Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. revokes the certificate of Medical Assessor Home dated 26 June 2025,
2. certifies that the degree of the claimant's permanent impairment resulting from the injuries caused by the motor accident on is 4% which is not greater than 10%, and
3. certifies that none of the treatment referred to the Personal Injury Commission for assessment is related to the injuries caused by the motor accident or is reasonable and necessary in the circumstances.

A statement setting out the Panel's reasons for the assessment is included with this certificate.

1. Ngar Man Maggie Siu was involved in a motor accident on 25 July 2023. She says she was travelling straight and a car turned right in front of her and a collision occurred and the claimant's vehicle was pushed into a traffic light.
2. Ms Siu says she injured her sternum, right ankle, right shoulder, lower back and neck in the accident. She made a claim for statutory benefits with NRMA, the third-party insurer of the vehicle that she says caused the accident and her injuries.
3. Medical disputes have arisen in respect of this claim:

(a) a dispute about the degree of the claimant's whole person impairment (WPI), and

(b) six disputes about various forms of treatment.

1. The claimant referred the disputes to the Personal Injury Commission (the Commission) for assessment.
2. On 26 June 2025, Medical Assessor Home determined Ms Siu had a WPI of 7% which is not of course greater than 10%. He also determined the treatment in dispute was not related to the accident and not reasonable and necessary.
3. The claimant then lodged an application with the Commission seeking a review of the Medical Assessor's decision. On 27 August 2025, Ms Baba, a delegate of the President determined there was reasonable cause to suspect a material error in the assessment and has allowed the Review and on 29 August 2025 the President's delegate convened this Panel to conduct the Review.
4. There have been other assessments of WPI undertaken at the Commission:

(a) 4 May 2025 - Medical Assessor Curtin

(b) 21 May 2025 - Medical Assessor Shen

(c) 8 August 2025 - Medical Assessor Hong

1. Ms Siu's claims and entitlements to compensation are governed by the provisions of the Motor Accident Injuries Act 2017 (the MAI Act). Injured persons are able to make two claims:

(a) a claim for statutory benefits under Part 3 of the Act, and

(b) a claim for damages under Part 4 of the Act.

1. Statutory benefits payable by the "relevant insurer"[1] in accordance with Part 3 of the MAI Act include:

(a) weekly loss of income benefits for "earners" under Division 3.3, and

(b) treatment and care benefits under Division 3.4.

1. A claim for damages can include both certain types of economic (pecuniary) losses and damages for non-economic (or non-pecuniary) loss. In a claim for lump sum compensation, damages are assessed in accordance with common law principles as modified by the MAI Act.
2. Damages for non-economic loss are limited and restricted by the provisions in Division 4.3 of the MAI Act. For example, non-economic loss damages are limited to a maximum amount in accordance with s 4.13[2] and entitlement to those damages is restricted by s 4.11 to persons who have a greater than 10% WPI as a result of the injuries sustained in the accident.
3. If there is a dispute about the degree of the claimant's permanent impairment, damages for non-economic loss cannot be awarded and disputes must be referred to a Medical Assessor for determination.[3]

1. Permanent impairment is assessed in accordance with Chapter 6 of the Motor Accident Guidelines (the Guidelines)[4] which are largely based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides).

1. Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matters, including:

(a) the degree of permanent impairment of the injured person that has resulted from the injury caused by the motor accident ... , and

(b) "whether any treatment and care provided or to be provided to the injured person is reasonable and necessary in the circumstances or relates to the injury caused by the motor accident ... 3.24".

1. Division 7.5 of the MAI Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as Medical Assessor Home's, further medical assessments and the review of medical assessments by this Panel[5].
2. Applications for review of a medical assessment are made to the President of the Commission on grounds that the assessment "was incorrect in a material respect" (s 7.26(1)). If the President, or his delegate is satisfied "there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect" then the President arranges for the application to be referred to a review panel consisting of a member of the Commission and two medical assessors (s 7.26(2) and (2B)).
3. The review is not an appeal looking for error and is not confined to the issues raised in the application (or the reply) but is "a new assessment of all the matters with which the medical assessment is concerned" (s 7.263A).
4. Rule 128 of the Personal Injury Commission Rules (the Rules) 2021 permits the Panel to determine its own proceedings and the Panel is not bound by the rules of evidence and may inquire into relevant matters as it thinks fit.

1. Medical Assessor Home examined the claimant on 23 June 2025 and issued his certificate on 26 June 2025.
2. The Medical Assessor confirms at [2][6] that he was asked to assess the following injuries for the purposes of WPI:

(a) cervical spine - C5/6, C6/7 radiculopathy;

(b) lumbar spine - L5/S1 radiculopathy;

(c) right shoulder - right shoulder musculoligamentous injury;

(d) sternum - fracture, and

(e) right ankle - right ankle musculoligamentous injury.

1. In respect of treatment the Medical Assessor says he was asked to assess disputes about:

(a) eight further physiotherapy sessions;

(b) an initial rehabilitation needs assessment;

(c) compression garments, blood tests and vascular lab testing;

(d) Hirudoid cream, and

(e) consultations with Dr Wines and Dr Chang.

1. The Medical Assessor took the following history:

(a) Ms Siu denied any previous neck, back, upper or lower limb symptoms;

(b) the accident occurred when a car travelling in the opposite direction turned right in front of her vehicle. Airbags deployed and the claimant was extracted from the vehicle and taken to Bankstown Hospital with chest pain;

(c) the claimant was diagnosed with a fractured sternum at hospital and attended her general practitioner thereafter complaining of pain in the neck, both shoulders and lower back. She also complained of right upper limb loss of sensation and bruising at the back of both her legs, and

(d) Ms Siu was referred to Dr Khong neurosurgeon but did not attend. She was referred to Professor Aggarwal neurologist and did attend. She has seen Dr Hall psychiatrist, and Dr Tang vascular surgeon and Dr Leech another vascular surgeon.

1. The claimant reported current intermittent neck pain with some stiffness, intermittent headaches exacerbated by stress. She had intermittent numbness in the entire right arm and hand and pain at the top of her right shoulder. She has intermittent chest discomfort. She reported lower back pain on most days and bilateral lower limb pain and in particular in the right ankle.
2. The claimant worked at the time in a nursing home but has not returned to this work.
3. After examining the claimant and considering the documentation, Medical Assessor Home diagnosed:

(a) a resolved non-displaced fractured sternum;

(b) injuries to the cervical spine and lumbar spine;

(c) bruising to the right hip and left breast;

(d) early complaints of left (then right) upper limb symptoms, and

(e) no right ankle injury as the claimant gave a history that this came on three months after the accident.

(a) cervical spine - DRE I - 0%;

(b) right shoulder - 5% less 2% using the left shoulder as a baseline measure;

(c) chest - 0%, and

(d) lumbar spine DRE II - 5%.

