Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. The Review Panel confirms the certificate of Medical Assessor Ian Cameron dated

Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. The Review Panel confirms the certificate of Medical Assessor Ian Cameron dated

1. Ms Mallia (the claimant) was involved in a motor accident on or about 2 February 2023.[1] She was the front seat passenger of a vehicle that was stopped at traffic lights when her vehicle was hit from behind by another vehicle.
2. As a result of the motor accident, the claimant says she sustained musculoskeletal injuries and an aggravation of her pre-existing Crohn's disease.
3. She made a claim for statutory benefits with GIO, the third-party insurer of the vehicle that she says caused the motor accident. GIO accepted the claim for statutory benefits (weekly payments and treatment and care) for up to 26 weeks from the date of the motor accident.
4. The claim for benefits beyond 26 weeks was declined because GIO considered the claimant's injuries to be threshold injuries only. This became a medical dispute and was referred to the Personal Injury Commission (Commission) for medical assessment.
5. On 23 November 2024, Medical Assessor Ian Cameron issued a certificate of assessment which found the claimant's injuries to be threshold injuries.
6. The claimant lodged an application with the Commission seeking review of the Medical Assessor's decision. This was allowed by the President's delegate (Ms Rachel Brittliff) and this Review Panel (Panel) was convened to conduct the review.[2]

1. Under the Motor Accident Injuries Act 2017 (the MAI Act), there is a scheme for statutory benefits (under Part 3) for persons injured in motor accidents in New South Wales. Such benefits can include treatment and care and weekly payments.
2. For injured persons who have "threshold injuries", they cannot receive statutory benefits beyond 26 weeks[3] after the accident and cannot recover damages.
3. For physical injuries, a threshold injury is defined as a "soft tissue injury".[4]
4. A "soft tissue injury" is defined as:

"An injury to tissue that connects, supports or surrounds other structures or organs of the body (such as muscles, tendons, ligaments, menisci, facia, fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage."[5]

1. A soft tissue injury includes an injury to a spinal nerve that manifests in neurological signs (other than radiculopathy).[6]
2. The Motor Accident Guidelines (the Guidelines)[7] defines radiculopathy as:

"Radiculopathy means the impairment caused by dysfunction of a spinal nerve root or nerve roots when two or more of the following clinical signs are found on examination when they are assessed in accordance with 'Part 6 of the Motor Accident Guidelines: Permanent Impairment'.

(a) loss or asymmetry of reflexes (see the definitions of clinical findings in Table 6.8 in these Guidelines)

(b) positive sciatic nerve root tension signs (see the

(c) muscle atrophy and/or decreased limb circumference

(d) muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution

(e) reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution."[8]

1. Where the neurological symptoms associated with the injured person's injury of the neck or spine do not meet the assessment criteria for radiculopathy, the injury will be assessed as a threshold injury.[9]
2. Table 6.8 of the Guidelines provides definitions for the clinical signs in (a) to (e) above.

1. The provisions regarding causation of injury are contained in cls 6.5 to 6.7 of the Guidelines and apply to both permanent impairment and threshold injury disputes.[10]

"6.6 Causation means that a physical, chemical or biological 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:

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

(b) 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. Further, the provisions of the Civil Liability Act 2002 apply, in particular ss 5D and 5E.

1. Medical Assessor Cameron was referred the following injuries for assessment:
   • cervical spine - whiplash - reduced flexion, extension and lateral flexion
   • lumbar spine - L4/5/S1 disc bulge
   • left shoulder - musculoligamentous
   • left wrist - musculoligamentous
   • right hip - bursitis
   • intestine - aggravation of Crohn's disease
2. With the exception of the intestinal injury, the Medical Assessor found that the claimant sustained soft tissue injuries to the multiple body parts listed above. The injuries satisfied the legislative definition of threshold injury.
3. The Medical Assessor was not satisfied that the claimant sustained a specific injury to the intestines or the digestive system. The claimant's pre-accident history revealed severe Crohn's disease which the Medical Assessor found "causes symptoms on a regular basis". As such, the intestinal injury was found to be not causally related to the motor accident.

