Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. The Medical Review Panel revokes the certificate of Medical Assessor Raymond Francis Wallace of 15 April 2025 and substitutes the determination that as a result of the accident, the claimant sustained the following injuries which gave rise to a permanent impairment of 25%:
   • Cervical Spine

1. On 15 July 2021, the claimant, Hosny Sayed (Mr Sayed), was involved in a motor vehicle accident when he was a front seat passenger in a vehicle that was stationary at a red light when it was rear ended in a multi-car accident (the accident).
2. QBE Insurance (Australia) Limited (the insurer) was the CTP insurer.
3. Mr Sayed made an Application for Personal Injury Benefits on 1 August 2021.
4. On 20 June 2024, Mr Sayed made an Application for Damages under common law.
5. On 10 September 2024, Mr Sayed requested the insurer to concede that his injuries had resulted in an impairment in excess of 10% so as to entitle him to damages for Whole Person Impairment (WPI).
6. A medical dispute about the degree of Mr Sayed's WPI has arisen in connection with his claim. This constitutes a medical assessment matter under Schedule 2, cl 2(a) of the Motor Accident Injuries Act 2017 (MAI Act).
7. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor: s 7.20 of the MAI Act.
8. The dispute was referred to the Personal Injury Commission (Commission) which then assigned it to Medical Assessor Raymond Francis Wallace for assessment.
9. On 1 April 2025, Medical Assessor Wallace assessed Mr Sayed and on

15 April 2025, certified that injuries to his cervical spine as a result of the accident gave rise to 0% WPI 10. The Medical Assessor further certified that the injuries to the lumbar spine and legs which were referred to him, were not caused by the accident and an assessment of WPI was therefore not required.

1. Mr Sayed sought a review of the Medical Assessment under s 7.26 of the MAI Act (the Review).
2. 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 Schedule 1 of the PIC Act. As the medical assessment which is the subject of the Review was made on or after 1 March 2021, the new review provisions apply.
3. On 13 June 2025, a delegate of the President of the Commission determined there was reasonable cause to suspect that the medical assessment by Medical Assessor Wallace was incorrect in a material respect and referred the matter to the Panel.
4. The review provisions provide that a review panel consists of two medical assessors and a member assigned to the Motor Accidents Division of the Commission: s 7.26(5A) of the MAI Act. Accordingly, the President's delegate has convened this Panel to conduct the review of the Medical Assessment.
5. Part 5 of 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: s 41(2) of the PIC Act.
6. 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. The review is by way of a new assessment of all matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act. However, s 7.25 of the MAI Act provides that the review of a medical assessment can be made on the basis of any agreement by the parties as to the degree of permanent impairment from a particular injury and whether a particular injury was caused by the accident, without those matters having to be the subject of assessment.
7. 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 proceedings solely based on the written application: Rule 128 of the PIC Rules.

1. Sections 5D and 5E of the Civil Liability Act 2002 (the CLA) apply to the MAI Act: s 3B(2) of the CLA.
2. Mr Sayed's claim and entitlements to compensation are governed by the provisions of the MAI Act. An injured person can make a claim for both economic losses and non-economic loss damages.
3. However, s 4.11 of the MAI Act provides that no damages for non-economic loss may be awarded in respect of injury unless the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%.

1. Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
2. Permanent impairment is assessed in accordance with Part 6 of the Guidelines.
3. Causation of injury is addressed in cls 6.5, 6.6 and 6.7 of the Guidelines.
4. Clause 6.6 of the Guidelines notes:

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

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

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

"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. Pre-existing impairment is addressed in cls 6.31, 6.32 and 6.33 of the Guidelines.
2. The evaluation of the permanent impairment may be complicated by the presence of an impairment in the same region that existed before the relevant motor accident. If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident, then its value must be calculated and subtracted from the current WPI value. If there is no objective evidence of the pre-existing symptomatic permanent impairment, then its possible presence should be ignored: cl 6.31 of the Guidelines.
3. Clause 6.32 of the Guidelines states:

"The capacity of a medical assessor to determine a change in physical impairment will depend upon the reliability of clinical information on the pre-existing condition. To quote the AMA 4 Guides (page 10): 'For example, in apportioning a spine impairment, first the current spine impairment would be estimated, and then impairment from any pre-existing spine problem would be estimated. The estimate for the pre-existing impairment would be subtracted from that for the present impairment to account for the effects of the former. Using this approach to apportionment would require accurate information and data on both impairments.' Refer to clause 6.218 for the approach to a pre-existing psychiatric impairment."

1. Medical Assessor Raymond Francis Wallace examined Mr Sayed on 1 April 2025 and issued his certificate on 15 April 2025. He certified that the following injuries were caused by the accident and gave rise to a WPI of 0%:
   • Cervical spine
2. Further, Medical Assessor Wallace certified that the following injuries referred to him by assessment were not caused by the accident and therefore an assessment of permanent impairment was not required: -
   • Lumbar Spine
   • Legs
3. At [2] of his certificate, Medical Assessor Wallace noted the following injuries were referred to him for assessment: -
   • Cervical spine
   • Lumbar spine
   • Legs
4. Medical Assessor Wallace summarised the submissions of the parties at [3]-[4], noting that Mr Sayed relies on the report of Dr Bodel who arrived at a WPI assessment of 29% and the insurer relies on clinical records from Dr Shakib and Dr Moses as well as evidence of a past C5/6 and C6/7 anterior cervical discectomy and fusion surgery.
5. The Medical Assessor took a pre-accident history at [7], noting that Mr Sayed was 64 years of age and was working as a self-employed business owner. Regarding his lumbar spine, he underwent instrumented fusion at the L4/5 and L5/S1 levels in 1993. As to his cervical spine, he underwent anterior cervical discectomy and fusion at the C5/6 and C6/7 levels on

