MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); degree of permanent impairment disputes; claimant was driving; claimant had been to have her eyes checked that morning; claimant's vehicle was stationary waiting to turn left when the insured utility vehicle ran into the back of the claimant's vehicle at speed; claimant believes that the insured driver did not see her vehicle; claimant was wearing a seatbelt; her airbags did not deploy; claimant recalls a jolt and her head striking the back headrest at the time of the collision; claimant was diagnosed with a right vitreous detachment with no retinal complications; claimant suffered various other physical injuries; after carefully reviewing the evidence and examining the claimant; Held - the Review Panel was not satisfied that the claimant's posterior vitreous detachments were caused by the accident; claimant did not provide any expert evidence to the contrary; vitreous detachment in right eye not diagnosed in right eye until 3 months post-accident; vitreous detachment in left eye not diagnosed until later; MAC confirmed.

REVIEW PANEL ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT

Certificate issued under s 7.26(7) of the Motor Accident Injuries Act 2017 (the Act)

1. The Review Panel confirms the certificate of Medical Assessor Kerrie Meades dated 5 August 2024.

1. Inas Sarofim (the claimant) was driving her Holden sedan on the afternoon of 6 November 2019 in Kensington. She had been to have her eyes checked that morning. The claimant's vehicle was stationary, waiting to turn left, when the insured utility vehicle ran into the back of the claimant's vehicle at speed. The claimant believes that the insured driver did not see her vehicle. The claimant was wearing a seatbelt. Her airbags did not deploy. The claimant recalls a jolt and her head striking the back headrest at the time of the collision. There were no other occupants in her vehicle. Neither Ambulance nor Police Officers attended the scene. The claimant was able to drive her vehicle the short distance to her home. Her vehicle subsequently was repaired.
2. The claimant immediately noticed blurred vision. Since the accident, the claimant has had blurred vision and sensitivity to light, with some double vision. A CT scan showed no skull fractures. About three months after the accident, the claimant was diagnosed with a right vitreous detachment, with no retinal complications. The claimant suffered various physical injuries which are the subject of separate assessment and review.
3. Allianz Insurance Australia Limited (the insurer) indemnifies the owner and/or the driver of the at-fault vehicle for liability to pay to the claimant any damages under the Motor Accident Injuries Act 2017 (the Act). The insurer concedes that the claimant has non-threshold injuries and that she may have an entitlement to common law damages. The claimant was paid statutory benefits beyond 26 weeks. The insurer does not concede that the claimant exceeds the 10% whole person impairment (WPI) threshold for an award of damages for non-economic loss.

1. As there is a dispute between the parties about the degree of permanent impairment under Schedule 2, cl 2(a) of the Act, the claimant was referred to Medical Assessor Kerrie Meades for assessment. Medical Assessor Meades certified on 5 August 2024 as follows:

The following injuries referred to me for assessment have been assessed and determined to be not caused by the motor accident:

• Injury to the eyes - posterior vitreous detachment in both eyes

An assessment of the degree of permanent impairment of these injuries is therefore not required.

Medical Assessor Meades found that the claimant suffered signs of bilateral vitreous detachments with no retinal complications that, in the Medical Assessor's opinion, are unlikely to be related to the accident. Medical Assessor Meades further stated that changes in the claimant's vitreous are a normal part of aging.

1. The claimant's other physical injuries were referred to Medical Assessor Nelukshi Wijetunga for assessment. Medical Assessor Wijetunga certified on 29 August 2024 as follows:

The following injuries caused by the motor accident give rise to a permanent impairment of 5% and IS NOT GREATER THAN 10%:

• cervical spine and bilateral shoulders - Whiplash Associated Disorder - aggravation
• lumbar spine - aggravation of musculoligamentous sprain of the lumbar spine

The following injuries referred to me for assessment have been assessed and determined to be not caused by the motor accident:

An assessment of the degree of permanent impairment of these injuries is therefore not required.

