Issued under s 7.23(1) of the Motor Accident Injuries Act 2017

1. Revokes the replacement certificate issued by Medical Assessor Cameron dated 23 December 2023.
2. Certifies that the claimant sustained the following injuries caused by the motor accident on 13 May 2018 that give rise to a whole person impairment that is greater than 10%, that is, 16%:

(a) right hand/right thumb - soft tissue injuries and the development or aggravation of underlying basal thumb osteoarthritis which, in turn, caused a gradual subluxation over time and resulted in the right trapeziectomy with ligament reconstruction and tendon interposition surgery;

(b) left arm - soft tissue injury - resolved;

(c) left elbow - soft tissue injury - resolved;

(d) left hand - soft tissue injury - resolved;

(e) left leg - soft tissue injury - resolved;

(f) left hip - soft tissue injury;

(g) left knee - soft tissue injury;

(h) lumbar spine - soft tissue injury, and

(i) thoracic spine - soft tissue injury.

1. Certifies that the following treatment and care relates to the injuries caused by the motor accident on 13 May 2018 but are not reasonable and necessary in the circumstances:

(a) eight sessions of chiropractic treatment with Mr Steve McCann;

(b) one year gym membership with a personal trainer at Elixer Gym;

(c) eight sessions of exercise physiology with Active Care Physiotherapy and Sports Therapy, and

(d) eight sessions of remedial massage at Bondi Massage.

A statement setting out the Review Panel's reasons for the assessment is attached to this certificate.

1. The claimant, Ms Simone Selkirk, is a 50-year-old woman who was involved in a motor accident on 13 May 2018 whilst a passenger in a taxi. There was an altercation between Ms Selkirk and the taxi driver and as a result, Ms Selkirk was dragged along by the taxi as the driver drove off causing her to fall onto the roadway and sustain injuries (the motor accident).
2. Ms Selkirk made an application for personal injury benefits. The relevant compulsory third party insurer is CIC Allianz Insurance Limited (the insurer).
3. Ms Selkirk claims that the motor accident caused injuries to her left arm, left elbow, left hand, right hand/right thumb, bilateral hips, left knee, left leg, thoracic spine and lumbar spine.
4. Ms Selkirk's claim is governed by the provisions of the Motor Accident Injuries Act 2017 (MAI Act). This legislation provides a scheme for the compulsory third party insurance of all motor vehicles registered in New South Wales and a scheme of statutory benefits (under Part 3) and compensation by way of lump sum damages (under Part 4) for persons injured in motor accidents in New South Wales.
5. A medical dispute about the degree of Ms Selkirk's whole person impairment (WPI) and a treatment dispute have arisen in connection with her claim. These constitute medical assessment matters under Schedule 2, cl 2(a) and (b) of the MAI Act respectively.
6. 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.
7. The medical dispute was referred to the Personal Injury Commission (Commission) and the Commission assigned it to Medical Assessor Ian Cameron for assessment.
8. Medical Assessor Cameron issued a certificate on 15 October 2023 and a replacement certificate on 23 December 2023. The latter certificate is the subject of this review in which Medical Assessor Cameron determined that Ms Selkirk suffered soft tissue injuries to the left arm, left elbow, left hand, right hand/right thumb, bilateral hips, left leg, thoracic spine, lumbar spine and left knee, together with a possible osteochondral injury caused by the motor accident and assessed her as having a WPI less than 10%, that is, 4%. He also determined that the proposed treatments in dispute related to the injuries caused by the motor accident, but were not reasonable and necessary in the circumstances (the Medical Assessment).

1. Ms Selkirk sought a review of the Medical Assessment in accordance with s 7.26 of the MAI Act (the Review).
2. The President's delegate determined that there was reasonable cause to suspect that the Medical Assessment was incorrect in a material respect and referred the matter to a Review Panel (the Panel).
3. 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, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
4. The new 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 motor 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.
8. On 26 March 2024, the Panel directed the parties to lodge with the Commission an indexed and paginated final bundle of documents on which they relied in the Review.
9. On 7 May 2024, the Panel informed the parties that it considered a re-examination of Ms Selkirk was required. Arrangements were made for Ms Selkirk to be re-examined by Medical Assessor Sophia Lahz on 3 July 2024 on behalf of the Panel. Ms Selkirk was directed to provide the Panel with the following:

(a) a copy of Ms Selkirk's general practitioners' (Edgecliff Medical Centre) clinical records from 17 July 2020 to date and clinical records from any other medical practice she may now attend, and

(b) access to electronic copies of all medical imaging studies of Ms Selkirk's injured parts of the body to date (in particular, the right thumb, right hand, right wrist and left knee) or ensure that the original imaging studies are made available at or before the time of the re-examination.

1. The medical imaging documents subject to the direction referred to above were not provided until 1 August 2024.
2. The Edgecliff Medical Centre clinical records subject to the direction referred to above were not provided until 1 November 2024.

1. Section 1.4 of the MAI Act defines 'injury' to mean a personal or bodily injury and includes a pre-natal injury; a psychological or psychiatric injury; and damage to artificial members, eyes or teeth, crutches or other aids or spectacle glasses.
2. Sections 5D (duty of care - general principles) and 5E (onus of proof) of the Civil Liability Act 2002 (the CLA) apply to the MAI Act: s 3B(2) of the CLA.
3. Ms Selkirk'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.
4. 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 version 9.3 effective from 6 December 2024 (the Guidelines).
2. The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association's Guides to the Evaluation of Permanent Impairment Fourth Edition (AMA 4 Guides). The Guidelines are definitive in respect of the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed: cl 6.2 of the Guidelines.
3. Permanent impairment is assessed in accordance with Chapter 6 of the Guidelines.
4. Causation of injury is addressed in cls 6.5, 6.6 and 6.7 of the Guidelines.
5. Clause 6.6 of the Guidelines notes:

"6.6 Causation is defined in the Glossary at page 316 of the AMA4 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. Pre-existing impairments should not be assessed if they are unrelated or not relevant to the impairment arising from the motor accident: cl 6.33 of the Guidelines.
2. Subsequent injury is addressed in cl 6.34 of the Guidelines which states:

"The evaluation of permanent impairment may be complicated by the presence of an impairment in the same region that has occurred subsequent to the relevant motor accident. If there is objective evidence of a subsequent and unrelated injury or condition resulting in permanent impairment in the same region, its value should be calculated. The permanent impairment resulting from the relevant motor accident must be calculated. If there is no objective evidence of a subsequent impairment, its possible presence should be ignored."

"Before an evaluation of permanent impairment is undertaken, it must be shown that the impairment has been present for a period of time, and is static, well stabilised and unlikely to change substantially regardless of treatment. The AMA 4 Guides (page 315) state that permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment. A permanent impairment is considered to be unlikely to change substantially (i.e. by more than 3% whole person impairment (WPI) in the next year with or without medical treatment). If an impairment is not permanent, it is inappropriate to characterise it as such and evaluate it according to these Guidelines."

1. The evaluation of permanent impairment should only consider the impairment as it is at the time of the assessment: cl 6.21 of the Guidelines.
2. The evaluation of permanent impairment must not include any allowance for a predicted deterioration. However, it may be appropriate to comment on this possibility in the impairment valuation report: cl 6.22 of the Guidelines.

1. The evidence before the Panel consisted of the following:

(a) the insurer's indexed and paginated bundle of documents lodged on the Commission's portal on 1 March 2024 (insurer's documents);

(b) Ms Selkirk's indexed and paginated bundle of documents lodged on the Commission's portal on 22 April 2024 (claimant's documents);

(c) Ms Selkirk's Application to Admit Late Documents dated 14 June 2024 and attached documents (AALD 14 June 2024);

(d) Ms Selkirk's Application to Admit Late Documents dated 3 July 2024 and attached documents (AALD 3 July 2024);

(e) Ms Selkirk's Application to Admit Late Documents dated 11 July 2024 and attached documents (AALD 11 July 2024);

(f) Ms Selkirk's Application to Admit Late Documents dated 1 August 2024 attaching I-Med Radiology clinical records (AALD 1 August 2024), and

(g) Ms Selkirk's Application to Admit Late Documents dated 1 November 2024 attaching Edgecliff Medical Centre clinical records (AALD 1 November 2024).

1. Medical Assessor Cameron examined Ms Selkirk on 3 October 2023 and issued a replacement certificate under s 7.23(1) of the MAI Act on 23 December 2023.[1]
2. Medical Assessor Cameron was asked to assess the dispute between the parties about the degree of permanent impairment under Schedule 2, cl 2(a) of the MAI Act in respect of the following physical conditions:

(a) left arm - soft tissue injury;

(b) left elbow - soft tissue injury;

(c) left hand - soft tissue injury;

(d) right hand/right thumb - soft tissue injury;

(e) bilateral hips - soft tissue injuries;

(f) left knee - soft tissue injury with possible osteochondral injury;

(g) left leg - soft tissue injury

(h) lumbar spine - soft tissue injury, and

(i) thoracic spine - soft tissue injury.

1. Medical Assessor Cameron was asked to assess the following treatment and care dispute between the parties under Schedule 2, cl 2(b) of the MAI Act:

(a) eight sessions of chiropractic treatment with Mr Steve McCann;

(b) one year gym membership with a personal trainer at Elixir Gym;

(c) eight sessions of exercise physiology with Active Care Physiotherapy and Sports Therapy, and

(d) eight sessions of remedial massage at Bondi Massage.

1. In respect of Ms Selkirk's pre-accident medical history and relevant personal details, Medical Assessor Cameron noted that she lived alone and worked full-time as a solicitor, largely from home. She reported that she had been in good health prior to the motor accident.
2. Medical Assessor Cameron took the following history of the motor accident:

"On 13 May 2018, Ms Selkirk was [sic: a] passenger in a taxi. There was an altercation and as a result, Ms Selkirk was dragged by the taxi. She was thrown to the roadway and injured her left knee and hip. She also said that she braced herself with her right hand and sustained an injury to the right wrist."[2]

1. Medical Assessor Cameron took the following brief history of symptoms and treatment following the motor accident:

"Ms Selkirk consulted her general practitioner, Dr Middleton. She returned to work very quickly.

There were continuing symptoms from the left knee and hip region; the right wrist and thumb gradually became worse.

Ms Selkirk, on 14 February 2023 from Dr Smithers, had a right trapeziectomy ligament reconstruction and tendon repositioning."[3]

1. In respect of Ms Selkirk's current symptoms, Medical Assessor Cameron noted that she had an ache in her right knee that altered her gait and caused pain walking up and down hill. She complained of right hamstring pain; some neck pain and back pain. On occasions, the left knee was uncomfortable in bed. The left knee was unstable and she was fearful of falling. The right trapeziectomy ligament reconstruction and tendon repositioning in 2023 helped her right wrist symptoms but right hand function had not returned to normal. There was reduced grip strength and ability to use the right hand. She reported a limited carrying ability and was unable to fly to Melbourne for work due to her inability to put a bag in an overhead locker. She reported driving but its duration was limited. A cleaner performs her heavy house work. She experienced difficulty with cooking. She was working full-time as a solicitor.
2. In respect of current treatment, Medical Assessor Cameron noted that Ms Selkirk medicated with Panadol or Nurofen and that her general practitioner was now Dr Foo. Hand therapy was continuing.
3. In respect of general presentation on clinical examination, Medical Assessor Cameron observed that Ms Selkirk was right-handed; 165cm in height; and weighed 66kg. She was cooperative and provided a clear history.
4. On examination of the cervical spine, Medical Assessor Cameron observed that there was a full range of movement in all planes with no muscle spasm, no muscle guarding, no dysmetria and no non-verifiable radicular complaints present. Nerve tension signs were negative.
5. On examination of the upper extremities, Medical Assessor Cameron observed that there was a full range of motion in both shoulders. At the right wrist, range of movement was flexion 50°; extension 50°; radial deviation 20°; and ulnar deviation 40°. At the right thumb, there was a full range of movement. There was a full range of motion at other upper extremity joints. There were no neurological abnormalities in the upper extremities. There was no difference in circumferences of the upper extremities detected.
6. On examination of the thoracic spine, Medical Assessor Cameron observed that there was moderately and symmetrically reduced range of motion to 70% normal in all planes, with no muscle spasm, no muscle guarding, no dysmetria and no non-verifiable radicular complaints present.
7. On examination of the lumbar spine, Medical Assessor Cameron observed that there was moderately and symmetrically reduced range of motion to 70% normal in all planes, with no muscle spasm, no muscle guarding, no dysmetria, and no non-verifiable radicular complaints present. Nerve tension signs were negative.
8. On examination of the lower extremities, Medical Assessor Cameron observed that left knee range of movement was 0° to 110° with crepitus. There was a full range of movement of the left hip. There was a full range of motion at other lower extremity joints. There were no neurological abnormalities in the lower extremities. Circumferences of the lower extremities were above the knee 44cm bilaterally and below the knee 38cm bilaterally. There were two small scars over the anterior aspect of the left knee. He also observed that Ms Selkirk walked with a normal gait.
9. Medical Assessor Cameron referred to and summarised the relevant documentation provided to him.[4]
10. Medical Assessor Cameron opined that Ms Selkirk had suffered the following injuries caused by the motor accident:

(a) left arm - soft tissue injury - using the abnormal range of motion method: 0% WPI;

(b) left elbow - soft tissue injury - using the abnormal range of motion method: 0% WPI;

(c) left hand - soft tissue injury - using the abnormal range of motion method: 0% WPI;

(d) right hand/right thumb - soft tissue injury - using Figure 26, page 36 and Figure 29, page 38 of the AMA 4 Guides: 2% WPI;

(e) bilateral hips - soft tissue injuries - using the abnormal range of motion method: 0% WPI each;

(f) left knee - soft tissue injury with possible osteochondral injury - using Table 62, page 83 AMA 4 Guides: 2% WPI;

(g) left leg - soft tissue injury - using the abnormal range of motion method: 0% WPI;

(h) lumbar spine - soft tissue injury - using the Diagnosis Related Estimate (DRE) method, assessed as DRE Lumbosacral Category I: 0% WPI, and

(i) thoracic spine - soft tissue injury - using the DRE method, assessed as DRE Thoracolumbar Category I: 0% WPI.