28 September 2013. He has had no other medical or surgical problems. He is currently taking medication for a prostate condition and has no known allergies. He currently with his wife and three adult children. 6. The Medical Assessor took a history of the accident at [8] noting that on 15 July 2021, Mr Sayed was a front seat passenger in his friends car. The vehicle was stationary at a red light at a traffic intersection, being the first in a line of three cars waiting at the red light. A fourth car collided with the third car, which hit the second car, which then collided with the vehicle that Mr Sayed was in. 7. At [9], the Medical Assessor took a history of symptoms and treatment following the accident, recording that Mr Sayed subsequently noted the onset of pain at his neck and some 10 days later on 25 July 2021, he was reviewed by his Local Medical Officer, Dr Shakaib at Lakemba complaining of headache and neck pain. He was prescribed Panadol analgesic medication and referred for physiotherapy. He subsequently noted increasing numbness at the right forearm. He was referred for a specialist review with Dr Parkinson, Neurosurgeon at Darlinghurst who diagnosed cervical myelopathy and recommended operative intervention. Mr Sayed was admitted to St Vincent's Private Hospital on 4 April 2022 and underwent anterior cervical discectomy and disc replacement at the C3/4 and C4/5 levels as a private patient. In the post-operative period, he was referred for physiotherapy, hydrotherapy and remedial massage. The Medical Assessor did not note any relevant injuries or conditions sustained since the accident. 8. Medical Assessor Wallace listed Mr Sayed's current symptoms at [12], reporting that at the cervical spine, Mr Sayed notes a constant aching pain at the C4/5 spinous process radiating to the lateral aspect of his shoulders to the level of the hands bilaterally. The pain is worse at night, on rotation of his head or lifting heavy objects and is relieved by range of movement exercises. He complains of paraesthesia at his bilateral forearms and hands. He complains of weakness at his bilateral arms and stiffness at his cervical spine. At the lumbar spine, he notes a constant aching pain at the L5 spinous process radiating to the left buttock and the lateral aspects of the thighs to the level of the knees bilaterally. The pain is worse with prolonged standing and is relieved by range of movement exercises. He notes intermittent paraesthesia at the lateral aspects of his thighs to the level of his knees bilaterally. He complains of weakness at his bilateral lower limbs and stiffness at his lumbar spine. 9. As to current and proposed treatment at [13], the Medical Assessor noted that Mr Sayed was currently attending physiotherapy once a week, hydrotherapy once a week and remedial massage once a week as well as using medications of Panadol, Panadeine Forte and Mobic. 10. Medical Assessor Wallace then undertook a clinical examination at [14]-[20] of his report (noting that the numbering is inconsistent) which the Panel reproduces below: -

Examination of his cervical spine shows an 8cm anterior oblique scar at the upper neck which has healed to a fine white line and is minimally visible. There is a further 5cm transverse scar at the lower anterior neck which has healed to fine white line and is minimally visible. He had an active range of movement at the cervical spine of flexion 60°, extension 10°, left rotation 40°, right rotation 40°, left lateral tilt 10° and right lateral tilt 10°. There was some "cogwheeling" on range of movement testing. There was tenderness at the C7 spinous process. Neurological examination of his upper limbs shows equal and symmetrical reflexes. His power is intact. He complained of decreased light touch sensation globally at his hands. His arm circumference measured 36cm on the right compared to 37cm on the left.

Examination of his lumbar spine showed no swelling or deformity. He had an active range of movement of forward flexion to the knees, extension 10°, left lateral tilt 20° and right lateral tilt 20°. There is tenderness at the L4/5 spinous processes. He walked with a short stepped gait but did not limp. He had straight leg raising to 20° bilaterally. Neurological examination of his lower limbs shows equal and symmetrical reflexes. His power and light touch sensation are intact. His calf circumference measures 42cm bilaterally.

Mr Sayed exhibited no pain behaviour at the time of review on 1 April 2025."

1. The Medical Assessor set out a summary of the relevant documentation upon which he relied in his assessment at [21]-[22].
2. Medical Assessor Wallace set out his diagnosis and reasons at [23], diagnosing the following as a result of the 2021 accident: -
   • Musculoligamentous strain cervical spine;
   • Central disc protrusion C3/4 level with cervical cord compression and myelomalacia, and
   • Aggravation of pre-existing multilevel degenerative cervical spondylosis.
3. He then set out his causation and reasons at [24], reporting that Mr Sayed suffered an injury at his cervical spine as a result of the 2021 accident. The mechanism described of a rear end motor vehicle collision is consistent with injury to the cervical spine. Mr Sayed complained of neck pain immediately after the accident. There is no objective medical evidence that Mr Sayed suffered any injury at his lumbar spine as a result of the index accident of 15 July 2021. I note that Mr Sayed previously underwent fusion at the L4/5 and L5/S1 levels in 1993. He was reviewed by Dr Moses in February 2021, 5 months prior to the index accident complaining of lumbar spinal pain. At the time of the index accident on 15 July 2021, he did not complain of any lumbar spinal symptoms to his treating doctors. Further, he did not list an injury to his lumbar spine on his Application for Personal Injury Benefits which he completed on 4 August 2021, some 2 weeks postinjury. Mr Sayed's current lumbar spinal symptoms are due to pre-existing multilevel degenerative lumbar spondylosis which is constitutional in origin and unrelated to the index accident of 15 July 2021.
4. At [25]-[26], the Medical Assessor noted that the injury to the Cervical Spine was caused by the accident, and the injuries to the lumbar spine and legs were not caused by the accident.
5. At [31], Medical Assessor Wallace set out his permeant impairment table which is reproduced below: -

MAA Guidelines to Assessment of Permanent Impairment

Chapter, Page, Paragraph, Figure & Table Numbers in AMA 4 Guides

% WPI Deductions pursuant to S323 for preexisting injury, condition & abnormality

Sub-Total/s % WPI (after any deductions in Column 5)

Total 0% WPI (Combined Tables Values of all sub-total/s)

1. As to pre-existing/subsequent impairment at [32], the Medical Assessor noted that Mr Sayed was suffering from a symptomatic cervical spinal condition prior to the accident in July 2021 which has been assessed as a whole person impairment of 25% as he previously underwent anterior instrumented fusion at the C5/6 and C6/7 levels in 2013.
2. Medical Assessor Wallace concluded at [35] that as a result of injuries caused by the accident, Mr Sayed sustained a WPI of 0%.

1. Causation - Any present day symptoms / disabilities have no relationship with the accident given its trivial nature. Any present day symptoms / disabilities are due to his extensive

pre-motor vehicle accident history. 2. Treatment and Care - He underwent a cervical spine fusion on 4 April 2022 which in my opinion was not appropriate. He attended physiotherapy which was appropriate. Dr Rimmer did not believe the C3/4 and C4/5 anterior cervical discectomy and disc arthroplasty was reasonable and necessary as a result of the accident and on the balance of probabilities was due to age related degenerative change. 3. Prognosis - Rated as good.

1. Injuries sustained as a result of the accident - Mr Sayed suffered a disc rupture at the C3/4 level and at the C4/5 level in the upper part of the cervical spine as a result of the accident that occurred on 15 July 2021. The C4/5 was the lesser injury of the two but the C3/4 was a very severe and significant disc prolapse causing cord compression and myelomalacia. This required urgent decompression and fusion, which was performed by Dr Richard Parkinson, neurosurgeon. There is also a musculoligamentous injury to the lower part of the back. He has referred pain into the legs, left worse than the right
2. Prognosis and Diagnosis - Mr Sayed has had the rupture of the C3/4 and C4/5 discs in the cervical spine and musculoligamentous injury to the lower part of the back. His prognosis is poor.
3. Causation - In my opinion the injuries were caused as a result of the accident. There is evidence of pre-existing pathology that had arisen as a result of injury. Also, in this circumstance although there had been previous fusion in the cervical spine at C5/6 and C6/7, the new areas of injury in this accident on 15 July 2021 are at a higher level at C3/4 and C4/5.
4. Pre-existing injuries - There is pre-existing pathology in the lumbar spine, but the injury caused the disc pathology at C3/4 and C4/5, for which the additional spinal fusion was required. In the lower part of the back there has not been a re-rupture at levels above the fusion but he does have mechanical backache in that area associated with the asymmetry of movement and guarding.

