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

16 April 2025. 2. The following injuries caused by the motor accident give rise to a permanent impairment of 15% and it is greater than 10%: * lumbar spine, soft tissue injury - 5%; * right knee, fracture of the tibial plateau - 8%, and * right ankle, soft tissue injury involving ligaments ATFL, CFL and deltoid - 2%.

1. The claimant is a 64-year-old woman who was injured when struck by a motor vehicle on

13 June 2022. The parties agreed that the claimant had sustained non-threshold injuries. 2. The claimant sought a concession from the insurer that her injuries exceeded 10% whole person impairment (WPI) for the purposes of the Motor Accident Injuries Act 2017. Following a review, the insured declined to make this concession and accordingly the claimant lodged an application for assessment of WPI. 3. The claimant was examined by Medical Assessor Mohammed Assem on 15 April 2025 who, in a certificate dated 16 April 2025, determined that the injuries caused by the motor accident gave rise to a permanent impairment of 13%. The insurer sought a review of this certificate and, in a decision dated 19 June 2025, President's delegate Stephanie Wigan determined that there was a reasonable cause to suspect that the medical assessment was incorrect in a material respect. 4. The matter was then referred to this medical panel. There were directions issued to the parties to upload all material which was before Medical Assessor Assem at the time of his examination. The parties have done this and the Panel is satisfied that all relevant materials are before it. The panel convened on 26 August 2025 and determined that it was appropriate that an examination of the claimant be undertaken. 5. Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A "new decision maker" is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply. 6. The new review provision provides that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission). 7. Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor. 8. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application. 9. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned. 10. The claimant attended the examination by Medical Assessor Oates at the Personal Injury Commission (PIC) Suites on 23 October 2025.

1. The claimant attended for re-examination by Medical Assessor Oates at the Commission's Medical Suites on 23 October 2025.

Pre-accident medical history and relevant personal details

1. Right hand dominant.
2. The claimant said she came from Hong Kong to Australia in 1986. She lives in a townhouse at Strathfield with her husband and one of her two daughters.
3. She started work with Australia Post in 1999 in parcel and mail processing, involving repetitive lifting of items weighing up to 16kg. She worked a lot of overtime, sometimes up to 60 hours per week during busy periods.
4. As she was not able to return to her physically demanding job following the accident, she was medically retired by Australia Post in July or August 2024.
5. Prior to the accident, she was in good general health and was on no regular medications, and had not had previous surgery. She had had no previous fractures or injuries to the knees or ankles.
6. She was asked about a general practitioner (GP) record of 26 July 2018 which referred to a three-month history of low back pain. She said it was diagnosed as muscular pain. She had a CT scan of the lumbar spine which showed significant facet joint degenerative changes and mild circumferential disc bulges at L3 to S1. She was given medications. She doesn't recall any time lost from work and was not on suitable duties, but rather normal duties. She can't recall how long the back took to settle, but she said she had no symptomatic low back condition immediately prior to the subject accident.

1. The claimant said on 13 June 2022, she had just done an afternoon shift for Australia Post and at about 7.45pm she was going to cross the road in Worth Street, Chullora, to meet her husband who was picking her up after work. She looked in both directions and saw no traffic nearby and started to cross the road. She was wearing her work issue high visibility safety vest and as she got to the centre of the road, she saw a vehicle on the opposite side to where she had started from with its lights turned off, but then the headlights suddenly turned on and without indicating, the driver took off and then made a U-turn to travel in the opposite direction and was coming directly for her.
2. She attempted to jump back out of the way, but the vehicle was travelling too fast and the front of the car struck her on her anterior right knee. She fell backward onto the road, landing on a bag which she was carrying on the right side of her body. She felt immediate severe right knee pain and low back pain.
3. She did not strike her head and there was no loss of consciousness. She was protected somewhat by a right-sided bag she was wearing. She remembers pain radiating from the back into the legs. She also had discomfort in the coccyx region, as she had landed on her back.
4. A passer-by assisted. The driver of the vehicle told her to get up and that she was all right, but then he ended up calling the police and ambulance when she said she was not all right.
5. She was taken by ambulance to Westmead Hospital. The ambulance records indicated tenderness in the neck and lower back, right knee and right ankle, with the major pain being in the right knee and an inversion deformity was present in the right ankle.

