Legal Bulletin No. 103

Issued 24 March 2023

Welcome to the hundred and third edition of the Personal Injury Commission’s Legal Bulletin. Please see here for details about the legal citations used for the Commission’s decisions. The decisions listed below are now available on AustLII and will be available shortly, on Jade and Lexis Nexis. Any legislative updates are provided at the base of the Bulletin.

Presidential Member Decision

UPVC Window Solutions Pty Ltd v Workers Compensation Nominal Insurer (icare) [2023] NSWPICPD 11

‘Worker’; consideration of Construction, Forestry, Maritime, Mining and Energy Union v Personnel Contracting Pty Ltd and ZG Operations Australia Pty Ltd v Jamsek; application of those authorities where a contract is oral; Secretary, Attorney-General’s Department v O’Dwyer; section 9B of the Workers Compensation Act 1987 in respect of a ‘stroke injury’; consideration of De Silva v Secretary, Department of Finance, Services and Innovation and associated decisions; section 352(5) of the 1987 Act; credit findings and cross-examination in the Personal Injury Commission; Aluminium Louvres & Ceilings Pty Ltd v Zheng, New South Wales Police Force v Winter, State Rail Authority of NSW v Earthline Constructions Pty Ltd and Pollard v RRR Corporation Pty Ltd discussed; Schedule 1, clause 2 of the Workplace Injury Management and Workers Compensation Act 1998; ‘deemed worker’; application of Humberstone v Northern Timber Mills, Scerri v Cahill and associated authorities; consideration of the phrase ‘incidental to a trade or business regularly carried on’; application of Dranichnikov v Minister for Immigration & Multicultural Affairs and Wang v State of New South Wales; Held – the Certificate of Determination dated 6 April 2022 is confirmed.

Decision date: 14 March 2023 | Before: Deputy President Michael Snell

Motor Accidents non-Presidential Member Decisions

AAI Limited t/as AAMI v Betland [2023] NSWPIC 90

Motor Accident Injuries Act 2017; damages claim; approval of settlement under section 6.23; claimant self-represented; motor accident occurred when the motor vehicle claimant was driving was rear-ended by another vehicle whilst stationary at traffic lights; claimant sustained injuries to his cervical spine, an aggravation of pre-existing C5/6 disco vertebral pathology, a consequential ruptured a right pectoral muscle as part of his rehabilitation requiring surgical repair and post-traumatic stress disorder; satisfied that the claimant’s whole person impairment not greater than 10% and thereby not entitled to damages for non-economic loss; claimant worked as a full-time section team leader in a warehouse involving labour intensive duties; returned to restricted duties at reduced hours after five months and after a further eight months was certified fit to return to his pre-injury duties by his general practitioner; after a further 12 months the claimant was made redundant and not worked since; claimant currently aged 40 years; settlement offer included $315,000 for past loss of earnings and $185,000 by way of buffer for the future; Held – the proposed settlement in the sum of $500,000 is approved under section 6.23(2)(b).

Decision date: 6 March 2023 | Member: Anthony Scarcella

Vanoostwaard v AAI Limited t/as GIO [2023] NSWPIC 97

Motor Accident Injuries Act 2017; claim for statutory benefits; liability denied for ongoing benefits on basis that claimant wholly at fault; claimant riding motorbike in rural setting when he had difficulty negotiating a cattle grid in the gravel road, lost control and hit an embankment on the other side of the grid; Held – claimant wholly at fault; cause of accident was claimant’s front wheel hitting the front of the cattle grid which dislodged claimant in his seat; as he regained his seat he accidentally adjusted the throttle and increased speed which led to him losing control and hitting the embankment; consideration of the term “fault” and the application of the principles of negligence in the Civil Liability Act 2002 to claims for statutory benefits under Part 3 of the 2017 Act.

