15% permanent impairment of the neck;
15% permanent loss of efficient use of the right upper limb at and above the elbow to include impairment below the elbow;
10% permanent loss of efficient use of the left upper limb at and above the elbow to include impairment below the elbow;
20% impairment of the back;
10% permanent loss of efficient use of the right lower limb above the knee to include impairment below the knee;
5% permanent loss of efficient use of the left lower limb at and above the knee to include impairment below the knee.
12 The appellant was then referred to Dr Paul Darveniza, a highly qualified neurologist, at St Vincents Clinic who examined him on 17 September 2001. In his report dated 19 September 2001, Dr Darveniza noted that on examination there was mild pain from neck movements, a mild to moderate restriction of back flexion with the hands just reaching to the upper third of the shins, mild para-spinal muscle spasm and a normal lumbar lordosis, and that straight leg raising induced back pain at about 80° in both legs. He noted that x-rays taken on 5 May 2000 showed no significant abnormalities of the cervical and thoracic spine. A CT scan of the lumbar-sacral spine on the same date was reported as normal although in Dr Darveniza's view, the appellant did have a minimal broad-based disc bulge at L4/5 without neural encroachment. Her Honour noted that the CT scan referred to was not tendered in evidence.
13 Dr Darveniza then opined that the appellant had suffered mechanical injuries to the neck and lower back in the accident, leaving him with chronic spinal pain and with headaches physically restricting him as he had detailed. As it was well over two years since the accident, he considered that the appellant's current disabilities must be considered permanent. Nevertheless the appellant remained fit for general duties not requiring repetitive heavy bending, stooping and lifting. He considered that the appellant's injuries and their sequelae had led to significant physical and psychosocial loss and had impaired his enjoyment of life in general.
14 The appellant was referred to Dr Robert Gertler, consultant psychiatrist, on 2 October 2001. In a report dated 4 October 2001, Dr Gertler opined that there was no evidence of psychotic thought disorder or organic brain dysfunction. However, the appellant was suffering from an adjustment disorder with depressed mood that manifested primarily as irritability and "snappiness". Dr Gertler considered that that was associated with the chronic pain and disability which he experienced and the associated marked restriction in his ability to pursue leisure activities, such as dancing, which he had previously enjoyed. Further, the appellant's adjustment disorder with depressed mood, whilst mild, did in Dr Gertler's opinion affect his ability to relate to people. However, to date it had not affected his work situation but it had affected his relationship with his family and friends. Nevertheless, he was fit for his employment in terms of his mild adjustment disorder.
15 Dr Gertler considered the appellant's prognosis from a psychiatric point of view to be "fair" and that, in time, with stabilisation of his physical complaints, he would come to terms with his altered physical circumstances.
16 Finally, the appellant saw Mr R Weiland, a chiropractor, on 15 June 2002 where he presented with marked pain throughout his cervical, thoracic and lumbar spine. He reported to Mr Weiland that he was experiencing the pain consistently every day and that the symptoms were aggravated by his current work which involved prolonged sitting at a computer for approximately seven and a half hours per day. Upon examination Mr Weiland found that there was spinal joint dysfunction on the left and right sacroiliac at L4/5, L5/S1, T8/9, T5-7, T1/2, C5/6 and C1/2 segments with overlying tenderness in these areas. There was marked spasming in the cervical, thoracic and lumbar para-spinal trapezius, levator scapulae, gluteal and piriformis muscle groups. Standing full spinal x-rays were taken on 17 June 2002 and confirmed the above structural analysis.
17 Thereafter, the appellant attended Mr Weiland on 13 July 2002, 27 July 2002 and 19 October 2002 with, according to Mr Weiland's report of 11 January 2003, similar symptoms, generally aggravated by an accumulation of daily activities. His opinion was that the appellant suffered from mechanical strain in the identified cervical, thoracic and lumbar segments of his spine and pelvis in the form of spinal joint dysfunction with associated muscle strain and spasm which he considered might well have been precipitated by the motor vehicle accident on 18 March 1999 due to the sudden acceleration/deceleration forces involved.