President's delegate Stephanie Wigan decided on 3 December 2024 that there is not a reasonable cause to suspect that Medical Assessor Wijetunga's assessment was incorrect in a material respect. Accordingly, the claimant's review application was refused.

1. Medical Assessor Murray Hyde-Page certified on 3 October 2023 as follows:

The following injuries caused by the motor accident give rise to a permanent impairment of 4% and IS NOT GREATER THAN 10%:

Medical Assessor Hyde-Page made no adjustment for pre-existing/subsequent impairment, apportionment of treatment effects.

1. Medical Assessor Hyde-Page found that the following injuries WERE NOT caused by the motor accident:
   • cervical spine
   • left elbow

1. The claimant sought a review of Medical Assessor Meade's certificate, on the grounds that the medical assessment was incorrect in a material respect, under s 7.26 of the Act. The claimant relied on the particulars set out in the application and supporting documentation.
2. The claimant submitted that Medical Assessor Meades failed to give adequate reasons for her finding that the posterior vitreous detachments in both the claimant's eyes are unlikely to be caused by the accident. The claimant also submitted that Medical Assessor Meades failed to disclose her path of reasoning in reaching her conclusion, particularly having regard to the material which Medical Assessor Meades was required to consider.
3. The claimant notes that her eyes had been checked at Spec Savers on the morning of the accident. The Spec Savers' notes of that date do not reveal symptoms similar to the symptoms the claimant described post-accident which included sensitivity to light with double vision and blurred vision. The claimant submits that similar symptoms are described in the report dated 28 February 2020 of Dr Azad. The claimant submits that further symptoms are comprehensively outlined in the report of Dr Pham (the Panel notes the reporter is an Optometrist), the clinical notes of Professor Coroneo.
4. The claimant submitted that, applying a common-sense approach to that material, and the factual question of causation, it is more likely than not there is a nexus between the accident and the onset of visual symptoms in the post-accident period, given the notes taken immediately prior to the accident do not disclose symptoms of which the claimant complains.
5. The claimant submits that "Medical Assessor Meades does not indicate how the information in the clinical notes on the day of the accident, or the opinions of Drs Azad, Pham and Professor Coroneo were resolved in reference to the symptoms described by the claimant in the post-incident phase, in coming to her conclusion that the posterior vitreous detachments were not related to the accident."
6. The claimant's application for review was opposed by the insurer. It submitted that the claimant has not provided evidence from her treating eye specialists, namely Dr Coroneo and Dr Azad, to the effect that either of them consider that the accident caused (or could have caused) her posterior vitreous detachment.
7. The insurer noted that Medical Assessor Meades agreed with the diagnosis of bilateral posterior vitreous detachments which, so the insurer submitted, are known to the associated with:
   1. older age (the claimant was 61 years old at the time of the accident);
   2. female sex;
   3. menopause;
   4. myopia (which the claimant has);
   5. ocular surgery (which occurred in 2016); and
   6. penetrating injury to the eye (absent).

In circumstances where no (insurer's emphasis) eye specialists have opined that there was a connection, and Medical Assessor Meades considers that the condition is aged-related, the insurer submitted the President's delegate ought not be satisfied there is reasonable cause to suspect that the medical assessment was incorrect in a material respect.

1. President's delegate Stephanie Wigan issued a Determination of an Application for Review of a Medical Assessment on 6 November 2024 which stated the satisfaction of the President's delegate that there is reasonable cause to suspect that Medical Assessor Meades' assessment was incorrect in a material respect. The basis of that decision was stated to be the claimant's submission that Medical Assessor Meades failed to provide adequate reasons with respect to the finding that "her changes in vitreous are a normal part of aging". The President's delegate refers to the notes of Spec Savers dated 6 November 2019 which do not reveal symptoms similar to the symptoms the claimant described post-accident which included sensitivity to light with double vision and blurred vision. The President's delegate essentially accepted the claimant's causation submissions to which reference has been made. Accordingly, the claimant's review application was accepted.