1. The Panel reproduces the submissions of Mr Sayed dated 17 May 2024 by reference to paragraph numbers:

[6] "Before the accident, I had previously sustained an injury to my lumbar spine at the L4/L5 and L5/Sl levels due to a motor vehicle accident 1993. Consequently, I undertook an anterior discectomy and fusion at these two levels of my lumbar spine.

[8] In 2013, I had a further car accident, when I was rear ended by another vehicle. A few months later, I experienced numbness and weakness in my hands and pain in my neck. I was referred to Dr Richard Parkinson. I underwent an operation with Dr Parkinson on 28 September 2013, however, it was in was in the C5/6 and C6/7 levels. After this procedure, it took me roughly two years to completely recover and I was able to resume operating my business and working in my two shops, managing them and doing all duties required.

[9] On 15 July 2021, I was involved in a motor vehicle accident which resulted in traumatic physical and psychological injuries. These injuries have had a detrimental impact on my life.

[10] At roughly 1:35pm on the day of the accident, I was seated as a passenger in a vehicle that my friend was driving. We were on the way to pick up another friend and were stationary at a set of traffic lights around 52 Great North Road, Five Dock. I remember my friend suddenly began screaming, as he saw a vehicle approaching from behind, and I had turned my neck to face him.

[11] Suddenly, we were subject to a rear-end collision, which involved two other vehicles; a white Hyundai and a black Fiat. Our vehicle was the first car from the front, meaning we were the last vehicle hit in the accident. Due to the impact of the collision, I believe my neck twisted side to side as I was initially looking at my friend screaming. I remember my entire body was shaking after the collision and I felt something had happened to my neck.

[12] I believe the driver in the white Hyundai was only travelling at around 5 kilometres an hour as he approached the traffic lights, moving quite slowly as he was aware that he needed to stop. To my understanding, the driver had planned to place his foot on the brake, when he instead placed it back on the accelerator, causing him to collide with the stationary black Fiat quite quickly. This caused the black Fiat to shunt about a metre or so forwards into the rear of our vehicle. I believe the driver of the white Hyundai did not remove his foot from the accelerator, which caused him to collide again with the rear of the black Fiat, which consequently collided with our vehicle a second time. I do not remember the force of the collisions, and mostly just remember my friend screaming as he saw the car approaching and my body shaking after the collision especially my neck.

[13] Following the accident, I experienced severe neck pain and lost sensation throughout my body, where I could only feel when my hands were on my face. I initially waited for my symptoms to subside as I believed they were merely from the impact of the collision, however after 10 days, my pain had not improved at all, and I therefore visited my General Practitioner and reported the accident.

[14] As a result of the accident, I sustained the following injuries:

(a) Cervical spine injury- C3/4 disc herniation and cervical myelopathy;

(b) Lumbar spine injury;

(c) Right leg injury;

(d) Left leg injury; and

(e) Psychological injury.

[16] Following my previous cervical spine injury before the accident on 15 July 2021, I was able to continue working in my two shops. I continued doing so until I required urgent invasive cervical spinal surgery on 4 April 2022 due to the accident. This surgery was performed at the C3/4 and C4/5 levels of my cervical spine, which I had never previously received surgery on, in which my previous surgery targeted my C5/6 and C6/7 levels.

[17] However, following my spinal surgery in April, which was necessary due to the accident, my functional capacity diminished significantly. Although I have regained sensation throughout my body, I continue to experience intense pain in my neck and am constantly reliant on pain relief medications to alleviate this. I also experience immense stiffness throughout my cervical spine and my range of motion when I try to move my neck in any direction is highly restricted.

[19] Prior to the accident, I was a normal person that could do whatever activity I wanted to do without any worries, whether that was going on a walk or sitting in a cafe. I no longer feel like my normal self, even after my surgery on 4 April 2022, as I continue to experience immense pain, restriction, and discomfort throughout my body. Even after my previous accident and spinal injury in 1993, I was able to manage my pain a lot more than I can now.

[20] My physical pain and restrictions have greatly hindered my functional capacity. I am limited to standing for roughly five minutes before I become dizzy and feel like I am losing balance. I am not able to walk for more than 10 minutes due to the pain and stiffness in my legs, or sit for more than 30 minutes before feeling discomfort. I am also limited to driving for no more than 10 to 15 minutes due to the immense pain in my neck and my reduced concentration. I avoid driving when I can by having a family member drive me where I need to be, and will only drive for short periods when I have no other option. I can only lift roughly 5 kilograms, allowing me to complete light shopping trips, although I cannot lift anything heavy and avoid attempting this due to my back pain and the weakness and numbness in my hands.

[26] Following the accident, my duties around the house have also decreased and I now rarely do anything at all. I previously had an active role in helping maintain our home and my wife, children, and I all greatly balanced our responsibilities. My wife and children have now taken complete responsibility of all the cleaning and cooking tasks, as I am always in immense pain, am unable to complete any heavy lifting, and have an extremely limited range of motion. I also have someone complete lawn mowing and other front yard duties every fortnight or three weeks. My wife has also hired a lady to provide domestic assistance when she is struggling to balance these duties, who comes to our home roughly twice a week to assist with cleaning tasks such as vacuuming and scrubbing the bathrooms. I will sometimes do the grocery shopping when I can, as it is only a five -minute drive from my home. Although, I am only able to complete a light shop and hold just a few things, such as a carton of milk and some bread. My wife and children mainly complete the grocery shopping by either attending the store or ordering the groceries to our home."

1. Correspondence with Dr Bou-Haidar - Dr Bou-Haidar reviewed the films and noted the previous history of cervical surgery and was able to compare the images with the MRI performed in 2013. Dr Bou-Haidar stated that there was at C3/4 the start of a small disc protrusion but was too much of a gap in years to comment on its significance. Dr Bou-Haidar advised that there was associated increase T2/STIR hyperintensity signal in the posterior column and right-side cord, reflecting at least cord oedema and underlying myelomalacia. Dr Bou-Haidar noted that the signs were reasonably bright suggesting a more recent event which could correlate with the claimed time frame. Dr Bou-Haidar stated that the C3/4 disc extrusion / changes would be considered subacute in nature and could possibly correlate to a 6-month frame.
2. Impression - Mr Sayed has been involved an incident on the 15 July 2021 with a long history of cervical disc pathology and previous surgery. Correspondence with radiologists, Dr Tej Dugal and Dr Pascal Bou-Haidar have confirmed that the reported C3/4 & C4/5 disc protrusions changes appear to be considered acute to subacute in nature with cord oedema indicating a secondary event exacerbating the protrusion or a sudden unprovoked disc protrusion / extrusion on a background of a dysfunctional disc. The disc pathology on CT scan & MRI of the cervical spine have been reported as acute to subacute in nature and appear to correlate with the claimed time frame and are considered related to & as a direct result of the claimed incident on the 15 July 2021. Mr Sayed's claimed neck symptoms and disc pathology appear to correlate to the claimed timeframes but a Medicare search and GP notes are recommended to access more recent imaging than 2016 for comparison and to clarify the period of absence noted in the documents reviewed from October 2021 to March 2022.

