(c) 2% WPI based on the left iliac fracture with displacement of
(d) 0% WPI based on the single pubic ramus fracture.

1. On 14 January 2026, Mr Lew was assessed in person by Medical Assessor Gorman at the Commission Medical Suites.

1. Mr Lew attended with an interpreter Xingyu Chen (CPN7TRO2D).

1. Mr Lew is a 56-year-old man who has returned to work as a truck driver after the accident.
2. He has different duties now and cannot do heavy lifting but otherwise is working as a truck driver.
3. He was previously well. He had no problems with his health in the past.
4. He is married. He does not have any children.
5. He smokes 15 cigarettes per day.
6. He has two to three bottles of beer per day.

1. On 6 February 2023, Mr Lu was walking towards his assigned truck. The truck was in front on the right side of another track. The tailgate on the left sided track dropped open and hit him hard on the right side in the pelvic/hip region. He fell to the ground. He had widespread pain.

1. Mr Lew was transported to Westmead Hospital. He was diagnosed with following:

(a) left sacral fracture;

(b) right iliac fracture;

(c) superior pubic ramus fracture;

(d) inferior pubic ramus fracture, and

(e) sacroiliac joint injury.

1. He was initially treated with traction.
2. On 10 February 2023, Dr Molnar performed a manipulation under anaesthetic and found no gross pelvic instability. Traction was removed. He rehabilitated with protected weight bearing for six weeks.

1. On 23 March 2023, Dr Molnar reported some sensory change in the legs. Lumbar spine demonstrated canal stenosis in the lumbar spine.
2. Dr Lew attended upon Dr Kulkarni, who noted the ongoing back pain as well as numbness over the left anterior thigh in the lateral femoral cutaneous nerve distribution. CT and MRI scans showed degenerative change at the L5/S1 disc as well as spondylosis at the L4/5 level.
3. By 8 February 2024, when seen again by Dr Molnar, the bilateral thigh numbness had improved.
4. In February 2024, Mr Lew returned to his pre-injury duties, with no lifting more than 20kg.

1. Mr Lew reports low back pain and discomfort when walking. However, he can walk for one hour.
2. If sitting for a long time he can get some low back pain.
3. He still has left thigh numbness and he describes it as sometimes "stinging". It is sharper on the left side.
4. He is working full time. He has no trouble with cooking or shopping.

1. Mr Lew takes an occasional Panadol, up to three per day. He does not have this every day.
2. He has ceased physiotherapy.

1. His height was 173cm and weight 67.9kg. He stated that he has lost weight.
2. There was no lower limb wasting. The thigh on the right measured 37.5 centimetres and on the left measured 38.5 centimetres, with measurements taken 10 centimetres above the patella.
3. Calf circumference is 35 centimetres on the right and left, measured 10 centimetres below the cubical.
4. He has abnormal pinprick sensation over the distribution of the left lateral cutaneous nerve of the thigh. The pinprick felt sharper.
5. Lumbar spinal movements were normal in all planes. There was no dysmetria. There was no muscle guarding.
6. Power and reflexes in the lower limbs were normal. Sensation was also normal except over the left lateral thigh.
7. Sciatic stretch testing was negative.
8. Pelvic compression did not cause pain. He could stand easily on one leg at a time and could stand on tip toes and heels.

1. Medical Assessor Gorman reviewed the radiology which Mr Lew brought to the medical examination. This included the following:

(a) X-ray of lumbar spine dated 9 March 2023. This demonstrates degenerative spondylolisthesis at L4/5 due to facet joint arthritis. There was disc degeneration at L5/S1.

(b) X-ray pelvis dated 20 March 2023. This demonstrates a comminuted displaced fracture of the right iliac wing.

(c) CT scan of lumbar spine on 20 March 2023. This demonstrates degenerative spondylolisthesis at L4/5 due to severe facet arthrosis. Disc degeneration at L5/S1. Probable impingement of the bilateral L4 and bilateral L5 nerve roots.

1. The following reports were noted but the images were not available:

(a) CT scan of abdomen and pelvis on 6 February 2023. This report notes a slightly displaced (6mm) right iliac wing with an adjacent haematoma. There was a fracture of left superior public ramus (2mm) and a comminuted minimally displaced fracture of left posterior ilium (2mm) with an overlying gluteal haematoma. There was a right sided retroperitoneal haematoma. There was diffuse haematoma of right iliac muscle.