1. The claimant submits that Medical Assessor Cameron failed to consider whether the motor accident caused a material aggravation of the claimant's pre-existing Crohn's disease, as was required under the causation provisions of the Guidelines (cl 1.6).
2. The claimant says the clinical notes of Dr Missiakos supports a deterioration of the claimant's Crohn's disease due to the "various medications she has to take for treatment of pain and psychological disorder including but not limited to Lyrica, Budesonide, Endone, Valium and Efexor."
3. It is contended that a material aggravation of Crohn's disease is a non-threshold injury for the purposes of the MAI Act.

1. The insurer submits that there is no evidence in the post-accident treating notes to suggest there has been a worsening or aggravation of the claimant's pre-existing Crohn's disease. It is further submitted that there is no expert evidence to suggest there is a recognised medical mechanism by which such an aggravation could occur.
2. In relation to the medical assessment under review, the insurer says it is not clear from

Dr Missiakos' notes that the doctor concluded there was any change in Crohn's symptoms due to the ingestion of medication. Furthermore, it is submitted that as the claimant was taking much of the same medication before the motor accident, there can be no aggravation as a result of the motor accident. 3. It is contended that Medical Assessor Cameron was not required to provide any further explanation in support of his finding on causation of the claimant's Crohn's disease. 4. In relation to the musculoskeletal injuries, the insurer says the evidence indicates these are either not causally related to the motor accident or, in any event, are soft tissue (threshold) injuries only.

1. The Panel has read all the material provided by the parties in the claimant's review bundle (indexed and paginated with page numbers 1-386) and the insurer's review reply bundle (indexed and paginated with page numbers 1-184).
2. At the Panel teleconference on 7 April 2025, it was determined that additional information was required with respect to the claimant's Crohn's disease condition. Accordingly, a Direction was issued requiring:
   • Any clinical notes from Dr Justine Mill, gastroenterologist, and
   • Any clinical notes from Dr Chen, gastroenterologist.
3. On 19 May 2025, the insurer provided the clinical records of Dr Chen. These contained various reports from Drs Mill and Chen with respect to the pre-accident history and treatment of the claimant's Crohn's disease. There were also post-accident reports from Dr Mahendran, gastroenterologist. The relevant detail from these reports is contained in the Panel re-examination report below.
4. The parties were also directed to provide the claimant's original submissions lodged with respect to the threshold injury dispute. This was not complied with.
5. The relevant detail from the parties' review bundles is also discussed in the Panel re-examination report below.

1. Following the Panel teleconference on 7 April 2025, the parties were advised[11] that the Panel's preliminary view was that the claimant's alleged musculoskeletal injuries were likely to be threshold injuries. This was based on the available radiology which showed an absence of any tears that would place the injuries outside the definition of threshold injury as per s 1.6 of the MAI Act. The Panel also noted that Medical Assessor Cameron's clinical findings did not reveal the presence of radiculopathy (as defined under cl 5.8 of the Guidelines) nor was there any radiculopathy found in the documentation before the Panel or referred to in submissions from the parties.
2. The Panel also felt little would be gained by physically examining the claimant's abdomen in relation to the alleged aggravation of her Crohn's disease with the determination of causation and any impairment would be made by reviewing the clinical notes and through an interview of the claimant.
3. The Panel therefore proposed to conduct the re-examination of the claimant via audio-visual link using Microsoft Teams. Both parties were advised and neither objected to this course.[12]
4. Accordingly, the claimant was re-examined by Medical Assessors Gibson and Oates on Microsoft Teams on 6 June 2025. The re-examination report is as follows:

• Cervical spine - whiplash - reduced flexion, extension and lateral flexion in the cervical spine
• Hip - right hip - bursitis
• Intestine - aggravation of Crohn's disease
• Lumbar spine - L4/5/S1 disc bulge
• Shoulder - left shoulder - musculoskeletal injury
• Wrist - left wrist - musculoskeletal injury

Ms Mallia attended for interview by MS Teams with Medical Assessor Gibson and Medical Assessor Oates on 6 June 2025 as arranged.

Pre-accident medical history and relevant personal details, including relevant file details

Ms Mallia, the claimant, said she is aged 50 and lives in Padstow in a one-level villa with her adult son. Her son is in the workforce.