History of symptoms and treatment following the motor accident

1. She was admitted to Westmead and was in hospital for about three and a half weeks. She was noted to have significant swelling and deformity in the right knee and imaging showed a comminuted depressed fracture of lateral tibia plateau, with extension of the fracture line into the proximal tibiofibular joint.
2. After one week's delay because of COVID-19 restrictions, she had open reduction and internal fixation of the right knee fracture on 22 June 2022 by Dr Lorentzos, orthopaedic surgeon. She developed a deep vein thrombosis post-operatively in the right calf.
3. She noticed increased pain and then numbness in the middle three toes of the right foot following the surgery.
4. On 6 June 2022, she was transferred to Westmead Rehabilitation Hospital for a four-week mobilisation program. At this time, because of complaints, there were further investigations which showed a coccyx fracture, however this did not restrict her mobilising program.
5. She then saw a GP, Dr Guirguis. The records referred to low back pain, tingling and numbness, and she said this started immediately after her fall but the pain was more pronounced, particularly in the right foot.
6. An MRI scan of the lumbar spine on 19 September 2022 showed a bulge in a degenerative L4/5 disc and Grade 1 L5/S1 anterolisthesis with bilateral facet joint arthropathy. As she became more mobile, she noticed increasing right ankle pain in the following months. An MRI on 29 November 2022 showed ligamentous injury and scarring to the ATFL (anterior talofibular ligament), CFL (calcaneofibular ligament) and the deep deltoid (medial ankle) ligament.
7. She had a CT- guided epidural steroid injection at L5/S1 on 28 November 2022 with only slight improvement. An ultrasound doppler scan on 14 December 2022 showed the DVT had resolved in the right calf.
8. She took Targin as an analgesic at first and then paracetamol, but ceased the latter on her GP's advice because she was noted to have elevated liver function tests.
9. She was offered surgery for the lumbar spine and further surgery for the right knee, but declined both because of the risks involved of further surgery. The metalware remains in situ in the right leg.
10. She had conservative treatment including hydrotherapy, physiotherapy and exercise physiology with a program.
11. She had continuing stiffness and pain and inability to fully straighten the right knee, with pain disturbing her at night, as well as an instability feeling in the right ankle. She had ongoing low back pain, worse with prolonged sitting, standing and walking, and discomfort over the tailbone.
12. She was reviewed by Dr Lorentzos in February 2025 and had an X-ray of the right knee showing 1.5cm shortening of the right leg and mild to moderate osteoarthritis of the medial and patellofemoral compartments in the right knee. He apparently offered her a right total knee replacement which she declined at this stage but realises that she may require one inevitably at some future point.
13. She tells me she was not prescribed a right heel raise because of the limb length inequality.

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

1. She was recently diagnosed with type 2 diabetes mellitus but this is controlled by diet alone, and she has lost 7kg. She has had no further injury or other health problem develop.

1. She has numbness in the distal sole of the right foot, in the ball of the foot and in the middle three toes of the foot. She has intermittent low back discomfort, worse with prolonged sitting and prolonged standing, in the mid-line and radiating towards the left buttock. There is tingling and pain sometimes in the left buttock and lower back, down the back of the leg to the heel. She sometimes feels a cold water sensation in the right calf, and the right leg gives way at times and the knee and she stumbles.
2. She has to go to the toilet a few times to defecate, but there is no problem with micturition. Her tailbone is a little tender with touch. The bowel problem worries her somewhat, as she has previously had haemorrhoidectomy and is worried about recurrence.
3. The anterior right knee pain is still present and extends to the shin, and there is clicking at times in the knee but no locking. She still has right lateral ankle pain and she notices some pigmentation colouring of the skin of the distal right calf following the DVT.

