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

1. The Review Panel revokes the certificate of Medical Assessor Mohammed Assem dated

16 April 2025 and issues a new certificate as follows:

(a) the Review Panel certifies the following injuries were caused by the motor accident:

(i) cervical spine - musculoligamentous injury, and

(ii) shoulder - left shoulder rotator cuff injury, supraspinatus tear and bursitis, and

(b) the Review Panel finds that the above injuries result in a whole person impairment of 8% which is not greater than 10%.

1. Gul Olgun (the claimant) was involved in a motor accident on 8 June 2021. She was the driver of a vehicle stopped at a traffic light. When the signal turned green, she proceeded forward when an oncoming vehicle turned into her path. There was a collision with the impact on the front right corner of her car. Airbags deployed and the force of the impact caused her vehicle to veer left and become immobile at the roadside.
2. The claimant says she suffered injuries to her neck, left shoulder, lower back and left knee.
3. She made a claim for personal injury benefits with QBE Insurance (Australia) Limited (the insurer), the third-party insurer of the vehicle that she says caused the accident.
4. A medical dispute arose about whether the degree of the claimant's whole person impairment (WPI) is greater than 10% WPI. If there is a dispute about the degree of a claimant's WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor for determination.
5. On 16 April 2025, Medical Assessor Mohammed Assem assessed the claimant's degree of WPI as 7% which is not greater than 10%.
6. The claimant lodged an application with the Personal Injury Commission (Commission) seeking a review of the medical assessment.
7. On 13 June 2025, a delegate of the President (Ms Melinda Drew), accepted the application for review and referred the matter to this Review Panel (the Panel) to conduct the Review proceedings.

1. Medical Assessor Assem was referred the following injuries for assessment:
   • cervical spine - musculoligamentous injury;
   • lumbar spine - recurrent disc prolapse at L5/S1;
   • shoulder - left shoulder rotator cuff injury, supraspinatus tear and bursitis, and
   • left knee - ACL rupture and meniscus tear.
2. Causation was accepted for the cervical spine and left shoulder injuries as symptoms to these areas were recorded in the ambulance and hospital notes. Examination revealed loss of range of motion in the left shoulder which was assessed at 7% WPI. The cervical spine injury was assessed at 0% WPI.
3. Causation was not accepted for the lumbar spine and left knee injuries. Lumbar spine symptoms were not documented until five weeks after the motor accident. For the left knee, the claimant did not report any direct trauma from the motor accident as the injury occurred while the claimant alighted from a vehicle. The first record of left knee pain was documented on 4 February 2022.The Medical Assessor stated that the mechanism and delay in reporting are inconsistent with a traumatic ACL injury caused by the motor accident.

1. The claimant submits that the motor accident caused a worsening of her pre-accident lower back symptoms. She refers to the clinical notes of her general practitioner, Dr Demdi who documented complaints of pain in the lower back five weeks post-accident. The claimant also refers to the injury referred for assessment, namely whether there was "recurrent disc prolapse at L5/S1" (emphasis added).
2. Other factors alleged to support causation of injury is the mechanism of the accident, described by the claimant as a "violent one", with the claimant being thrown about in the cabin and the deployment of airbags.
3. Generally, it is submitted that the medical assessment must deal with all the evidence relevant to causation of injury and not only to whether there was a contemporaneous complaint in the ambulance report or hospital notes.

1. Although it is conceded that left knee complaints were not recorded in the ambulance report of Fairfield Hospital notes, the claimant said she reported to Medical Assessor Assem that she experienced immediate left knee pain following the accident. The claimant also refers to her statement where, at paragraph 14, she states prior to the accident she never had any issues with her knee, however two months after the accident, the pain in her knee started to intensify.
2. The claimant also points to a consequential injury to her left knee as a result of her lumbar spine injury. She refers to her statement and a note from her general practitioner dated

13 September 2021 where she claims that her lower back pain was causing her to walk with an altered gait. She recalled an incident where she was alighting from her car when she heard a crack as she put her left leg down on the ground. 3. The Panel is directed to State Government Insurance Commission v Oakley (Oakley)[2] which dealt with subsequent injury and the legal principles to be considered. The Panel is cognisant of this case and will refer to it below in its reasons. 4. The balance of the claimant's submissions refers to the alleged failure of the Medical Assessor to provide adequate reasons on the issue of causation which the claimant says was a clearly articulated argument raised in the original application for assessment and the documentation relied upon in support.