1. A medical assessment matter is determined in accordance with s 63 of the Act. The matter is determined at first instance by a Medical Assessor pursuant to and, on review, by a Review Panel consisting of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
2. Part 5 of the Personal Injury Commission Act 2020 (the 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.[1]
3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the 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 proceedings solely based on the written Application.[2]
4. The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[3]
5. All members of the Review Panel had no previous involvement with the claimant or with this matter.

1. Causation of injury is addressed in the Guidelines as follows:

"6.5 An assessment of the degree of permanent impairment is a medical assessment matter under cl 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical Assessors must be aware of the relevant provisions of the AMA 4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.

6.6 Causation is defined in the Glossary at page 316 of the AMA 4 Guides as follows:

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

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

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. See Briggs v IAG Limited t/as NRMA Limited.[4] See also Insurance Australia Limited t/as NRMA Insurance v Trkulja [2023] NSWSC 956,[5] wherein his Honour Justice Wright stated at (35):

"The question of causation of injuries was not dealt with in Part 5 of the Guidelines but causation was addressed in Part 6, which related to assessment of permanent impairment. There is no reason to think that different principes were intended to be applied when a medical assessment was being made in relation to causation of minor injuries."

1. Wright J then described the Panel's role in a medical review which is to:

"Consider whether the motor accident did cause or contribute to (the claimant's condition). This requires, not a consideration of material derived as a result of an internet search... but rather a consideration of the material referred to in 5.6 of the Guidelines, namely all the evidence available to the Panel, including all relevant findings derived from:

(1) a comprehensive, accurate history, including pre-accident history and pre-existing conditions;

(2) a review of all relevant records available at the assessment;

(3) a comprehensive description of the injured person's current symptoms;

(5) diagnostic tests available at the assessment, noting that imaging findings that are used to support the assessment should correspond with symptoms and findings on examination."

1. The parties have presented their respective bundles of documents upon which they rely. The Review Panel (Panel) has read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel, or a Panel Member, has not read it, nor taken it into consideration. The same principle applies to parties not referring to, nor specifically relying upon, a document in their own bundle and submissions.
2. The fact that evidence is not referred to in these reasons does not mean it has been overlooked. It is not required that each piece of evidence be mentioned. The Panel is not required to "analyse every piece of information from every opinion contained in a document with which it was provided". The Panel has come to its own conclusions and has taken its own history.

1. The claimant relied upon the following material which the Panel has considered:

Claimant's submissions made to President's delegate

Claimant's further submissions in Reply to insurer's submissions dated 21 October 2024

• As to paragraph 15 of the insurer's submissions, the claimant says that the information referred to and relied upon was not part of the reasoning process identified by Professor Meads and, respectfully, the submission is not open, particularly as it relies on matters of specialist knowledge that are not included in the certificate. The claimant concedes the insurer's submission does suggests the type of matters the Assessor ought to have reference in demonstrating the reasoning path deployed to reach the ultimate conclusion. The claimant says no such matters are evident in the certificate.
• In relation to the insurer's submission that the claimant has not lodged evidence from her treating eye specialists, namely Dr Coroneo and Dr Assad, to the effect that either of them consider that the accident caused (or could have caused) her posterior vitreous detachments, the claimant says that Dr Assad does not state that the posterior vitreous detachment in the right eye was age related.
• The claimant notes that the claimant was examined on 10 March 2020 by an optometrist, Ms Chen, who opined that the symptoms of posterior vitreous detachment were exacerbated by the subject accident.