At the time of the subject accident, the claimant was working as a driver and engineer fitter and turner for her father, and had been in this position for about 12 months before the accident. She felt she was getting her life back on track because she had been on the disability support pension because of Crohn's disease, and no-one would employ her before her father took her on in his company. This was because of her frequent need to use the bathroom during the work day. She has not been able to return to work since the accident because of pain.

She does not drive now because of anxiety and pain, and stays home a lot.

She had been receiving a disability support pension since the mid-2000s, prior to her father offering her employment.

She was diagnosed with Crohn's disease, an inflammatory bowel disorder, in about 1998. This caused severe symptoms and she had been placed on a disability support pension for this condition since the mid-2000s.

She had undergone two hemicolectomies in 2016 and 2019, and after diagnosis was having an annual colonoscopy which was performed by various gastroenterologists who rotated through the public hospital system, but she was assured the result was always within normal limits. She was attending various doctors at the Liverpool Hospital Pain Clinic.

She had a motor vehicle accident at age 12 and was told she had a bulging disc in her back, but does not recall any other injuries before the subject accident.

She had a repair of atrial septal defect in the heart at age eight.

At the time of the accident, Dr Justine Mill, gastroenterologist, was reviewing her for Crohn's disease at Bankstown Hospital.

Before the accident she took Panadeine Forte when required, about 5 - 6 tablets per week, Valium to help her sleep, Prednisone for flare-ups of Crohn's disease, and Entyvio, a monoclonal antibody injection for Crohn's disease.

She added that she had developed difficulty with sleeping since her mother had passed away in about 2006.

The Assessors noted a report from Dr Justine Mill, gastroenterologist, dated 22/10/2019 noting Crohn's disease was diagnosed in 1999 and there was an ileal structuring phenotype. Colonoscopy on 5/5/2015 showed ileocolonic anastomosis stricture requiring balloon dilatation.

There had been a previous laparoscopic right hemicolectomy in September 2006 and an ileocolic resection on 6/2/2019 by Dr Catherine Turner. She had been on Vedolizumab (Entyvio) infusion since 29/2/2016. This is a monoclonal antibody used to treat moderate to severe inflammatory bowel disease, including Crohn's disease and ulcerative colitis.

The report noted she also attended the Chronic Pain Service at Liverpool Hospital and they had put her on a Norspan patch for control of pain, and that her anxiety was better controlled since she was seeing a psychologist.

A further report from Dr Mill dated 28/4/2020 noted no abdominal pain or any concern with her bowels, but there was back pain radiating to her hip and she had been told she may require surgery, but she is fearful about going down this approach.

She was continuing to see the Chronic Pain Service at Liverpool Hospital.

She continued an infusion of Entyvio every eight weeks.

She continued to have low back pain and was visiting her General Practitioner (GP), Dr Missiakos, in October and November 2021 for lumbar back pain. He noted the pain clinic was prescribing Norspan for this chronic back pain.

The Assessors noted a report from Dr Wan dated 1/2/2022 from Liverpool Hospital Pain Clinic. Dr Wan noted she had abdominal pain from time to time and mostly she would have diarrhoea, going up to 20 times a day, but with no blood in the stool. She continued to see Dr Mill, gastroenterologist, Bankstown Hospital, regularly.

She had already attended the Liverpool Pain Clinic one-day pain education program and had been assessed by the physiotherapist and psychologist, and that she had continuing appointments with those two paramedical services. She was on the waiting list to do the multi-disciplinary activity improvement program of the pain clinic.

At this time, she had pain in both legs behind the calves at 7/10, and low back pain 8/10, with pins and needles in fingers and feet, but not much pain in the abdomen now. She was waking almost hourly from sleep and sometimes that was because she had to go to the toilet. Her bladder function was normal.

Dr Wan noted she had been helping her father in his engineering company, basically doing the paperwork, but had stopped working there in 2021 and was not working at the time of this report, 1/2/2022. She continued with Norspan patch 5mg per week, Panadeine Forte two tablets twice daily or as required, Valium 5mg at night when necessary, and she used this twice in a week, along with the Entyvio injections which had changed to subcutaneous once a fortnight, and Vitamin D and supplements. She was not using cannabis oil now, although she asked whether she could try it again, but Dr Wan advised there was no evidence that it helped in chronic pain.