1. In respect of the right hand/right thumb injury, Medical Assessor Cameron opined that there was no evidence of a significant injury to the right wrist of sufficient severity to require surgical intervention a considerable time after the motor accident. Further, there was no evidence of significant symptoms from the right wrist and right thumb for a considerable time after the motor accident.
2. In respect of the treatment and care dispute for the proposed treatments referred for assessment, Medical Assessor Cameron opined that they relate to the injuries caused by the motor accident but were not reasonable and necessary because there was no indication for ongoing treatment of the types requested for the injury sustained by Ms Selkirk. She had undergone extensive treatments and there was no justification for further treatments of the types requested.

1. Ms Selkirk completed an undated application for personal injury benefits in respect of the motor accident.[5]
2. The application form set out the basic particulars of the motor accident, including the time of the motor accident as being 12.04am on 13 May 2018.
3. In the application form, Ms Selkirk provided a description of the motor accident in the form of a diagram accompanied by the following words:

"Me getting into the back seat of taxi to get mobile phone.

Cab drove off with me hanging out of back seat of taxi.

Landed heavily on road dragged out of taxi. *Very injured."[6]

1. In respect of the injuries caused by the motor accident, Ms Selkirk wrote the following words in the space provided in the application form, "see attachment".[7] However, there was no such attachment to the application form in evidence.
2. In the application form, Ms Selkirk denied having suffered an illness or injury affecting the same or similar parts of her body at the time of the motor accident.[8]

1. In evidence, were Ms Selkirk's clinical records from 28 November 2009 to 6 June 2024 produced by Edgecliff Medical Centre.[9]
2. On 19 March 2014, Ms Selkirk consulted Dr Rosalee Fuzes, general practitioner, of Edgecliff Medical Centre complaining of a painful right shoulder for about 15 months. On examination, Dr Fuzes observed a free range of movement but Ms Selkirk complained about a lot of pain. She was referred for a right shoulder ultrasound and advised to take Nurofen. If no better, she recommended referral for a steroid injection. Dr Fuzes noted no history of injury.[10]
3. On 21 March 2014, Ms Selkirk underwent right shoulder and left knee ultrasounds by Dr Michael Reeves on the referral of Dr Fuzes. The clinical history provided in respect of the right shoulder was that of right severe pain radiating to the scapular and right arm. The clinical history provided in respect of the left knee was that of a clicky left knee. In respect of the right shoulder, Dr Reeves observed no abnormality in the rotator cuff. In respect of the left knee, Dr Reeves concluded that there was no cause for Ms Selkirk's symptoms demonstrated on ultrasound.[11]
4. On 23 June 2014, Ms Selkirk consulted Dr Fiona Murphy, general practitioner, of Edgecliff Medical Centre complaining of right shoulder joint pain.[12]
5. On 10 May 2017, Ms Selkirk consulted a nurse at Edgecliff Medical Centre with a wound to her right hand. A swab was taken of the wound. The wound was cleansed and steri-strips and dressing were applied.[13]
6. On 14 February 2018, Ms Selkirk consulted Dr Barbara Middleton, general practitioner, of Edgecliff Medical Centre complaining of some numbness in her right little finger over the past few weeks and reporting a wrist injury a few weeks earlier. She also reported some low back pain for which she was seeing a chiropractor.[14]

1. On 14 May 2018, Ms Selkirk consulted Dr Middleton and advised that she had been assaulted by a taxi driver at about midnight on 12 May 2018 when he drove off with her halfway out the back door. She sustained some injuries and Dr Middleton noted them as a left elbow abrasion, 3cm x 1.5cm; a left knee abrasion, 3cm x 3cm; a left thigh contusion, 7cm x 7cm; a left ankle abrasion and swelling; a right big toe abrasion, 2cm x 2cm; a bruised and swollen right ankle; low back pain; headache; and a bruised right knee.[15]
2. On 14 May 2018, Ms Selkirk consulted Dr Erin Hawken, chiropractor, who she had been consulting prior to the motor accident. The entry dated 14 May 2018 in Dr Hawken's clinical records noted the following history:

Taxi driver drove off whilst Simmone was getting into the rear drivers side of taxi with intention to eject her from the car. She managed to hold on for a short distance & eventually fell from the car onto the road side with significant impact on landing to the LHS of her body. Bilat ankle sprain due to trying to maintain footing, contusion on L knee and elbow, massive bruise on L hip and thigh, grazing on R big toe, broken R thumbnail. Clearly very traumatised from incident - emotional & crying.

Now experiencing headaches temporal and frontal - no visual changes, no NNTW. Pain in L arm from shoulder region to forearm and wrist only. Lower back pain & seizing across entire lower back and R glut region. Mid thoracic discomfort. Neck painful & 'seizing up'.

Symptoms all increasing in severity with time & feeling generally sore all over."[16]

1. In evidence, there are photographs of the grazing to the left elbow, grazing and bruising to the left knee and lower leg, bruising to the right knee and the broken right thumb nail alleged to have been caused by the motor accident.[17] The entry in the Bondi Junction Massage and Float Centre clinical records dated 24 June 2018 noted that Ms Selkirk "hit her right arm"[18] in the motor accident.
2. On 16 August 2018, Ms Selkirk consulted Dr Middleton advising that she was having ongoing treatment by a chiropractor for her ankle and knee injuries. She still had some pain in the left knee and needed a certificate of capacity for the insurer.[19]
3. On 23 August 2018, Ms Selkirk consulted Dr Middleton advising that the insurer had approved a left knee MRI scan in relation to the motor accident. Dr Middleton provided her with a referral for the MRI scan.[20]
4. On 10 September 2018, Ms Selkirk underwent a left knee MRI scan by Dr Faisal Rashid on the referral of Dr Middleton. The clinical history provided to Dr Rashid was that of left knee pain after a motor vehicle accident. Dr Rashid observed a broad late subacute osteochondritis dissecans at the weight-bearing medial femoral condyle with some evidence of persisting instability; intact discoid lateral meniscus; borderline patellar alta with retropatellar chondral wear/softening in keeping with chondromalacia patellae; and

intra-articular body within the medial gastrocnemius bursar, possibly grade IV osteochondritis dissecans from the medial femoral condyle osteochondritis dissecans.[21] 5. On 13 September 2018, Dr Lex Bilsen, general practitioner, of Edgecliff Medical Centre referred Ms Selkirk to Dr Bradley Seeto, orthopaedic surgeon, for an opinion and management of her left knee pain following an accident in May 2018.[22] 6. On 15 October 2018, Ms Selkirk consulted Dr Bradley Seeto, orthopaedic surgeon, of Sydney Knee Specialists on the referral of Dr Bilsen. Dr Seeto took the following history:

"Simone was attempting to retrieve her mobile phone from the backseat of a taxi when the taxi took off dragging her behind and causing an injury to her left thigh, left elbow, and left knee. Prior to her injury, she advises that she did not present with any previous problems with the left knee and has had no previous left knee surgery or injections.

Over the past six months, there has been worsening pain over the anterior, anteromedial, and anterolateral aspects of the knee. The pain is present on a daily basis, a dull ache in nature, and rated 6 to 7 out of 10 in severity. Pain is worse with weight bearing, worse when negotiating stairs and hills, particularly descending, and is associated with episodes of pseudo-instability on unstable ground. There is night and rest pain and knee joint locking experienced. The pain is associated with swelling and locking. Simone has been on some analgesia on particularly painful days but has had no previous requirement for any analgesia use for knee pain prior to the taxi incident. She has had no recent physiotherapy, but has undergone a remedial massage which she finds helpful as well as chiropractic therapy."[23]

1. On examination, Dr Seeto observed that Ms Selkirk stood with physiological lower limb alignment; there was a traumatic scar affecting the anterior aspect of the right knee (childhood soft tissue injury); ability to perform a full squat, but with instability and generalised anterior discomfort; mild tenderness over the medial and lateral joint lines to palpation; small effusion present in both knees; patellofemoral crepitus through range of motion; loading the patellofemoral joints was not particularly painful; cruciate and collateral ligaments were stable and not painful to stressing; the leg was neurovascularly intact; and the hip was asymptomatic to rotation.
2. Dr Seeto reviewed the MRI scan dated 10 September 2018 and noted some arthritic change affecting predominantly the medial and patellofemoral compartments of the left knee. He observed a subchondral cyst affecting the weight-bearing portion of the medial femoral condyle with surrounding subchondral oedema. The lateral compartment of the knee was well preserved. There were multiple loose bodies in the posterior aspect of the left knee.
3. Dr Seeto opined that Ms Selkirk's left knee was previously asymptomatic but that, since the motor accident, it had now become symptomatic and was deteriorating. The situation was compounded by the presence of arthritis. The loose bodies in the posterior aspect of the left knee may have been as a consequence of her trauma in the motor accident.
4. Dr Seeto recommended a trial period of ongoing conservative management including activity modification, intermittent use of anti-inflammatory medications, physiotherapy, massage therapy and an ultrasound guided steroid and local anaesthetic injection into the left knee.
5. Dr Seeto opined that, in the future, should Ms Selkirk have ongoing disabling pain, she would be facing a total knee replacement, which should be avoided if at all possible. He arranged for a review one week after the left knee injection to gauge her response to it.
6. On 30 October 2018, Dr Middleton referred Ms Selkirk to Mr Christopher Jones for treatment of her left knee pain.[24]
7. On 29 November 2018, Ms Selkirk consulted Dr Middleton requesting referrals for various treatment of her left knee and left hip as she was still experiencing ongoing pain from the motor accident. Dr Middleton noted that Ms Selkirk's pain improved after receiving treatment. She referred Ms Selkirk to Ms Colleen Kent, osteopath.[25]
8. On 1 February 2019, Ms Selkirk consulted Dr Middleton complaining that her right knee had been painful when she was walking in the ocean but that otherwise, it was not painful. Dr Middleton issued her with a certificate of capacity.[26]
9. On 1 May 2019, Ms Selkirk consulted Dr Middleton complaining that her left knee had not been as well as it had been and that she was sometimes still experiencing some pain at night. She advised Dr Middleton that her physiotherapist wanted her to increase her exercise program. Dr Middleton issued her with a certificate of capacity.[27]
10. On 1 July 2019, Ms Selkirk consulted Dr Middleton advising that she needed a referral to an exercise physiologist to develop an exercise program. Dr Middleton issued her with a certificate of capacity.[28]
11. On 22 July 2019, Ms Selkirk underwent X-rays of the full spine, pelvis and bilateral