Decision date: 13 March 2023 | Member: Belinda Cassidy

Workers Compensation non-Presidential Member Decisions

Uzunovska v Secretary, Department of Education [2023] NSWPIC 86

Workers Compensation Act 1987; whether applicant had sustained a psychological injury arising out of her employment which was a substantial contributing factor to it; sections 4 and 9A; respondent alleged any injury was wholly or predominantly caused by a reasonable action taken by it for the purposes of section 11A(1); in this case discipline; whether notification of Public Health Order requiring the respondent’s employees to be vaccinated and related guidelines constituted disciplinary action for the purposes of section 11A(1) or clear indication of at least the possibility of disciplinary action (given later) marked the commencement of action with respect to discipline; claim for incapacity by reason of psychological injury accepted in good faith by respondent; sufficient evidence to establish that applicant suffered a psychological injury during the course of her employment and that such injury was not a consequence of a disciplinary process at the time the condition developed; any disciplinary process occurred later in time and was not a predominant cause of psychological injury; Held – award for the applicant.

Decision date: 17 February 2023 | Member: Christopher Wood

The Estate of the Late Marc Sibille v Inn Hospitality Pty Limited & Ors [2023] NSWPIC 91

Workers Compensation Act 1987; application for lump sum death benefit; identification of dependants; emotional dependence; application for discretionary interest; when claim duly made; appropriate rate of interest; funeral expenses; Held – liability to pay compensation conceded; the deceased worker died leaving no dependants; orders for payment of the lump sum pursuant to section 25(1)(a) to legal personal representative; award for discretionary interest from date full particulars of dependants provided at 2% above Reserve Bank of Australia cash rate.

Decision date: 7 March 2023 | Member: Rachel Homan

Browne v State of New South Wales (NSW Police Force) [2023] NSWPIC 92

Workers Compensation Act 1987; the applicant claims weekly compensation payable under section 40 for partial incapacity resulting from multiple physical injury sustained in the course of his employment with the respondent; the applicant claims he has an entitlement to two awards of weekly compensation payable under section 40 because he suffers from separate and distinct incapacities arising from his physical and psychological injuries sustained in the course of his employment with the respondent; the respondent disputes the applicant’s claim; Held – the applicant suffers a partial incapacity resulting from multiple physical injuries sustained in the course of his employment with the respondent; the applicant has an entitlement to two awards of weekly compensation payable under section 40; he suffers from separate and distinct incapacities arising from his physical and psychological injuries sustained in the course of his employment with the respondent.

Decision date: 7 March 2023 | Member: Jacqueline Snell

Wang v State of New South Wales (Sydney Local Health District) [2023] NSWPIC 93

Workers Compensation Act 1987; weekly benefits and medical expenses claim in relation to alleged psychological injury; respondent disputes injury and alleges the death of the applicant’s father was the main contributing factor to her psychological condition; capacity for employment also in dispute; Held – the applicant suffered a psychological injury in the course of her employment, to which her employment was the main contributing factor under section 4(b)(i); alternatively, even if the applicant suffered a grief reaction, her perception of real events in the course of her employment was plainly the main contributing factor to an aggravation of that grief reaction under section 4(b)(ii); the preponderance of the medical evidence supports a finding of total incapacity for employment for the period claimed; respondent ordered to pay weekly compensation and the applicant’s reasonably necessary medical and treatment expenses pursuant to section 60.

Decision date: 8 March 2023 | Member: Cameron Burge

Bates v Filter Cair Pty Limited [2023] NSWPIC 95

Workers Compensation Act 1987; allegation of cervical spine injury at work for which the applicant sought a determination in respect of proposed cervical spine surgery; allegation of injury consisting in the heavy and repetitive nature and conditions of work causing an aggravation, acceleration, exacerbation or deterioration of an underlying disease to which employment alleged to have been the main contributing factor;  undisputed that the bilateral upper extremities injured; no contemporaneous reporting of neck injury and absence of contemporaneous complaints of neck pain in medical records; Held –all of the evidence weighed in the balance and found that the applicant had suffered an injury to the cervical spine by way of an aggravation, acceleration, exacerbation or deterioration of an underlying disease to which employment was the main contributing factor; further held that the respondent was the last relevant employer liable to pay compensation; further held that the proposed surgery was not reasonably necessary in the absence of any conservative treatment and accordingly there was an award for the respondent in respect of the proposed surgery under section 60.