Report of Synergy Radiology (Dr Dugal) dated 4 August 2022

1. "At C3/C4, there is a central broad based disc protrusion/extrusion measuring anteroposteriorly 9mm causing severe AP canal narrowing of greater than 50% resulting in severe central canal stenosis and most certainly compressing the spinal cord at the C3/4 level. I note on the previous two CTs, a small disc protrusion was present presumably measuring up to 4mm indicating the current protrusion has developed/significantly progressed since the earlier study. I note that the external MRI report indicates cord oedema or myelomalacia consistent with the severity of the cord compression. At C4/C5, a broadbased disc protrusion is also noted, measuring 4mm anteroposteriorly slightly more prominent to the left of the midline associated with moderate in severity central canal stenosis. When compared to the previous CT, this protrusion has also progressed, previously notable to be a small bulge without neurocentral compression. This concords with the external MRI finding demonstrating moderate-grade central canal stenosis. I do note on the current examination, there is endplate remodelling with mild sclerosis, subchondral cyst formation and uncovertebral marginal osteophytes seen bilaterally at C3/4 and C4/C5, these changes having developed since the earlier examination consistent with altered functional biodynamics of the C3/4 and C4/5 discs reflecting the prior disc protrusions on the earlier examinations from 2016 and 2013. Given the magnitude of the C3/4 disc protrusion and the severe central canal stenosis, this is highly likely to be acute or a subacute phenomenon reflecting the disc protrusion, extrusion superimposed on the background of the underlying abnormal degenerate disc. The C4/5 disc protrusion I favour to be also acute to subacute on the background of degenerated dysfunctional disc given that I would have anticipated if there was slow progression of the disc protrusion, a greater degree of bony changes than seen currently. On balance on review of the current CT with review of the CT scan of the cervical spine of 28/07/2016 and 14/08/2013 and the context of the MRI of the cervical spine dated 29/03/2022, I favour the C3/4 disc protrusion to be acute or subacute with cord oedema indicating a secondary event exacerbating the protrusion or a sudden unprovoked disc protrusion/ extrusion on a background of a dysfunctional disc. The C4/5 disc protrusion I favour to be on similar mechanism with a lesser degree of protrusion having occurred in the interval."

1. Description of Procedure - "Clinical note: Mr Sayed is a 61-year-old man who underwent a C5-7 anterior cervical discectomy and fusion in 2013, and presented with acute neck pain and a cervical myelopathy with difficulty mobilising and a spastic ataxic gait. He also had numbness and clumsiness in both hands. CT and MRI scanning confirmed a large acute central disc herniation at C3/4 with severe cord compression and cord signal change. There was a bilateral posterolateral disc bulge at C4/5 as well. I elected to do a 2 level disc arthroplasty to maintain movement, reduce the risk of adjacent level degeneration, and achieved a discectomy with canal decompression. Risks and benefits were discussed including spinal cord injury, infection, haematoma, adjacent level deterioration, and recurrent laryngeal nerve injury given his previous surgery. He was very keen to proceed and I did not see a reasonable alternative.
2. After satisfactory induction of general anaesthesia and endotracheal intubation with intravenous Keflin given, an indwelling catheter inserted and a timeout form, the patient was positioned supine on the flat Jackson spinal table, pressure points carefully padded, and check x-ray performed confirm level. After routine prep and drape, an anterior oblique skin incision was performed at the right neck, and a routine muscle splitting approach to the prevertebral space performed and the Koros minimally evasive retractor placed. Check x-rays were performed confirm level. 16 mm Caspar pins were placed. The operating microscope was brought into position, and routine anterior discectomy, endplate removal, and insertion of prosthesis was performed. A meticulous anterior cord decompression was carried out. The cord was very compressed at C3/4 due to a large central disc herniation and the decompression to do was achieved at both levels. A 10 French Bellovac surgical drain was placed in the prevertebral space, after meticulous haemostasis was secured and a routine wound closure performed. Patient woke well moving all limbs with no new deficits.
3. Post-operative Management: Analgesia as charted, ICU care overnight for anterior neck observations, vac drain, CT scan tomorrow, neurological observations overnight. I anticipate a good recovery."

1. The CT scan shows grade 1 retrolisthesis of C3 on C4. There is anterior instrumented fusion from C5 to C7. There is a large broad based central disc protrusion at C3/4 resulting in significant canal stenosis and cord compression. There are moderate broad based disc bulges at C4/5 resulting in significant canal stenosis and suspected cord impingement. There are bilateral congenitally shortened pedicles and moderate foraminal stenosis at this level.

Application for Personal Injury Benefits dated 4 August 2021

1. Mr Sayed reports his injuries as neck pain, chronic headache, pain radiating to the shoulders, and pain in the left knee. There is no mention of any lumbar spine pain.

Clinical records of Dr Shakib, local medical officer, dated July 2021 to September 2022

1. Mr Sayed does not complain of any lumbar spinal symptoms in relation to the accident.

Report of Dr Moses, sport physician, dated 18 February 2021

1. Five months prior to the accident, Mr Sayed gave a history of suffering from "intermittent lower back pain."

1. The MRI scan shows anterior instrumented fusion at the C5/6 and C6/7 levels. There is a large broad based osteophyte at C3/4 with a right paramedian disc protrusion extending to the right foramen and compressing the exiting right C4 nerve root. There is a large broad based disc osteophyte complex at C4/5 compressing the thecal sac and compromising the exiting C5 nerve roots bilaterally.

1. Shows a previous laminectomy at L4/5 and L5/S1 with disc spacers in-situ.

1. Shows evidence of previous laminectomy at L5 with disc spacers at L4/5 and L5/S1.

1. Shows multilevel degenerative cervical spondylosis. There is reduced disc height and broad based disc bulges at C5/6 without central canal compromise.

1. Background - On the 6 November 2007 he was driving a car which was slowing down when it was hit on the rear by another car. He was not knocked out. He was "shaken" and sustained the following injuries: 1. An injury to his neck. 2. An injury to his upper back. 3. An injury to his left knee when he hit the steering wheel with the knee. He continued on his way to work and worked for about 2 weeks. His work involved office work and he avoided physical work.
2. Opinion - Mr Sayed does appear to have developed symptoms referable to a cervical strain with nerve root irritation affecting the left upper limb and there is evidence of discogenic lesions at the C3/4, C4/5, C5/6 and C6/7 levels as well as a left lateral epicondylitis and a thoracic strain as well as a contusion to his left knee with associated chondromalacia of the left patella. It is consistent that the incident he described on the 6 November 2007 has produced such lesions. He has been advised treatment and has been considered fit for duties as outlined. In order to minimise an exacerbation of his symptoms I would suggest he restrict his future activities to activities not involving significant bending or lifting, significant use of the right upper limb or significant walking, climbing or squatting.

1. The Panel summarises the submissions of the insurer dated 4 June 2025 by reference to paragraph numbers:

[1]-[3] The insurer sets out the background of the dispute. The insurer addresses Mr Sayed's submissions as follows:

Assessor Wallace "failed to provide adequate reasons for his decision on the issue of causation"

[4]-[5] The insurer does not understand this submission. Medical Assessor Wallace accepted Mr Sayed sustained a cervical spine injury from the accident. Mr Sayed's complaint appears to relate instead to the application of cls 6.31-6.32 of the Guidelines regarding pre-existing impairment. This is addressed below.