weight-bearing knees by Dr Jonathan Seeff on the referral of Dr Gavin Gordon. In respect of the bilateral knees, Dr Seeff observed bilateral bicompartmental osteoarthritic changes involving the medial tibiofemoral joint (left greater than the right) and the patellofemoral joints; no significant joint effusion; and no periarticular soft tissue calcification or osteochondral lesion. In respect of the full spine and pelvis, Dr Seeff observed a thoracolumbar scoliosis convex to the left; intact pedicles within the thoracic and lumbar spine; maintained disc spaces without vertebral body collapse; straightening of the cervical spine loss of disc height from C5 to T1; no vertebral body collapse; and normal alignment of the atlas and axis.[29] 12. On 13 August 2019, Ms Selkirk consulted Dr Middleton advising she required another certificate for the treatment of her left knee. Dr Middleton issued her with a certificate of capacity.[30] 13. In a report dated 24 September 2019, Mr Michael Ward, specialist musculoskeletal physiotherapist, of Core Health concluded that remedial massage therapy was not considered reasonable and necessary given the current stage of rehabilitation, noting that the rationale provided on the treatment plan was not consistent with his current understanding of the presentation. Mr Ward did consider that up to eight standard chiropractic consultations were reasonable and necessary with the expectation that such treatment would focus on active based rehabilitation.[31] 14. On 1 October 2019, Ms Selkirk consulted Dr Middleton complaining of ongoing left knee pain. She advised that the insurer would not pay for remedial massage. She requested referral to a psychologist for pain management. Dr Middleton noted that Ms Selkirk felt that remedial massage was the best treatment. Dr Middleton encouraged her to exercise as much is possible. Dr Middleton issued her with a certificate of capacity.[32] 15. On 25 October 2019, Dr Christopher Jones, osteopath, reported to the insurer in response to its request to provide a summary of his notes in respect of consultations with Ms Selkirk.[33] Dr Jones provided a history of the motor accident and Ms Selkirk's symptoms thereafter that was consistent with the evidence in respect of her left knee. Dr Jones was involved in the treatment of Ms Selkirk's left knee. Between 30 October 2018 and 28 May 2019, Ms Selkirk had attended 14 sessions with Dr Jones. During that period, she reported periods of improvement and then aggravation/deterioration. Dr Jones provided treatment in the form of soft tissue massage for the quadriceps, hamstrings, popliteus calves and joint mobilisation. He also recommended that Ms Selkirk perform stretching, vastus medialis oblique activation exercises, exercise bike activity and wall squats at home. 16. On 14 November 2019, Ms Selkirk consulted Dr Middleton complaining of ongoing left knee pain that ached at night and also when just sitting. She complained that when she walks she gets left hip pain. Dr Middleton prescribed one 15mg Mobic tablet daily.[34] 17. On 9 January 2020, Ms Selkirk consulted Dr Middleton requiring a certificate of capacity. Dr Middleton noted that she had seen an insurer medical specialist and that she would not be having any further massage therapy. Ms Selkirk required treatment by an exercise physiologist and Dr Middleton provided a referral as well as a certificate of capacity.[35] 18. On 28 May 2020, Dr Middleton referred Ms Selkirk to Dr Seeto for opinion and management of left knee pain.[36] 19. On 16 June 2020, Ms Nicole Baer, sports and exercise physiotherapist, of Active Care Physiotherapy and Sports Therapy provided a report to Dr Middleton.[37] Ms Baer reported that Ms Selkirk had presented to her that day for an assessment of her persistent medial knee pain and right lumbo-pelvic pain which had commenced 18 months earlier when she was thrown from a moving taxi on her left knee. Since then, she reported feeling knee instability with knee pain and right lumbo-pelvic region pain that affected her activities of daily living. Ms Selkirk reported that her pain was eased most by regular massages and chiropractic readjustments but that the relief was not long lasting. She believed that massage gave her the greatest pain relief and she had a fear of increasing activity due to pain without the benefit of massage. Ms Baer opined as follows:

"Based on my clinical assessment and the findings of the detailed medical reports from Dr Chris Oates Simone's best treatment option must include exercise, education and a weight loss program. Following evidence-based guidelines of patellofemoral pain and knee osteoarthritis I had a discussion with Simone about the benefits of a graduated individualised exercise program incorporating cardiovascular exercise together with specific knee, hip and trunk strength exercises. The program must also include a neuromuscular stability component.

As part of Simone's physiotherapy treatment plan she would benefit greatly in incorporating education on pain science as well as education about exercise to assist in desensitising her to pain and increasing her load capacity without the fear of pain which appears to be limiting her ability to progress."[38]

1. On 17 June 2020, Ms Selkirk consulted Dr Seeto on the referral of Dr Middleton. Dr Seeto noted that since the last consultation on 18 October 2018, Ms Selkirk's left knee symptoms had progressively deteriorated and had been particularly bad over the past five months. He noted that she had not been receiving any chiropractic therapies, remedial massage therapies, physiotherapy or other treatment for the left knee for some time because of a dispute with the insurer. He noted that plain X-rays of both knees demonstrated bilateral medial compartment arthritis.[39]
2. In respect of the future management of Ms Selkirk's left knee, Dr Seeto opined as follows:

"I have explained to Simone that her left knee has likely reached its maximal medical improvement. Given the duration since her original injury, her symptoms are chronic and stable. I would expect that her symptoms will progressively deteriorate over time and at some stage in the future when her symptoms are severe enough and interfering with her quality of life and function and unresponsive to nonoperative means, she will be facing a total knee replacement.

Exercise Physiology and remedial massage could be useful as combined therapy to address her pain and muscle tightness. Simone has used chiropractic treatment with good effect in the past and provided it improves her symptoms I would support her continued use of the therapy. Psychological counseling [sic] may assist her to manage her mental health concerns associated with her chronic ongoing knee pain and associated sleep disturbance."[40]

1. On 10 December 2020, Ms Selkirk consulted Dr Middleton by telephone requesting another certificate of capacity for her knee injury. Dr Middleton issued a certificate of capacity.[41]
2. On 15 February 2021, Ms Selkirk consulted Dr Middleton by telephone requesting another certificate of capacity. Dr Middleton issued a certificate of capacity.[42]
3. On 22 March 2021, Ms Selkirk consulted Dr Middleton reporting that she had been seeing an exercise physiologist and stating that she was desperate to undergo remedial massage, requesting a certificate in this regard. Ms Selkirk advised that the exercise physiologist was performing muscle release with heavy pressure on her muscles. She told Dr Middleton that she actually had not done any exercise and was wanting more remedial massage so that she could exercise. Dr Middleton explained to her that, after two years of massage therapy that was not helping, she needed to concentrate on exercise.[43]
4. In evidence, were Ms Selkirk's clinical records from 18 October 2019 to 1 September 2022 produced by Oxford Village Medical Centre and Skin Cancer Clinic.[44] Most of the entries in the clinical records referred to medical issues unrelated to the claimed injuries sustained in the motor accident. The first entry in those clinical records in respect of Ms Selkirk's claimed motor accident related injuries was with Dr James Lam, general practitioner, on 6 July 2022, when he referred her for a right hand ultrasound.[45]
5. In evidence, there is a list of treatments undergone by Ms Selkirk and paid by the insurer between 25 July 2018 and 10 May 2021.[46] The treatments include physiotherapy, chiropractic therapy, remedial massage therapy, osteopathy services and general practitioner visits.
6. On 15 July 2022, Ms Selkirk underwent an ultrasound of the right hand by Dr Kenneth Sesel on the referral of Dr Lam. Dr Sesel concluded that the predominant abnormality was the degenerative change in the first carpometacarpal joint at the base of the thumb. He opined that this finding should be correlated with a plain X-ray series in the first instance and, provided there was no contraindication visible, it could be targeted with a steroid injection under ultrasound guidance if it correlated clinically.[47]
7. On 18 July 2022, Ms Selkirk consulted Dr Lam, who explained the results in the recent ultrasound of her right hand. In accordance with Dr Sesel's advice, Dr Lam recommended a steroid injection under ultrasound guidance into the base of the right thumb. Ms Selkirk declined the injection and commented that "they always tell me to get an injection" and so, Dr Lam referred her for an X-ray of the right hand and right thumb.[48]
8. On 26 July 2022, Ms Selkirk underwent an X-ray of the right hand and right thumb by Dr Sesel on the referral of Dr Lam. The clinical history provided to Dr Sesel was that of pain at the right thumb base. Dr Sesel concluded that there was early development of osteoarthritis in the small joints of the fingers with more advanced involvement at the first carpometacarpal joint at the base of the thumb, which was currently symptomatic. He opined that if symptoms warranted intervention, it could respond very well to an ultrasound guided steroid injection.[49]
9. On 28 July 2022, Ms Selkirk consulted Dr Allison Ward, general practitioner, of Oxford Village Medical Centre and Skin Cancer Clinic to discuss the results in the recent

X-ray of her right hand and right thumb. Ms Selkirk was provided with a copy of the results.[50] 10. On 1 August 2022, Ms Selkirk presented to Sydney Hospital complaining of a recent flare-up of symptoms in her right hand and right thumb. The hospital discharge summary noted a history of falling out of a taxi four years ago onto her outstretched right hand. The summary also noted a chronic inability to extend the right thumb. In the hospital's referral to Dr Baffsky, the attending medical officer reported that Ms Selkirk had presented with chronic first carpometacarpal joint pain and queried post-traumatic arthritis or a ligamentous injury that was treated with rest, splinting and simple analgesia. 11. On 10 August 2022, Ms Selkirk consulted Dr Lam and provided a history of the motor accident. Dr Lam recorded that she had sustained injuries to her left knee, left hip, right hand/thumb when she fell from a moving taxi. Ms Selkirk complained that her thumb was getting worse and that she had consulted a hand surgeon at Sydney Hospital, who diagnosed her with "subsequent arthritis". Dr Lam noted that Ms Selkirk required a new private hand surgeon and he issued her with a referral to a hand surgeon and a certificate of capacity.[51] 12. On 11 October 2022, Ms Selkirk consulted Dr Serena Foo, general practitioner, of Edgecliff Medical Centre advising that she had been involved in a taxi accident in May 2018 and now noted an increase in pain and weakness in her right thumb. She required a referral to a hand surgeon. Dr Foo referred her to Dr Christopher Smithers, orthopaedic surgeon.[52] 13. In her referral letter to Dr Smithers, Dr Foo referred to the motor accident and noted that Dr Middleton had assessed Ms Selkirk for "her general obvious injuries, which were extensive". Dr Foo added the following:

"Ms Selkirk had also injured her right hand, as per the pictures that have been provided of her broken Right Hand thumb nail arising from the accident road impact. Ms Selkirk sprained and grazed her Right Hand on impact, however, as it was not considered by her as her more significant injuries, Ms Selkirk did not identify her right-hand injuries as significant and an injury that she expected she would recover from so the reporting of her right-hand injury was overlooked in Dr Middleton's medical notes listed injuries.

Ms Selkirk states that her right-hand sprain and injury took around 6 odd weeks to heal, after which time she did not experience any further symptoms for around 19 months.

Ms Selkirk states she recalls mild Right Hand thumb twinges being experienced around late 2019/early 2020, but again dismissed the symptoms as nothing of lasting concern.

Ms Selkirk states that the twinges were experienced on and off over 2020 and became more regular and more painful by mid to late 2020. Ms Selkirk recalled she was mainly aware of this right-hand thumb pain when she was holding her steering wheel. She reports that gripping the steering wheel was uncomfortable, but that the pain came and went so she dismissed it as requiring any medical attention.

Ms Selkirk did not seek any medical intervention again dismissing the pain as, in her belief, carpal tunnel syndrome. Ms Selkirk does not however report she experienced any numbness to her hand in that period.

Ms Selkirk reports her right-hand thumb pain continued to worsen over 2021 and became chronic in early 2022, where she has now sought medical advice for treatment.

Ms Selkirk has not been involved in nor identified any other intervening trauma incidents involving injuring her Right Hand since the Taxi Accident on 13 May 2018 that could have contributed to the current Right Thumb injury presentation relevant to this referral. No medical notes have been noted at our clinic on any other right-hand injury incidents to date.