Claimant's submissions in Reply to Insurer's Application for medical assessment

• The claimant submits she sustained the following injuries in the subject accident:
  1. soft tissue injury to the neck;
  2. soft tissue injury to the lumbar spine;
  3. tear of the medial meniscus in the left knee;
  4. bilateral rotator cuff tears;
  5. injury to the bilateral wrists causing carpal tunnel syndrome;
  6. concussion syndrome; and
  7. bilateral eye injuries,
• The insurer has applied for assessment of the claimant's WPI arising out of the following injuries only:
  1. soft tissue injuries to the neck;
  2. soft tissue injury to the lumbar spine; and
  3. soft tissue injury to the left knee.
• The claimant says that she has no prior history of left knee, lumbar spine, bilateral shoulder and/or bilateral median nerve injuries or vision problems.
• The claimant says that she was involved in a previous car accident on 25 February 2015, when a tree fell on her vehicle, causing her to suffer a whiplash injury which resolved.
• The claimant says that, in or around mid-February 2020, she started to experience floaters in her right field of vision. The floaters increased and she also started to experience flashes. The claimant attended an optometrist on 26 February 2020 who diagnosed Posterior Vitreous Detachment.
• The claimant relies upon the reports of Dr James Bodel dated 16 October 2023 who assessed the claimant's whole person impairment as it pertains to her orthopaedic injuries as follows:

(a) DRE cervical Category II - 5%

(b) Bilateral shoulders - 6%

(c) Injury to wrists and right carpel tunnel syndrome - 10%

(d) Left knee - 4%

No assessment is given in relation to the claimant's eyes as this falls outside Dr Bodel's expertise.

Claimant's Reply to Insurer's Application for Medical Assessment (including annexures)

Referral for medical assessment to Medical Assessor Meades

Claimant's application to admit late documents (including annexures)

• Photographs of claimant's vehicle.
• Report of Paola Pham, treating Optometrist, 25/09/2020 being referral to Professor Coroneo.
• Clinical notes of Dr Kyrillos.

Decision of President's delegate Ashley Payne admitting late documents

Letter to Professor Minas Coroneo from Daniel Meoli, Lighthouse Optometrists

1. The insurer relied upon the following material which the Panel has considered.

Insurer's submissions in response to the claimant's application for a review

• The insurer firstly deals with the legal principles relating to causation which are not contentious.
• In relation to the Eye Injury, the insurer submitted as follows:
  1. On 26 February 2020, the claimant attended an ophthalmic surgeon, Dr Assad. She reported a history of floaters in the vision of her right eye for the last week, and then two days prior, she had developed flashes in her vision. She had cataract surgery to that eye some years prior.
  2. Dr Assad diagnosed "right posterior vitreous detachment" in the right eye. This condition is a normal part of aging. He reassured the claimant there was no retinal detachment.
  3. He then reported that a few days later she called and asked that he had to her history an account that the floaters developed subsequent to the motor accident.
  4. The insurer notes that the physiotherapist observed the claimant had a black eye in around March 2020. She queried whether this was due to the accident, and the claimant thought it was due to bushfires smoke/ash.
  5. The insurer submitted that an injury to the eye as a result of the accident would have been apparent immediately thereafter, and on the balance of probabilities cannot be linked to the collision some three months prior.
  6. In any event, the presence of floaters in the vision does not give rise to an assessable impairment.

1. The claimant's medical evidence, relating to the subject dispute, consisted of the following material:
   1. Clinical notes of Specsavers (R18) of various dates.

Recently for 2 - 3 weeks feeling eyes sticky in morning. Itchy too. No eyedrops used. Sees floater still. No headaches. No diplopia.

Left cataract operation. Couldn't see long distance but now can. Right eye did something wrong and can't see long distance. Not pleased with opthal. Feels can't see peripheral vision well now. Three years ago. Floaters seen. Doesn't want to see any other opthal.

Visit recommended by GP. Right eye now sees a big black spot? Saw Dr Assaad and said might need laser tx in future? And similar will happen to left eye in time (sounds like PBD). No retinal complications. No further appointment.

1. Report dated 28 February 2020 by Dr Nagi Assaad, ophthalmic surgeon, to Specsavers Eastgardens.

Thank you for referring Mrs Sarofim who attended for assessment on 26 February 2020. She reported a one-week history of floaters in her right vision. Two days ago she developed flashes and increased floaters in her right vision. Since I saw her in 2016, she has had cataract surgery to the right eye elsewhere which she reports was around three years ago.