18 It should be noted from the foregoing summary of the medical reports tendered before her Honour on behalf of the appellant that they related to examinations of the appellant by Dr Alam on 6 April 2000, Dr Mahony on 31 July 2001, Dr Darveniza on 17 September 2001, Dr Gertler on 2 October 2001 and Mr Weiland on 15 June 2002. It would be a fair comment that these reports were, as her Honour implied (at Red 24J), outdated by the time the hearing before her commenced on 27 July 2003 being two years after Dr Mahony had examined the appellant and 22 months after he had been examined by Dr Darveniza.
19 The only medico-legal consultant retained by the respondent to which the appellant was referred was Dr Richard Sekel, a consultant in occupational medicine. He examined the appellant on 24 January 2000 and again on 18 June 2002. In his first report dated 24 January 2000, he noted that on examination of the appellant's lower back, forward flexion of the back was "refused" beyond fingers to lower shins because of a complaint of "pulling" in the lower back. However, Dr Sekel noted that at a later stage whilst the appellant was lying on a couch with his legs outstretched before him, unaware that he was being observed, forward flexion of the back was possible so that his fingers reached his toes without apparent difficulty or discomfort indicating, according to Dr Sekel, exaggeration of responses during the earlier part of the examination.
20 Dr Sekel considered that his physical examination of the appellant did not reveal evidence of any significant pathology and, specifically, no evidence of an intervertebral disc lesion or pressure on nerve roots in either the back or neck. The appellant was therefore fit for all normal activities including sport.
21 Dr Sekel next examined the appellant on 18 June 2002. He noted in his report dated 19 June 2002 that a plain x-ray of the appellant's spine and pelvis performed on 17 June 2002 revealed no significant abnormality. On physical examination Dr Sekel considered that there were a few inconsistencies suggestive of exaggeration or falsification of responses, which he then described. These related in particular to examination of the appellant's lower back where, as he had on the first examination by Dr Sekel, the appellant had refused to forward flex his back beyond fingers to mid-shins because of claimed lower back pain. However, at a later time whilst lying outstretched on a couch while his lungs were being examined with a stethoscope, he was able to lean forward so that his fingers reached to his ankles without apparent discomfort or difficulty.
22 On examination of the appellant's lower limbs, Dr Sekel noted that straight leg raising was refused beyond 60° with each lower limb because of a complaint of lower back pain. At a later time, whilst the appellant's legs were being tested for pinprick sensation, straight leg raising was possible through 85° without apparent difficulty or discomfort, suggestive of earlier falsification of responses.
23 Accordingly, Dr Sekel considered that any soft tissue injury to his lower back that the appellant may have sustained during the relatively minor rear end motor vehicle collision of 18 March 1999 would have completely resolved within the initial four to six weeks without long term complication as a consequence whereof there were now no ongoing physical abnormalities resulting from the accident.
24 That was the state of the medical evidence when the proceedings went to arbitration on 10 December 2002. At that time, although the respondent had the benefit of a relatively recent report of Dr Sekel dated 19 June 2002, the reports of the medical consultants upon which the appellant relied were all more than 12 months out of date.
25 The arbitrator made an award in favour of the appellant on 12 February 2003 that was not accepted by him and, as was his right, he sought a rehearing. The rehearing was listed for call-over on 6 May 2003 and fixed for hearing commencing on 28 July 2003. As at the beginning of July 2003, some four weeks before the commencement of the hearing before the primary judge, the medical evidence remained the same and, in particular, the appellant had not consulted with a medical practitioner for the purpose of the proceedings since he had seen Dr Gertler on 2 October 2001. In particular, he had not seen Dr Alam since 6 April 2000, Dr Mahony since 31 July 2001 and Dr Darveniza since 17 September 2001. Nevertheless, as appears from the evidence he gave before the primary judge, the appellant's complaints and symptoms had not changed. If anything, they had worsened. Thus her Honour described his complaints given in evidence in the following terms (Red 18T-X):
"By July 2003 when he went to see Dr Mahony he was finding if he lent on his elbows he experienced pins and needles through his hands and he continued to drop things. He was having difficulty sleeping and with his memory.