Ms Selkirk did indicate that some time before May 2018 Ms Selkirk had experienced numbness to her Right Little Finger (there was no referral nor complaint relevant to her Right-Hand Thumb involved with this). Ms Selkirk identified this as a potential symptom of a pinched nerve in her neck/shoulder or elbow for which she sought Chiropractic treatment and adjustments to address that left [sic: right] little Finger numbness, which had subsequently resolved itself in early 2018."[53]

1. On 24 November 2022, Ms Selkirk consulted Dr Christopher Smithers, shoulder, elbow, wrist and hand orthopaedic surgeon, at the request of Dr Foo. Dr Smithers took the following history:

"I reviewed Simone, aged 47 years, today in regard to her right thumb CMC joint osteoarthritis. She is right-hand dominant and works as a lawyer and is now having significant troubles with right hand function due to the thumb base pain and weakness. This has been consistently troublesome for approximately two years. Prior to this she did have intermittent symptoms which commenced following an accident while alighting from a taxi. While attempting to retrieve her mobile phone from the rear or [sic: of] the vehicle with the door open the taxi moved forward from a stationary position resulting in Miss Selkirk falling out of the vehicle while it was moving. This resulted in multiple abrasions and contusions involving the right and left upper and lower limbs, though the predominant impact was taken by the left side of her body. She did break her right thumb nail and approximately six weeks following the injury describes relatively mild thumb pain and swelling. This occurred on 13 May 2018. Miss Selkirk describes mild intermittent symptoms in 2019 which progressed in 2020 to become consistent thumb base pain by late 2020. Symptoms have now progressed such that she has pain throughout the day with difficulty holding pens or coffee cups or water jugs and has severe pain and difficulty opening jars or turning heavy door knobs. She now requires a hand-based splint throughout the day and night. Miss Selkirk denies any other injury to the right thumb and any contralateral thumb pain. There is no family history of thumb arthritis."[54]

1. On examination, Dr Smithers observed a subtle adducted posture to the right metacarpal compared with the left, 20° of passive extension at the metacarpophalangeal joint and a mildly reduced hand span. On the right thumb carpometacarpal joint, she had marked tenderness and a positive grind test. There was no other identifiable source for radial-sided wrist pain. The left thumb carpometacarpal joint examined normally and sensation was intact throughout.
2. Dr Smithers opined as follows:

"Simone's right thumb pain is due to CMC joint osteoarthritis. Based on the timeframe of development of symptoms and the pain in the weeks following, the accident likely contributed to the thumb CMC joint subluxation and early development of osteoarthritis."[55]

1. Dr Smithers formed the view that the chances of satisfactorily managing Ms Selkirk's arthritis in the long-term with non-operative means were very low. He referred her for an ultrasound-guided cortisone injection in the right thumb carpometacarpal joint. They also discussed the surgical option of trapeziectomy with ligament reconstruction and tendon interposition and he tentatively booked her in for surgery on 14 February 2023.
2. On 14 February 2023, Ms Selkirk underwent a right trapeziectomy, ligament reconstruction and tendon interposition by Dr Smithers. The operation report noted that the indication for surgery was right thumb carpometacarpal joint arthritis.[56]
3. On 27 February 2023, Ms Selkirk consulted Dr Smithers, who noted that she was doing really well post-surgery. She did not require any analgesia. She had her sutures removed and transitioned to a removal splint. There was mild swelling of the surgical site and the wound had healed well. She complained of mild paraesthesia at the thenar eminence and no paraesthesia otherwise. Finger range of motion was full and limited thumb interphalangeal, metacarpophalangeal and carpometacarpal joint range was not causing pain. She was to proceed with range of motion exercises under the direction of Ms Jo Munro.[57]
4. On 27 March 2023, Ms Selkirk underwent an X-ray of her right thumb by Dr Salman Ansari on the referral of Dr Smithers. Dr Ansari noted the trapeziectomy and that no post-operative complication was identified.[58]
5. On 27 March 2023, Ms Selkirk consulted Dr Smithers, who noted that she was making good progress post-surgery. She was out of the splint and using her right hand for many of her normal activities. Over the past week she had some increasing pain, which was more likely related to too much activity early in the rehabilitation period. Post-surgery imaging reassured the maintenance of position. He encouraged Ms Selkirk to use the splint intermittently and not to push through any pain. She was to continue with simple range of motion exercises.[59]
6. On 1 June 2023, Ms Selkirk consulted Dr Foo by telephone advising that she had undergone right thumb surgery some months ago but still had some pain and restricted movement, for example, when doing up buttons. She requested a referral to the Sydney Hand Hospital.[60]
7. On 22 June 2023, Ms Selkirk consulted Dr Foo advising that she had injured her left knee along with her right thumb and right hand in the motor accident in 2018. She complained of constant pain, worse with walking and on hills. She had undergone remedial massage and had ongoing issues. She had consulted a hand therapist due to the right thumb abnormality since surgery and requested a second opinion and X-rays. Dr Foo referred her to a hand specialist and for X-rays.[61]
8. On 23 June 2023, Ms Selkirk underwent an X-ray of her right thumb by Dr Talia Friedman on the referral of Dr Foo. The history provided to Dr Foo was a complaint of pinch strength pain. Dr Friedman reported that there was a lucency through the dorsal aspect of the base of the metacarpal which raised the possibility of a subacute fracture. Dr Friedman opined that this could be further confirmed or excluded by CT scan. Dr Friedman also observed some minor degenerative change at the interphalangeal joints of the thumb.[62]
9. On 28 November 2023, Ms Meredith Rogers, senior hand therapist at St Vincent's Hospital, reported on Ms Selkirk to the hospital's occupational therapy department.[63] Ms Rogers noted that Ms Selkirk was referred to her by Sydney Hospital to which she had been referred by Dr Foo. Ms Selkirk first consulted her on 1 June 2023 and had been undergoing regular hand therapy since then. Ms Rogers concluded as follows:

" ... Simone's pain and function as self-reported on the PRWHE remain at a similar level after 5 months of therapy. She has reported a small increase in her ability to perform some ADLs however she still experiences base of thumb pain with gripping and pinching that is impacting on her ADLs such as cleaning. She has reported benefit from a shoulder massage which she will continue to pursue and she has been compliant with her home program. To date, MCPJ hyperextension correction has been difficult to achieve with therapy. We are hopeful with longer term use of the Push CMCJ brace this may be achieved. Whilst functional improvements take some time to achieve after LRTI, Simone seeks your opinion about her thumb and is interested in any suggestions you may have to assist with her pain and function."[64]

1. On 29 November 2023, Ms Selkirk consulted Dr Foo advising of ongoing right thumb issues. She had an upcoming appointment at the hand clinic and requested repeat X-rays. Dr Foo advised her to attend the hand clinic before undergoing repeat X-rays as the clinic may require her to undergo an MRI scan.[65]
2. On 18 April 2024, Ms Selkirk consulted Dr Foo by telephone advising that she was still having issues with her right hand and that it was now affecting her mental health.[66]
3. On 22 April 2024, Ms Selkirk consulted Dr Foo to discuss her mental health, reporting that ever since the hand surgery she has experienced ongoing pain and weakness in the right thumb. Many movements exacerbated her pain.[67]
4. On 29 May 2024, Ms Selkirk consulted Dr Foo by telephone advising that her left knee was still painful and that she was experiencing difficulty walking, especially down stairs or downhill. Ms Selkirk requested an ultrasound. Dr Foo noted that an MRI scan suggested a meniscal injury. Ms Selkirk stated that she now also experienced right hip and piriformis pain that she queried was related to her compensatory gait.[68]
5. On 3 June 2024, Ms Selkirk underwent an ultrasound of her right hip and buttock region by Dr Sesel on the referral of Dr Foo. Dr Sesel opined that the study was normal apart from some mild tenderness over the trochanteric bursa.[69]
6. On 5 June 2024, Ms Selkirk underwent a left knee MRI scan by Dr Jules Comin on the referral of Dr Foo. The clinical history provided was that of pain following a trauma. Dr Comin observed a discoid lateral meniscus without tearing or degeneration; scarring and free margin fraying of the medial meniscus without an acute or distracted tear; cruciate ligament scarring; advanced degenerative change at the medial tibiofemoral and patellofemoral compartments with patchy areas of subcortical oedema; synovitis and effusion but no loose fragments. Dr Comin opined that, given the severity of degenerative changes, referral for specialist surgical opinion would be appropriate. Alternatively, a joint steroid injection could be considered.[70]
7. On 6 June 2024, Ms Selkirk consulted Dr Foo complaining of worsening right hip pain that affected her ability to sit and walk, especially on stairs. Dr Foo advised that an ultrasound demonstrated trochanteric bursitis and that the piriformis was okay. Ms Selkirk also complained that her left knee pain affected her ability to walk and that her gait was abnormal. Last week she had to walk like a crab. Dr Foo opined that her symptoms were all likely due to poor biomechanics following the motor accident, compensating with gait, causing pain in the right hip, leg and ankles. A biomechanics assessment was needed.[71] Dr Foo referred Ms Selkirk to Ms Danielle Richter, podiatrist[72] and Dr Michael Solomon, orthopaedic surgeon.[73]
8. There are no clinical records or reports in evidence from Ms Richter or Dr Solomon.

1. On 23 June 2020, Ms Selkirk consulted Dr Peter Conrad, surgeon, via an audio-visual platform at the request of her lawyers. Dr Conrad provided two reports both dated 23 June 2020.[74]
2. Dr Conrad took a history of the motor accident and Ms Selkirk's subsequent treatment that was consistent with the evidence.
3. In respect of current symptoms, Dr Conrad noted that Ms Selkirk's main problem was pain, stiffness and restriction of movement in her left knee. She also reported that, due to the favouring of her left leg, she had put extra strain on her right hip that had also become painful. She had pain in her lumbar spine which was worse when standing, sitting, bending or lifting. He noted that she was consulting Dr Middleton and Dr Seeto and that the latter had foreshadowed a total knee replacement.
4. In respect of Ms Selkirk's past medical history, Dr Conrad noted that she had sustained a minor right knee injury in childhood and that it had quickly settled and given her no further trouble. In 2014, she had a strain to her right shoulder which had quickly settled. About

18 years ago, she strained her left ankle which had quickly settled. She denied any problems with her left knee, right hip or back prior to the motor accident. 5. Dr Conrad opined that, as a result of the motor accident, Ms Selkirk's main injury was to the left knee. There had been no history of previous problems in the left knee and therefore, the changes described on MRI scan and her ongoing symptoms, were directly attributable to the motor accident. Due to her irregular gait and the effects of the motor accident, she sustained some pain in her right hip. However, there were normal movements on visual examination. He further opined that Ms Selkirk had injured her thoracolumbar spine. 6. Dr Conrad opined that, if chiropractic treatment or remedial massage helped Ms Selkirk, then such treatment should be granted by the insurer. 7. Dr Conrad opined that Ms Selkirk's injuries had reached maximal medical improvement. He assessed Ms Selkirk's WPI at 9% (left knee: 4% WPI; lumbar spine: 5% WPI; and right hip: 0% WPI).

1. On 8 September 2020, Ms Selkirk again consulted Dr Conrad at the request of her lawyers. Dr Conrad provided two reports both dated 8 September 2020.[75]
2. Dr Conrad repeated the opinions he provided in his earlier report in respect of the injuries caused by the motor accident.
3. Dr Conrad conducted a physical examination and recorded his findings.
4. Dr Conrad opined that Ms Selkirk's prognosis was guarded and that she may need an arthroscopy to the left knee.
5. On this occasion, Dr Conrad assessed Ms Selkirk's WPI at 16% (left knee: 8% WPI; lumbar spine: 5% WPI; and right hip: 4% WPI). Dr Conrad explained the difference in his assessment to be that, on this occasion, he was able to measure the patellofemoral and tibiofemoral joints and the loss of movement in the right hip in the in-person clinical examination. Whereas his initial assessment was conducted via an audio-visual platform.

1. On 10 August 2020, Ms Selkirk consulted Dr Robin Mitchell, occupational physician, at the request of the insurer. Dr Mitchell prepared a report dated 4 September 2020.[76]
2. Dr Mitchell took a history of the motor accident and Ms Selkirk's subsequent treatment that was consistent with the evidence.
3. In respect of Ms Selkirk's past medical history, Dr Mitchell noted that she had experienced right shoulder pain in 2014, which on ultrasound reported normal; right knee pain in 2014, which on ultrasound reported normal; and a left ankle inversion injury in 2016 whilst attempting to move an oven.
4. In respect of current symptoms, Dr Mitchell noted that Ms Selkirk experienced pain in the lower neck, thoracic spine, lumbar spine and left knee.
5. Dr Mitchell conducted a physical examination of Ms Selkirk's cervical spine, thoracic spine, lumbar spine, shoulders, arms, hands, wrists, elbows and legs and reported her findings.
6. In respect of diagnoses, Dr Mitchell opined that Ms Selkirk had suffered a degree of chondromalacia patella of the left knee joint and soft tissue injuries to the cervical spine, thoracic spine and lumbar spine caused by the motor accident.
7. Dr Mitchell opined that no future treatment was indicated and that there was no clinical evidence to indicate any requirement for surgery in the foreseeable future.
8. Dr Mitchell opined that Ms Selkirk had reached maximum medical improvement and that there would be a small permanent impairment due to the clinical indication of a degree of chondromalacia patella, reasonably caused by the nature of the motor accident.
9. Dr Mitchell assessed Ms Selkirk's WPI at 2% (left knee: 2% WPI).

1. On 11 November 2020, Dr Mitchell provided a supplementary report at the request of the insurer after having provided her with the reports of Dr Conrad and Dr Seeto.[77]
2. In respect of the possibility of a left total knee replacement, Dr Mitchell opined as follows:

"The radiological changes in the left knee joint are relatively mild and the likelihood of a left knee replacement procedure in the future, although possible, in my opinion would be unlikely for many years and may not be required at all.

The changes in the knee joint are predominantly due to osteochondritis of the medial femoral condyle, which is [sic] condition of unknown cause and not related to the subject motor vehicle accident. There was a degree of arthritis in the medial compartment, but a normal lateral compartment, indicating that a total knee joint replacement would be unlikely to be required in the near future.

The clinical degree of chondromalacia patella is mild and would never justify a total knee joint replacement procedure."[78]

1. Dr Mitchell disagreed with Dr Conrad's assessment of WPI. In respect of Dr Mitchell's examination of the right hip, Ms Selkirk demonstrated a normal range of movement in all directions. In respect of the lumbar spine, Dr Mitchell found no evidence of asymmetry of movement or increased muscle tone to indicate an impairment, which he accordingly assessed at 0% WPI.