(a) while related to the injuries caused by the accident, the physiotherapy is not reasonable and necessary as there was no likely durable benefit from it;

(b) while related to the injuries caused by the accident the further rehabilitation assessment was not reasonable and necessary as Ms Siu had already been referred to two providers;

(c) the compression garments, blood tests and vascular lab testing was not related to the accident or reasonable and necessary on the basis there is no evidence of an injury that could cause leg swelling;

(d) Hirudoid is a cream for bruises which is not related to or reasonable and necessary on the basis it was first proposed 18 months after the accident, and

(e) the referral to Dr Wines and Dr Chang concerns the claimant's ankle and this injury is not related to the accident.

1. The claimant challenged the finding that the right ankle injury was not caused by the accident, the various treatment disputes the 0% WPI assessment and the combined 7% WPI assessment.
2. In terms of the right ankle injury the claimant said the treating medical evidence established that right ankle pain developed three months after the accident due to "altered biomechanics and overcompensation" following the accident. The claimant says the Medical Assessor did not engage with this argument and found the right ankle injury was not caused by the accident due to the gap between the accident and the onset of symptoms.
3. The claimant argues that the Medical Assessor then found the disputed treatment to be unrelated and not reasonable and necessary. The claimant says that Dr Lemech's recommendation for compression garments and the like was determined to be related to pre-existing varicose veins and not an injury and that the Medical Assessor did not consider whether the claimant's underlying condition could have been aggravated by the accident.
4. The claimant submits that the Hirudoid cream was dismissed without giving consideration as to why a late arising complication could not stem from the accident.
5. The claimant notes the appointments with Dr Wines and Dr Chang were disallowed solely due to the Medical Assessor's finding on causation which the claimant says was inadequately reasoned.
6. The claimant takes issue with the assessment of cervical spine WPI at 0% and says this has not been explained. The claimant points to signs of radiculopathy being present before the assessment and says that this would be sufficient for a WPI rating.
7. The claimant says in terms of the lumbar spine that treating doctors have noted radiation of pain to the lower limbs, but that Medical Assessor Home did not explain why he did not find radiculopathy.
8. The claimant submits that Dr Rosenberg's assessment of 15% was not considered or referred to.
9. The claimants says she was denied procedural fairness and that the Medical Assessor failed to apply the relevant Guidelines properly.

(a) the Medical Assessor has adequately explained the right ankle finding when the whole of his reasons are considered (and not selective passages quoted by the claimant);

(b) the Medical Assessor has explained his DRE I finding in the cervical spine;

(c) the Medical Assessor has explained why the claimant's presentation attracts a 5% WPI for the lumbar spine and in particular why the claimant does not have radiculopathy, and

(d) the Medical Assessor's finding of right ankle non-causation was not an issue of inconsistency.

1. The insurer submits that the claimant's medical records indicate she injured her hand following a fall at home on 10 April 2024 and that she made a workers compensation claim in respect of her left leg on 17 September 2024.
2. The insurer points to a clinical note from 9 November 2021 which suggests the claimant had been diagnosed with arthritis due to neck pain and had numbness in the upper limb 10 years previously.
3. The insurer points to the range of flexion and abduction in the left and right shoulders as reported in various Allied Health Recovery Request forms (AHRR) and Drs Rosenthal and Rosenberg's range of motion measurements. For example, when examined by Dr Rosenberg the claimant had a full range of motion in the uninjured left shoulder (180 degrees) whereas the treating physiotherapist had recorded 170 degrees consistently for flexion and 140 degrees for abduction. Similarly in the right shoulder Dr Rosenberg found less motion (150 and 100) compared to the consistent records of the treating physiotherapist (170 and 140).
4. The insurer said there was no evidence of radiculopathy in the cervical or lumbar spine.
5. In terms of the right ankle the insurer says the claimant was able to ambulate after the accident and there was a significant gap in the records of complaints of right ankle symptoms.
6. The insurer submitted the sternal fracture and left breast haematoma had resolved leaving no impairment.

1. The Panel issued directions to the parties on 2 September 2025 seeking bundles of documents relevant to the Review. The claimant provided a bundle of 440 pages, and the insurer provided a bundle of 123 pages. At the request of the Panel the claimant also provided a copy of the claim form.
2. To avoid doubt, the Panel has determined in accordance with s 67C that all of the documents lodged by the parties to date should be admitted into evidence as they concern the nature of the accident and injuries and are necessary "to facilitate the just, quick and cost-effective resolution of the real issues" in the matter.
3. The claimant responded to the Panel's directions in a message on the portal dated

(a) the sternal fracture and left breast haematoma did not need to be assessed;

(b) the claimant never saw Dr Khong and Dr Khong has no records relating to the claimant, and

(c) the claimant remains registered with Centrelink as her husband's carer.

1. The claimant also advised that none of the disputed treatment has occurred and there has been no expense incurred in relation to any of the disputed treatments.
2. The insurer advised the Panel the day before the re-examination that clinical records had been requested from Healthpac Medical Centre as directed. The Panel advised the insurer that the re-examination would take place but requested any documents be provided before the Panel's teleconference on 15 December 2025. No further response from the insurer was received and no additional documents were provided.
3. The Panel met on 15 December 2025. In the light of the re-examination findings the Panel determined it was not necessary to defer finalisation of the Review pending the insurer's documents.

1. Ms Siu's claim form was signed and dated 30 July 2023, five days after the accident. She says the accident occurred at 10.40pm in Bexley at the entrance to the M5.
2. Ms Siu described her injuries as follows:

"Because both front and side air-bags explode, they injure fingers, right hand, arm, waist, left, foot, maybe the seatbelt caused my chest swell, rib fratures."

1. The claimant says she was taken to Bankstown Hospital by ambulance and was discharged the next day.
2. She denies any previous "illness or injury affecting the same or similar parts of [her] body at the time of the accident."
3. The claimant says she has been away from work for eight weeks and that she works in aged care and received the Carer payment.
4. The first certificate of fitness completed by Dr Tai was dated 1 August 2023 and notes this was the first attendance after the car accident. He lists as the injuries:[7]

"MVA sternal fracture, neck strain, bilateral upper limb pain and some numbness L upper limb, bilateral shoulder strain, R hip bruising, bruising Left breast chest, both lower legs, left arm".