Anterior segment examination showed minimal posterior capsula opacity in the right eye and a clear intraocular lens in the left eye. The optic discs appeared healthy and the maculae showed normal age related changes. Peripheral retinal examination fortunately showed no signs of retinal tears or retinal detachment. There was evidence of posterior vitreous detachment in the right eye. OCT examination of the macular was normal in each eye.

I reassured her that there were fortunately no retinal complications related to the posterior vitreous detachment but I did explained the need for prompt review should she developed increased flashes or floaters in her vision. I have not arranged a further appointment at this stage.

Subsequent to her appointment, Mrs Sarofim sent further information regarding her history, in which she reports that she was involved in a motor vehicle accident in late 2019 and that the floaters in her vision developed subsequently. She wished to have this added to her history and this was noted.

1. Report dated 10 March 2020 by Jacintha Chen, optometrist, to Dr Kyrillos.

Inas came in today as she wasn't sure what is happening to her eye? She saw Dr Assaad back in February but wasn't entirely sure what is happening, all she was told about needing laser if it worsens? Examination today revealed a posterior vitreous detachment which correlated to her symptoms and information that she's given to me so far from Dr Assaad. There are early signs of the same happening in her left eye which Dr Assaad has advised her to see him if she gets the same symptoms. All these are common with age but also exacerbated in her case due to the accident she had back in 2019. I have reassured her that there is nothing she needs to avoid except high impact sports.

Dr Assaad February 2020, was told need laser in future? Was told left eye might have same thing? No review, open appointment.

1. Report dated 25 September 2020 by Paola Pham, optometrist, to Professor Coroneo.

Inas presented for an eye examination today for a few reasons. Firstly, she had been diagnosed with PVD after a car accident she had in November 2019. She has been seeing black floaters since the accident and in February 2020, she saw Dr Nagi Assaad who checked the retina and was cleared of any tears or detachments.

Despite this, Inas has always noticed a white cloud temporal to the right eye. It has been steadily growing in size and at times covers her vision, and is grey and shadowy.

Her hypercholesterolemia is well controlled with medication and has no other health issues at present.

Anterior eye examination on slip gland revealed some capsular fibrosis right worst that left. There appears to be some proptos of both eyes..... I noted some possible exudative changes around both maculae, right being worst than left. Ambler is normal.

Given the retinal changes and capsular fibrosis, I have referred Inas to you for your assessment and treatment.

1. Clinical notes of Professor M Coroneo as at 6 October 2023.

She had been involved in a car accident in November 2019. Following this event, she has been most troubled not so much by the floaters but she senses that the vision "has darkened" on both sides.

On examination, visual acuity was 6/18 on the right and 6/6 on the left. She corrects to 6/6 on the right and now has myopic astigmatism in this eye... She does have some capsular fibrosis particularly in the periphery..... She has an obvious posterior vitreous detachment on the right with a Weiss right. Her fundus appearance reveals some early lamellar maculae split on this side.

As previously noted, she has a posterior vitreous detachment... I have warned her of the symptoms of retinal detachment.

Her vision changes are of great concern to her. Inas states all of these things from the time she was involved in the car accident in November 2019.

There has been bilateral vitreous detachment. There was left more than right cellophane maculopathy.

1. The Panel cannot discern that Professor Coroneo expressed an opinion as to the cause of the claimant's posterior vitreous detachment in both eyes.
2. The insurer's medical evidence, relating to the subject dispute, consisted of the Specsavers' clinical notes and the eye examination report by Ms Jacintha Chen which previously have been referenced.

1. The report of Medical Assessor Malcolm Capon is as follows:

1. On 6 November 2019 the claimant was the driver of a car which was stationary and waiting to turn left when her car was hit on its rear end by a utility vehicle. She said her head was jolted and hit the head rest. She was disorientated and could not get out of the car. She claimed to me that she was "concussed" and that she was immediately light sensitive.
2. The claimant saw her GP on 7 November 2019 and 8 November 2019 with "headache, neck pain, confusion, whiplash" but there is no mention of photosensitivity.
3. On 15 November 2019 the claimant was referred for a CT of brain. I could not find a result of this in the documents provided but the claimant told me this scan was normal.