1. On 7 July 2021, Ms Selkirk consulted Dr Andrew Porteous, occupational physician, at the request of her lawyers via an audio-visual platform. Dr Porteous provided two reports both dated 4 August 2021.[79]
2. Dr Porteous took a history of the motor accident and Ms Selkirk's subsequent treatment that was consistent with the evidence.
3. In respect of current symptoms, Ms Selkirk reported that her main pains were located in the left lateral posterior hip and in both the medial and lateral aspects of left knee.
4. In respect of past medical history, Ms Selkirk reported a mild soft tissue right knee injury as a child that resolved; a soft tissue right shoulder sprain in 2014 that resolved within a short period of time; and a sprained left ankle a number of years ago that also resolved within a short period of time.
5. Dr Porteous conducted an examination of Ms Selkirk's cervical spine, shoulders, elbows, wrists, hands, lumbar spine, knees and hips and reported his findings.
6. Dr Porteous opined that Ms Selkirk had suffered extensive soft tissue injuries and grazing but substantial left knee and left hip pain, with the left knee being the most prominent injury. Due to her knee and hip conditions and associated altered gait, she had lumbar back pain which was, at times, referred up the spine.
7. In respect of diagnoses, Dr Porteous opined that Ms Selkirk had sustained contusions and grazing to the left elbow, left hip, left thigh, left knee, left ankle and right great toe in the motor accident. Further, the injuries to the spine, left hip and left knee were, more likely than not, soft tissue injuries. She also aggravated pre-existing degenerative changes in her left knee.
8. Dr Porteous opined that Ms Selkirk would require an earlier than expected left knee total joint replacement.
9. Dr Porteous opined that Ms Selkirk's prognosis was guarded. He was of the view that her left knee condition will deteriorate.
10. Dr Porteous opined that Ms Selkirk's condition had stabilised. He assessed Ms Selkirk's WPI at 15% (cervical spine: 5% WPI; lumbar spine: 5% WPI; hip: 3% WPI; and left knee: 2% WPI).

Associate Professor Michael Shatwell: 21 July 2022

1. On 14 July 2022, Ms Selkirk consulted Associate Professor Michael Shatwell, orthopaedic surgeon, at the request of the insurer's lawyers. Associate Professor Shatwell provided a report dated 21 July 2022.[80]
2. Associate Professor Shatwell took a history of the motor accident and the treatment Ms Selkirk received thereafter that was consistent with the evidence.
3. In respect of present symptoms, Associate Professor Shatwell noted that Ms Selkirk had continuing feelings of instability and some giving way of the left knee with pain and swelling on occasions. She also complained of some low back pain and intermittent aches and pains in the hips and the right knee.
4. Associate Professor Shatwell conducted a physical examination and reported his findings.
5. Associate Professor Shatwell opined that the left knee complaints were related to osteochondritis dissecans which was not caused by the motor accident. The separation of osteochondral fragments in the medial femoral condyle has given rise to the problem of a feeling of instability and intermittent pain and giving way. These are not related to the motor accident. The osteoarthritic changes in the knees are another cause of the symptoms and were not caused by the motor accident but may have been aggravated by it.
6. Associate Professor Shatwell opined that chiropractic and massage treatments were not reasonable and necessary for the osteoarthritis in her left knee due to osteochondritis dissecans. There was no likelihood of any benefit accruing from that form of treatment. Further, the massage and manipulative treatment received for the back and lower extremities was unlikely to change the natural history of Ms Selkirk's knee problems.
7. Associate Professor Shatwell opined that, the treatments proposed which are the subject of this review, will be of no benefit to Ms Selkirk in the preservation of her left knee function. The osteochondritis dissecans was present prior to the motor accident and the lesions of that condition are not caused by acute trauma in a mature patient. The condition develops in adolescence. Ms Selkirk would likely have reached the stage of arthritic change in her knees that had developed whether the motor accident had occurred or not.
8. Associate Professor Shatwell opined that there was no WPI relating to the soft tissue injuries sustained in the motor accident for the reasons stated below.
9. Associate Professor Shatwell opined that there was no cervical or lumbar spinal impairment as there was a symmetrical range of movement in the neck with no pain or symptoms.
10. In respect of the left hip, Associate Professor Shatwell opined that there was no trochanteric bursitis of the left hip. Any tenderness around the hip was due to the fact that soft tissues were uncomfortable if pressed. There was no evidence that Ms Selkirk developed trochanteric bursitis.
11. In respect of the left knee, Associate Professor Shatwell opined that there was no significant crepitus caused by direct trauma. There was no basis for any WPI relating to any patellofemoral degenerative change. There had been no aggravation of the underlying arthritic change caused by the motor accident. If there had been separation of the osteochondral defect in the medial femoral condyle of the left knee at the time of the motor accident, there would have been intense pain, swelling and a referral for urgent treatment in a hospital emergency department. Ms Selkirk would not have been able to walk.

Medical Assessor Christopher Oates: 28 November 2019

1. On 26 November 2019, Ms Selkirk was assessed by Medical Assessor Christopher Oates in respect of a treatment dispute, namely, whether a further six sessions of remedial massage were reasonable and necessary in the circumstances.
2. On 28 November 2019, Medical Assessor Oates issued a certificate in respect of the care and treatment dispute.[81]
3. Medical Assessor Oates took a history that was consistent with the evidence.
4. In respect of current symptoms, Medical Assessor Oates noted that Ms Selkirk had medial and lateral left knee swelling and a grabbing pain in the knee on walking downstairs and down slopes, on the medial side more than the lateral side. The knee felt hot and aching. It felt sore when sitting for too long. There was some localised left lateral hip joint pain and tenderness with tightness radiating to the lateral gluteal muscles and proximal hamstrings that caused her to hobble. This became worse after the knee adjustments ceased.
5. Medical Assessor Oates conducted a physical examination of Ms Selkirk's lower extremities and recorded his findings in respect of the same.
6. Medical Assessor Oates determined that the proposed further six sessions of remedial massage were not reasonable and necessary in the circumstances for the left knee injury caused by the motor accident because clinical practice guidelines, including the State Insurance Regulatory Authority (SIRA) Treatment Guidelines 2014, indicate that passive treatment modalities, which include remedial massage, are only effective in the early stages following injury. Medical Assessor Oates added:

"By this stage, 18 months post-accident, although there may be temporary symptomatic benefit experienced from the treatments, there is no evidence that these treatments are producing any long-term benefit in leading to resolution of the injury or moving the claimant towards self-management, if the injury is to be ongoing in terms of symptoms.

As I understand it, in this case, the aim of remedial massage is to relax tight muscles at the gluteals and hamstrings and upper calf, which are then reported to tighten up again after 1-2 weeks. This unfortunately is a closed loop and will not produce any benefit in the long run.

I note that an active functional restorative exercise-based approach has been proposed but was declined by the claimant for fear of worsening pain if she adopts active exercise. This unwanted outcome will not automatically be the case if she is placed with a knowledgeable EP (exercise physiologist), preferably a sports physiotherapist, who is used to treating chronic injuries in younger people, and is able to adopt a start slow early exacerbation in pain and result in early abandonment of the program before it had time to be of optimal benefit.

I note that there is significant articular cartilage damage to the patellofemoral and medial compartments of the left knee, which in the longer term will worsen and result in the need for premature knee replacement, which may be forestalled by a MACI procedure, but these treatments are for the future and not the present time.

A sports physiotherapy/EP approach would generally incorporate elements of gymnasium-based exercise, preceded by muscle stretches and warm-ups, and may also incorporate a component of exercises in the pool."[82]

1. Ms Selkirk, through her lawyers, provided written submissions dated 9 February 2024 in support of her application for review of the replacement medical assessment certificate by Medical Assessor Cameron.[83] A brief outline of the submissions is provided below.
2. Ms Selkirk submitted that, in the motor accident, she injured her left arm, left elbow, left hand, right hand/thumb, hips, left knee, left leg, thoracic spine and lumbar spine.
3. Ms Selkirk submitted that her WPI is greater than 10% and that all the proposed treatments are reasonable and necessary in the circumstances.
4. Ms Selkirk alleged that Medical Assessor Cameron made material errors by failing to provide lawful reasons; treating the absence of contemporaneous evidence is determinative of causation; and failing to apply the lawful test of causation. She provided reasons in this regard.
5. There was evidence that Ms Selkirk sustained a right wrist and right thumb injury in the motor accident. There were continuing symptoms that gradually became worse. There was no suggestion of any other cause for Ms Selkirk to have undergone a right trapeziectomy with ligament reconstruction and tendon repositioning on 14 February 2023. There was ample evidence that her accident related right wrist and right thumb injury was of such a degree that surgery was required. In this regard, Ms Selkirk relied on the reports of Dr Smithers and Dr Foo. Those reports also provided a justification as to why Ms Selkirk did not initially consider her right hand injury to be significant.
6. All that is required for the right trapeziectomy with ligament reconstruction and tendon repositioning surgery to have been considered causally related to the motor accident is that it could have contributed to the need for surgery, and it need not have been the only cause as long as it was more than negligible.

1. The insurer provided written submissions dated 18 December 2020 in reply to Ms Selkirk's application for assessment of the permanent impairment dispute.[84] Further, it provided written submissions dated 6 July 2021 in reply to Ms Selkirk's application for assessment of the treatment dispute.[85] It also provided written submissions dated 14 February 2024 in respect of Ms Selkirk's application for a review of Medical Assessor Cameron's medical assessment.[86] A brief outline of the submissions is provided below.
2. The insurer submitted that Ms Selkirk's WPI is not greater than 10% and that none of the proposed treatments are reasonable and necessary in the circumstances.
3. The insurer disputed the material errors alleged by Ms Selkirk and provided its reasons in this regard.
4. The discharge summary from Sydney Hospital dated 1 August 2022 recorded that Ms Selkirk attended for a second opinion in respect of her right hand and right thumb and noted a history of the motor accident that involved her falling out of a taxi onto her outstretched right hand. This appeared to be the first time that such a history was recorded. There was no mention of any injury to Ms Selkirk's right hand prior to 1 August 2022.
5. Reference to Ms Selkirk's right thumb was made to Dr Lam and was contained in his referral letter dated 10 August 2022. Injury to the right wrist appeared to have been first reported to Dr Foo, which led to a referral to Dr Smithers, on 11 October 2022.
6. Ms Selkirk attended medico-legal examinations arranged by her lawyer with Dr Conrad and Dr Porteous. No mention was made by her of any injury to the right hand, wrist or fingers. The most recent medico-legal examination was undertaken by Associate Professor Shatwell on 14 July 2022, some three weeks before Ms Selkirk presented to Sydney Hospital for a second opinion. No mention was made by her of any injury to her right hand, wrist or fingers.
7. In respect of the treatment dispute, the insurer relied on the medical opinion of Associate Professor Shatwell, which was consistent with the insurer's position, namely, that the treatment sought is not reasonable and necessary as a result of any injuries sustained in the motor accident.

1. The Panel re-examination and assessment of Ms Selkirk was undertaken on 3 July 2024 by Medical Assessor Lahz on behalf of the Panel at the Commission's Darlinghurst medical suites. The re-examination and assessment commenced at 11.00am and concluded at 1.15pm.
2. Ms Selkirk was a very detailed, verbose historian who was difficult to interrupt. At the commencement of the assessment, she remarked, "I have a lot of pain and I know my body definitely feels over 10%." It was explained to her that it was necessary to take the history in chronological order to make it easier to write-up.
3. At the outset of the medical assessment, Ms Selkirk produced various documents from her handbag and asked whether Medical Assessor Lahz had seen them. There was the report of Dr Smithers in 2022 and then a subsequent (post-operative) hand therapy report also in 2022. Medical Assessor Lahz told her that she could not recall immediately if she had seen them or not (having been provided with over 800 pages) but would re-check the evidentiary bundle and if not present, she could certainly submit these as additional documents. Ms Selkirk expressed annoyance with her solicitor in case the documents were not present. However, following the medical assessment, Medical Assessor Lahz was able to locate the said documents in Ms Selkirk's evidentiary bundle.

1. Ms Selkirk is aged 49 and is right-handed. She is a self-employed solicitor with over 20 years' experience, mostly working from home currently due to reduced mobility secondary to the injuries from the motor accident. She explained that she often works through a labour hire company on secondment. She is currently working approximately 40 hours per week.
2. Ms Selkirk lives alone in a second floor apartment at Darling Point (since 2013), with approximately 50 steps to the front door. She described her local area as being very hilly and difficult to negotiate.
3. Ms Selkirk said that she had been in excellent general health before the motor accident. She is a non-smoker and non-drinker.
4. Ms Selkirk reported that, prior to the motor accident, she had no musculoskeletal problems whatsoever, aside from having rolled ankles a few times whilst playing netball. She said that she regularly attended the gym, played tennis and played the piano. Medical Assessor Lahz drew to her attention the entry in the general practitioner records regarding attendance with a chiropractor for right little finger numbness and what her general practitioner on 14 February 2018 had described as a slight injury to the right wrist (three months prior to the motor accident). She was asked if she had been seeing a chiropractor for any other reasons besides the right hand (little finger numbness) to which she responded in the negative. The abovementioned entry in the general practitioner records on 14 February 2018 did mention Ms Selkirk seeing a chiropractor for some low back pain although she was adamant that there were no pre-existing spinal symptoms.
5. Ms Selkirk did not recall any specific problems with the right wrist during early 2018 although, she remembered some right shoulder discomfort which she related to carrying a heavy suitcase up a flight of stairs following a trip. She referred to shoulder adjustments being made to relieve the neurological symptoms at the little finger. She added that the symptoms in the right little finger were irrelevant to the current matter. Medical Assessor Lahz informed Ms Selkirk that she was obliged to ask her about any conditions affecting the right upper limb before the motor accident, given that she had claimed an injury of the right hand associated with surgery on 14 February 2023 due to the motor accident.