Currently he complains of a sore neck, tenderness in the shoulders, he has trouble turning and putting his head down, he has pain in his lower back extending into his right leg with an area of numbness in the top corner of his lower back. He still suffers from headaches. If he bends his head forward he feels a sharp pain in the middle of his neck and tenseness in his shoulders. His arms have no strength. He is so weak on occasions that he cannot even pick up a bottle of Coke."
26 Within a month or so prior to the commencement of the hearing before the primary judge, the appellant's solicitors appear to have had a change of heart in terms of the desirability of his being further examined at least by Dr Alam and Dr Mahony. The appellant was thus re-examined by Dr Mahony on 1 July 2003 at which time he related the same symptoms and complaints as he had conveyed to Dr Mahony when he first saw him on 31 July 2001. Examination of his neck, shoulders, upper limbs and back yielded precisely the same results as the examinations conducted on 31 July 2001. So far as Dr Mahony's examination of the appellant's lower limbs was concerned, the position had worsened in that straight leg raising was only possible to 45° on both sides rather than the 60° on the earlier examination. Accordingly, Dr Mahony's opinion was the same as that expressed in his earlier report, as was his assessment of the appellant's permanent disabilities.
27 Dr Mahony's reports of 1 July 2003 were served upon the solicitors for the respondent on 2 July 2003.
28 The appellant was also re-examined by Dr Alam on 14 July 2003. Essentially, his complaints had not changed. In some respects his position had worsened. Thus, with respect to movements of his neck, whereas when first examined he was able to rotate to the right 65° and to the left 70°, on re-examination he was only able to rotate to the right 45° and to the left 50°. Further, although on the earlier examination his grip strength was satisfactory, it was now reduced, with the right hand having less than the left. With respect to his thoracic spine, there were areas of tenderness that were described in Dr Alam's first report as "considerable" and in his second report as "indicating traumatic active spondylitic process". On examination of the appellant's lumbar spine, when first examined the appellant's leg raising was impaired right 45° and left 40° whereas now the impairment was right 40° and left 45°.
29 Furthermore, at the current examination, measurement of his two limbs indicated some degree of circumferential wasting by 2cm in the left thigh compared with the right, and 1cm in the left calf compared with the right. Dr Alam's assessment on this occasion was essentially the same as that resulting from his first examination of the appellant, although, with respect to Item 3 referred to in [8] above, he made no reference in his second examination to the appellant's injuries bespeaking lumbar disc lesion(s). However, under the heading "Prognosis", Dr Alam confirmed his previous remarks in his first report including his comment that if a lumbar disc lesion was confirmed by a CT scan and clinical findings, then that would require treatment in its own right. His assessment of permanent impairment remained the same. The report of this examination by Dr Alam was dated 19 July 2003 and was served on the respondent's solicitors on 21 July 2003, just seven days prior to the commencement of the hearing before the primary judge.
30 At the commencement of the hearing before her Honour on 28 July 2003, the appellant sought to tender all the medical reports referred to above including those of Dr Alam dated 19 July 2003 and Dr Mahony dated 1 July 2003. All were admitted except the last two which were objected to. Their tender was pressed but, after legal argument, they were rejected by her Honour. Regrettably, the transcript does not contain any details of the legal argument that ensued or any reasons given by her Honour for rejecting the tender. Nevertheless, it was common ground that the reports were rejected by her Honour upon the basis that she had refused to grant leave pursuant to Pt 28 r 8(6) of the Rules to admit the reports as they had not been served in accordance with the provisions of Pt 28 r 8(3) which, unless the Court otherwise ordered, required all expert reports to be served at least 28 days before the day first scheduled for a status conference in the proceedings. We were informed that that would have been some time prior to the commencement of the arbitration on 10 December 2002.
31 The only reference in her Honour's judgment to the rejection of these reports was in the following paragraph (at Red 23H-J):
"Dr Alam was called to give evidence in the plaintiff's case. He first saw the plaintiff on 6 April 2000 and saw him again more recently. The second report was not served in accordance with the rules and objection was taken to the tender of the report and the doctor's evidence of his most recent consultation. The tender of the report was disallowed and the doctor's evidence restricted to his initial consultation."