(b) Chest X-ray on 6 February 2023. This is reported to be normal.

(c) X-ray of pelvis report dated 27 February 2023. This reports a healing mid-moderately displaced fracture of the right iliac wing.

(d) X-ray pelvis report dated 3 August 2023. This reports the fracture was healed.

(e) Ultrasound left hip/thigh report dated 23 August 2023. This reports the left lateral femoral cutaneous nerve is not identified. There is no space occupying lesion or collection around the anterior hip and thigh. No hip effusion. No trochanteric bursal fluid collection.

(f) X-ray lumbosacral spine report on 27 September 2023. This reports moderate to severe lower lumbar spondylosis with degenerative related L4-5 spondylolisthesis.

(g) X-ray pelvis report dated 27 January 2024. This reports there is a partially healed fracture of the right iliac crest superiorly. No pubic ramus fracture or proximal femoral fracture is seen. The sacroiliac joints are intact with mild degenerative changes. There is mild osteophyte formation in both hips.

(a) the sacral fracture is undisplaced;

(b) the left superior and inferior pubic rami fractures are undisplaced;

(c) the iliac wing/crest fractures on right and left are displaced, and

(d) the sacroiliac joints are undisplaced. On scans available there is no evidence that the sacroiliac joint was involved in the fracture. Dr Molnar notes a zone 1 sacral fracture with crescent to the ileum. Zone 1 fractures are often either insufficiency fractures in the elderly or in younger patients high energy trauma, which is a description of what happened here. This is where the fracture line extends from the sacrum to the posterior part of the iliac wing. This is a specific type of fracture-dislocation of the sacroiliac joint.

1. Permanent impairment is determined using the methodology set out in the AMA4 Guides and Part 6 of the Guidelines. Clause 6.19 of the Guidelines provides:

"The AMA4 Guides (page 315) state that permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment. A permanent impairment is considered to be unlikely to change substantially (i.e. by more than 3% whole person impairment (WPI) in the next year with or without medical treatment. If an impairment is not permanent, it is inappropriate to characterise it as such and evaluate it according to these Guidelines."

1. It is now almost three years since the accident. Mr Lew is back at work and has minimal symptoms. He is not having any specific treatments. Medical Assessor Gorman has found that his condition is stable for the assessment of permanent impairment.
2. Hence, the Medical Assessor has made an assessment of a whole person impairment.

1. The Medical Assessor notes cl 6.8 of the Guidelines, which provides that it is critically important to clearly define the term impairment and distinguish it from the disability that may result. Clause 6.9 provides that impairment is defined as an alteration to a person's health status. It is a deviation from normality in a body part or organ system and its functioning. Hence, impairment is a medical issue and is assessed by medical means.
2. The evaluation only considers impairment as it is at the time of the assessment: cl 6.21 of the Guidelines.

1. In respect of the lumbar spine, relying on Tables 6.7 and 6.8 of the Guidelines, Medical Assessor Gorman opined DRE Category I, constituting 0% WPI. This is due to a history of injury without radiculopathy or non-verifiable radicular complaints, no asymmetry of movement and no guarding.

1. In accordance with cl 6.96 of the Guidelines, pelvic fractures must be assessed using section 3.4 (page 131, AMA4 Guides). Section 3.4 is table showing impairment values associated with selected disorders of the pelvis. Accordingly, Medical Assessor Gorman assessed the following impairment:

(a) Sacral fracture: This is discussed below under "Sacroiliac injury".

(b) Left superior pubic ramus fracture: 0% WPI. Mr Lew's left superior pubic ramus fracture is a healed fracture without displacement or residual signs. In accordance with section 3.4, this gives rise to 0% WPI.

(c) Left inferior pubic ramus fracture: 0% WPI. This is a healed fracture without displacement or residual signs. It is noted that Mr Lew submits that Dr Molnar's letter of February 2023 stated that "the inferior ramus was minimally displaced". While this letter was noted, the relevant CT scan was not brought to the Medical Examination. Accordingly, there was no radiological support for the statement that the inferior ramus was "minimally displaced". In any event, the table in section 3.4 relevantly provides that a single ramus displaced gives 0% WPI. Accordingly, regardless of whether there is displacement, the healed left inferior pubic ramus fracture gives rise to 0% WPI.