1. The claimant's pre-accident records commence with an attendance on Dr Tai on 9 November 2021. He takes a history from his patient of an X-ray 10 years previously and a diagnosis of cervical spine arthritis due to neck pain. On 9 November 2021 she reported neck pain with some numbness (left more than right) in the upper limbs. He also records bilateral foot and heel pain and 7 kg weight gain during the pandemic. On 23 November 2021 the claimant returned to review the radiology. A referral to Mr Low, a script for Meloxicam and advice was given to wear orthotic shoes. Acupuncture was provided for neck pain on 30 November 2021.
2. On 8 and 15 September 2022 acupuncture for a "neck trapezius muscle strain" (left more than right) was provided.
3. On 22 April 2023 Dr Tai saw the claimant for a rash and notes "her other Doctor has prescribed her Prednisone."
4. The claimant's discharge summary from Bankstown hospital[8] does not identify the claimant's GP and refers to the claimant having been t-boned from the right side. The claimant reported immediate chest pain, and it was noted the airbags deployed and the claimant was wearing a seatbelt. The claimant was "very tender' at the centre of her chest and had "mild bruising of left ring finger."
5. The claimant attended Dr Tai on 1 August 2023 reporting the accident and complaining of neck pain, upper limb pain, some numbness in the right-side upper limb. He notes the sternal fracture, right hip bruising and bruising left breast. On examination the claimant was tender in the sternum and tender at C5/6 and in the shoulders. Radiology of the cervical spine was requested (but not of the lumbar spine). Endone was prescribed.
6. On 3 August 2023 the claimant attended Dr Tai again and was prescribed paracetamol, ibuprofen and Hirudoid cream. On 10 August 2023 Dr Tai notes the claimant was having pain in the sternal area and neck pain with reduced mobility and was having difficulty with activities of daily living and house chores. A referral for rehabilitation and assistance was provided (Synergy Medical). There is no mention in this referral of lower back pain, hip pain or leg swelling.
7. On 16 August 2023 Dr Tai referred the claimant to Dr Khong, neurologist and prescribed Lyrica (the claimant subsequently advised she never saw Dr Khong). The referral sought opinion and management of neck pain and radiculopathic symptoms in the left more than right upper limb. On 22 August 2023 the claimant was referred to Ms Wu for physiotherapy to treat a sternal fracture, neck, upper limb and shoulder strain (no back or lower limb symptoms). The claimant requested a certificate that she was not fit for work. On 24 August 2023 the claimant saw Dr Tam concerned about a lump and tenderness in the left breast. The next day she saw Dr Tai seeking a referral to Mr Low, physiotherapist for a sternal fracture, "neck upper limb shoulder strain bruising anterior chest area" (no lower limbs and no lower back mentioned).
8. On 26 August 2023, Mr Low requested eight sessions of physiotherapy in an Allied Health Recovery Request form (AHRR).[9] He diagnosed a cervical spine strain with radiculopathy symptoms in the left upper limb, rotator cuff strains in both shoulders, chest pain and a right contusion injury affecting both legs. A second AHRR was completed on 26 September 2023 and a third on 13 November 2023. A fifth was dated 18 January 2024 and noted that 32 sessions had been completed to date, and says that further sessions were required.
9. Due to continued concern over a left breast lump and pain, Dr Tam referred the claimant to Dr Cheung, breast surgeon on 7 September 2023. On 11 September 2023 Dr Tai conferred with Mr Low about the claimant's neck and chest discomfort.
10. The claimant saw Dr Cheung on 18 October 2023 who confirmed "a lumpy area in the medial aspect of the left breast." Examination and ultrasound revealed fat necrosis, but no treatment was recommended. On 15 May 2024 the claimant returned complaining of intermittent sharp pains in the medical aspect of the left breast, which was fleeting occurring sometimes when driving. There was a 9mm lesion consistent with an organised haematoma not seen on the previous ultrasound. A further report dated 15 May 2024 but likely to be 5 July 2024 as it refers to an ultrasound of that date which showed no suspicious lesions.
11. On 31 October 2023 the claimant reported sternal ache "at times" and, for the first time, right leg ankle pains as well as neck pains and numbness in the hand.
12. On 27 November 2023 the claimant saw Dr Tam who noted there was no lump or haematoma palpable, but the claimant was tender in the chest. The claimant attended on Dr Tam again on 25 January 2024 with mild tenderness and "vague lump".
13. On 28 November 2023 the claimant reported to Dr Tai "persistent right upper limb and right leg numbness" there was no wasting in the limbs reported but there was restriction of shoulder abduction. A referral to Professor Aggarwal neurologist and rehabilitation pain specialist was provided.
14. On 15 January 2024 the claimant reported to Dr Tai, "bilateral lower leg swelling 2 weeks, today is improved. Nil calf tenderness. Pedal pulse ++ both sides." On 16 February 2024 the claimant was reviewed after the Doppler studies with Dr Tai referring her to Dr Tang and he advised compression stockings.
15. Professor Aggarwal wrote to the claimant's GP on 19 February 2024. He has a history of the car accident and the claimant's trip to hospital. He then has a history that two days after the accident the claimant developed numbness of her "entire right side of the body from her right shoulder to her fingers and her right leg to her toes" and this has persisted. She denied any associated pain (no sharp, stabbing or burning pain) however she had pain in her right ankle.
16. He reviewed the MRI noting degenerative discs in the cervical spine and left (not right) C5/6 foraminal narrowing and compression. He requested a lumbar spine and right ankle radiology. He thought there might be carpal tunnel issues on the right. He prescribed Amitriptyline.
17. On 15 March 2024 the claimant saw Dr Tai complaining of "pain in low back, right upper limb and right leg numbness and today some numbness in left upper limb."
18. On review with Professor Aggarwal on 18 March 2024, the claimant had not improved, and a higher dose of Amitriptyline caused dry mouth, confusion and drowsiness. He changed the medication to Gabapentin. The claimant's numbness persisted but she reported an improvement in "sharp stabbing pain." The nerve conduction studies had been done showing no carpal tunnel involvement.
19. On 9 April 2024 the claimant reported to Dr Tai "chronic pain, falls, numbness in upper limb and lower limb, has had MVA accident low mood, teary for counselling." On 15 April 2024 the claimant saw Dr Tai again complaining of right upper limb and lower limb numbness and pain in her lumbar and right ankle area which was affecting her gait (she was recorded as having an antalgic gait). The claimant also reported intermittent sternal ache with neck pain and right sided upper limb numbness.
20. On 15 April 2024 after the lumbar spine MRI the claimant reported to Professor Aggarwal no improvement. The claimant's husband suggested his wife was more irritable and had swelling of her ankles since Gabapentin was started. Despite the Amitriptyline being stopped the claimant had drowsiness and a dry mouth. Professor Aggarwal reviewed the scan and said that the changes reported "is unlikely to account for her symptoms". Lower limb nerve conduction studies were normal. He said:

"I have indicated to Mrs Siu that it is likely her symptoms are related to abnormal sensory processing and central sensitsation rather than a significant organic cause. Referral to an Orthopaedic Surgeon."

