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

1. The Review Panel confirms the certificate of Medical Assessor James Bodel dated

1. Hammed Ahmad Siddiqui (the claimant) is a 35-year-old man who was injured in a motor vehicle accident on 20 November 2023. On 11 March 2024 the claimant completed and lodged an Application for Personal Injury Benefits. Thereafter the claimant sought a concession from the insurer that the injury he sustained in the motor vehicle accident ought to be considered a non-threshold injury. Following an internal review, the insurer declined to make this concession and consequently the claimant lodged an Application for Assessment of Threshold Injury.
2. The claimant was examined by Medical Assessor James Bodel on 24 April 2025 who, in a certificate dated 15 May 2025 determined that the claimant sustained a threshold injury. The claimant lodged an Application for a Review of this certificate and, in a decision dated

23 July 2025, President's delegate Ashley Payne decided that there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect. The matter was then referred to this medical Review Panel. 3. The Panel convened on 22 September 2025 and was satisfied that all material which was before Medical Assessor Bodel was now before the Panel. The Panel determined that it was appropriate that the claimant be re-examined to clarify aspects of the clinical history and undertake an examination of the claimant. 4. Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A "new decision maker" is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply. 5. The new review provision provide that a Review Panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission). 6. Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a Panel reviewing a decision of a Medical Assessor. 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 matter solely based on the written application. 8. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.

1. Mr Siddiqui (the claimant) attended for re-examination at the Commission's Medical Suites in Sydney on the 7 November 2025. He was assessed by Medical Assessor Les Barnsley. A chaperone was present for the entire examination.
2. The purpose and procedures of the examination were explained to the claimant. Specifically, the Medical Assessor explained that the examination was not confidential in the same way as a standard medical consultation. It was also explained that the Medical Assessor would have no involvement in the medical management of the claimant's condition. The possible need to focus on particular aspects of the history and examination were outlined. The broad areas of questioning and the extent of any physical examination was also pre-empted. The claimant confirmed that they understood these explanations.
3. Mr Siddiqui initially expressed concern that his English was not good enough to understand some of the questions or issues. It was confirmed that he had not had an interpreter at previous appointments. We agreed to proceed with the assessment on the basis that if there were any concerns the claimant would voice them during the assessment. Medical Assessor Barnsley also considered that his English was entirely adequate for the assessment on the basis of his responses to early questions and had no reason to qualify any of the conclusions on the basis of any lack of understanding from the claimant. Paraphrasing and reflection were used extensively during the interview to test for understanding. At the conclusion of the assessment the Medical Assessor was confident that the claimant's English had been entirely adequate for the examination.

1. Mr Siddiqui is a 35-year-old gentleman. He trained as an accountant in Pakistan and moved to Australia in 2019. He initially worked in Canberra in security services and subsequently moved to Sydney.
2. He denies any prior problems with neck or back pain, and there is no history of any prior injury. Indeed, to maintain his security qualification he had to demonstrate high levels of fitness.

1. On 20 November 2023 he was driving home from work at Liverpool Hospital in a Toyota Aurion. He was stationary at a red light when he saw a car approaching from his rear in the rearview mirror. The car failed to stop and he was hit from behind. Mr Siddiqui indicated that his vehicle was propelled into the intersection but there was no secondary impact. The impact wrote off the vehicle. He said he felt shocked and shaky. He cannot recall his exact movements in the car but knows that at some point he was flung forward. There was no direct strike on the inside of the vehicle. The police and ambulance did not attend. He said he had some pain at the scene. This primarily affected his low back and neck. He indicated that over time the neck pain has substantially settled.

1. He did not seek medical help initially. Within a few days of the accident, he made an unscheduled trip to care for his mother in Pakistan. She had become unwell. He discussed his recent accident and back pain with the airline and they were able to accommodate him on a crew couch so that he could lie flat during the trip. His pain at that time was coming and going. He had pain which radiated down the left leg from the upper part of the buttock. It radiated further over the lateral aspect of the thigh into the left lateral ankle and foot. I asked him if he had any right sided symptoms, but he denied this. Because of ongoing symptoms he saw a doctor in Pakistan and was prescribed what he understands to be Voltaren. He stated that he did have some records of his consultations in Pakistan.
2. He returned to Australia in late 2023. He said that he was still experiencing significant back pain and eventually saw his local doctor in February. He explained that he did not have a regular general practitioner in Sydney at that time. Around this time he also was obliged to move out of his rental property as it had been sold. He moved to Bankstown where he saw Dr Hussain because of geographic convenience.
3. Unfortunately, his symptoms have persisted and have been unchanged. He experiences pain at the base of the spine on the left-hand side. It is at about the L2 level, radiates into the buttock and only occasionally into the right side of his back. He experiences pain, numbness and tingling over the lateral aspect of the left thigh and into the lateral left calf and foot. He finds the symptoms made worse by driving and prolonged standing. He said the leg can feel weak but he is able to manage steps.
4. He was treated with physiotherapy for six to seven months. He is currently using Norgesic tablets and Voltaren gel. He has moved back to Canberra and is currently under the care of his local doctor.
5. The Medical Assessors on the Panel reviewed the original findings on the MRI scan, and concluded that the changes were not due to injury, but rather were disc bulge due to degenerative disease.