1. The insurer provides a chronology of the pre-and-post accident treating medical evidence relevant to the injuries in dispute. Reference is also made to the Commission treatment certificate of Medical Assessor Home and the medico-legal reports of Dr Bodel and

Dr Wallace. 2. The insurer disputes that the injuries to the claimant's back and left knee are causally related to the motor accident. The insurer says the medical assessment should consider the claimant's extensive pre-accident history of back complaints. In relation to the left knee, the insurer refers to the significant delay regarding the reported onset of the left knee injury, a factor relevant to the issue of causation.

1. The Panel notes from the parties' submissions that the matters in dispute in the review proceedings relate only to causation of the injuries to the lumbar spine and left knee.
2. On 23 June 2025, the Panel issued a direction requiring submissions on whether the parties agree that the only issues to be determined by the Panel is causation (and any subsequent impairment) with respect to the injuries to the lumbar spine and left knee.[3]
3. The parties duly responded and there was consensus on the approach suggested by the Panel.
4. The Panel therefore will not review, assess or otherwise disturb the findings of Medical Assessor Assem with respect to his assessment of the cervical spine and left shoulder.

1. At its preliminary conference on 13 August 2025, the Panel noted that notwithstanding the parties' agreement that Medical Assessor Assem's findings with respect to the left shoulder should not be disturbed, the Panel discovered a calculation error and a possible methodological error in the impairment evaluation.
2. The parties were referred to the table of the shoulder movements at paragraph 17 of the certificate reasons. For ease of reference this is reproduced below.

Note: the parentheses in each plane of motion denotes the upper extremity impairment (UEI).

1. The Panel noted that Medical Assessor Assem concluded that the current WPI of the left shoulder was 7%. As illustrated in the Panel's above table, the correct WPI, according to the Medical Assessor's range of motion findings, should be 8%.
2. In addition, the Panel noted the Medical Assessor found bilateral loss of range of motion in the shoulders, yet made no deduction under the contralateral joint provisions in cl 6.51 of the Motor Accident Guidelines (version 9.3) by reason that other medical examiners had documented a normal range of motion. The Medical Assessor also noted other medical examiners had found lesser restrictions in the left shoulder yet decided to rely on his own findings on the day of the assessment.
3. As such, while the Panel agreed with the parties that left shoulder causation was not in issue (i.e the left shoulder was injured in the motor accident), the Panel could not allow a certificate to stand with the calculation error and, perhaps more materially, an inadequate explanation on why the contralateral joint provisions in cl 6.51 was not applied.
4. Given the parties' agreement that the left shoulder impairment is not in dispute, the Panel decided to request submissions on whether the parties wished the Panel to re-assess the left shoulder or, and despite the Panel's above observations, allow the 7% WPI or 8% WPI (corrected) as assessed by the Medical Assessor to stand.
5. Both parties returned with submissions stating that the degree of impairment to the left shoulder is 8% WPI.
6. As such, the Panel finds that the degree of impairment to the left shoulder and cervical spine as a result of the injuries caused by the motor accident is 8% WPI and 0% WPI respectively. It was further found that these injuries need not be re-examined by the Panel.