1. The Professor amended the claimant's medication and sought a review in two months' time.
2. The claimant saw Dr Tang, vascular and endovascular surgeon on referral by Dr Tai. His report is dated 19 April 2024. The claimant gave a history of no prior lower leg varicose vein treatment and no previous deep vein thrombosis. He has a history from her of lower leg swelling and lower leg varicose veins. He has a history of the airbags deploying and hitting the right anterior lower leg and that she developed "significant bruises" over her lower legs and since then she has had pain and difficulty walking some times. She reported lower leg swelling since December but that this had got better. "She does not use compression stockings". He considered she had lower leg primary varicose veins and that this was contributing to her lower leg swelling and he advised her to wear travel socks in the daytime. He requested further scans and a further review.
3. On 20 April 2024 Dr Tai referred to the claimant to Dr Lemech, vascular surgeon. He first saw the claimant on 11 July 2024 and had a history of the car accident. The claimant said she had some swelling of her right foot and had difficulty walking on it. He said she had lower limb oedema. He prescribed class 2 below knee compression stockings and requested ultrasounds. On 18 December 2024, Dr Lemech reported the claimant had "bilateral lower limb oedema" with varicose veins on her right medial calf and she had pain in both legs with prolonged sitting. She "limped into my office today". He referred to the ultrasound noting incompetent veins in the left and right legs. He said:

"Mrs Siu's lower limb oedema is most likely to be multifactorial. It is likely due to a combination of her venous disease as well as calf muscle failure from her disturbed gait. There [is] some perhaps oedema related to the trauma itself."

1. He refers again to the compression stockings but did not need to see her again unless she requires intervention on her varicose veins.
2. On 14 May 2024 the claimant was referred by Dr Tai to a psychiatrist, Dr So and then on

15 May 2024 the claimant requested a referral to see Dr Chiam. On 12 June 2024 she sought a referral to a different psychiatrist, and a referral was provided to Dr Hall. 3. On 17 June 2024 the claimant saw Dr Tai for neck and shoulder pains, low back pain, right upper limb numbness, hip pain and right lower leg swelling which was "affecting her gait". The claimant had been using Neurontin however had noticed short term memory loss and temperamental changes and tiredness.

1. A number of pelvic scans were performed in 2014 - 2016.
2. Chest radiology includes:

(a) a chest X-ray performed on 20 March 2017 due to chest pain was reported to be normal;

(b) bilateral breast ultrasound on 16 April 2015 showed a number of "tiny" nonsuspicious cysts;

(c) bilateral breast ultrasounds on 24 August 2023 due to a history of a car accident a month before and a left breast lump - there was no mass, no haematoma or collection but there was fat necrosis at the left breast medial aspect, and

(d) bilateral breast ultrasounds on 1 February 2024 which indicated a cyst structure in the left and right breasts. The left breast cyst may have represented fat necrosis which would have been from a previous car accident. Follow up was suggested in a year.

1. Venous Doppler ultrasounds were done of both legs on:

(a) 25 and 31 January 2024. The claimant had three incompetent veins in both the left and the right legs.

(b) 3 May 2024 with a history of ? DVT showing stable appearances of the veins since the previous scans.

(a) a CT scan done on 9 November 2021 which showed no disc bulging at C2/3, C3/4 or C4/5 but some mild or moderate degenerative changes. At C5/6 it was reported there was mild loss of disc space with marginal osteophytes and both C6 nerve roots are compressed, and

(b) a CT scan was done on 1 August 2023 due to neck pain in both upper limbs and with some numbness on the right side. The results were of spondylosis most pronounced at C5/6 with severe left-sided foraminal narrowing "clinical correlation for left C6 radiculopathy."

1. The lumbar spine MRI performed on 9 April 2024 at the request of Professor Aggarwal which revealed:

(a) a physiologic disc bulge and minor facet joint arthrosis at L3-4 but no stenosis or nerve root compression;

(b) at L4-5 a very minor degenerative anterolisthesis, a shallow disc bulge and "tiny central annular fissure" and moderate facet joint arthrosis with mild central stenosis but no compression of the L4 nerve roots, and

(c) minor bone marrow oedema on either side of both sacroiliac joints suggesting "very minor degenerative change."

1. X-rays of the claimant's right and left ankles were undertaken on 9 November 2021 due to heel pain. Tiny calcaneal spurs and Achilles insertion spurs were seen with what appeared to be "loose bodies behind the ankle." A right ankle MRI was done on 10 April 2024 and correlated with x-rays of 2 April 2012[11]. The clinical note was of "recent MVA. Right ankle pain following impact from airbag ? Fracture". This showed a small ankle effusion, an osteochondral lesion, two small bodies within the joint space displaced from the underside of the tibia, a soft tissue ganglion abutting the medial plantar nerve, sheath effusions and mild plantar fasciitis.

1. On 30 August 2023 the claimant was seen by Synergy Medical Pty Limited who provided a report to the insurer on 5 September 2023. The claimant gave a consistent history of the accident but reported pain in all areas of the body. It was noted the claimant could not bend down due to chest pain and her symptoms were occasional numbness in both hands, ongoing shoulder tightness in both shoulders and difficulty flexing and abducting the shoulders due to chest pain.
2. The claimant was said to have reduced capacity to perform activities of daily living, said her husband had medical conditions and she was his primary carer (although they received three hours a week of support).
3. Dr Rosenberg, spinal surgeon examined the claimant on 1 August 2024 at the request of Ms Siu's solicitor. He had a history of the accident, her treatment at Bankstown Hospital and her attendance at her GP and physiotherapy.
4. He has a history of the claimant seeing Dr Khong, neurosurgeon who advised no surgery was necessary. She says, "her right leg was bruised and swollen" which he suggests was from "the impact of the airbag". It was noted she had right and left leg varicose veins which "would have pre-dated the accident.".
5. Dr Rosenberg has a history of the claimant seeing Professor Aggarwal with no improvement.
6. The claimant had not returned to work and was unable to do any cleaning or cooking. She reported improvement with the sternal fracture, pain in her arms (particularly the right) and an inability to lift any weight. She says her whole arm was numb and she is right hand dominant. She reports ongoing back pain radiating into her right leg to the calf and occasional discomfort in the left leg. She says she has very swollen legs and has seen a vascular surgeon. Her main complaint was numbness in her right hand and pain in her right leg.
7. Dr Rosenberg's examination revealed:

(a) near normal cervical spine motion with "a great deal of grimacing and complaining". She was tender globally in the neck but neurological examination was normal other than some weakness about the shoulder girdle due to pain;

(b) shoulder movement was normal for flexion and abduction in the left shoulder and the right should was not normal in any of the six units of measurement. There was evidence of impingement and tenderness;

(c) in the lumbar spine she limped heavily had a positive Trendelenburg stance (indicative of gluteal weakness) however she could heel and toe stand and forward flex to her shins. Neurological examination was normal and straight leg raised was unimpeded, and

(d) hip and sacroiliac joints were not affected.

1. Dr Rosenberg diagnosed the facture of the sternum an exacerbation of pre-existing cervical; spondylosis and lumbar spine spondylosis and soft tissue injuries to the cervical spine.
2. He notes:

"She has seen many doctors. She seems to present with far more symptoms than are readily explicable by any objective radiological evidence. It is over a year. If she is to be believed, she is incapable of any work.