1. She is no longer taking medications, last having taken paracetamol but this was ceased on medical advice.
2. She continues in the same living situation, but gets more help from family members now for house cleaning and food preparation.

1. Clinical examination was carried out in the presence of a female chaperone. She undressed to an examination gown, not observed by me.
2. She sat comfortably whilst giving the history and transferred freely out of a chair and on and off the couch. She used a walking stick for support, having antalgic gait limited by her right knee stiffness.
3. She was of slim small build with height 156cm and weight 50.9kg.

1. There was normal lumbar lordosis. There was no muscle guarding or spasm. There was dysmetria of flexion and extension with flexion limited to two-thirds of normal and extension limited to one-quarter of normal. Lateral flexion and rotation were one-half normal bilaterally.
2. Reflexes in the lower limbs were symmetrical. Plantar responses were both flexor. Power right equals left. There was partial decrease to light touch and pin prick across the ball of the right foot and under the three middle toes of the right foot. Sensation was otherwise intact in the lower limbs.
3. Leg length from anterior superior iliac spine to medial malleolus; right 84cm, left 84.5cm.
4. Thigh girth; right 40cm, left 41.5cm at 10cm above the patella.
5. Calf girth; right 35.5cm, left 37cm at 15cm below the patella.
6. Supine straight leg raising 60° bilaterally with complaint of low back pain but negative stretch test.

1. Active range of movement of the joints was measured with a goniometer.
2. There was crepitus at the right patellofemoral joint with pain on patellar compression. Both knees were stable in anteroposterior and mediolateral direction.

1. There was no instability demonstratable in either ankle.

1. A 13cm linear, longitudinal, very well healed surgical scar over the lateral aspect of right knee and adjacent shin. There was no colour contrast with surrounding skin, no tethering, no adherence, no trophic change, and there were barely visible suture marks. The claimant indicated she had assiduously treated the scar with Vitamin E cream with good result.

1. The claimant presented in a straightforward manner.

SUMMARY OF RELEVANT RADIOLOGICAL AND MEDICAL IMAGING AND OTHER INVESTIGATINOS

1. The following films were brought to the Panel's re-examination:
   • 3 August 2022 - X-ray lower leg showing ORIF plate and screws in lateral tibial plateau fracture;
   • 14 September 2022 - X-ray right knee and doppler ultrasound scan right leg and x-ray lumbar spine - Fractured coccyx and ORIF in the right knee;
   • 19 September 2022 - MRI right knee and lumbar spine - The films imaging were consistent with the report on file;
   • 21 December 2022 - X-ray and CT scan right knee - The films were consistent with the reports in the file;
   • 17 February 2023 - X-ray right knee and right lower leg - The imaging was consistent with the report on file;
   • 8 November 2023 - Bone scan - The imaging was consistent with the report on file, and
   • 18 February 2025 - report only, no images - X-ray right knee and bilateral lower limbs, Dr Harris - Post-tibial ORIF - The entire right leg measures 840mm. The right femur measures 483mm, the right tibia measures 357mm. The entire left leg measures 855mm.
2. The left femur measures 479mm, the left tibia measures 372mm.
3. Weight-bearing alignment of the right leg demonstrates borderline mild valgus alignment and there is mild to moderate varus alignment of the left leg. There are minor osteoarthritic changes of the hips and sacroiliac joints. There is right proximal tibial ORIF with position at alignment of hardware appearing normal and no hardware failure is identified. There is mild to moderate osteoarthritis of the medial and patellofemoral compartments of the right knee.
4. Following the re-examination the panel reconvened and jointly made the following determinations.

1. Injury to lower back lumbar spine - disc desiccation and disc bulge.
2. The diagnosis is redefined as soft tissue injury. The accident was a cause of this injury, because the ambulance record refers to lumbar and right pelvic pain.

1. The diagnosis is fracture of right tibial plateau, followed by deep vein thrombosis which subsequent resolved.
2. The accident was a cause of this injury, since the ambulance record refers to right knee pain and hospital report also refers.