1. The Panel required the parties to upload indexed and paginated bundles of the information they relied upon. The Panel stated that unless documents are uploaded to the review file, the Panel would not be able to read and consider those documents. The parties responded with the lodgement of bundles - the claimant's bundle comprising of pages 1-654 and the insurer's bundle comprising of pages 1-227.
2. The Panel has read the documentation relied upon by the parties. Given the voluminous nature of the material, the Panel will only specifically refer to material that is relevant to the resolution of the permanent impairment dispute and the issues in dispute.
3. Report of Dr McGee-Collett dated 16 July 2018 - MRI scans of whole spine show disc degeneration at C5/6 and C6/7 without spinal cord or nerve root compression and left L5/S1 foraminal stenosis with a degree of L5 nerve root compression due to the combined effects of disc herniation and facet joint hypertrophy.
4. Royal Prince Alfred Hospital Discharge referral dated 24 January 2019 - Underwent L5 medial facetectomy and rhizolysis for left L5 radiculopathy performed by Dr Martin McGee-Collett (neurosurgeon). History of long-standing left leg pain.
5. Report of Dr McGee-Collett dated 7 March 2019 - review of left L5 nerve root decompression six weeks earlier. Surgery relieved neurogenic left lower limb pain. No solution to ongoing low back pain which should originate in spondylotic change. Encouraged increase in level of aerobic activity.
6. Ambulance report dated 8 June 2021 - left sided shoulder pain and left lateral neck pain. Nil altered sensations to lower limb. Nil injuries to legs or back. Denies lower back/pelvic pain.
7. Fairfield Hospital Discharge referral dated 8 June 2021 - Pain in left shoulder from hitting steering wheel. Nil spine tenderness.
8. MRI left knee dated 15 November 2021 - Clinical history of inability to extend knee suggesting possibility of an acute meniscal tear. Radial tear anterior horn of lateral meniscus with breach of tibial and femoral articular surfaces.
9. Application for Personal Injury Benefits signed by Ms Olgun on 4 February 2022 -

Ms Olgun stated that as a result of the motor accident she had left shoulder pain, left knee meniscus tear and an exacerbation of back pain. She also declared that she suffered from "aggressive pain on my back" before the motor accident but that after the accident it was "much worse". 10. Statement of the claimant dated 10 February 2022 - prior to subject motor accident, had misplaced disc in lower back causing numbness on left side. Underwent surgery in 2018. Continued intermittent pain in back after surgery, managed by analgesics. Recalls impact of collision as being "very hard". Shaken and in a lot of pain. Could not see doctor the following week - dealing with NRMA to get insurance money to buy new car. Then went back to doctor complaining of pain in shoulder, left knee and back. Analgesics prescribed.

No issues with knee prior to accident. Two months after accident, pain in knee started to intensify. Could not weight bear properly. Pain in lower back causing altered gait when walking. Knees felt unstable. Went to Woolworths for groceries shopping. "...I moved very slowly to get out of the car because of the pain in my back and when I put my left leg down on the ground, I heard a crack... Once I got home, I noticed how swollen my knee was." Went to hospital but was turned away due to COVID-19. When pain did not subside, went to GP and was referred for an x-ray. Could not undergo X-ray due to COVID-19 lockdown. Constant pain in knee and back. Shops using wheelchair. Saw specialist at Bankstown Hospital - on waiting list for surgery to knee.

1. Report of Dr Renata Bazina, neurosurgeon, dated 19 August 2022 - MRI scans shows L5 nerve root impingement from an L4/5 disc herniation which she gathered was acute as she did not see it previously on the MRI scans from 2017 or 2019. Note, no reference made to MRI Lumbar dated 15 June 2018. Also recurrent disc herniation at L5/S1 with foraminal narrowing. Recommended decompression of the L5 nerve root, "She explained to me that she was recovering after her first spinal operation, in fact when she saw Dr Pope she did have chronic pain in the back but accepted that as he explained to her that she had to live with this".
2. Report of Dr Renata Bazina, neurosurgeon, dated 2 September 2022 - Noted previous L5 laminectomy for left L5 radiculopathy in 2019 by Dr Pope. This is pre-existing pathology however most recent MRI scan (8 August 2022) demonstrates L4/5 problems, however