1. On 25 February 2015 the claimant's car was hit by a falling tree and she sustained a whiplash injury. This resolved without ocular sequelae.
2. When I saw her the claimant told me there was no history of myopia before she had bilateral cataract surgery and she did not wear spectacles for distance.
3. The claimant had bilateral cataract surgery by Prof Coroneo around 2013. On 9 August 2018 her corrected vision (ie with a correction for mild myopia) was 6/5 with each eye. On the morning of the accident the claimant saw an optometrist who found her vision to be 6/6 with each eye (with a correction for very mild myopia).
4. When I saw the claimant she said she had had floaters from about 2000. This is corroborated by the optometrist's notes on 9 August 2018, on 7 December 2018 and prior to the accident on the morning of 6 November 2019 where on each occasion it is noted that the claimant was symptomatic for floaters.

1. The claimant told me her floaters were worse from the time of the accident on 6 November 2019. On 20 February 2020 the claimant was seen by an optometrist and complained of "spots in vision about 2-3 weeks ago." When she saw Dr Assaad on 26 February 2020 the claimant "reported a one-week history of floaters in her right vision" and Dr Assaad found a right posterior vitreous detachment as the cause.
2. On 10 March 2020 she saw a second optometrist who confirmed the presence of a right posterior vitreous detachment. She also confirmed the claimant's best corrected vision to be 6/6 each eye.
3. On 25 September 2020 the claimant saw a third optometrist about floaters and a white cloud in her right temporal visual field. The optometrist noted capsular fibrosis (scarring of the lens capsule) in each eye.
4. On 6 November 2020 the claimant saw Prof Coroneo who gained a history of "darkened" vision in each eye. Her vision with a myopic correction was 6/6 each eye. He confirmed the presence of capsular fibrosis.
5. The claimant saw Dr Jen Sandbach on 27 January 2021 complaining of a right floater and dark shapes with both eyes. She noted a normal left macula and a mild right epiretinal membrane. She saw Dr Sandbach again on 15 June 2022 when her corrected vision was 6/6 with each eye and Dr Sandbach noted bilateral epiretinal membranes.
6. The claimant was assessed by Medical Assessor Dr Kerrie Meades on 23 July 2024. Her corrected vision was 6/9 right eye, 6/7.5 left eye. Dr Meades found intermittent exotropia both for distance and near but no persistent diplopia. She said the "retinal examination and visual fields were satisfactory." She did not mention the presence of an epiretinal membrane.
7. I saw the claimant on 22 April 2025. She was weepy and appeared anxious. At her request, a female staff member was present for her entire examination. Her current visual complaints are distorted vision, and an increased floater which she dated from the time of the accident. Intermittently she notes white shapes in her fields of vision. She did not mention she currently has photosensitivity. Her best corrected acuities were 6/18 and J9 right eye, and 6/21 and J9 left eye. She had patchy loss of her visual fields with 17% loss right eye, and 30% loss left eye. She had constant diplopia for the central 45 degrees of binocular field. I could not elicit the exotropia which had been noted by Dr Meades. Her intraocular lenses were central and stable. She had bilateral posterior lens capsular opacities through which I could not see the posterior vitreous detachment noted by others. OCT examination showed bilateral macular epiretinal membranes much worse in the left eye. Her optic discs were normal. There were no peripheral retinal abnormalities.