Assessor Wallace "commentary that Mr Sayed's pre-existing condition "in the same region" is incorrect"

(a) Mr Sayed previously made submissions about the interpretation of "in the same region".

(b) at paragraph 5 of the Certificate, Medical Assessor Wallace confirmed that he "considered the documents... including the reply".

(c) he considered the parties' submissions and disagreed with Mr Sayed's interpretation. This finding was open to him, and

(d) mere disagreement with the assessor's clinical judgment is not a reviewable error.

Medical Assessor Wallace failed to consider key documents

[7]-[9] The insurer refers to paragraph 5 of the certificate confirming that all documents provided in the application (including the reply) were considered and submits that the documents listed by Mr Sayed were all before the assessor (pp 4-9, 25-34, 35-41, 42-60, and 162-166 of Mr Sayed's application). In Dunbar v Allianz (2015) NSWSC 119, the Court held that a medical assessor is not required to specify why particular material was or was not accepted.

[10]-[11] In Wingfoot v Kocak (2013) HCA 43 at [55], reasons must explain the actual path of reasoning, not address every alternate conclusion. At [56], the High Court held there is no obligation to explain why a different opinion (held by another doctor) was not adopted.

[12]-[13] Paragraph 31 of the certificate clearly records the Medical Assessor's reasoning regarding the cervical spine impairment, including prior surgery and contemporaneous symptoms (e.g., consultation with Dr Matter in September 2020). Following Wingfoot, the assessor was not obliged to adopt the opinions of other doctors. He took a thorough history, examined Mr Sayed, reviewed all materials, and provided reasons.

[14]-[16] The insurer submits it was open to the assessor to interpret "same region" as the cervical spine as a whole, consistent with the insurer's submissions. It was open to the assessor to conclude Mr Sayed's prior cervical spine condition was symptomatic at the time of accident based on the September 2020 presentation. The insurer submits the statement of reasons adequately set out the path of reasoning regarding the pre-existing impairment.

The Medical Assessor failed to reference Medical Assessor Herald's Certificate

[17]-[20] The insurer notes Medical Assessor Wallace accepted the cervical spine injury was caused by the accident. A difference of opinion on causation is not a material error (Pinarbarsi v AAI t/as GIO (2023) NSWSC 80). Medical Assessor Herald's Certificate (pp 35-41) was before the Medical Assessor. Paragraph 5 confirms all documents were considered; the Insurer submits explicit citation was unnecessary.

Failure to reference Herald and the Review Panel constitutes error

[21]-[24] Medical Assessor Wallace accepted causation. A different medical opinion does not establish error (Pinarbarsi). Medical Assessor Herald's certificate was before him and the Review Panel Certificate was before him. Paragraph 5 shows all documents were considered; no need to specifically list them.

[25]-[26] Dr Parkinson's notes appear at pp 162-166 of Mr Sayed's application. Paragraph 5 confirms they were considered; explicit mention was not required.

[27]-[28] Dr Bodel's report was before the assessor. Paragraph 5 confirms all documents were considered.

[29]-[31] Under Pinarbarsi, a different opinion on causation is not evidence of error. The insurer submits that the fact that the Medical Assessor disagreed with Dr Bodel does not constitute error; paragraph 24 of the Certificate clearly sets out the reasoning. The assessor reviewed submissions and evidence and formed the view that the lumbar spine injury was not caused by the accident. This was open to him.

1. The Panel summarises the submissions of Mr Sayed dated 14 May 2025 by reference to paragraph numbers:

[1.1]-[1.3] Mr Sayed sets out the background to the dispute,

[2.1]-[2.2] Mr Sayed sets out the provisions of the MAI Act upon which he relies.

[2.3] In Craig v South Australia [1995) 184 HCA 58, jurisdictional error includes identifying a wrong issue, asking the wrong question, ignoring relevant material, or making an erroneous finding affecting the exercise of power.

[2.4] In Dominice v Allianz [2017] NSWCA 171, the Court of Appeal confirmed the threshold is reasonable cause to suspect error, not establishing its actual existence.

[2.5] Meeuwissen v Boden [2010] NSWCA 253 clarifies that what must be materially incorrect is the medical assessment, not necessarily the resulting certificate. A different certificate need not be inevitable; it is sufficient to identify possible error.

[3.1]-[3.4] Mr Sayed sets out the findings of the Medical Assessor, noting he found a WPI of 0%.

[4.1]-[4.3] Mr Sayed submits Medical Assessor Wallace's history notes confirm post-accident neck pain, numbness, specialist review, diagnosis of cervical myelopathy, and subsequent C3/4 and C4/5 disc replacement surgery in 2022. The Medical Assessor noted prior C5/6 and C6/7 fusion in 2013 and listed current symptoms as constant aching neck pain, bilateral arm symptoms, paraesthesia, weakness, and stiffness.

• Musculoligamentous cervical strain
• Central disc protrusion C3/4 with cord compression and myelomalacia
• Aggravation of multilevel degenerative cervical spondylosis

[4.5]-[4.6] The Medical Assessor accepted the cervical injury was caused by the accident as symptoms were consistent with a rear-end collision and reported immediately. Mr Sayed submits the Medical Assessor failed to give further adequate reasons regarding causation or pre-existing pathology. The Medical Assessor assessed DRE Cervico-Thoracic Category IV = 25%, but then attributed the entire 25% to pre-existing impairment due to surgery in 2013 and LMO records from 2020. Mr Sayed submits this reasoning is materially incorrect.

[4.7]-[4.8] The Medical Assessor concluded Mr Sayed had symptomatic pre-existing cervical impairment of 25% WPI due to the 2013 C5/6-C6/7 fusion. Mr Sayed submits Medical Assessor Wallace failed to provide adequate reasons on causation and incorrectly treated the pre-existing fusion as being "in the same region", despite the prior surgery being lower cervical (C5/6-C6/7) and the accident-related surgery being upper cervical (C3/4-C4/5).

[4.9] Mr Sayed sets out key documents which he submits the Medical Assessor failed to consider.

Certificate of Medical Assessor Herald dated 29 November 2023

[4.10]-[4.14] Medical Assessor Herald found the most likely cause of the acute disc prolapse and cord compression was the 15 July 2021 accident. He assessed C3/4 disc herniation and cervical myelopathy to be non-threshold injuries caused by the accident. Medical Assessor Herald confirmed earlier fusion (2013) involved C5/6-C6/7 and the C3/4-C4/5 levels had not required surgery and had improved post-2013. He concluded the accident caused the acute disc prolapse and cord compression. Mr Sayed submits the Medical Assessor's failure to refer to Medical Assessor Herald's Certificate is a material error.

[4.15] Confirms 2013 fusion was in a different region and symptoms had largely resolved within two years.