1. On examination he was 176cm tall. He weighed 88.7kg. He was able to stand on his heels and his toes and on either foot.
2. On examination of the lumbar spine there was no guarding or spasm on palpation of the paravertebral muscles. Flexion was 75% of expected and extension 50%. Lateral flexion was 75% on both sides. On assessing straight leg raising on the left side at 50° of extension and also on straightening from 90° of hip flexion and knee flexion, he experienced reproduction of his left sided spinal pain with pain and paraesthesia reported in the left foot and ankle. This was exacerbated by passive dorsiflexion of the left foot. This would constitute a positive sciatic stretch test.
3. Neurological examination of the lower limb revealed normal power on both sides although there was some giving away due to pain reproduction particularly on the left side. Reflexes were brisk and symmetrical at both knees and ankles. He had decreased cutaneous sensation over an extensive part of the left lower limb. This included the anterior thigh, the lateral thigh, the entire calf, the entire foot and the entire sole of the foot. These areas are innervated by nerves arising from L3, L4, L5 and S1 nerve roots. These findings are therefore not reproducible sensory loss in a single dermatome. Thigh circumference measured 10cm above the upper pole of the patella was 44cm on the right and 44cm on the left. Maximum calf circumference was measured 14cm below the inferior pole of the patella and was 40cm on the right and 40cm on the left.

1. The reassessment did not find evidence of a radiculopathy on the basis of the definitions employed by the motor accident guidelines. Specifically, he only had one of two clinical signs being a positive left sided sciatic stretch test.
2. The Panel then considered whether there was any evidence of a non-threshold injury other than on the basis of radiculopathy. This would require demonstration of a partial or complete tear of cartilage, ligament, tendon or meniscus. We note that in submissions subsequent to Medical Assessor Bodel's assessment it was argued that the findings on the lumbar spine MRI scan on 22 March 2024 represented a partial or complete tear of cartilage.
3. The Panel firstly considered whether or not the motor vehicle accident in question could have caused a lumbar disc injury. The lumbar spine is well protected in rear end accidents, due to the car seat limiting any injurious excursions. Furthermore, disc injury typically occurs with rotational as well as flexion and extension forces. However, in individual cases variations of positioning in the seat, eccentric directions of forces and prior susceptibilities due to injury or degeneration mean that the rear end impact, whilst unlikely to be a cause of injury, could be.
4. The Panel then turned its mind to the question of whether the rear end accident did cause an injury to the lumbar spine and specifically the right sided disc protrusion noted on the MRI scan. The Panel accept that the initial symptoms were not brought to medical attention, but that within a few days of the accident there were provisions being instituted to help with his symptoms, specifically being allowed to lie down on a commercial flight. However, the claimant's symptoms were left sided, whereas the purported injury to the disc was on the right side so are inconsistent with a new symptomatic injury. It is therefore concluded that the accident did not cause any disc injury.
5. The Panel acknowledged the centrality of the lumbar spine MRI scan of the 22 March 2024 to the determination of whether Mr Siddiqui has suffered a threshold or non-threshold injury. The CD reproduction of the scan was provided to Medical Assessor Barnsley. The Medical Assessor's review of the scan was considered in concert with the report of Dr Sweeney-Knapp.
6. Contact or possible irritation of nerves in the absence of clinical radiculopathy are not indications of radiculopathy. Similarly, spinal canal stenosis does not define non-threshold injury in the absence of clinical signs.
7. The key finding advanced as evidence of a non-threshold injury was the disc bulge at L5/S1. Both the original report and review demonstrate that this bulge is exclusively right sided with no left sided component. The Medical Assessor considered that this change was most consistent with degenerative changes. Specifically, the annulus is intact with no evidence of prolapse of nucleus pulposus. There are osteophytic edges to the adjacent vertebrae which indicates longstanding pathology. Finally, despite the referral specifically raising the possibility of injury "MVA Nov 2023. Back pain with left buttock/leg radiation? Disc prolapse? Retrolisthesis? Pars defect". The radiologist's conclusion was that there were "Mild degenerative changes of the lumbar spine". There is explicitly no mention of any of the clinically suspected conditions including disc prolapse. This would accord with the review of the imaging.
8. Had the motor vehicle accident caused a tear in the disc it would be expected to be painful, but any changes would have been on the left side, corresponding with his symptoms. The changes suspected of representing disc injury (but which as outlined above are believed to be degenerative) are on the right side. The Panel therefore concluded that these changes are not related to any injury sustained in the motor vehicle accident.

1. The Panel is satisfied that the injuries sustained by the claimant in the subject motor accident are threshold injuries.