Yes, she does note numbness in her right arm and pain in her right leg, but I do not see why she is not capable of any work whatsoever. Surely she would be capable of working in a more sedentary role, sitting and supervising as part of her duties as an activities officer."

"There is nothing apparent to treat on all the investigations. Physiotherapy has not helped in the past so I cannot see how further physiotherapy could be expected to help. I would, however, recommend some final investigations. I believe she should have erect x-rays of her lumbar spine including flexion and extension views. I feel she warrants an MRI of the right shoulder to exclude significant rotator cuff pathology (I do not believe 67 any will be found). Bone scan would be worthwhile of the whole spine to see if a source of pain could be identified such as a facet joint, potentially amenable to an injection. She does not require any surgical treatment at this point."

1. In a separate report he assessed WPI as follows:

(a) sternal fracture - 0%;

(b) right shoulder impairment - 6% - it appears he used the left shoulder as the baseline measurement;

(c) cervical spine - DRE I = 0%, and

(d) lumbar spine - DRE III = 10% due to "evidence of radiculopathy" however he does not address the definition in the Guidelines or say which of the two signs of radiculopathy she has.

1. Dr Rosenthal examined the claimant for the insurer on 23 September 2024.
2. He had a history of the accident noting the claimant's car was written off and that she was admitted overnight in Bankstown Hospital.
3. The claimant reported fairly constant neck and low back pain of varying intensity. The claimant complained of numbness intermittently in her right arm, stiff shoulders, right ankle pain and right leg swelling. She has not improved since the accident and had trouble walking. She sees a specialist for her leg circulation and Professor Aggarwal neurologist and pain specialist.
4. She has counselling, takes three medications but does not have physiotherapy.
5. The claimant confirmed a low back injury 10 years previously which resolved after a few weeks but had no other accident or injuries.
6. The claimant worked developing activities with the elderly in a nursing home but had not returned to work.
7. The claimant's husband was disabled and the claimant said she did no household chores. She then reports she gets takeaways, does small amounts of shopping and drives short distances to see her doctor or get groceries.
8. Dr Rosenthal was of the view the claimant had pain behaviours and inconsistencies but had soft tissue injuries all masked by a pain syndrome. He found no impairment to any of the allegedly injured body parts.

1. On 4 May 2025, Medical Assessor Curtin certified that a left breast haematoma and fat necrosis had resolved and did not give rise to a permanent impairment.
2. On 25 May 2025, Medical Assessor Shen diagnosed the claimant with a post-traumatic stress disorder and depressive disorder and assessed WPI at 9%. That assessment is the subject of an application for review determined and allowed by Ms Gupta the President's delegate on 25 June 2025.
3. On 8 August 2025, Medical Assessor Hong assessed a dispute about psychiatric medication (Venlaxafine) and considered it related to the injuries caused by the accident and reasonable and necessary in the circumstances.

RE-EXAMINATION FINDINGS - MEDICAL ASSESSOR GORMAN

1. Ms Siu attended the re-examination at the Commission's medical suites on 12 November 2025. An interpreter was present and was utilised throughout the examination. I was able to understand the claimant and her symptoms and with the aid of the interpreter I was satisfied that the claimant was able to understand and answer my questions and understand my requests for movement during the course of the clinical examination.

1. Ms Siu is a 58-year-old woman who was born in Hong Kong. She has been in Australia since 2008.
2. She worked in a nursing home for 12 years but has not returned to work after the accident. She was doing meal service and was told that she could not return to work there unless she could do all aspect of her job and she says she cannot.
3. She is married with one child aged 29 years.
4. She is a nonsmoker and does not drink alcohol. She has been well in the past and while she may have had minor complaints before the accident, she denied any significant illnesses.

1. On the 25 July 2023 she was the seat belted driver of a Mazda CX3 station wagon. A car travelling in the opposite direction turned right, hitting her vehicle near the front on the right driver's side. Front airbags (dash and steering wheel) were deployed. The claimant did not indicate that side airbags were deployed or any airbags below the steering wheel.
2. She was assisted from the vehicle by emergency service fire officers. She was transferred by ambulance to Bankstown Hospital. She said her main complaint and focus at that stage was severe chest pain.

History of symptoms and treatment following the motor accident

1. She had an undisplaced sternal fracture noted at Bankstown Hospital. Ms Siu said she went to her GP (she could not remember the name) soon after the accident complaining of chest pain as well as neck pain, bilateral shoulder pain, paraesthesia in the right upper limb and low back pain. She said that bruising over the anterior aspect of both legs was recorded by him. The whole lower back symptoms were not recorded by her GP until February 2024, the claimant was of the view that she had complained of pain in her lower back but she was more concerned with her chest, neck and arm symptoms which were very painful.
2. Her GP arranged for a CT scan of the cervical spine to be done because of the right arm numbness.
3. Ms Siu was asked about her lower limb symptoms, and she said she did little walking for the first three months because of the pain from the fractured sternum and generalised pain all over her body. She said she was not active at all during this period. She said by November 2023 she had started walking again and with this increased activity she noted increased right ankle pain.
4. Ms Siu said she saw Professor Agarwal. He is a neurologist who arranged imaging in the lumbar spine and prescribed medications. Ms Siu then said she developed bilateral leg swelling in December 2023 and saw Dr Tang, vascular surgeon, who felt that she had varicose veins. She also saw Dr Lemech, another vascular surgeon, who prescribed compression stockings for this condition. I noted Doppler studies showed venous incompetence in the lower limbs.
5. She is also seen Dr David Hall, a psychiatrist.

1. After walking one block around her home, she says she develops increased back pain.
2. Ms Siu says the whole of her right arm feels numb. As well as numbness in the right arm she says there can be occasional shooting sensation down the arm.
3. On occasions she said that her walking is not steady and that last year she had one fall at home after getting up and having weakness in both her legs. She sometimes needs to push herself up with her arms when getting out of bed or chairs because of what she says is the weakness in the legs.
4. She says she can only sit for half an hour or stand for half an hour before lying down.
5. Ms Siu said if she walks for more than half an hour she gets swelling in the right ankle. As well she says she now has left ankle pain in association with swelling. The Panel notes the left ankle was not referred for assessment.
6. The claimant says she is limited to half an hour of shopping but does more online shopping now. She says she can only do simple cooking because of her arm symptoms.
7. Ms Siu said she had no chest pain and no bruising of her chest.
8. On specific questioning however she said she continues to care for her husband and is in receipt of the carer's payment from Centrelink as a result of this.

1. Ms Siu says she has had physiotherapy paid for by the insurer and now continues treatment once per month paid for by herself. This is mainly for the shoulders, right arm and right ankle. She gets temporary relief of her pain but reports no long-term improvement.