1. On 13 May 2018, Ms Selkirk had attended a wedding (being a bridesmaid) at Catalina and it was around midnight. She took a Silver Service taxi from the Catalina carpark home to Edgecliff and was being dropped off, before realising that she had no cash nor other means of paying for the fare. She asked the taxi driver to stop the meter, and also left her mobile telephone with him so she could go upstairs to fetch $20 to pay for the $18 displayed on the meter.
2. When Ms Selkirk returned, it transpired that the taxi driver had left the meter running, with the fare now up to $25. She had only brought down a $20 note which she asked the driver to accept. However, he was unwilling and she then wished to retrieve her mobile telephone which was sitting in the centre console. She climbed into the rear of the taxi to remove her mobile telephone whereupon the driver suddenly sped off uphill. She said that at the time, she was half in and half out of the cab, with the propulsion of the vehicle causing her to fall out of the cab and land on the ground.
3. Ms Selkirk explained that the left side of her body (hip and knee) took the brunt of the fall although when she fell, she instinctively extended the right arm to brace the fall. She said that the force of the impact was sufficient to "smash" her artificial right thumb nail, which she noted was "very hard".
4. During the immediate aftermath, Ms Selkirk tearfully sought help from a neighbour who assisted her telephone the police and make a report. The following day (Sunday), she said she was still very upset about the turn of events and there were ongoing discussions with the police.
5. The taxi driver was later apprehended by police and charged with reckless driving because Ms Selkirk was able to track the whereabouts of her mobile telephone, which she said the driver dumped in the local area.

1. On Monday, 14 May 2018, Ms Selkirk attended her local doctor complaining of pain in the knees, hips and grazing on both feet. In the clinical records dated 14 May 2018, the doctor referred to left elbow abrasion, left knee abrasion, left thigh contusion, left ankle abrasion/swelling, right big toe abrasion, right ankle bruising, low back pain, a right knee bruise and headache. Ms Selkirk added, "I'm not a doctor, who knows what these subtle little knocks do to one's body?"
2. Ms Selkirk said that her general practitioner initially referred her to the chiropractor for treatment. The next entry in the general practitioner records was not until 16 August 2018. Ms Selkirk agreed with the suggestion that she has not greatly relied on medical treatment for her injuries, preferring instead treatment from the chiropractor, osteopath and remedial masseuse.
3. An entry in the general practitioner records on 16 August 2018 referred to chiropractic treatment for ankle injuries and left knee pain. The entry on 23 August 2018 referred to a request for a left knee MRI due to left knee pain since the motor accident. On 13 September 2018, Dr Bilsen referred Ms Selkirk to Dr Seeto regarding the left knee. The next entry on 21 November 2018 alluded to a referral to Mr Christopher Jones, osteopath.
4. On 29 November 2018, Dr Middleton noted that Ms Selkirk needed treatment referrals for the left knee and left hip due to ongoing pain from the motor accident, noting that pain had been improved after treatment. On 1 February 2019, in the clinical records, there was mention of right knee pain whilst walking in the ocean and it was noted that Ms Selkirk was still seeing the osteopath.
5. On 1 May 2019, the clinical records noted left knee pain at night and that the physiotherapist wanted her to increase the exercise program. By 1 July 2019, Ms Selkirk had been referred to an exercise physiologist to develop an exercise program. On 1 October 2019, the clinical records noted ongoing left knee pain and that the insurer had refused to fund remedial massage which Ms Selkirk thought was the best treatment. Ms Selkirk also wanted to see a psychologist regarding pain management and the doctor encouraged her to do as much exercise as possible. On 14 November 2019, the clinical records noted that the left knee remained painful and there was nocturnal ache as well as pain on sitting. There was reference to left hip pain on walking.

1. Ms Selkirk was questioned about the lengthy delay before there is mention in any medical records about the right thumb/hand. She agreed that the right hand was not mentioned in the general practitioner records on 14 May 2018 although, she thought she would have told Dr Middleton of the broken right thumb nail. She added that she originally thought that the right thumb/hand injury was a sprain, was quite trivial and would simply recover. Instead, at the outset, she said that she focused on the main injuries which were then the left hip and the left knee, having taken most of the impact of the fall from the taxi.
2. Ms Selkirk explained further that the right hand (thumb and thenar muscles) ached for a few weeks (six to eight weeks) after the motor accident. She said there was a bruise in that location which did resolve. For approximately 12 months, there were no symptoms in the right hand/thumb. Over the subsequent six months, that is 12 to 18 months after the motor accident, she developed increasing pain, initially, "niggles" at the right thumb base which she noticed especially whilst gripping the steering wheel. She thought the symptoms "odd" though "not being a doctor", she said she thought there was maybe "RSI" or else carpal tunnel. It was only later that X-rays showed the problem.
3. Right basal thumb symptoms continued to worsen to the point that she could not pick up a cup or a kettle to pour water. Symptoms reached the stage that she could neither don a necklace nor her earrings. She reported that the symptoms became very bad and she had become a virtual "cripple". There were no similar problems at the left thumb.
4. Ms Selkirk saw the doctor in 2022 with X-rays being arranged. She said that "not being a doctor and not having X-ray vision" she had not realised there was "subluxation" at the right thumb base, which was demonstrated on an X-ray. She believes that since the motor accident, she had been using her injured thumb so that the surfaces were just "grinding away".
5. On 11 October 2022, Dr Foo referred Ms Selkirk to Dr Smithers who she consulted in November 2022. Dr Foo described the 2018 motor accident, noting that there were photographs of the broken right thumbnail afterwards. There had also been some grazing of the right hand. It was noted that the patient had not earlier thought that the right hand injury was significant and therefore, it had not figured in the general practitioner records. Ms Selkirk told Dr Foo that the right hand "sprain" took around six weeks to heal following which she did not experience any further symptoms for around 19 months. From late 2019/early 2020, she told Dr Foo of "twinges" at the right thumb, again dismissing these as not of great concern. However, symptoms at the thumb escalated during mid to late 2020 especially when gripping the steering wheel. Symptoms continued during 2021 and 2022, becoming disabling so that she then sought medical help. Dr Foo noted that there had been no other traumatic events affecting the right hand. There was reference to the earlier complaint of right little finger numbness preceding the motor accident which Ms Selkirk ascribed to a pinched nerve of the neck, shoulder or elbow for which she sought chiropractic adjustments higher up (neck/shoulder) to resolve.
6. Ms Selkirk was particularly concerned that the Panel noted the contents of Dr Smither's report dated 24 November 2022, which is summarised at [110]-[113] above.
7. Ms Selkirk came to right thumb surgery (right trapeziectomy with ligament reconstruction and tendon interposition) on 14 February 2023. The operation has significantly reduced but not eliminated basal thumb pain and, as Dr Smithers predicted, she reports persistent weakness of grip. Ms Selkirk reported that she self-funded the right thumb surgery.
8. Ms Selkirk also wished to ensure that the Panel noted the hand therapy progress report by Ms Rogers dated 28 November 2023, which is summarised at [121] above.
9. During this assessment, Ms Selkirk referred to ongoing weakness at the right thumb, compromising grip strength as well as reduced dexterity. She also reported reduced position sense (later, it was clarified that she actually meant "numbness" at the thumb), compromising use. She reported that she generally had to use the left hand to cut cheese given the persistent weakness at the right thumb. She often resorted to using the left hand due to the latter mentioned weakness.
10. Day-to-day, amongst various activity limitations, Ms Selkirk reported difficulties turning the front door knob with the right hand. She said that she often prefers using the left hand which is stronger. Aside from lack of feeling in the right thumb, there are no other neurological symptoms in the right hand.
11. Ms Selkirk is no longer receiving regular hand therapy (ceased in late 2023) although, she mentioned that she still attends the therapist for specific measurements to be undertaken. She referred to measurements undertaken on 16 June 2023 of 10kg right-sided grip strength and then on 28 November 2023 right-sided grip strength 18kg (significantly less than the

non-dominant side) and right pincer strength of 2.5kg. She continues with a home program using bands. 12. Ms Selkirk has conducted her own research about "thumb subluxation" and informed Medical Assessor Lahz that there could be no other explanation for this besides the subject accident. "At my (young) age, the only way a CMC joint can sublux is with a blunt force and the MVA was the only thing subjecting me to a blunt force. I just didn't realise the pain in the right thumb after the accident was due to subluxation because I don't have X-ray vision."

1. In respect of her claimed hip injuries, Ms Selkirk presented Medical Assessor Lahz with various theories derived from her earlier studies of anatomy and physiology. The main problem now resides in the right hip and not the left, yet the left hip was the one taking the brunt of the fall from the taxi. Medical Assessor Lahz asked Ms Selkirk to explain what she feels has happened and how the present right hip symptoms have been caused by the motor accident.
2. Ms Selkirk started by explaining that early on after the motor accident there was significant pain at the left knee at the medial aspect. In turn, she explained this has caused excessive load on the right knee, with attendant increased pressure/strain on the right-sided gluteal muscles and hamstrings. She believes that the right hip has to do most of the "pulling up" which the left knee used to do.
3. Currently, there are no longer any symptoms at the left hip. Ms Selkirk remarked, "The left hip was bruised after the accident although it never really played up. It was mainly OK". The hip symptoms are confined now to just the right hip. When Medical Assessor Lahz asked the location of the latter, Ms Selkirk pointed to the right inferior buttock. Asked when these right buttock symptoms developed, because there is no mention of them in the available general practitioner records, she reported that the right buttock did not become problematic until either mid or else, late 2022, nearly two years after the motor accident.
4. Ms Selkirk reported intense right buttock pain whilst sitting, so much so that she had great problems sitting during her recent birthday celebrations. There is a persistent "searing" pain in the right inferolateral buttock, remote from the ischial tuberosity (the "sitting" bone). The pain is mostly dull whilst sitting although, it can occasionally become sharp.
5. Ms Selkirk experiences right buttock pain which restricts walking and standing. Right buttock/hip pain is made worse too by walking uphill or up a set of stairs. She can walk for up to 15 minutes, about one kilometre, being limited by right buttock pain > left knee pain. Standing tolerance is limited to 20 minutes due to right buttock pain, with tendency to change from one side to the other. Right buttock pain can sometimes spread to the mid posterior thigh and very occasionally she feels a "tension pull" at the right heel. There are no lower limb neurological symptoms.
6. Ms Selkirk reported that a recent right hip ultrasound showed "bursitis" which she believes has arisen due to lack of massage/adjustment treatment. In fact, the formal report of the 2024 hip ultrasound cited no positive findings besides probe tenderness at the trochanteric region which is remote (distant) from Ms Selkirk's pain complaint at the right inferior buttock.

1. Ms Selkirk said that, since the motor accident, she has experienced non-radiating low back pain for which she has received (initially) chiropractic therapy and massage. Ms Selkirk believes that the low back pain has progressed to involve the right piriformis/buttock and on this basis, "I can't use my right hip properly and there is now severe bursitis". She said that the progressive tension in her back typically caused problems in the right piriformis (buttock) and this was the reason that chiropractic/osteopathic adjustment of the back could relieve the right buttock symptoms.
2. Ms Selkirk complains of ongoing right > left low back pain, which in turn, she believes "puts the middle back out". With prolonged sitting, she reports "massive" pain in the middle back in the mid-thoracic region. It was in fact the severe middle back pain which drove her return to the osteopath (self-funded) in late 2023. Thoracic back pain comes on, in particular, whilst she is in the kitchen cooking (standing and leaning) for any longer than about 20 minutes.
3. Ms Selkirk reported that she uses a medicine ball at home in order to "roll" her back. She also likes using a bolster when sitting for long periods. She reported that low back pain also comes on with prolonged sitting.
4. Ms Selkirk was asked about the sequence of treatment received since the motor accident. She originally received chiropractic therapy (with Hawkes practice) directed towards the hips, lower back, upper/mid back and (possibly, she could not remember) the left knee. Later, there was further chiropractic treatment with McCann.
5. After approximately six months, Ms Selkirk changed treatment tack to osteopathy treatment (Mr Christopher Jones) which she received for six months after the motor accident. She said such treatment did not overlap with the chiropractic treatment. She said that the insurer declined to pay for the chiropractic treatment resulting in change of therapy to osteopathy. She said that osteopathy was to address more "muscular" issues, representing a change from the previous chiropractic treatment.
6. Ms Selkirk said that osteopathy treatment focused on left knee alignment, specifically she believes that it was discovered "her left patella was out of place" requiring regular adjustments to the hips and back for patellar remediation. Further, she stated that if the "misalignment" of the left knee causing gait alteration were not addressed, this in turn resulted in overuse of the right lower limb causing secondary hip bursitis, the problem which she believes is now causing the right inferior buttock pain.
7. According to Ms Selkirk, funded treatment for chiropractor/osteopathy ceased during 2019, since which time, there has been no insurer-funded treatment. She blames the lack of treatment for now the development of a "major" right hip bursitis.