Dr Bazina's understanding is that the claimant had surgery for the L5/S1 segment. Therefore, appears motor vehicle accident pertains to new pathology and not pre-existing pathology. Therefore, previous surgery considered unrelated to current symptoms. 3. Report of Dr Renata Bazina, neurosurgeon, dated 19 September 2022 - Worsening back and left leg pain following motor accident. Note previous L5 Laminectomy for left L5 radiculopathy in 2019. Impression claimant had chronic pain before motor accident and was referred to see the Pain Clinic. No indication L5 radiculopathy is worse after motor accident however accepts claimant's self-report that pain is now worse. Opined that accident caused a new disc herniation at L4/5 - no aggravation, acceleration or exacerbation. Concluded that proposed surgery is causally related and reasonable and necessary. 4. Report of Dr George Konidaris, orthopaedic surgeon, dated 16 June 2022 - review following left knee arthroscopy, debridgement of ACL ganglion, partial lateral meniscectomy and chondroplasty and excision of medial plica six weeks post-op. 5. Certificates of capacity / fitness (various) - first seen at practice by Dr Aldred Massoud on 4 February 2022. L shoulder pain, L knee meniscus tear, exacerbation of back pain, exacerbation of anxiety/depression. 6. Report of Dr Alfred Massoud dated 27 October 2022 - diagnosed chronic back pain which required previous decompressive surgery. Accident caused an acute exacerbation in chronic lumbar pain and knee pain. Opined that prior to accident, back pain was well-controlled. Agree with neurosurgeon Dr Bazina that surgery is warranted. 7. Bone scan dated 22 December 2023 - L5/S1 severe discovertebral arthritis. Moderate arthritic changes in the knees (greater on left). 8. MRI Lumbar spine dated 8 August 2022 - moderate spondylitic changes with significant disc degeneration at L5-S1 level. At L4-5 level broad-based disc bulge with left lateral prominence and annular tear causing possible irritation to the origin of the left L5 nerve. Significant dehydration of L4-5 and L5-S1 discs. At L5-S1 level large broad-based disc bulge is compromising the exiting right and the left L5 nerves. 9. MRI left knee dated 15 November 2021 - radial tear anterior horn of lateral meniscus with breach of tibial and femoral articular surfaces. 10. Reports of Dr James Bodel, orthopaedic surgeon, dated 24 January 2023 and

15 May 2024 (x2) - opined that the claimant sustained accident-related injuries to her cervical spine, lumbar spine and left shoulder. Impairment was assessed at 23% WPI overall. 11. Report of Dr Raymond Wallace, orthopaedic surgeon, dated 18 August 2023 - opined that the motor accident did not cause any injuries to the lumbar spine or left knee. The left shoulder was assessed at 3% WPI 12. Certificate of Medical Assessor Alan Home, treatment and care dispute, dated

27 November 2023 - found the request for L5 decompression surgery (two levels) as recommended by Dr Bazina did not relate to the injury caused by the motor accident.

1. At the initial teleconference on 13 August 2025, the Panel determined that the claimant be re-examined. This took place on 9 September 2025 and the re-examination report of Medical Assessor Gray is below:

"Consultation 9 September 2025 (9.30-11.10am) at PIC.

A female chaperone - Rachel, was present during the consultation and physical examination.

Her sister Gunay was present for part of the consultation.

Ms Olgun is now 52, born in Turkey and migrated to Australia as a 15-year-old, having earlier had an arranged marriage in Turkey; she had no subsequent schooling.

She said she had essentially been a housewife from 1989 onwards, apart from 1-2 years after the birth of her first daughter, working in a plastics and then a chocolate factory doing process work.

Later from 1996 to 1999 she had worked in a kebab shop with her husband, with no substantive employment since.

Ms Olgun said she separated and came to Sydney from Melbourne in 2000 with her two children. Since about 2009-10 she has been receiving disability payments, saying her mental health was not good after the separation, having had issues with domestic violence associated with her ex-'partner.'

Currently Ms Olgun said she lives in a housing commission home with her two adult daughters. She has been on a pension for depression since about 2008, and continues to see a Psychologist regularly on a two-four weekly pattern, and a Psychiatrist intermittently.

Ms Olgun described longstanding treatment for hypertension, currently taking Micardis 40/12.5 and Cartia. For many years, she has used Indocid suppositories intermittently treating her more severe migraine episodes.

At the time of the subject motor accident, Ms Olgun said she had been taking blood pressure medication only, advising initially that she had not been taking Palexia or other strong analgesics, at the time of the accident.