1. Ms Siu moved easily around the examination area and did not have a walking stick on this occasion. There was no gait derangement evident as she walked into or out of the examination room or as she navigated around the examination room.
2. She demonstrated frequent pain behaviours with much grimacing when asked to perform any movement. As she stood up from the chair to begin the examination, she indicated pain in the left leg posteriorly which was "pulling".
3. Her height was recorded as 151 centimetres with a weight of 77kg. She reported that she was around 65 to 66kg before the accident.

1. In the cervical spine there were complaints of discomfort but no spasm or guarding.
2. I recorded the following movements which show there was no dysmetria:

(a) flexion and extension were both normal;

(b) rotation to the left and right was equal and two thirds normal, and

(c) lateral flexion on both sides was equal and two thirds of normal.

1. There was no wasting of the upper limbs Ms Siu's arm circumference was measured at:

(a) upper arm 31cm at the same point above the elbow on both sides, and

(b) forearm circumference was 28cm on both sides at the same point below the elbow.

1. There was negative cervical stretch testing.
2. Power and reflexes in both arms were normal.
3. Ms Siu was asked to demonstrate the area of her arm where she was experiencing numbness and she indicated an area in her palm and all fingers which did not, in my clinical judgment follow a true dermatomal distribution. On objective testing (pin prick and light touch) there was no abnormality of sensation.
4. Ms Siu was asked to demonstrate the pattern of pain in her arm which she reported as occasional shooting pain and was not present today. She indicated a global pain over the whole of the arm which was not radicular in nature and did not follow the pattern expected of a nerve or nerve root injury.

1. The lumber spine examination revealed no tenderness on palpation, spasm or guarding. There was restriction of movement measured as follows:

(a) flexion and extension were both reduced to half, and

(b) lateral flexion was reduced on both sides by half.

1. There was no dysmetria. Ms Siu did not complain of any radiation of pain or symptoms to the legs.
2. There was no abnormality of power, sensation or reflexes in the lower limbs and sciatic stretch testing was negative.
3. There was no wasting evident in the muscles of the lower limbs with measurements recorded as:

(a) calf circumference was 43cm on the left and right, and

(b) thigh circumference 49cm on the left and 50cm on the right which is not in accordance with table 6.8 in the Guidelines.

1. Ms Siu indicated she pain around the right ankle but there was a normal range of motion in the right and left ankle and hindfoot as recorded in the table below:

1. There was no abnormal motion in the claimant's hips or knees.
2. There was no evidence bruising of the upper or lower limbs.

1. Dr Rosenthal did not record shoulder motion but noted inconsistencies (which he did not explain further) and pain behaviours.
2. The right shoulder had a consistent restriction in movement (on three repetitions) as recorded below.

1. The claimant's left shoulder movement was near normal (very minor limitation of internal rotation) and improved in flexion and abduction since Medical Assessor Home's examination six months ago and Dr Rosenberg's assessment on 1 August 2024.
2. The claimant's right shoulder movement was very similar to the range measured by Medical Assessor Home and much improved from Dr Rosenberg's examination.
3. There was normal range of motion in the claimant's elbows, wrists, hands and fingers.

1. Despite her frequent grimaces and pain behaviours, Ms Siu was pleasant and co-operative throughout the assessment. I formed the view that she was demonstrating the maximum amount of motion in the examination of all her body parts. Her movements were consistent across the three repetitions of each shoulder movement performed.
2. It is now more than two and a half years since the accident, and the claimant has continued to make progress in her recovery. Her sternum, neck, lower back and right ankle have improved to the extent that they no longer attract a permanent impairment percentage. This does not mean that those body parts were not injured in the accident but that the injuries have improved and left her with no assessable impairment.

1. In accordance with Schedule 2(2)(a) the Panel is required to undertake an assessment of the degree of permanent impairment that has resulted from the injuries caused by the accident. This requires as a preliminary matter for the Panel to determine what were the injuries caused by the accident.
2. In accordance with Schedule 2(2)(b) the Panel is required to determine whether the disputed treatment is reasonable and necessary in the circumstances and whether it relates to the injuries caused by the accident. Again, this requires, as a preliminary matter for the Panel to determine, what the injuries were that were caused by the accident.
3. The test of causation of injuries is two-fold: a medical judgment about whether the motor accident could have caused or materially contributed to the injuries alleged, and then a factual determination of whether the accident did cause or materially contribute to the injuries.
4. The claimant referred for assessment the following injuries:

(a) cervical spine - C5/6, C6/7 radiculopathy;

(b) lumbar spine - L5/S1 radiculopathy;

(c) right shoulder - right shoulder musculoligamentous injury;

(d) sternum - fracture, and

(e) right ankle - right ankle musculoligamentous injury.

1. The Panel notes the circumstances of the accident, a t-bone collision to the driver's side of her car with a secondary impact to a pole. The claimant's airbags deployed, she was removed from the car by emergency services and taken to hospital. It is the clinical judgment of the Medical Assessors that this mechanism of accident could have caused or contributed to an injury to the chest, cervical and thoracic spine and the upper and lower limbs.
2. In terms of whether the accident did cause or contribute to the alleged injuries, the Panel notes:

(a) the discharge summary from Bankstown Hospital mentions chest and left finger injuries only (with bruising);

(b) the claim form completed five days after the accident did not specify a lower back injury, shoulder or neck injury but alleged injuries to the fingers, right hand and arm, left foot and chest / ribs;

(c) after the claimant's first attendance on Dr Tai (1 August 2023) he records complaints of neck pain, pain in both upper limbs, numbness on the right upper limb, shoulder strains, right hip bruising, bruising on the left breast and chest, lower legs and left arm pain;

(d) a lower limb contusion injury was first proposed 26 August 2023 by Mr Low, physiotherapy and on 31 October 2023 the GP records right leg and ankle pains, and

(e) lower back pain was not mentioned or investigated until February 2024.

1. On the basis of the contemporaneous medical records, the claim form and in particular the certificate of fitness completed by Dr Tai, the Panel accepts the claimant had symptoms indicative of injury to her chest, neck, upper and lower limbs. The Panel found it difficult to accept that the claimant injured her lower back in the accident as there is no mechanism of injury which could result in the development of symptoms more than six months after the accident however the claimant's complaints of pain symptoms have been very general since the accident which is suggestive in the Medical Assessors' view of general muscular soft tissue injuries resulting from the claimant being thrown about in the collision. The Medical Assessors also noted the significant chest injury which would likely have distracted the claimant from other less significant pains.