(d) Right iliac crest complex fracture: 2% WPI. This is a healed fracture with displacement and deformity. As both displacement and deformity are present, this gives rise to 2% WPI.

(e) Left iliac crest fracture: 2% WPI. This is a healed fracture with displacement and deformity. As both displacement and deformity are present, this gives rise to 2% WPI.

1. In respect of the sacroiliac joint injury, Dr Molnar describes a zone 1 sacral fracture with crescent to the left ilium. No radiology was provided to Medical Assessor Gorman in support of this diagnosis, nor was there any documentation in the medical records produced by the hospital in the bundles relied on by the parties. However, Medical Assessor Gorman notes that Dr Molnar is an expert orthopaedic surgeon specialising in pelvic fractures. Accordingly, on balance, the Medical Assessor accepts Dr Molnar's letter and his opinion that there was a zone 1 sacral fracture with crescent to the left ilium. The fracture is not displaced. However, based on Dr Molnar's description, Medical Assessor Gorman opines that the pelvic fracture must involve the sacroiliac joint and must therefore be considered a fracture of the sacroiliac joint. This gives 1 to 3% WPI based on Table 64 of AMA4 Guides. On balance, Medical Assessor opines 2% WPI, being the mid-point.
2. Clause 6.155 of the Guidelines provides that multiple fractures of the pelvis must be assessed separately and then combined. Accordingly, Medical Assessor Gorman assessed 6% permanent impairment in respect of the pelvic fractures.

1. Medical Assessor Gorman notes that the lateral cutaneous nerve of the thigh was not referred for assessment. Medical Assessor Gorman found there is some persisting dysaesthesia in the distribution of this nerve caused by the pelvic fracture. Using Table 68 in AMA4 Guides, as there is some sensory loss, WPI is assessed as 1%. However, this has not been added as a nerve injury was not referred.

1. As noted above, the Medical Examination report prepared by Medical Assessor Gorman was provided to the other members of the Panel. This report was considered in advance and discussed in detail when the Panel reconvened. The Panel agrees with and adopts the medical examination report and findings of Medical Assessor Gorman. The Panel adds the following further reasons.

1. Causation is addressed in Part 6 of the Guidelines. Clauses 6.5 to 6.7 set out how causation of injury is to be assessed:

6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:

'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:

1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.

2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'

This, therefore, involves a medical decision and a non-medical informed judgement.

6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes."

1. The provisions of the Civil Liability Act 2002 (NSW) (CL Act) apply in determining the issues of negligence and causation.[6] It is therefore necessary for the Panel to consider whether the accident caused or contributed to the injuries. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.[7]
2. The Medical Assessors opine that the nature of the accident, where Mr Lew was pinned between two trucks and hit hard on the right side in the pelvic / hip region by a truck tailgate, causing him to fall to the ground, could have caused soft tissue injury to his lumbar spine and pelvic fractures. On balance, noting the absence of evidence before the Panel of pre-existing injuries to these areas, and noting the contemporaneous clinical records of Westmead Hospital and Dr Huy An, the Panel finds that the accident did cause the following injuries:

(a) lumbar spine - soft tissue injury with aggravation of degenerative disease - no ongoing radicular symptoms or signs and no radiculopathy, and

(b) pelvic fractures - right and left iliac fractures with displacement; public rami fractures without displacement; sacral fracture without displacement, and zone 1 sacral fracture with crescent to the left ileum.

1. The certificate of Medical Assessor Woo dated 18 August 2025 is revoked.
2. The Panel finds that the injuries of lumbar spine - soft tissue injuries and pelvis - fractures caused by the accident give rise to a permanent impairment of 6%, which is not greater than 10%.

[2] Wingfoot Australia Partners Pty Ltd v Kocak (2013) 252 CLR 480; [2012] HCA 43 at [47]; Insurance Australia Group Ltd t/as NRMA Insurance v Keen [2021] NSWCA 287 and Insurance Australia Ltd v Marsh [2022] NSWCA 31.

[3] The Panel notes that these submissions are referred to as being dated 19 May 2025 in the insurer's index to its bundle.

[4] The Panel notes that this list, which appears in the submissions dated 23 September 2025, differs from the list in the submissions dated 2 April 2025. The Panel notes that, given the insurer's failure to comply with its submissions to rely on one set of submissions addressed to the Panel, it has assumed the list in the 23 September 2025 submissions supersedes the list in the 2 April 2025 submissions.

[7] Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50].