She did not want to try Palexia, but she found her symptoms were severely aggravated when she tried to stop the Norspan patch, and she was also taking Gabapentin. Dr Wan advised her to start Endep 10mg at night to help with the pain. The claimant told Dr Wan at that point she was 76kg and 160cm tall.

At further review on 10/5/2022, she was working virtually full-time as an engineer but had constant pain in the lower back 8/10. She had tried Endep but it caused nausea, so was ceased.

She had completed the multi-disciplinary pain management program the week before and found it useful, and had seen the physiotherapist and psychologist, and the bowel symptoms were not a major issue for her at that time. She continued with Norspan, Entyvio, Panadeine Forte 1-2 tablets as necessary, Valium 5mg at night and Efexor. She tried Lyrica but could not tolerate it, and also tried Palexia but could not tolerate it.

A progress report from Dr Mill dated 24/5/2022 noted that she felt well from the Crohn's disease perspective, and blood tests done in February reflected a very good picture. Her gut was really quite good and she was not having any pain anymore. She was still seeing the pain clinic at Liverpool Hospital for her chronic back pain issues mainly.

A CT abdomen and pelvis dated 1/6/2022 showed subtle stranding in the right iliac fossa, which was non-specific but did suggest mesenteric inflammation, possibly related to colitis, however there was no bowel obstruction, thickening of bowel wall, or pericolonic or ileal stranding to suggest this. No stricture was seen at the anastomosis site.

The Assessors noted a GP record of 7/11/2022 with Dr Dias, which referred to severe pain, with abdominal pain and diarrhoea, from a current flare-up of Crohn's disease. She found that Endone helped the pain. There was no rectal bleeding or fever.

On 24/11/2022, the GP, Dr Missiakos, referred her for five sessions of physiotherapy for chronic lower back pain accessed under Medicare.

There was a further report from Dr Wan dated 6/12/2022, noting her Crohn's disease is severe from time to time and she has continued to use the Entyvio injection. She was working 20 - 25 hours per week over five days as an engineer in her father's factory, which manufactured tools, and she didn't have to lift heavy weights because she could ask others to do that.

She was on the waiting list to have a cortisone injection at Liverpool Hospital requested by Dr Jason Kwan. She had been referred to private physiotherapy but found this expensive. Acupuncture had helped in the past as well. She continued with Norspan patch 5mg weekly, Panadeine Forte as required but not found very useful, and Valium 5mg at night.

The claimant asked Dr Wan for Endone to use as required and he told her it is not indicated in chronic pain and should be limited to one box of 20 per month, to be only used when the pain is really bad.

When asked to clarify the dates of the two hemicolectomies, the claimant was adamant that the first was in 2006 and the second in 2019, and this disagrees with documented medical evidence on file. She said she remembered when the first operation was because it was the same year as her mother passed away, that is 2006.

The claimant stated the date of accident is 2/2/2023. The date of injury as specified on the referral was 1/2/2023.

The Assessors noted a GP report of Dr Dias dated 31/1/2023 referring to a car accident last week causing hip and back pain radiating to the leg, with no bladder or bowel complaints, on a background of known L4/5 and L5/S1 disc disease.

The claimant said she was a front seat passenger in a Ford Ranger 4WD, her vehicle but being driven by a girlfriend, and her new infant granddaughter was in the back seat. They were at a traffic light and she had turned around to check on her granddaughter in the back seat, when the vehicle she was in was hit from behind by a van at high speed.

She had impact between her right hip and the centre console and developed immediate pain and was in shock. She also had immediate left shoulder pain from the seatbelt tensioning. No ambulance or police attended and her car was still driveable. She stayed the night at her friend's place, rather than going home.

She contacted a GP by phone on the day of the accident and the entry in the file of 31/1/2023 with Dr Dias is a telephone consultation. She also recalls seeing a doctor at some medical centre because she was getting a lot of pain.

She then saw her usual GP, Dr Missiakos, in person on 9/2/2023 complaining of right hip, low back pain and left wrist pain.

History of symptoms and treatment following the motor accident

She had a few physiotherapy sessions which she found ineffective and treatment was directed to the right hip and left shoulder.