• C3/4 and C4/5 cervical injuries
• Musculoligamentous lower back injury
• Referred pain to both legs

[4.24] Combined impairment = 29% WPI (25% cervical, 5% lumbar).

[4.25] Mr Sayed submits that, contrary to the need for caution, Dr Bodel expressly opined that "although there had been previous fusion in the cervical spine at C5/6 and C6/7, the new areas of injury in this motor vehicle accident on 15 July 2021 are at a higher level at C3/4 and C4/5." Mr Sayed submits Dr Bodel further stated that the need for the spinal fusion was directly caused by the 15 July 2021 accident. When assessing WPI, Dr Bodel stated: "He had a rating for the previous injury back in 2013. That rating was for two different levels of the cervical spine unrelated to this injury that occurred on 15 July 2021. I am confident that he was asymptomatic in the area of C3/4 and C4/5 and based on the medical evidence available also at the area at C5/6 and C6/7 (the previously fused areas) at the time of this motor vehicle accident. The upper part of the cervical spine became symptomatic at that time leading to the need for the C3/4 and C4/5 spinal fusions."

[4.26]-[4.28] Mr Sayed submits that the records of Dr Parkinson confirm the 2013 fusion was performed at different levels to the post-accident surgery. He continues that Dr Parkinson's operative report for the C3/4 and C4/5 arthroplasty on 4 April 2022 states: "Clinical note: Mr Sayed is a 61-year-old man who underwent a C5-7 anterior cervical discectomy and fusion in 2013 and presented with acute neck pain and a cervical myelopathy with difficulty mobilising and a spastic ataxic gait. He also had numbness and clumsiness in both hands. CT and MRI scanning confirmed a large acute central disc herniation at C3/4 with severe cord compression and cord signal change. There was a bilateral posterolateral disc bulge at C4/5 as well. I elected to do a 2 level disc arthroplasty to maintain movement, reduce the risk of adjacent level degeneration, and achieved a discectomy with canal decompression... He was very keen to proceed and I did not see a reasonable alternative." Mr Sayed submits that Medical Assessor Wallace does not refer to Dr Parkinson's records at all in his certificate.

[4.29]-[4.30] Mr Sayed submits that Dr Bodel detailed clear clinical findings, observing "tenderness on palpation at the lumbosacral junction and guarding... restricted range of motion... flexion half of normal; extension one-quarter; lateral flexion to the left one-quarter; and lateral flexion to the right three-quarters." Mr Sayed submits these findings demonstrate asymmetrical limitation, most restricted on left lateral flexion. He further submits that although Medical Assessor Wallace found the lumbar spine not related to the accident, he failed to give sufficient reasons for his causation conclusion and did not properly consider Dr Bodel's evidence.

1. The Panel summarises the submissions of the insurer dated 16 February 2025 by reference to paragraph numbers:

[1] The insurer submits the dispute concerns whether the alleged cervical spine, lumbar spine, and referred bilateral leg pain exceed 10% WPI.

[2]-[5] The insurer refers to Guidelines cll 6.6-6.7, ss 5D-5E Civil Liability Act 2002, Briggs v IAG (2022) NSWSC 372, and Fernandez v Tubemakers of Australia Ltd [1975] 2 NSWLR 190

[6] The insurer submits Mr Sayed had three prior motor accidents in 1993, 2007, and 2016.

[7]-[9] A 2013 CT cervical spine showed multilevel degenerative changes and disc pathology at C3/4 and C4/5. On 26 Sept 2013, neurosurgeon Dr Parkinson recorded acute myelopathy with right-arm weakness/numbness. Mr Sayed underwent C5/6 and C6/7 ACDF surgery on 28 Sept 2013.

[10]-[12] On 4 Dec 2013, Dr Parkinson recorded postoperative dysaesthesia. A 29 Jan 2014 X-ray confirmed hardware from C5-6 and mild C4 spurring. On 25 Feb 2015, Dr Parkinson recorded ongoing paraesthesia - 17 months post-surgery.

[13] A 20 March 2017 MRI (cervical & lumbar) showed:

• Cervical: disc protrusions at C3/4, C4/5, C5/6, multilevel facet arthroses, mild bilateral/mild left foraminal encroachment.
• Lumbar: prior prosthetic discs L4-S1, scar tissue at right L5/S1, mild foraminal narrowing, mild S1 nerve root encroachment, multilevel arthroses.

[14] The insurer summarises GP records from City Doctors-Wangee Clinic, recording:

• recurrent neck pain (2015-2020),
• neck/shoulder/left-knee injuries (2016),
• headaches, pins and needles, radicular symptoms,
• documented ongoing arm/leg weakness and tightness in 2019,
• MRIs recommended.

[15]-[17] The insurer submits there are significant credibility issues, noting Mr Sayed did not disclose prior injuries on the 4 Aug 2021 claim form. Paragraphs 6-14 show an extensive undisclosed history of cervical and lumbar pathology. The insurer submits that Mr Sayed failed to disclose three prior motor accidents.

[18]-[19] Orthopaedic surgeon Dr Rimmer, on 10 Dec 2024, recorded repeated denials of prior injuries despite clear evidence of multiple CTP claims and cervical surgery, calling the history "sheer dishonesty". Dr Rimmer added that Mr Sayed "without question displays signs of embellishment" and that the history provided was "highly untruthful".

[20] The insurer submits Mr Sayed's statement, saying he fully recovered after 2013 surgery, is inconsistent with GP records showing persistent cervical pain and radicular symptoms in 2016-2017.

(a) there is a clear prior history of cervical and lumbar injuries;

(b) Mr Sayed's subjective reporting to the PIC assessor is not reliable;

(c) Mr Sayed is exaggerating symptoms.

[22] The insurer submits no weight should be given to Dr Bodel's opinion because:

(a) he recorded an inaccurate history that prior cervical/lumbar symptoms had "fully resolved";

(b) this contradicts the long clinical history of continuing pain since 2016;

(c) Mr Sayed's cervical symptoms did not settle after 2013 surgery; and

(d) his assessment of pre-existing impairment deductions is inconsistent with the Guidelines and PIC decisions.

[23]-[27] The insurer submits there are significant causation issues regarding the cervical spine. Mr Sayed was not attended by ambulance and not transported to hospital and the Police did not attend the accident. The first cervical complaint was 10 days later on 25 July 2021 by Dr Shakaib. Therefore, the insurer submits Mr Sayed did not sustain a cervical injury in the accident.

[28] If causation is nevertheless accepted, the insurer submits:

(a) any radiculopathy is due to pre-existing degenerative pathology, not the accident;

(b) there is objective evidence of prior cervical pathology including 2013 ACDF;

(c) prior scans showed degeneration at C3/4 and C4/5;

(d) Dr Parkinson recorded dysaesthesia (Dec 2013) and paraesthesia (Feb 2015);

(e) Mr Sayed required a 2017 MRI due to cervical radicular symptoms and spasm, predating the accident.

[29] Mr Sayed submits that there is objective evidence of pre-existing permanent cervical spine impairment arising from the 2013 C5/6-C6/7 fusion, properly assessed as DRE III or 15% WPI, which should be deducted if any impairment from the 2021 accident is found.