1. The diagnosis is redefined as soft tissue injury involving injury to ligaments ATFL, CFL and deltoid.
2. The accident is a cause of this injury, as ambulance record refers to right ankle pain and inversion deformity. X-ray and MRI scans were consistent with an inversion injury.

1. The accident was a cause of this injury, because it is shown on bone scan of

8 November 2023 as a healed fracture. 2. There was coccygeal pain noted in the contemporaneous medical records. The coccyx fracture has healed without deformity giving 0% WPI.

1. There was dysmetria of flexion and extension present, and this was also noted by the original Medical Assessor. Although there was a history of pre-existing lumbar spine symptoms, the claimant told me that this condition was not symptomatic at the time of the accident and there was no evidence in the file material to indicate any findings apart from symptoms, giving a pre-accident impairment of DRE category I with 0% WPI.
2. With respect to the accident-related injury, dysmetria is a differentiator for DRE Lumbosacral Category II giving 5% WPI.
3. There were not two or more criteria present on clinical examination to diagnose lumbar radiculopathy. The partial numbness present in the middle three toes of the right foot, which manifested after surgery in the right knee, does not follow a dermatomal pattern and hence does not represent a clinical sign of radiculopathy, rather a peripheral nerve condition.

1. Fracture of right tibial plateau.
2. The accident was a cause of this injury, as this injury is mentioned in the ambulance and hospital records, and was diagnosed on investigations carried out at the hospital.

1. There is loss of range of movement in the knee which forms a basis for assessing permanent impairment.
2. Extension -10° in right knee gives 8% WPI. Alternatively, this is 20% lower extremity impairment.

1. There is active loss of movement in the right ankle, forming the basis for assessing an impairment.
2. Dorsiflexion 0° is 7% lower extremity impairment or 3% WPI.
3. The range of movement evident at the right hind foot does not give rise to assessable impairment, however there is slight impairment at the uninjured left hind foot with eversion of 10° giving 2% lower extremity impairment. This can be used as a baseline.
4. Motor Accident Guideline, cl 6.85, referring to Tables 40 - 45 of the AMA4, used to assess range of motion in lower extremity indicate that where there is loss of motion in more than one direction or axis of the same joint, only the most severe deficit is rated, the ratings for each motion deficit are not added or combined. However, motion deficits arising from separate tables can be combined.
5. This is the case with the ankle and hind foot, which are in separate tables.
6. For the right ankle and hind foot, there is 7% lower extremity impairment. For the left ankle and hind foot, there is 2% lower extremity impairment. 7 - 2 is 5% lower extremity impairment. This is equivalent to 2% WPI.
7. For the right lower extremity, 8% WPI from the right knee combined with 2% WPI from the right ankle gives 10% WPI.
8. For leg length discrepancy, Clause 6.76 and 6.77 of the Motor Accident Guidelines are relevant. They indicate that Table 35 of AMA4 must have the element of choice removed, such that impairments for leg length should be read as the higher figure of the range quoted. A discrepancy of 0 - 1.9cm is 0% WPI.
9. With respect to scarring and adopting the TEMSKI criteria, we assessed 0% WPI as the 'best fit'. The injured person is conscious of the scar, however it is barely noticeable. There is good colour match with surrounding skin. The injured person is able to locate the scar. There are no trophic changes. Suture marks are barely visible. The anatomical location of the scar would not be clearly visible with usual clothing or hairstyle, apart from when wearing shorts in warmer months. There is no contour defect, no effect on any ADL, no requirement for treatment now, and no adherence.
10. The combined WPI is 10% from right knee and right ankle combined with 5% from lumbar spine giving 15% WPI.
11. The findings of the original Medical Assessor are not confirmed. Although the Panel had similar findings, 10° flexion contracture of the right knee which was found by the original Medical Assessor should have been assessed as 8% WPI, rather than 4% WPI.

1. The certificate of Medical Assessor Assem is revoked. The panel determined the degree of WPI caused by the subject motor accident is 15%.