She also had a cortisone injection later in the right trochanteric bursa of the hip. This did not help. She had imaging done, which she was told showed inflammation in the right hip.

She went back to work for a few days but had to cease work again after three days and did not return thereafter. She recommenced on the disability support pension.

She says that after the accident, her Crohn's disease was worsened with respect to symptoms. She discussed this with Dr Missiakos and he explained that the inflammation had travelled from her hip, which was more painful after the accident, and this then caused pain and inflammation to increase in the bowel. She said she now goes to the toilet for bowel actions 10 - 15 times per day, compared with five bowel actions per day before the accident.

Note: The medical documentation quoted above noted flare-ups of Crohn's disease with up to 20 bowel actions a day before the accident.

She further explained that after eating, she has to go to the toilet quickly. There was no blood but mucous sometimes. The bowel action is always liquid but before the motor vehicle accident, she was sometimes even constipated and the motion would be solid but flat like a ribbon.

Before the accident, she sometimes had urgency of defecation after meals but it was not as frequent as after the accident.

The Assessors noted a report from Dr Wan dated 13/4/2023 referring to a car accident on 1/2/2023, noting there was more pain from Crohn's disease and she couldn't sleep at night. She was medications of Norspan 5mg weekly, Panadol one tablet twice daily, and Panadeine Forte one tablet twice daily for pain, and that the only medicine she could tolerate was Endone, Oxycontin and Targin.

Dr Wan advised continuation of Norspan and to change Panadeine Forte to Panadol Osteo six tablets a day, because Panadeine Forte was not strong enough, and also add Endone 5mg twice daily as required, but as a short-term measure only. She was to have a colonoscopy with her new gastroenterologist, Dr Chen.

An Allied Health Recovery Request (AHRR) dated 17/4/2023 to the physiotherapist noted diagnoses of whiplash, left subacromial shoulder pain, right hip bursitis, L4/5/S1 disc bulge.

The GP referred her back to Bankstown Hospital gastroenterology department on 21/4/2023 for a follow-up colonoscopy due to Crohn's disease.

The Assessors noted a referral letter from the GP to Professor Mark Sheridan, neurosurgeon, Kogarah, dated 5/5/2023 for opinion and management, but the claimant stated she did not see this doctor, as far as she could recall.

An x-ray and ultrasound of left shoulder on 11/5/2023 showed low-grade cuff insertional tendinopathy with no tear and subacromial bursitis. A right hip x-ray and ultrasound of even date showed no fracture with joint spaces preserved and no soft tissue calcification. Ultrasound showed no joint effusion or synovitis, with an intact anterosuperior labrum and no cyst, with low-grade gluteus minimus and medius insertional tendinopathy but no tear. Mild greater trochanteric bursitis was suspected and there was no soft tissue calcification and no evidence of iliopsoas bursitis or tendinopathy, with normal neurovascular structures.

The Assessors noted a further GP record of 8/11/2023 stating neck and back pain worse, pain worse than ever, insurance denied claim, next pain clinic January. The diagnosis was lumbar back pain and this was a telephone consultation.

An x-ray of cervical spine dated 11/1/2024 for clinical history of injury, pain and stiffness, showed moderate C4/C5 spondylosis but no acute bony injury or cervical spine injury seen.

A report from Dr Mahendran, the new gastroenterologist at Bankstown Hospital gastroenterology department, reported on a colonoscopy performed on 15/10/2024 noting poor colon preparation, decreased mucosa vascular pattern in the sigmoid colon, which was biopsied, but that the entire examined colon was normal and the examined portion of the ileum was normal. The multiple biopsies taken from the large intestine were all showing no significant abnormality.

A follow-up report from Dr Mahendran dated 15/1/2025 performed via telehealth noted liquid to soft stools once a day with no rectal bleeding and no abdominal pain or mucous. There were no features of extra-intestinal manifestations of inflammatory bowel disease and her appetite had improved with a couple of increased kilograms.

Blood tests performed on 25/9/2024 were pristine. She was given a prescription for continuing Vedolizumab every two weeks by subcutaneous injection.

A CT-guided L5/S1 facet joint injection performed on 4/7/2024 was not of assistance, according to the claimant.