[30] Mr Sayed submits that Dr Bodel's opinion dated 28 June 2024 confirms the prior impairment related to different cervical levels (C5/6-C6/7), and that Mr Sayed was asymptomatic at C3/4-C4/5 at the time of the accident, with the 2021 accident rendering the upper cervical spine symptomatic and necessitating the C3/4-C4/5 fusion.

[31]-[32] The insurer submits no weight should be given to Dr Bodel because Mr Sayed continued to report cervical pain from 2016, including a 2017 MRI prompted by "cervical spine radicular symptoms and spasm." Mr Sayed submits this overlooks the distinction between pre-existing symptoms and symptomatic levels relevant to the 2021 accident. The insurer submits Dr Bodel did not deduct pre-existing impairment because the accident-related injury was at C3/4-C4/5 and the earlier surgery was at C5/6-C6/7; however, Mr Sayed submits Dr Bodel correctly applied the clinical distinction.

[33]-[34] The insurer refers to Guidelines 6.31-6.32 concerning pre-existing symptomatic impairment in the same region. Mr Sayed submits these clauses support the need for objective evidence and reliable clinical information before deducting impairment. The insurer submits that "same region" means the entire cervical spine, relying on various Guidelines clauses. Mr Sayed submits these provisions do not mandate that all cervical levels be treated as one impairment for deduction purposes and that the insurer's interpretation is overly broad.

[35]-[36] The insurer relies on GIO v Djuric (2025) NSWPICMP 33, where a prior asymptomatic fusion was still considered objective evidence of permanent impairment. Mr Sayed submits the facts of Djuric differ materially, including symptomatic status and biomechanical relationships. The insurer submits Djuric demonstrates that the existence of a prior fusion constitutes objective evidence of impairment regardless of symptoms. Mr Sayed submits this misapplies the Review Panel's reasoning, which turned on objective evidence that is absent here.

[37] The insurer submits that Mr Sayed's 2013 C5/6-C6/7 fusion (DRE III or 15% WPI) must be deducted. Mr Sayed submits this is incorrect because the 2013 impairment was unrelated to the accident-affected levels and was asymptomatic.

[38] The insurer submits there are significant causation issues. Mr Sayed submits the absence of initial reports is not determinative of causation.

[39]-[40] The insurer notes no ambulance attendance and no police attendance. Mr Sayed submits these are irrelevant to medical causation.

[41]-[43] The insurer submits Mr Sayed made no lumbar complaints in early GP consultations nor in the PIP form. Mr Sayed submits delayed onset is medically recognised and consistent with soft tissue or discogenic injury.

[44] The insurer submits there was no lumbar diagnosis in the 4 August 2021 Certificate of Capacity. Mr Sayed submits this reflects the initial clinical focus on acute cervical symptoms.

[45]-[47] The insurer submits no lumbar radiology was pursued post-accident. Mr Sayed submits that lack of imaging is not evidence of absence of injury. The insurer notes the first lumbar complaint was at Dr Bodel's exam on 28 June 2024. Mr Sayed submits that contemporaneous cervical dominance may explain delayed reporting. The insurer submits Mr Sayed did not sustain lumbar injury from the accident. Mr Sayed submits this is inconsistent with Dr Bodel's clinical findings.

[48]-[49] If causation is accepted, the insurer submits there is clear evidence of pre-existing lumbar impairment, including prior L4/5-L5/S1 surgery in 1993. Mr Sayed submits this was long-standing and biomechanically distinct.

[50] The insurer relies on Dr Lim's 2008 assessment of 20% WPI (DRE IV). Mr Sayed submits this was remote in time and not reflective of pre-accident functioning.

[51]-[52] The insurer cites 2013 CT and 2017 MRI demonstrating ongoing symptoms (DRE III or 10% WPI). Mr Sayed submits these records do not demonstrate impairment at the time of the 2021 accident.

[53] The insurer notes that Dr Moses, in February 2021, recorded intermittent lower-back pain. Mr Sayed submits intermittent symptoms do not amount to permanent impairment.

[54] The insurer submits Dr Lim's evidence establishes objective pre-existing lumbar impairment (DRE IV or 20% WPI) requiring deduction. Mr Sayed submits the insurer has not demonstrated symptomatic permanent impairment as required by clause 6.31.

1. The Panel summarises the submissions of Mr Sayed dated 29 January 2025 by reference to paragraph numbers:

[1]-[3] Mr Sayed sets out the background of the dispute.

The Insurer's decision being referred for PIC Assessment

[4]-[6] On 10 September 2024 Mr Sayed requested that the insurer concede permanent impairment exceeding 10%. By correspondence dated 25 November 2024, the insurer advised that they do not concede that Mr Sayed sustained >10% permanent impairment. Mr Sayed submits that this decision is wrong and seeks a PIC determination.

[7] Mr Sayed seeks a Commission assessment determining that:

(a) the injuries are causally related to the motor accident; and

(b) the injuries exceed 10% permanent impairment.

[8] Mr Sayed submits that the insurer failed to consider, or failed to properly weigh, relevant factors, including:

(a) The report of Dr James Bodel dated 28 June 2024 indicating permanent impairment >10%.

[9]-[10] Mr Sayed submits that the insurer's determination is incorrect and substantially impacts Mr Sayed's right to compensation. The insurer is obliged under s 6.4 of the Act to resolve the claim justly and expeditiously. Mr Sayed submits that the most efficient way to fulfil this duty is to change the decision and concede entitlement to non-economic loss.

[11]-[12] Mr Sayed submits that the insurer failed to consider or properly weigh Dr Bodel's medicolegal report of 28 June 2024. Dr Bodel provides a comprehensive assessment, identifying accident-related injuries to:

(a) Cervical spine - C3/4 and C5/6

(b) Lumbar spine

(c) Referred bilateral leg pain

[13] Based on this diagnosis, Dr Bodel assesses 29% WPI:

(a) DRE Cervicothoracic IV - 25% WPI

(b) DRE Lumbosacral II - 5% WPI

[14] The insurer contends the injuries are not causally related due to prior spinal complaints. Mr Sayed submits this is incorrect. The PIC Medical Review Certificate (14 June 2024) records that although Mr Sayed had prior fusion at C5/6 and C6/7, the C3/4 and C4/5 levels had not required treatment and Mr Sayed had returned to work. The report of Dr Antoun dated 4 August 2022 further notes that cervical spine pathology was acute to subacute, correlating with the accident and that the C3/4 disc prolapse was "not a pre-existing condition".

[15] The PIC Medical Assessment Certificate dated 29 November 2023 states that the "most likely cause" of the acute disc prolapse and cord compression was the motor accident. Dr Bodel similarly concludes the injuries were caused by the accident, noting rupture at C3/4 and C4/5 and associated myelomalacia. He acknowledges pre-existing pathology but clarifies that the new injuries are at different, higher levels.

Mr Sayed submits that the medical evidence firmly establishes causation and permanent impairment exceeding 10%.