1. Ms Selkirk said that there has been ongoing left knee pain since the motor accident mostly over the medial aspect although, to a lesser extent, at the lateral side. Knee pain has been associated with catching and locking, most often in a hyperextended position. She reported that traversing inclines and stairwells especially uphill was very difficult. She said too that the left knee very easily jarred.
2. Regarding the left knee, the general practitioner referred Ms Selkirk to Dr Seeto in late 2018 and she has consulted him twice, approximately 12 months apart. She said that she underwent an MRI of the left knee during the latter part of 2018, which demonstrated that the knee injury was not "minor" but actually "major" according to the legislation. According to Ms Selkirk, Dr Seeto informed her of "wear and tear" at the knee and supported treatment inclusive of remedial massage and exercise, specifically to strengthen the knee in order to maintain the adjustments. According to Ms Selkirk, Dr Seeto advised that she would likely need a total knee replacement in about 10 years.
3. The left knee MRI scan report dated 10 September 2018 showed findings of subacute osteitis dissecans at the weight bearing aspect of the medial femoral condyle with persistent instability, a discoid lateral meniscus, borderline patella alta, chrondromalacia patellae and intra articular bodies.
4. Dr Seeto's report dated 15 October 2018 referred to anterior left knee pain on weight bearing, at night and with rest pain. There had also been instances of knee locking. On examination, he found tenderness at the joint line with small effusion and patellofemoral crepitus. He noted that Ms Selkirk's hip was asymptomatic on internal rotation. He concluded that there were arthritic changes in the patellofemoral and medial knee compartments with multiple loose bodies at the posterior left knee and recommended non-steroidal

anti-inflammatory drugs along with a steroid injection. If there were ongoing pain, he suggested that a left total knee replacement could be necessary. 5. On review with Dr Seeto in 2019, according to Ms Selkirk, the condition of the left knee had worsened and he reiterated that she would likely require surgery. However, according to Ms Selkirk, he reaffirmed his earlier recommendations for exercise, chiropractic treatment and remedial massage. 6. Ms Selkirk reported that, in 2019, she was referred to exercise physiology (Active Care Physiotherapy and Sports Therapy, Ms Baer) for an exercise program. However, given the denial of funding for remedial massage and chiropractic/osteopathy adjustments, she simply could not comply with the recommended exercises, which only increased the pain. She said that the sessions largely came to comprise of left thigh massage (80% of the time) given she simply could not exercise due to pain intensity and, according to her, absence of massage and adjustments. 7. In June 2024, Ms Selkirk underwent a progress left knee MRI scan that showed advanced medial compartment and patellofemoral osteoarthritis. Due to the severity of the degenerative changes, she was referred to Dr Solomon although, she noted that she has not yet had time to make an appointment with him. Regarding time constraints, she cited that she was "still getting over the right hand surgery" and also she had needed to dedicate substantial time to her disabled sister living in Queensland, who needed support from the National Disability Insurance Scheme. 8. Ms Selkirk went on to say that she wants to be out of pain and feels that she will most likely require a left knee replacement at some stage during the next five years.

1. Ms Selkirk reported to have been self-funding osteopathic treatment with Mr Holbert which had been "amazing" since late 2023. Continuing treatment has consisted of deep right buttock massage and acupuncture.
2. Ms Selkirk has been receiving virtually continuous remedial massage sessions from Bondi Massage since the motor accident with massage of the left knee, lower back, left thigh (tight muscles) and hips/pelvis. The insurer funded these interventions until 2019 and since this time, Ms Selkirk has been funding massage sessions, currently monthly although, she believes that she requires weekly sessions. At best, she obtains symptomatic relief for 10 days after each treatment session.
3. Ms Selkirk was asked about the disputed gym membership. The request was reportedly made either, late 2018 or early 2019. The insurer initially agreed to fund both gym membership and exercise physiology sessions with a view to strengthening muscles and maintaining the various adjustments. However, things did not go to plan and in the finish, the exercise physiologist, Ms Baer, had to limit the treatment provided to just massage of the "tight" muscles about the left hip, left thigh and left knee. Ms Selkirk reported that she could not tolerate the exercises in the absence of massage/adjustment treatments.
4. Given that she is unable to afford any massage/adjustments, Ms Selkirk believes that she now has a "very serious" right hip injury. The right hip was nowhere near as bad as it is now compared with when the left knee had been better. Lack of treatment to the left knee, she says, has served to worsen the right buttock symptoms.
5. Ms Selkirk said that she has been self-treating the lower medial left thigh with a "massage hammer gun" which is painful although, she believes that this provides useful release of tight muscles, which, in turn, helps the right hip.

1. Ms Selkirk reported an inability to complete heavy cleaning due to the combined effects of symptoms at the right hand/thumb, left knee, right buttock and lower/middle/upper back. She explained, "My left knee is very painful to push up on, my right buttock is very painful and my right hand has no grip strength. I can't bend over and I can't do any lifting/gripping. I can't do any heavy cleaning at home."
2. Ms Selkirk explained that she is suffering from post-traumatic stress disorder due to the motor accident and receiving psychological interventions with a psychologist, Mr Nunn.
3. Ms Selkirk said that, whilst she is currently working, her career was not going well due to the effects of the motor accident, as well as having to take time off earlier in order to look after the needs of her disabled sister. She has since eased back to working from home as a litigation consultant.
4. On specific enquiry, Ms Selkirk said that she is not taking any painkillers nor is she taking any medication for psychological symptoms.
5. Ms Selkirk reported feeling unstable and having to crab walk whilst traversing inclines close to her home. Although she drives, she often takes public transport and reported that persistent pain, particularly in the right hip (actually inferior buttock) and left knee which she attributes to the motor accident, makes this extraordinarily difficult. She explained that she cannot generally afford an Uber so, must rely on trains. She also remarked that she was thinking of moving house despite having good views from her apartment.
6. Ms Selkirk reported that she had gained some weight since the motor accident due to pain with reduced mobility.

1. On examination, Ms Selkirk's height was 165cm and her weight was 71.5kg. She was of tall and solid build.
2. Joint movements were recorded with a goniometer on three occasions and Ms Selkirk was asked to provide her best efforts.
3. There was full active range of neck, shoulder and elbow movements, not attracting WPI according to any of the specific figures/tables in the AMA 4 Guides.
4. The left elbow, left wrist, left hand and left thumb examined normally.
5. Active range of wrist motion is shown in the following table (degrees):

50 2% upper extremity impairment (UEI) Fig 26 p36 AMA 4 Guides

1. Active range of thumb motion is shown in the following table again checked with goniometer with movements repeated to check for consistency:

80 0% thumb impairment (TI) Fig 10 p26 AMA 4 Guides

1. Ms Selkirk could not quite reach the tip of the right little finger with the thumb (reduced opposition). There was lack of right thumb hyperextension compared with the uninjured left. There was also reduced palmar adduction.
2. The left thumb examined normally and there was normal light touch sensation.
3. At the right thumb, there was reduced sensation over the radial aspect of the distal phalanx and absent sensation over the radial aspect of the proximal phalanx which is a

non-anatomical finding (because this should be in the reverse, that is, the worst sensory loss should be distal). Therefore, there is deemed partial loss at the radial aspect over the entire length of the thumb. At the ulnar aspect of the right thumb, there was reduced sensation (again partial loss) over both the proximal and distal phalanges. 4. At the thoracic spine, there was normal thoracic kyphosis. There was mild mid-thoracic tenderness in the bra strap region. There was no muscle spasm or guarding and there was no dysmetria, with normal flexion, extension and rotation to either side. There were no thoracic non-verifiable radicular complaints. There were no signs of thoracic radiculopathy. 5. At the lumbar spine, there was normal lumbar lordosis. There was mild right paravertebral tenderness without muscle guarding or spasm. Ms Selkirk could bend over, fingertips reaching knee level, associated with complaint of right inferior buttock pain, not low back pain. Extension was reduced in proportion to flexion (one half normal), and lateral flexion full to either side. There was no dysmetria. There were no lower limb non-verifiable radicular complaints. She could sit with each leg extended, that is, straight leg raise in the seated position. Lower limb neural tension signs were bilaterally negative. Knee and hamstring jerks were bilaterally absent whereas ankle jerks were present bilaterally. Lower limb sensation was normal in all areas. 6. Gait was unremarkable on entering the consulting room. There were pain related difficulties with tiptoeing (right buttock and left knee) and also with heel walking for similar reasons. However, she could do both unaided, albeit in obvious discomfort. 7. Active hip movements in the supine position were measured with a goniometer, repeated for consistency and tabulated as follows:

1. However, in the seated position, she could flex the right hip to 100° although, she pointed out that this was facilitated by leaning backwards.
2. The thighs measured symmetrically 10cm above the superior patellar border at 43cm and the calves at maximal mid girth 34cm.
3. Trendelenburg tests were bilaterally negative.
4. There was no well localised tenderness at the right buttock. Ms Selkirk indicated the site of pain as well lateral to the ischial tuberosity and deep within the right buttock.
5. The knees moved actively through +5° -110°. There was left-sided medial joint line tenderness with lesser lateral joint line tenderness. The left knee was stable in the anteroposterior and mediolateral planes. There was painful left patellofemoral crepitus. There was no left knee effusion.
6. The right knee examined normally.

1. The Panel accepts Ms Selkirk's description of the motor accident as set out in [202]-[204] above.
2. The Panel considered that the mechanism of Ms Selkirk's fall from the taxi at speed could have caused the symptoms complained of in her left arm, left elbow, left hand, right thumb, right hand, left hip, left leg, left knee, thoracic spine and lumbar spine.
3. There was evidence of abrasions and/or bruising to the left elbow and left knee in the