On questioning, the claimant said she had been changed from intravenous monoclonal antibody given every eight weeks to subcutaneous given every fortnight about three years ago. She continued to see the gastroenterologist once a year for a colonoscopy and had two phone calls per year to get repeat prescriptions of the Vedolizumab. The only change in her Crohn's disease treatment was to use Entocort (Budesonide) as a high-dose steroid during flare-ups of the inflammatory bowel disease, rather than prednisone, which she would take for a course of varying length and with varying intervals between the courses.

The claimant added that she thought she had lost about 10kg in weight since the accident and that she felt there was no muscle tone in her legs.

Details of any relevant injuries or conditions sustained since the motor accident

She has continuing back pain symptoms and pain in the lateral right hip area. There is tenderness in this area. There is also some neck pain and left shoulder pain.

She is very anxious. She gets stressed and anxious when she has more hip pain and she feels the symptoms of the Crohn's disease are then worsened.

About two months ago, she had further imaging of the hip ordered by the GP. The two cortisone injections to the right trochanteric bursa at the hip did nothing, but she has had no further treatment for this since.

She feels her abdominal pain is worse, with frequency of flare-ups being more often and urgency of defecation. She has sleep disturbance and puts a water bottle or something similar to give firm support underneath the hip.

• Entocort (budesonide) for inflammation
• Efexor
• Lyrica 25mg mane and 75mg at night
• Endone 5-10mg up to three times a day
• Valium 5mg at night

She explained that Dr Mill went to a private clinic and her gastroenterologist changed to Dr Mahendran at Bankstown Hospital.

There has been no change in the medications given for her Crohn's disease since the motor vehicle accident, apart from change in the type of steroid used. She does feel she needs the steroid more frequently because of exacerbation of symptoms.

She has not seen any specialist specifically about the right hip. She feels she needs help with her right hip, as she is living a nightmare at the moment.

She is losing her hair and developing bald patches, which has come on over the last 12 months.

Note: With respect to the claimant relaying the GP's explanation that pain and inflammation in the hip has increased inflammation and symptoms in Crohn's disease, the Assessors note the result of serial blood tests for C-reactive protein on 21/4/2023, 8/6/2023, 17/8/2023 and 26/10/2023 has been less than 4mg/L on all occasions and the normal value for CRP is less than 6mg/L, indicating no increase in inflammation, as C-reactive protein is a marker of inflammation generally in the body."

1. The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned.[13]
2. The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[14]
3. The Panel refers to the above re-examination report of Medical Assessors Gibson and Oates and adopts the findings in their entirety. The Panel reconvened on 16 June 2025 and discussed the re-examination report findings before collectively making the below determinations.

1. The diagnosis is soft tissue injury.
2. The motor accident was a cause of this injury after consideration of the forces involved in a significant rear-end collision.
3. It was mentioned by the physiotherapist on 17 April 2023 but did not figure in the GP reports. In fact, the first mention of the neck was not until 8 November 2023, although the AHRR of 17 April 2023 does pass through the general practice.

1. The diagnosis is trochanteric bursitis of right hip. This is a soft tissue injury.
2. The accident was a cause of this injury, as it is mentioned in the telephonic GP record of

Dr Dias on 31 January 2023, Dr Missiakos' record of 9 February 2023, and in the Medical Certificate which accompanied the Application for Personal Injury Benefits Claim Form.

1. The diagnosis is Crohn's disease. This is a form of IBD (inflammatory bowel disease).
2. The motor accident did not cause aggravation of Crohn's disease, in the opinion of the Panel, based on the evidence.
3. There was no record indicating abdominal injury in the accident. The Crohn's disease was variable in symptomatology and severe at times prior to the accident, as indicated in the