[16] Dr Bodel's report outlines significant objective findings:

• Cervical spine: localised tenderness, muscle guarding, asymmetrical and restricted ROM (various directions).
• Lumbar spine: tenderness at lumbosacral junction, guarding, marked ROM restriction.

Mr Sayed submits these findings support permanent impairment exceeding 10%.

[17] Mr Sayed submits that Dr Bodel's findings demonstrate detailed, accident-related injuries and a permanent impairment rating above the 10% threshold.

1. Medical Assessor Shane Moloney examined Mr Sayed for the Panel at the Commission Medical Suites on 22 October 2025. The findings of the Medical Assessor Moloney are reproduced by the Panel below:
2. Mr Sayed was accompanied by his daughter and had the assistance of an accredited interpreter.

1. Mr Sayed stated that he was working full-time in his own convenience store at the time of the accident. He currently lives with his wife and three adult children.
2. There was a past history of a lumbar spine injury in 1993 which he sustained whilst working as a refrigeration mechanic. This resulted in a lumbar fusion at L4/5 and L5/S1. He was compensated for this injury and purchased a convenience store.
3. In 2013 due to persistent neck pain, he had a fusion at C5/6 and C6/7 which he states improved his symptoms. He had occasional neck pain after this procedure which was treated with physiotherapy. In 2016 he was in another motor vehicle accident which aggravated his neck but he was able to continue working. He states that prior to the accident in 2021 he was working full-time but had a poor memory.

History of motor accident and subsequent treatment

1. On 15 July 2021, Mr Sayed was a front seat passenger in a car that was stationary at red lights when hit from the rear. He states that he was looking at the driver at the time of impact and felt pain in his neck and left leg. The police and ambulance did not attend the scene of the accident and his vehicle continued on. Mr Sayed states that he had increasing headaches in the next few days and felt shaky. After one week, he consulted his GP, Dr Haikeb with pain in the lower back, left leg, left shoulder and neck. His GP organised several MRIs and physiotherapy.
2. Due to the development of weakness and numbness in both hands and both legs, he was referred to a neurosurgeon, Dr Parkinson who diagnosed cervical myelopathy and undertook an anterior cervical discectomy and disc replacement at the C3/4 and C4/5 levels. After this procedure he states that his symptoms in the arms and legs improved but he continued to have neck pain.
3. Mr Sayed states he had had no further injuries sustained since the accident.

1. Mr Sayed has persistent cervical pain and feels weak in the feet and legs. There is a constant pain in the forearms and fingers and bilateral trapezius muscles. He has had several falls since the accident due to feeling of weakness and dizziness.
2. He is able to do short drives but feels he can only walk for about five minutes before having a rest. He is not working at present.

1. Present medication is Panadeine Forte one to two at night, Panadeine during the day and medication for his prostatism. He was given treatment for poor balance but stopped due to drowsy side-effects. He has physiotherapy once a week which comprises massaging and dry needling.
2. His last consultation with Dr Parkinson, his neurosurgeon was a year ago and he wants a follow-up appointment. He was also referred to Dr Nguyen for a second opinion.

1. Mr Sayed walked into the rooms with a slow shuffling gait and had soft braces on both knees for walking support. He had a depressed affect and stated that he is right-handed. His weight was 104kg and height 179cm.

1. On palpation there was tenderness over the lower cervical spines and both trapezius muscles but no guarding or spasm was noted. On testing range of movement flexion/extension was 20% of expected range. Side bending and rotation was 30% of expected range with no asymmetry.
2. On neurological examination of the upper limbs, reflexes were equal bilaterally with normal power and no sensory changes were noted. There was mild tremor in both hands. No muscle wasting was apparent with the circumference the upper arms 32cm bilaterally (10cm above the olecranon process) and in the upper forearms 29cm on the right and 28cm on the left (5cm below the olecranon process). This is consistent with a right-handed male.

1. Mr Sayed walked with a shuffling gait and when attempting to walk on his heels and toes was unable to due to poor balance. On testing range of movement flexion/extension was 20% of expected range with side bending 40% of expected range bilaterally with no asymmetry. On palpation there was tenderness globally over the lumbar spine region but no guarding or spasm was noted. Straight leg raise when lying was 20 degrees bilaterally limited by hamstring tightness and hip discomfort and when repeated sitting 80 degrees bilaterally with negative sciatic nerve root tension signs.
2. There was a full pain free range of movement of the hips and knees.
3. On neurological examination of the lower limbs, reflexes were equal bilaterally with normal power and no sensory changes were noted although there was a slight global decrease in sensation in the left leg which was not dermatomal. No muscle wasting was apparent with the circumference of the lower thighs 44cm bilaterally (10cm above the superior patella pole) and at the maximum circumference of the calves 39cm bilaterally.

1. There was no mention in the application form from Mr Sayed that he had a lumbar spine injury nor was it recorded by the treating GP. There was a past history of low back pain at various times with an MRI in 2015 reporting the previous laminectomy with disc spacers. The Panel has determined that Mr Sayed did not sustain an injury to his lumbar spine in the accident.
2. If there had been a soft tissue injury to the lumbar spine at that time the impairment would be 0% WPI. As there was no dysmetria on testing range of movement with no guarding on palpation and no signs of radiculopathy or non-verifiable radicular complaints in the lower limbs.

1. It was documented by the treating GP at the first consultation after the accident that Mr Sayed had neck pain associated with headache and left knee pain. A CT of the cervical spine on 21 March 2022 reported a large broad-based central disc protrusion at C3/4 and moderate disc bulge at C4/5. The Panel notes at the previous fusion was at C5/6 and C6/7 which are levels below the more recent changes.
2. A radiologist, Dr Bou-Haidar has compare the films in 2013 to that of 2022. He gave an opinion that the more recent MRI was showing bright signs suggesting a more recent event at C3/4 which could correlate with a six-month timeframe of the MRI after the accident. Another radiologist Dr Dugal formed the same opinion as it was associated with cord oedema. They both formed the opinion that the MRI changes in 2022 were acute to subacute in nature correlated with the timing of the accident.
3. WPI for the cervical spine is DRE IV which is 25% WPI using table 72 of AMA 4. This is multilevel structural compromise without radiculopathy. There is no deduction as the previous fusion was at a different cervical spine level.

1. The first meeting of the Medical Review Panel was held on 19 August 2025 at 4pm and there was a further Medical Review Panel meeting at 3.00pm on 11 November 2025 at 3pm.
2. The whole of the Review Panel discussed the findings on examination by Medical Assessor Moloney.
3. The Panel agreed that in the course of the more recent operative procedure, there was evidence of cord oedema which was more recent than the previous procedure and therefore good evidence of a new injury.
4. The original operation to the neck was at C5/6 and C6/7 in 2013 whereas this procedure was at C3/4 and C4/5, a totally different level of the neck.
5. The whole Panel concurred with the clinical findings of Medical Assessor Moloney and the conclusions which are set out above.

1. The Medical Review Panel revokes the certificate of Medical Assessor Raymond Francis Wallace of 15 April 2025 and substitutes the determination that as a result of the accident, the claimant sustained the following injuries which gave rise to a permanent impairment of 25%:
   • Cervical Spine