Decision date: 9 March 2023 | Member: Jane Peacock

Hathaway v MGI Resources Pty Ltd & Ors [2023] NSWPIC 96

Workers Compensation Act 1987; application for the distribution of the lump sum death benefit; Held - the lump sum benefit is payable in accordance with section 25(1)(a).

Decision date: 10 March 2023 | Senior Member: Elizabeth Beilby

BCW v Illawarra Shoalhaven Local Health District 98

Workers Compensation Act 1987; claim for injury on 23 March 2017 to back, left thigh, left knee, right knee, left foot, right foot, left ankle, and right ankle; claim for injury to back, left foot, right foot, left knee, right knee, left ankle and right ankle as a result of nature and conditions of employment; claim for injury to back and left hip as a result of altered gait and nature and conditions of employment; claim for weekly benefits; cost of bilateral total knee replacement surgery and permanent impairment as a result of injury to lumbar spine, left lower extremity, and right lower extremity; liability for frank injuries to left ankle, right ankle and left knee accepted; liability for frank injury to right knee and back disputed; liability for injury to back, left ankle, right ankle, left knee and right knee as a result of nature and conditions of employment disputed; liability for injury to back and left hip as a result of altered gait and nature and conditions of employment disputed; consideration of Castro v State Transit Authority (NSW) and Murphy v Allity Management Services Pty Ltd; Held – award for respondent in respect of claim for injury to or consequential condition of lumbar spine; award for respondent with respect to the claim for injury to the left knee, right knee, left ankle and left hip, due to nature and conditions of employment; award for applicant pursuant to section 60 for the costs of bilateral total knee replacement surgery; matter remitted to President of the Personal Injury Commission for referral to Medical Assessor for assessment of permanent impairment as a result of injury to left and right lower extremities (knees and ankles); matter to be listed for further preliminary conference after issue of Medical Assessment Certificate, for directions as to claim for weekly benefits.

Decision date: 15 March 2023 | Senior Member: Kerry Haddock

Workers Compensation Presidential Delegate Decision

Sarangan v State of New South Wales (Sydney Local Health District) [2023] NSWPIC 100

Workers Compensation Act 1987; work capacity dispute; whether applicant suffered a secondary psychological injury; whether motor vehicle accident after work injury constituted a novus actus interveniens; whether medical opinions provided in a fair climate; whether Kooragang Cement Pty Limited v Bates and State Government Insurance Commission v Oakley can sit together; Held – applicant suffered a secondary psychological injury; motor vehicle accident did not break the chain of causation; applicant had capacity for eight hours per week.

Decision date: 13 March 2023 | Delegate: Parnel McAdam

Motor Accidents Medical Review Panel Decisions

Labib v Insurance Australia Limited t/as NRMA Insurance [2023] NSWPICMP 69

Motor Accident Injuries Act 2017;the claimant suffered injury on 12 March 2019 from a rear end car accident; the dispute related to the assessment of permanent impairment under of physical injuries; claimant re-examined; Panel required to form its own opinion on diagnosis and assessment; Insurance Australia Ltd v Marsh applied; lumbar spine assessed at diagnosis related estimate (DRE) II; no deduction made for pre-existing condition as insurer not satisfied that there was objective evidence of pre-existing impairment; no discrete injury to shoulders; inconsistent movement on examination; lack of movement assessed by analogy; Held – claimant assessed at 7% permanent impairment; original assessments revoked.