post-accident photographs in evidence. There was post-accident photographic evidence of Ms Selkirk's broken false right-sided thumbnail. 4. Dr Middleton's clinical records entry on 14 May 2018 noted a left elbow abrasion (3cm x 1.5cm); a left knee abrasion (3cm x 3cm); a left thigh contusion (7cm x 7cm); a left ankle abrasion and swelling; a right big toe abrasion (2cm x 2cm); a bruised and swollen right ankle; low back pain; headache; and a bruised right knee. On 14 May 2018, Dr Hawken noted bilateral ankle sprain; contusions to the left knee and left elbow; a "massive" bruise on the left hip and thigh; grazing on the right big toe; a broken right thumbnail; pain in the left arm from the shoulder to the forearm and wrist; lower back pain; mid-thoracic discomfort; and neck pain. Dr Hawken also noted that symptoms were all increasing in severity with time and that Ms Selkirk was feeling generally sore all over. 5. In respect of the absence of any early reference in the Edgecliff Medical Centre's clinical records of symptom complaints, the Panel was careful in considering such absence of symptom complaints. In such circumstances, not too much weight can be placed on the clinical notes of treating doctors, given their primary concern with treatment. Experience demonstrates that busy doctors sometimes misunderstand, omit or incorrectly record histories of accidents or complaints by a patient, particularly in circumstances where their concern is with the treatment or impact of an obvious frank injury or injuries: Davis v Council of the City of Wagga Wagga[87]; and applied in King v Collins[88] and Mastronardi v State of New South Wales[89]. Inconsistencies between a party's evidence and medical histories in clinical records should be treated with caution: Mason v Demasi.[90] 6. The value of contemporaneous evidence has been repeatedly endorsed by the courts. However, the absence of contemporaneous evidence is not determinative on the issue of causation where there is other evidence: Owen v. Motor Accidents Authority of NSW [91]and Bugat v Fox.[92] There was Ms Selkirk's evidence of grazing to the right hand and the broken false thumbnail, the latter of which was recorded by Dr Hawken on 14 May 2018. The Panel considered the insurer's submissions summarised at [190]-[192] above but accepted Ms Selkirk's explanation in respect of her initial right thumb and right hand symptoms, the abeyance of those symptoms, then followed by a deterioration of symptoms as described in [212]-[214] above. Ms Selkirk's explanation was accepted by Dr Foo and her treating/operating surgeon, Dr Smithers. 7. Basal thumb osteoarthritis is most generally considered a constitutional condition although it can be aggravated by trauma, engendering post-traumatic osteoarthritis. The constitutional condition of basal thumb arthritis is almost invariably bilateral so, whilst one side may be more symptomatic than the other, it is certainly very unusual that Ms Selkirk had such marked symptoms on just one side. She had no symptoms in the left thumb. 8. Accordingly, the Panel finds that there was blunt trauma to the right hand due to the fall at the time of the motor accident. The direct impact in the fall from the taxi caused the progression of underlying, hitherto asymptomatic basal thumb osteoarthritis with gradual subluxation of the carpometacarpal joint in the months following the motor accident as well as wrist restriction. By mid-2022, the right thumb base had become markedly symptomatic. The motor accident made a more than negligible contribution to the development or aggravation of underlying basal thumb osteoarthritis which, in turn, caused the gradual subluxation over time and resulted in the right trapeziectomy with ligament reconstruction and tendon interposition surgery by Dr Smithers on 14 February 2023. 9. The Panel finds that there were soft tissue injuries to the left arm, the left elbow, left hand and left leg caused by the motor accident, given the recorded grazes, bruising and symptoms shortly thereafter. The Panel finds that these soft tissue injuries are now asymptomatic and have completely resolved without residual impairment. 10. The Panel finds that there were soft tissue injuries to both knees caused by the motor accident, given the recorded presence of bruises and abrasions at these sites shortly thereafter. The right knee symptoms have resolved without residual impairment and the Panel notes that the right knee was not included in the referral for assessment. In respect of the left knee, persisting symptoms, disabilities and an unbroken chain of causation since the motor accident would indicate, on the balance of probabilities, that the motor accident did cause or contribute to Ms Selkirk's current left knee symptoms to an extent that is more than negligible and has resulted in a residual impairment. 11. The Panel finds that there were mild soft tissue injuries to the thoracic spine and the lumbar spine caused by the motor accident. Low back pain was noted by Dr Middleton two days after the motor accident. The chiropractic records on 31 May 2018 referred to lumbar, sacral and thoracic symptoms and in June 2018 referred to both lower and upper back pain. The Panel finds that the motor accident did cause or contribute to Ms Selkirk's thoracic spine and lumbar spine symptoms to an extent that is more than negligible. 12. In respect of the left hip, there was no mention of any injury in the contemporaneous records although, there was reference to left hip symptoms in the massage therapist's allied health recovery request dated 29 July 2018. The left hip was referenced in the Edgecliff Medical Centre clinical records on 21 November 2018. The mechanism of Ms Selkirk's fall from the moving taxi caused her left hip to impact the roadway. The Panel finds that the motor accident did cause or contribute to Ms Selkirk's left hip soft tissue injury to an extent that is more than negligible. 13. In respect of the right hip/right buttock, there was no mention of any injury in the contemporaneous records until the Edgecliff Medical Centre clinical record entry dated 1 February 2019. So, the right hip symptoms (actually right buttock) symptoms did not develop until much later. The right buttock symptoms are not accident-related and have not developed due to the contralateral soft tissue injuries at the left hip and left knee. Accordingly, the Panel finds that there has not been any right hip injury caused by the motor accident. 14. Based on the findings on physical examination and the documents in evidence, the Panel finds that the following injuries were caused by the motor accident:

(a) right hand/right thumb - soft tissue injuries and the development or aggravation of underlying basal thumb osteoarthritis which, in turn, caused a gradual subluxation over time and resulted in the right trapeziectomy with ligament reconstruction and tendon interposition surgery;

(b) left arm - soft tissue injury - resolved;

(c) left elbow - soft tissue injury - resolved;

(d) left hand - soft tissue injury - resolved;

(e) left leg - soft tissue injury - resolved;

(f) left hip - soft tissue injury;

(g) left knee - soft tissue injury;

(h) lumbar spine - soft tissue injury, and

(i) thoracic spine - soft tissue injury.

1. Permanent impairment is defined by the AMA 4 Guides as impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment. A permanent impairment is considered to be unlikely to change substantially, that is, by more than 3% WPI in the next year with or without medical treatment.[93]
2. The Panel considered the question of permanency of impairment and is satisfied that Ms Selkirk's injuries caused by the motor accident have stabilised and are permanent within the meaning of the above definition.

1. The Panel assesses Ms Selkirk's degree of permanent impairment as set out below.

1. At the right wrist, there is 2% UEI for loss of flexion compared with the uninjured side.
2. At the right thumb for loss of motion, subtracting the constitutional left thumb impairments, there is 9 - 1 = 8% TI.
3. There is a transverse partial sensory loss (both digital nerves involved) at the right thumb. According to the instructions on page 24, AMA 4 Guides and Figure 7 there is 25% TI for partial sensory loss at the thumb.
4. The 8% TI for loss of thumb motion is combined with 25% TI transverse partial sensory loss at the thumb, giving 31% TI, namely, 12 hand impairment = 11% UEI total for the right thumb.
5. There is also11% UEI for thumb carpometacarpal resection arthroplasty Table 27, page 61, AMA 4 Guides. The instructions on page 62 AMA 4 Guides state that impairment for motion restriction is derived separately and then combined with that for arthroplasty.
6. The 11% UEI for loss of thumb motion and sensation is combined with 11% UEI for carpometacarpal resection arthroplasty (trapeziectomy) giving 21% UEI.
7. There is 2% UEI for the right wrist due to the injury, combined with 21% UEI giving 23% UEI namely, 14% WPI (Table 3, page 20 AMA 4 Guides).

1. The soft tissue injury to the left arm has completely resolved and therefore, is assessed at 0% WPI.

1. The soft tissue injury to the left elbow has completely resolved and therefore, is assessed at 0% WPI.

1. The soft tissue injury to the left hand has completely resolved and therefore, is assessed at 0% WPI.

1. The soft tissue injury to the left leg (bruising to the thigh) has completely resolved and therefore, is assessed at 0% WPI.

1. There is no impairment of the left knee for loss of range of motion according to Table 41, page 78, AMA 4 Guides. There is 2% WPI for painful patellofemoral crepitus (Table 62, AMA 4 Guides, page 83 footnote).

1. Examination of the thoracic spine did not indicate any positive findings and therefore, is assessed as DRE Thoracolumbar Category I impairment for the reasons stated in [265] above, attracting a 0% WPI.

1. Examination of the lumbar spine did not indicate any positive findings and therefore, is assessed as DRE Lumbosacral Category I impairment for the reasons stated in [266] above, attracting a 0% WPI.

1. At the left hip, the clinical examination findings incorporating range of movement do not indicate a greater than 0% WPI for the reasons stated in [268]-[272] above.

1. On 24 March 2014, Ms Selkirk underwent a left knee ultrasound with a history of having a "clicky" left knee. The radiologist concluded that there was no cause for Ms Selkirk's symptoms demonstrated on ultrasound.
2. On 14 February 2018, Ms Selkirk consulted Dr Middleton complaining of some numbness in her right little finger over the past few weeks and reporting a wrist injury a few weeks earlier. She also reported some low back pain for which she was seeing a chiropractor.
3. The Panel finds that there was no history of preceding symptoms within a reasonable time prior to the motor accident to suggest any prior impairment. There was no objective evidence of pre-existing symptomatic impairment at the time of the motor accident.
4. There was no evidence of any subsequent impairment.
5. Accordingly, the Panel finds apportionment of impairment irrelevant.

1. The Panel assesses Ms Selkirk's permanent impairment as follows:

(a) current WPI: 16%;

(b) pre-existing WPI: 0%, and

(c) subsequent WPI: 0%.

1. Since the motor accident, Ms Selkirk has received extensive chiropractic treatment causally related to the injuries sustained in the motor accident. She was immediately referred to the chiropractor by her general practitioner for myriad symptoms after the motor accident. She has also received extensive remedial massage treatment.
2. Ms Selkirk acknowledged that the abovementioned interventions have only short-term symptomatic benefits (7 to 10 days at the moment). Therefore, the above treatment interventions are not providing any sustained symptomatic relief.
3. As noted by other Medical Assessors, the abovementioned passive interventions are not in accordance with the SIRA Treatment Guidelines. Therefore whilst these interventions are related to the motor accident, they are not reasonable and necessary in the circumstances.
4. The proposed gym membership is also related to the motor accident and in the present circumstances, Ms Selkirk does not wish to pursue this particular intervention due to the lack of funded passive interventions. Ms Selkirk says that she cannot comply with the prescribed exercises due to absence of osteopathy and chiropractic adjustments.
5. Similarly, the exercise physiology interventions are related to the motor accident although, they are not reasonable and necessary for the reasons mentioned above regarding the gym membership.
6. Accordingly, the Panel finds that, whilst the disputed proposed treatment and care, namely, eight sessions of chiropractic treatment with Mr Steve McCann; one year gym membership with a personal trainer at Elixir Gym; eight sessions of exercise physiology with Active Care Physiotherapy and Sports Therapy; and eight sessions of remedial massage at Bondi Massage relate to the injuries caused by the motor accident, such treatment and care is not reasonable and necessary in the circumstances for the reasons stated above.

1. The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[94] and Insurance Australia Ltd v Marsh.[95]
2. The Panel adopts the re-examination findings and conclusions of Medical Assessor Lahz based on her examination and specific findings pertaining to diagnosis, causation and assessment of permanent impairment.
3. The Panel determines that Ms Selkirk did not sustain an injury to her right hip caused by the motor accident.
4. The Panel determines that Ms Selkirk sustained the following injuries caused by the motor accident:

(a) right hand/right thumb - soft tissue injuries and the development or aggravation of underlying basal thumb osteoarthritis which, in turn, caused a gradual subluxation over time and resulted in the right trapeziectomy with ligament reconstruction and tendon interposition surgery;

(b) left arm - soft tissue injury - resolved;

(c) left elbow - soft tissue injury - resolved;

(d) left hand - soft tissue injury - resolved;

(e) left leg - soft tissue injury - resolved;

(f) left hip - soft tissue injury;

(g) left knee - soft tissue injury;

(h) lumbar spine - soft tissue injury, and

(i) thoracic spine - soft tissue injury.

1. The Panel determines that the injuries caused by the motor accident give rise to a WPI that is greater than 10%, that is, 16%.
2. The Panel determines that the disputed proposed treatment and care, namely, eight sessions of chiropractic treatment with Mr Steve McCann; one year gym membership with a personal trainer at Elixir Gym; eight sessions of exercise physiology with Active Care Physiotherapy and Sports Therapy; and eight sessions of remedial massage at Bondi Massage relate to the injuries caused by the motor accident.
3. The Panel determines that the disputed proposed treatment and care referred to above is not reasonable and necessary in the circumstances.
4. The Panel revokes the replacement certificate issued by Medical Assessor Cameron dated 23 December 2023.

1. The Panel's determination is set out in the Certificate of Determination attached to this Statement of Reasons.

[1] Claimant's documents at pages 16-28.

[2] Claimant's documents at page 19 at [10].

[3] Claimant's documents at page 19 at [11].

[4] Claimant's documents at pages 21-23 at [17]-[18].

[5] Claimant's documents at pages 413-418.

[6] Claimant's documents at page 415 at [3].

[7] Claimant's documents at page 415 at [3].

[17] Claimant's documents at pages 772-774.

[31] Insurer's documents at pages 62-65.

[33] Claimant's documents at pages 547-548.

[37] Claimant's documents at pages 551-552.

[39] Claimant's documents at pages 550.

[46] Insurer's documents at pages 135-136.

[52] AALD 1 November 2024 at pages 47-48.

[63] Claimant's documents at pages 800-801.

[67] AALD 1 November 2024 at pages 54-55.

[74] Claimant's documents at pages 78-84.

[75] Claimant's documents at pages 71-77.

[76] Claimant's documents at pages 419-429.

[77] Claimant's documents at pages 430-433.

[78] Claimant's documents at page 431 at [2].

[79] Claimant's documents at pages 733-745.

[80] Insurer's documents at pages 137-153.

[81] Insurer's documents at pages 43-51.

[83] Claimant's documents at pages 7-15.

[84] Insurer's documents at pages 14-22.

[85] Insurer's documents at pages 11-13.

[87] Davis v Council of the City of Wagga Wagga [2004] NSWCA 34.

[88] King v Collins [2007] NSWCA 122.

[89] Mastronardi v State of New South Wales [2009] NSWCA 270.

[90] Mason v Demasi [2009] NSWCA 227.

[91] Owen v. Motor Accidents Authority of NSW [2012] NSWSC 650 at [52].

[92] Bugat v Fox [2014] NSWSC 888 at [31], [32] and [34].

[93] AMA 4 Guides at page 315 and cl 6.19 of the Guidelines.

[94] Insurance Australia Group Ltd v Keen [2021] NSWCA 287 at [40], [41] and [45].

[95] Insurance Australia Ltd v Marsh [2022] NSWCA 31 at [11], [21], [64].