1. It is the clinical judgment of the Medical Assessors that the claimant's injuries sustained in the accident and referred for assessment are appropriately diagnosed as:

(a) cervical spine - a musculo-skeletal, soft tissue injury which has caused aggravation of degenerative changes in the cervical spine;

(b) lumbar spine - a musculo-skeletal, soft tissue injury aggravation degenerative changes in the lumbar spine;

(c) right shoulder - soft tissue injury caused by the seat belt injury leading to restriction in range of motion. The Panel notes the claimant said she had symptoms in both shoulders since the accident. The Panel notes the left shoulder was not included in the referral for medical assessment but that even if it was, there is a near normal range of motion in the left shoulder and no assessable impairment as a result;

(d) sternal fracture - this was diagnosed at hospital, but the claimant has now largely recovered from this. There was underlying bruising to the chest which has been diagnosed and impairment assessed by Medical Assessor Curtin, and

(e) right ankle - soft tissue injury caused most likely by the claimant's foot being pressed on the brake and dislodged at the time of the impact hitting part of the interior of the car.

1. It is the clinical judgment of the Medical Assessors that the motor accident did not cause of materially contribute to the claimant's leg swelling. The swelling in the claimant's legs has been diagnosed as being due to venous insufficiency by Dr Tang, the first vascular surgeon consulted by the claimant and a tenuous connection with the accident suggested by Dr Lemach due to the possibility of their being oedema since the date of the accident. The Medical Assessors note that there was no reference to bruising of the legs in the hospital discharge summary and that Dr Tai on 1 August 2023 refers only to right hip bruising (although he possibly refers to bruising in both legs on the certificate of fitness but it is not entirely clear). Venous doppler studies on 31 January 2024 confirm bilateral venous incompetence which would explain the swelling.
2. The Medical Assessors are of the view that there is no medically plausible mechanism where the bilateral lower limb swelling could be related to the motor vehicle accident or could have been aggravated by the accident including any alteration in gait. The Panel notes that the claimant's gait was entirely normal at the re-examination and that it is more likely the claimant's gait was altered because of the leg swelling and varicose veins rather than any alternation in gait being the cause of the leg swelling and varicose veins.

1. Impairment is assessed as at the time of the assessment (see cl 6.21) based on an interview with the claimant, a clinical examination and a consideration of the medical records (cl 6.18).

1. Assessment of the spine requires consideration of Chapter 3 of AMA 4 Guides. The Guidelines permit only the diagnostic related estimate (DRE) method of assessment (cl 6.111). The spine is divided (cl 6.131) into three regions:

(a) cervical;

(b) thoracic, and

(c) lumbar.

1. If injury to the spine is alleged, then each of the affected regions is assessed and the percentage impairments combined to obtain a total spinal impairment (6.131). If there are multiple impairments within one spinal region the impairments are not combined but the highest rating category is chosen (6.132)
2. There are five diagnostic related categories, and a number of indicia provided (see Table 6.7). Clause 6.125 provides that the starting point is Table 6.7 and the DRE descriptors from pages 102 - 107 of the AMA 4 Guides as amended by the clause are to be considered. There are neurological differentiators (for example radicular symptoms versus radicular signs) and structural inclusions (for example vertebral fractures) to be considered.
3. The first category is DRE category I which is selected if there are symptoms which may include pain.
4. DRE II requires there to be:

(a) pain with guarding; or

(b) non-uniform range of motion - dysmetria; or

(c) non-verifiable radicular complaints defined in table 6.8 as:

(i) symptoms (shooting pain, burning sensation, tingling), and

(ii) which follow the distribution of a specific nerve root but no objective clinical findings such as loss or diminished sensation, loss or diminished power or loss or diminished reflexes

1. DRE III requires radiculopathy which is defined in cl 6.138 as

"Radiculopathy means the impairment caused by dysfunction of a spinal nerve root or nerve roots when two or more of the following clinical signs are found on examination ...

(a) loss or asymmetry of reflexes (see Table 6.8 in the Guidelines);

(b) positive sciatic nerve root tension signs (see Table 6.8 in the Guidelines);

(c) muscle atrophy and/or decreased limb circumference (see Table 6.8 in the Guidelines);

(d) muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution, and

(e) reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.

1. If any impairment to the claimant's shoulders results from an injury to the neck, then, in accordance with the decision of the Court in Nguyen v Motor Accidents Authority of New South Wales and Anor that impairment must be assessed, and its value included in the determination of the claimant's total WPI[12].

1. In the cervical spine Ms Siu has no dysmetria and there was no muscle guarding, but the claimant complained of neck discomfort and pain in the right arm which she said was not present all of the time. She also complained of have right arm numbness. It is the clinical judgment of the Medical Assessors that these symptoms could not be described as non-verifiable radicular symptoms because:

(a) the radiating pain was occasional and not present at the time of re-examination and therefore not indicative of a permanent impairment, and

(b) the symptoms of numbness were not reproducible on objective testing and in any event did not follow a dermatomal distribution as required by the Guidelines.

1. The claimant's neurological examination did not reveal any of the five signs of radiculopathy required by the Guidelines.
2. It is the clinical judgment of the Medical Assessors that the cervical spine impairment is therefore assessed as DRE I giving her a 0% WPI for her soft tissue injury.

1. There were symptoms of pain complained of but no tenderness, no guarding and no dysmetria nor any radiating pain symptoms to the lower limbs. Neurological examination did not reveal any of the five signs of radiculopathy.
2. It is the clinical judgment of the Medical Assessors that Ms Siu is assessed therefore as having a DRE I which attracts a 0% WPI for her lumbar spine soft tissue injury.

1. The assessment of upper extremity impairment (UEI) is governed by Chapter 3, section 3.1 of the AMA 4 Guides. The upper extremity is divided into four regions: the shoulder, the elbow, the wrist and the hand. Regional impairments such as the hand and wrist impairments are combined to obtain a total UEI which is then converted to a WPI using Table 3 on page 20 of AMA 4.
2. There are several methods of assessment:

(a) amputation (part 3.1b);

(b) sensory loss of the digits (part 3.1c);

(c) abnormal range of motion (part 3.1d);

(d) peripheral nerve disorders (part 3.1k);

(e) vascular disorders (part 3.1l), and

(f) other disorders (part 3.1m).

1. Ms Siu has had persisting restriction in right shoulder range of motion. It is the clinical judgment of the Medical Assessors that range of motion is the most appropriate method of assessment. This impairment may be due to shoulder dysfunction caused by a shoulder joint injury (from the seat belt) but may also be contributed to by the claimant's soft tissue neck injury and her cervical spinal pain (Nguyen principle).
2. The range of motion method requires the measurement of six units of motion:

(a) flexion and extension;

(b) abduction and adduction, and

(c) internal and external rotation.