However, later in the consultation, Ms Olgun advised she had taken Palexia regularly from 2008 or so onwards, continuing to take it regularly before the subject accident, and increasing the dose since the accident.

However, still later in the interview, Ms Olgun revised her analgesic history to say that she had formerly taken Panadeine Forte regularly before the motor accident, and had increased the dose since the back operation; however, she appeared inconsistent in recalling her history of taking Panadeine forte and Palexia analgesics, saying at one stage that Palexia was Panadeine Forte.

Past surgery included caesarean sections for both of her children.

A 'gastric sleeve' operation that she said had helped her weight to an extent, but since the motor accident she had put on more weight, despite that surgery.

She had lumbar spinal surgery, two years before the motor accident.

Post-accident, she had arthroscopic surgery to the left knee, which she said was of some help, saying she had been told that she would require a total knee replacement in time, but that at present she is too young.

Ms Olgun said that she was the sole occupant of a car, driving from Merrylands to Liverpool on the Cumberland Highway, between 6-7pm on 8 June 2021, in heavy rain.

She said she had stopped at lights and believed another vehicle inappropriately turned in front of her on a green arrow, colliding with the front right hand side of her vehicle.

She was wearing a seat belt and the airbags deployed.

She immediately felt a burning sensation across her face and said she recalls vividly that her left shoulder hit the steering wheel, but that there no other direct contact between her body and the vehicle. She said she was able to extricate herself from the car, and was then helped by a passerby to a shelter out of the rain, until an ambulance arrived.

At that stage Ms Olgun described left shoulder pain and she said that she also told them that her low back hurt; to further questioning, she said that she believed that she advised them that she had a problem with her back, but then said she could not really remember the details as she was overwhelmed and in shock, but remembering quite specifically the left shoulder pain from hitting the steering wheel.

She said that she did not want to go to hospital but was taken to Fairfield Hospital, near where she was living at that time.

To further questioning, Ms Olgun said she did not remember specific back pain early post-accident.

On questioning Ms Olgun regarding pre-accident back pain, she said that she had a continuing problem with her low back before the subject motor accident; subsequent to the motor accident, she said she hadn't realised that the low back pain was 'that bad'.

She said that at that time of the accident she was quite upset and scared, saying that 'life is not easy' and she also said she 'tried to brush it off'.

She also said that she did not know for a while that she could get compensation from the effects of the motor accident.

Note: when questioned about pain in the low back immediately after the accident, Ms Olgun initially said that she had told the ambulance people. I advised her that there was no record in the ambulance report, and also no record in the ER notes or in the early GP notes of specific low back pain.

Ms Olgun said she did not remember back pain early post-accident but said that she was very confused at the time - shocked and couldn't really recall.

She said she did not want to go by ambulance but because of the left shoulder pain, she agreed to go to Fairfield Hospital.

She said she had spoken to her general practitioner and had advised him of the accident. I advised Ms Olgun that there was no record of this in his early notes.

Ms Olgun advised that her own GP does not take notes and that the conversation was in Turkish. She said that her car had been written off. She said that he didn't ask any further questions but only increased her pain killers per phone.

Ms Olgun was requestioned regarding low back pain before the subject accident and she said that Dr Collette at RPAH had undertaken a low back operation, which she thought was at L4 or L5. She said she continued to have some back pain and had Panadeine Forte for that but earlier she had confused Panadeine Forte with Palexia. She said that she was advised that she had arthritis in the low back and that it would become worse in cold weather. She said that after the car accident the pain in the low back was worse. [She had applied for NDIS in the last four years.]

She said that because of the pain in the back, she commenced Palexia after the accident because of this pain, stating that she had trouble with the medications because of the former gastric sleeve operation.

She said that subsequently she used Palexia SR regularly and then intermittent Palexia IR with more severe pain. She felt this change occurred about six to seven months post-accident.

With regard to the left knee, she said that there was no obvious injury to the left knee in the motor accident. One to two months later she was driving her daughter, and she wanted to exit the vehicle; on doing so and dealing with her back, there was a cracking sound in the left knee, with difficulty weightbearing but the knee didn't literally give way; she said that she thought that the left knee problem was coming from her back initially.