1. My view is that neither her lens capsular opacities nor her macular epiretinal membranes are caused by her accident. The lens capsular opacities are an inherent consequence of cataract surgery.
2. The epiretinal membranes are a consequence of vitreous detachment from the retina. In the claimant's case, the vitreous detachment from the retina is from the combined effect of her age plus her cataract surgery. The progression of symptoms over years can be because the vitreous detaches episodically from the retina, thus giving repeated symptoms over a protracted period.
3. The claimant has the symptom of floaters which occur when the vitreous detaches from the retina. The claimant is now aged 64 years. Vitreous detachment occurs in 27% of persons of age 60 to 69 years and rises to 40% of those who have cataract surgery (see WR Green in Retina SJ Ryan (ed), 2nd ed, chapter 122, Mosby St Louis, Miss,1994). Her vitreous detachments are from both age and from her cataract surgery, not from the accident. Her symptoms of floaters have been documented on several occasions by eye care professionals prior to her accident.
4. The claimant has generalised posterior vitreous detachments. Such vitreous detachments are very unlikely after blunt trauma such as occurred when she hit her head on the head rest during the accident. Vitreous detachments after blunt ocular trauma are usually focal.
5. The contemporaneous notes show that the claimant noted the onset of increased floaters only 2-3 weeks prior to her presentation to her optometrist on 20 February 2020, ie about 3 months after her accident. This extended duration between accident and the onset of these symptoms makes it much more likely than not that the accident was not the cause of these symptoms nor aggravated any pre-existing problems.
6. Her myopia is unrelated to her vitreous detachment as it is acquired, occurring after her cataract surgery, and is very mild. In contrast, the myopia which causes vitreous detachment arises in the teenage years and is much more marked.
7. Her decreased visual acuity and field loss are not related to her accident but are a consequence of her opaque post lens capsules and the epiretinal membranes.
8. The posterior lens capsular opacifications should be treated with laser capsulotomy to improve her acuities. After this treatment a decision should be made whether she would benefit from vitrectomy surgery to remove the epiretinal membranes.
9. The claimant's diplopia is not related to her accident. Intermittent exotropia (found by Dr Meades) causes intermittent diplopia and is controlled when the vision is excellent. When I saw the claimant her vision was much worse (than when she saw Dr Meades) and she had constant diplopia. Her diplopia is likely to resolve if she has laser capsulotomies to improve her vision.
10. No explanation has been found for the claimant's symptoms of a white cloud or white shapes in her vision.

1. The claimant's symptoms of floaters, posterior vitreous detachment, reduced vision and diplopia are not secondary to her accident.

1. The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[6] The Panel adopts the examination findings and reasons of the Medical Assessor Capon with which Medical Assessor Wechsler agrees.
2. The Panel is not required to choose between competing medical opinions and is required to form its own opinion.[7]
3. The Panel met on 12 February 2025 to consider the following:

(a) the nature of the dispute and the matters in issue;

(b) whether any additional documents were required; and

(c) whether a re-examination is necessary.

1. The Panel reconvened on 7 May 2025 to consider its findings and decide its determination.
2. The Medical Assessors have explained the basis for their assessments and findings. To the extent that they differ to the views expressed by Dr Assaad, the Medical Assessors respectfully disagree. As previously stated, it does not seem to the Medical Assessors that Professor Coroneo expressed a view as to the causation of the posterior vitreous detachment in the claimant's right and left eyes. The Medical Assessors have come to the same conclusion as Medical Assessor Meades for the reasons stated.
3. The Panel finds, as a matter of medical determination and as a matter of factual non-medical determination, that the motor accident did not cause injury to the eyes, consisting of posterior vitreous detachment in both eyes. For that reason, an assessment of the degree of permanent impairment of these injuries in not required.

1. For the above reasons, the Panel concludes that the Certificate issued by Medical Assessor Kerrie Meades on 5 August 2024 should be confirmed.

[4] Briggs v IAG Limited t/as NRMA Insurance [2022] NSWSC 372.

[5] Insurance Australia Limited t/as NRMA Insurance v Trkulja [2023] NSWSC 956.

[7] Allianz Australia Group Limited v Keen [2021] NSWCA 287 and Insurance Australia Group Limited v Marsh [2021] NSWCA 31