1. Measurement of motion is done using a goniometer and only active motion (not passive) is measured. Each of the six UEI figures is added to get a total UEI percentage impairment which is then converted to a WPI in accordance with table 3 on page 20 of AMA4.
2. The assessment of Ms Siu's upper extremity impairment (UEI) using the range of motion method is as follows utilising:

(a) flexion 140 degrees which is a 3% UEI (see figures 36; 37 and 38 at pages 42 - 43 of AMA 4);

(b) extension which is normal and therefore a 0% UEI (see figures 36; 37 and 38 at pages 42 - 43 of AMA 4);

(c) abduction 130 degrees which is a 2% UEI (see figures 39; 40 and 41 at pages 43 - 44 of AMA 40);

(d) adduction 50% which is normal and therefore a 0% UEI (see figures 39; 40 and 41 at pages 43 - 44 of AMA 40);

(e) internal rotation 70 degrees which is a 1% UEI (see figures 42; 43 and 44 at pages 44 - 45 of AMA 4), and

(f) external rotation 80 degrees which attracts a 0% UEI (see figures 42; 43 and 44 at pages 44 - 45 of AMA 4).

1. The total UEI is 6% which converts to a 4% WPI in accordance with Table 3 on page 20 of the AMA 4 Guides.

1. Clause 6.23 of the Guidelines provides that some injuries will not result in an assessable impairment and gives the example of "uncomplicated healed sternal and rib fractures". Ms Siu's sternal fracture and the associated bruising has healed and does not result in any impairment.

1. The assessment of lower extremity impairment is governed by Chapter 3, section 3.2 of the AMA 4 Guides. There are 13 methods of assessment provided for as follows:

(a) limb length discrepancy (3.2a);

(b) gait derangement (3.2b);

(c) muscle atrophy (3.2c);

(d) manual muscle-testing (3.2d);

(e) range of motion (3.3e);

(f) joint ankylosis (3.2f);

(g) arthritis (3.2g);

(h) amputations (3.2h);

(i) diagnosis-based estimates (3.2i);

(j) skin loss (3.2j);

(k) peripheral nerve injuries (3.2.k);

(l) causalgia and reflex sympathetic dystrophy (3.2l), and

(m) vascular disorder (3.2m).

1. There is no evidence of any fracture damage to the right ankle and the diagnosis made by the Medical Assessors is that of a soft tissue injury. It is the Medical Assessors' clinical judgment that the most appropriate method of assessment is the range of motion method.
2. The claimant said that her right ankle is symptomatic and she has pain. While the claimant complains of pain in the right ankle, cl 6.38 of the Guidelines provides that "medical assessors must not make a separate allowance for permanent impairment due to pain" and that each chapter of the AMA 4 Guides includes pain in the impairment percentages.
3. Her history of not noticing the right ankle discomfort for three months after the accident until she started to walk after a period of inactivity could be a medically plausible explanation for her later presentation with the right ankle injury in the light of the significant impact of the accident. However, the claimant maintained that during this three-month period she continued to provide care and assistance to her husband in accordance with the Centrelink allowance she was receiving.
4. Bearing in mind the range of motion of the right and left ankles is now completely normal Ms Siu has a 0% WPI due to the right ankle injury. The Panel does not therefore propose to consider the issue of causation any further.

(a) Cervical spine DRE I = 0%

(b) Lumbar spine DRE I = 0%

(c) Right shoulder 4% WPI

(d) Right ankle 0% WPI

(e) Sternal fracture No assessable impairment

1. The claimant has confirmed that none of the disputed treatment has been provided therefore the Panel is considering this as treatment to be provided and whether this future treatment is related to the accident and reasonable and necessary in the circumstances.
2. The treatment disputes referred for assessment are addressed in turn:

(a) eight further physiotherapy sessions - it is the Medical Assessor's view that some of the claimant's ongoing symptoms (neck and back pain plus shoulder restriction of motion) are related to the motor accident and therefore any further physiotherapy or rehabilitation assessment would be related. However, the claimant has had significant levels of physiotherapy to date from Mr Low which she says has not given her long term benefit. On that basis it is the clinical judgment of the Medical Assessors that this disputed treatment is not reasonable and necessary. She will not benefit from further physiotherapy at this stage two years after the injury and should focus on self-directed exercises and stretching;

(b) an initial rehabilitation needs assessment - the claimant was referred to Synergy Medical early on due to difficulty with activities of daily living and household chores and she has continued to provide care and assistance to her husband. It is the clinical judgment of the Medical Assessors that Ms Siu no longer has physical symptoms or functional limitations which would require an "initial rehabilitation needs assessment";

(c) compression garments, blood tests and vascular laboratory testing - these treatments as recommended by Dr Lemech dated 11 July 2024 are not related to the injuries caused by the accident. These treatments are related to the leg swelling and the unrelated varicose vein condition;

(d) the Hirudoid cream would have been reasonable and necessary treatment for local bruising in the acute post injury phase. The claimant did have bruising recorded soon after the accident but at the time of the re-examination with Medical Assessor Gorman there was no bruising evident in the upper or lower limbs and the claimant did not complain of any chest bruising. Therefore, the Hirudoid cream is not allowed on the basis that it is no longer a reasonable and necessary form of treatment, and

(e) consultations with Dr Wines or Dr Chang - both Dr Wines and Dr Chang are orthopaedic surgeons and the claimant was referred to them for her right ankle complaint. The Medical Assessors are of the view that the claimant only required one referral, not two and that two opinions would not be reasonable and necessary. The Medical Assessors are also of the view that the referral would have been related to the accident caused injuries in the first six months or so after the accident as the Panel has accepted Ms Siu's explanation that she did develop the right ankle pain from a soft tissue injury after she resumed activities three months after the accident. However, Ms Siu now has a normal range of motion in the right ankle and says she has now developed left ankle pain. Overall, it is the clinical judgment of the Medical Assessors that the left ankle pain which she says has recently developed, cannot plausibly be related to the motor accident more than two years ago. In the light of both ankles now being symptomatic, the cause of the bilateral ankle symptoms is not due to any right ankle soft tissue injury sustained in the accident. The Panel cannot relate the consultations with Dr Wines and Dr Chang to the accident. The Panel is therefore not satisfied that the consultations with Drs Wines or Chang are related to the injuries caused by the accident or that they are reasonable and necessary now in the circumstances.

1. While the Panel has come to the same conclusion as Medical Assessor Home, we have found a different percentage (4% as opposed to 7%). Because Medical Assessor Home included the actual percentage in his certificate it follows that his certificate should be revoked.
2. In addition, the Panel has found the right ankle injury caused by the accident and this has impacted the Panel's decision about some of the treatment. Therefore, the Panel has decided to revoke the treatment and care certificate of Medical Assessor Home and issue a fresh certificate to clarify the final outcome.

[1] The "relevant insurer" is determined in accordance with s 3.2 of the MAI Act.

[2] The current maximum as of October 2025 is $691,000.

[4] Section 7.21. The current version of the Guidelines is Version 10.

[6] The numbers in square brackets are a reference to the section number in the Medical Assessor's reasons.

[7] This is as written with the punctuation used by Dr Tai.

[10] The insurer obtained documents from The Cross Radiology which commence at page 26 of the insurer's bundle.

[11] These 2012 x-rays are not before the Panel.

[12] [2011] NSWSC 351. This is referred to as the "Nguyen Principle".