She said that she attended a GP and a few days later she attended a specialist in Bankstown, whom she said 'put my name down for surgery'; she described an arthroscopic procedure to the left knee that she said helped for a while, but then the dominant problem was pain in her back.

She also said that she had pain into her left leg from her back, which started after the accident and that her GP just kept giving her pain killers.

Ms Olgun said she was referred to a female neurosurgeon, who initially recommended an operation but then apparently declined proceeding to surgery.

Ms Olgun said the low back pain continued and described the pain radiating into the posterolateral aspect of the left thigh and left knee, plus pins and needles over the outer aspect of the left thigh, with her left leg feeling bigger than the right.

Note: Ms Olgun advised undergoing lumbar spine surgery at Royal Prince Alfred Hospital in May 2025, saying that it significantly helped and said that now the left shoulder is playing up, describing, 'a swollen left shoulder'. She said a recent cortisone injection to the left shoulder helped initially.

Ms Olgun described intermittent pain over both the left and right trapezius areas and said that her daughter massages these areas with effect. She said she had had multiple cortisone injections on the left side and X-ray at Toongabbie.

Some intermittent discomfort in the thoracic spine, pointing to the central thoracic spine.

She has continuing pain in the central low back, with the pain in the left leg that had now considerably resolved, but still with the pain over the posterolateral thigh on the left.

She again reported considerable improvement since the recent back surgery. She said the symptoms in the left knee are unchanged and she is unable to kneel on the left knee. There is intermittent swelling of the left knee but no literal instability. She has intermittent clicking in the left knee with walking.

Ms Olgun weighed 105kg and said she was 158cm in height (BMI = 42).

She intermittently stood up to walk around during the consultation and walked with a definite limp.

In the lumbar spine there was a 10cm central longitudinal surgical incision, consistent with the known surgery, with no particular local tenderness about the lumbar spine. There were negligible ranges of flexion and extension. with a reasonable range of rotation/tilt.

Straight leg raising bilaterally produced no sciatic/root tension symptoms

In the lower limbs, thigh circumference (10cm above each suprapatellar border) measured 61cm on the right and 62cm on the left.

The maximal circumference of each calf measured 46cm on the right and 47cm on the left.

There was no specific power loss in the lower limbs.

On assessing sensation, there was reduced subjective sensation in a circumferential fashion in both the left and right legs, less marked on the inner aspect of the left lower leg, with no specific radicular pattern to the sensory change.

Assessment of both knees was difficult due to the excessive adipose tissue about both lower limbs. There appeared to be no definite effusion in the left knee and no literal instability elicited.

Full extension was obtained with both the right and left knees but flexion of the left knee was limited to 70° by complaint of general knee pain."

1. The assessment of the degree of permanent impairment is to be made in accordance with the Guidelines.[4]
2. Version 10 of the Guidelines applies to the Review. Part 6 deals with the assessment of permanent impairment.

1. Causation is dealt with at cls 6.5-6.7 of the Guidelines.
2. Clauses 6.6 and 6.7 states as follows:

"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:

1. The alleged factor could have caused or contributed to the 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. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and 5E.

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.[5]
2. The onus is on the claimant to prove, on the balance of probabilities, that the motor accident caused injuries to the claimant's lumbar spine and left knee.[6]
3. The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[7]
4. The Panel refers to the above re-examination report of Medical Assessor Gray. The Panel reconvened on 23 September 2025 and discussed the re-examination report findings before collectively making the below determinations.