pre-accident records from the gastroenterologist and pain clinic, as referred to above. 4. There was no objective evidence of worsening of the Crohn's disease. Whilst there may have been some symptom increase, this was on an episodic basis. This was also the pattern of Crohn's disease in the claimant before the accident, with the claimant describing the disease as being "severe" in December 2022, just two months before the motor accident. 5. The Medical Assessors could not verify that there has been weight loss because there was no written documentation of her weight prior to the accident, only a self-reported weight in one of the specialist letters. 6. There was no change in the type or dose of medication used for Crohn's disease before and after the accident and, as mentioned above, there was no evidence of an increase in general inflammation in the body, according to the CRP (C-reactive protein) levels repeated regularly. There was no abnormality in the serial colonoscopies performed after the accident, according to the claimant and to the one report which was on file dating from September 2024. 7. The Medical Assessors reviewed the medications that the claimant is taking and none of these would exacerbate symptoms of Crohn's disease, nor aggravate the pathology of the Crohn's disease. 8. Entocort (budesonide) is a corticosteroid and in the EC (enteric coated) form is used to treat inflammatory bowel disease such as Crohn's disease. This EC form means the medication is control-released into the small intestine, the site of its action, thus potentially reducing the risk of systemic side-effects, as compared to prednisone which is absorbed generally throughout the body. 9. If, as alleged by the claimant, right hip pain is causing her stress and thereby temporarily worsening symptoms of Crohn's disease, the hip pain evidently requires to be better controlled and symptoms will improve. On balance however, the documented evidence and the Panel's understanding of the condition does not support the claimant's view on the aetiology of the aggravation of her Crohn's disease.

1. The diagnosis is soft tissue injury.
2. This is a pre-existing condition with documentation on file of a long history of low back pain, necessitating regular surveillance at the Chronic Pain Clinic at Liverpool Hospital and ongoing long-term treatment.
3. The accident may have caused some temporary flare-up of symptoms of the lumbar spine, but there is no aggravation of the pre-existing lumbar spine pathology overall.

1. The diagnosis is soft tissue injury and the accident was a cause of this injury, as it is mentioned in the physiotherapy referral of 17/4/2023 and in the GP record of 21/4/2023.
2. An ultrasound scan done shortly after this on 11/5/2023 showed tendonitis and bursitis, but no tendon tear.

1. The diagnosis is soft tissue injury.
2. The accident was a cause of this injury, as it is referred to in the GP record of 9/2/2023 and the certificate accompanying the APB.

1. Based on the history taken from the claimant and the medical information documented on file, the cervical spine and lumbar spine conditions are threshold injuries.
2. There was no evidence of radiculopathy in either the cervical or lumbar areas in any of the medical evidence, nor in the medical examination performed by the original Medical Assessor.
3. There was no imaging evidence proffered of any tear of disc fibrocartilage in these regions.

1. The right hip is a soft tissue injury and is a threshold injury. The ultrasound scan showed no evidence of a tear of tendon, ligament or cartilage at the right hip.

1. The left shoulder is a soft tissue injury and a threshold injury. An ultrasound scan showed no evidence of tendon, ligament or cartilage tear of this part.

1. As mentioned above, there is no indication that the accident was a cause of aggravation of Crohn's disease and therefore a determination of threshold injury is not required.

1. The following injuries were caused by the motor accident:
   • cervical spine - soft tissue injury;
   • hip - soft tissue injury;
   • lumbar spine - soft tissue injury;
   • left shoulder - soft tissue injury, and
   • left wrist - soft tissue injury.
2. The following injuries were not caused by the motor accident:
   • intestine - aggravation of pre-existing Crohn's disease.

1. The Panel concludes that the claimant's injuries caused by the motor accident are threshold injuries.
2. The certificate issued by Medical Assessor Ian Cameron dated 23 November 2024 is confirmed.

[1] There are conflicting accounts as to the date of injury which range from 24 January 2023 to 3 February 2023. The exact date of injury is not required for the purposes of the Review Panel proceedings.

[3] For motor accidents occurring after 1 April 2023, this was extended to 52 weeks under the Motor Accident Injuries Amendment Bill 2022.

[6] Section 4(1) of the Motor Accident Injuries Regulation 2017.

[7] The applicable version of the Guidelines is version 9.3.

[10] Briggs v IAG Limited Trading as NRMA Insurance [2022] NSWSC 372 per Wright J at [35].

[11] See Review Panel Report and Directions dated 8 April 2025.

[12] Via written submission on the portal dated 24 April 2025.

[13] Section 7.26(6) of the Motor Accident Injuries Act 2017 (MAI Act).