1. The Panel acknowledges that the subject motor accident was a significant event that could have caused an injury to the lumbar spine. Airbags were deployed with the police and ambulance in attendance. Photographs of the vehicles showed significant damage to the claimant's vehicle, both externally and internally.
2. However, the Panel recognises that causation is a two-pronged test. The Panel must also be satisfied, on the balance of probabilities, that the motor accident did cause an injury to the claimant's lumbar spine. It is the Panel's view that the claimant has not discharged her onus of proving that the motor accident did in fact cause or contribute to her alleged recurrent disc prolapse at L5/S1.
3. At the time of the motor accident the Panel noted that MRI imaging showed degenerate disc disease at L5/S1 which became symptomatic following a previous injury in November 2017.[8] In the years that ensued, GP Dr Demdi's records showed marked chronicity and when conservative treatment measures were exhausted, the claimant underwent a L5 facetectomy and rhizolysis in January 2019. Unfortunately, as documented in the GP records, the claimant continued to have lower back symptoms right up to April 2022, just weeks before the subject motor accident.
4. Following the motor accident, the claimant reported neck and left shoulder symptoms. The Panel noted that there was no record of lower back pain for the first month post-accident. This was despite the claimant being assessed by ambulance, Fairfield Hospital and attendances at her GP. The first mention of lumbar spine symptoms was on 13 July 2021, over a month after the motor accident. The mention was made in the context of chronic lower back pain with the previous surgery stated as providing only minimal relief. The claimant also reported that recent cold weather had aggravated her pain further. There was no mention of the motor accident.
5. As detailed in the above re-examination report of Panel Medical Assessor Gray, which the Panel accepts in full, the Panel carefully questioned and re-questioned the claimant regarding her recollection of her early symptoms following the motor accident. There were inconsistent responses, with the claimant's recollection being that she was confused, in shock and could not really recall whether she had back pain early post-accident.
6. In the Panel's view, it is more likely than not that the motor accident did not cause or contribute to her alleged recurrent disc prolapse at L5/S1. Had such a prolapse (or recurrence of a pre-existing prolapse) occurred as a result of the motor accident, the claimant would have experienced a prompt onset of increased lumbar symptoms, for which she was already symptomatic in the weeks before the motor accident. When she did report lumbar symptoms, some five weeks after the motor accident, it was in the context of her chronicity with no mention of the motor accident increasing her symptoms.
7. The claimant's current presentation is a continuation of her pre-existing history consistent with a progression of the pathology shown in the radiology. The motor accident did not cause or contribute to the alleged recurrent disc prolapse at L5/S1.
8. The Panel was therefore in agreement with the lumbar spine causation findings of

Dr Wallace and Medical Assessors Home and Assem. Dr Bodel's opinion on causation was, in the Panel's view, almost completely reliant on the history given by the claimant with no reference made to the documented evidence. This was confirmed by Dr Bodel referring to immediate lower back and left knee pain when there are no records of such pain being reported. This is particularly true with the left knee as this injury occurred as a separate incident, detached from the alleged accident-related lumbar spine injury and occurring some three months after the motor accident.

1. It follows that the post-accident fall which injured the claimant's left knee did not occur as a consequence of any accident-related lumbar spine injury. The third Oakley scenario applies as there is no connection between the motor accident and the subsequent fall. In other words, the fall would have happened independent of the motor accident, and mostly likely due to the claimant's pre-existing lower back condition.

1. The following injuries were caused by the motor accident:
   • cervical spine - musculoligamentous injury, and
   • shoulder - left shoulder rotator cuff injury, supraspinatus tear and bursitis.
2. The following injuries were not caused by the motor accident:
   • lumbar spine - recurrent disc prolapse at L5/S1, and
   • left knee - ACL rupture and meniscus tear.

1. The parties are in agreement that the WPI for the cervical spine and right shoulder are assessed at 0% and 8% respectively.
2. The claimant's combined WPI is therefore 8% and is not greater than 10%.
3. While the Panel is in agreement with the Medical Assessor's findings on causation, the change in WPI for the left shoulder injury was due to a calculation error and required correction by the Panel.
4. Accordingly, the certificate of Medical Assessor Assem dated 16 April 2025 is revoked. A new certificate is issued at the front of these reasons.

[2] (1990) 10 MVR 570.

[3] Pursuant to section 7.25 'Agreement between parties as to matters in dispute - further assessments and reviews' of the MAI Act.

[6] Briggs v IAG Limited Trading as NRMA Insurance [2022] NSWSC 372 per Wright J at [73].

[8] Clinical note entry of GP Dr Suleyman Demdi dated 13 November 2017 (page 451/654 of claimant's review bundle).