Decision date: 3 March 2023 | Panel Members: Principal Member John Harris, Dr Chris Oates and Dr Ian Cameron | Injury module: Spine and Upper Limb

Singh v AAI Limited t/as GIO [2023] NSWPICMP 71

Motor Accidents Injuries Act 2017; medical dispute about minor injury and review of assessment under section 7.26; claimant injured in rear end collision in March 2021 with arms outstretched gripping the steering wheel; claimant had previous accident in 2016 injuring neck, left shoulder and back; claimant alleged injury in current accident to shoulder and neck; claimant assessed by Medical Assessor Wijetunga who found all accident-related injuries to be minor injuries withing meaning of section 1.6; claimant sought review on basis 2021 radiology revealed tears to left subscapularis insertion and inferior labrum not present in radiology after 2016 accident; Held –no re-examination necessary; claimant conceded neck injury minor; insurer conceded if tears found to be caused they were non-minor injuries; test of causation is whether accident could have caused the injury and did cause the injury; claimant had worked full time after 2016 accident until 2021 accident without left shoulder issues and no regular ongoing attendances for left shoulder symptoms; claimant reported immediate complaints of left shoulder pain and radiology within two months revealed the tear; Panel satisfied tears revealed in 2021 radiology were caused by the accident and that this was an injury that is not a minor injury; Certificate of Medical Assessor Wijetunga revoked.

Decision date: 3 March 2023 | Panel Members: Member Belinda Cassidy, Dr Tai-Tak Wan and Dr Clive Kenna | Injury module: Upper Limb

Zaiter v Lawrence and Hanson Group Pty Ltd [2023] NSWPICMP 72

Motor Accidents Compensation Act 1999;the claimant suffered injury on 8 May 2017 when an unsecured cabinet fell from a forklift striking the claimant causing him to fall to the ground; the dispute related to the assessment of permanent impairment under of physical injuries; claimant re-examined; Panel required to form its own opinion on diagnosis and assessment; Insurance Australia Ltd v Marsh applied; Panel not satisfied that the motor accident caused any fractures in the thoracic spine because the initial complaints of tenderness were in the upper thoracic spine around T3; the scans show degenerative changes rather than acute fractures and the accident would result in compression fractures; claimant assessed at 5% in the cervical spine for dysmetria and 1% for haemorrhoids due to medication; Held – claimant assessed at 6% permanent impairment; original assessments revoked.

Decision date: 3 March 2023 | Panel Members: Principal Member John Harris, Dr Chris Oates and Dr Les Barnsley | Injury module: Spine, Upper Limb and Digestive

Allianz Australia Insurance Limited v Vella (No 1) [2023] NSWPICMP 73

Motor Accidents Compensation Act 1999;medical dispute and review under section 63 of Medical Assessor (MA) Bodel’s determination of treatment and care lumbar fusion surgery, domestic assistance past and future and child-care assistance past and future; MA had allowed all treatment and care; claimant involved in two accidents; these proceedings concerned the second in time (September 2014); insurer sought review on basis lumbar spine injury not caused by accident; Held–  Parties agreed child care assistance is not treatment provided or to be provided to the claimant and therefore not a medical assessment matter; claimant sustained soft tissue cervical, thoracic and lumbar spine injury; the claimant said her radiating pain from her back to her legs occurred a year after the accident and medical records indicated first complaints of radiating pain 20 months after the accident and neurological symptoms developed two years after the accident; surgery not related to this accident; panel accepted claimant would have required some assistance after the accident to the end of December 2014; Certificate of Assessor Bodel revoked.

Decision date: 3 March 2023 | Panel Members: Member Belinda Cassidy, Dr Geoffrey Stubbs and Dr Ian Cameron | Treatment Type: Surgery, Domestic Assistance and Child Care Assistance

Insurance Australia Limited t/as NRMA Insurance v Vella (No 2) [2023] NSWPICMP 74

Motor Accidents Compensation Act 1999;medical dispute and review under section 63 of Medical Assessor (MA) Bodel’s determination of treatment and care lumbar fusion surgery, domestic assistance past and future and child-care assistance past and future; MA had allowed all treatment and care; claimant involved in two accidents; these proceedings concerned the first in time (December 2013); insurer sought review on basis lumbar spine injury not caused by accident; Held– Parties agreed child care assistance is not treatment provided or to be provided to the claimant and therefore not a medical assessment matter; claimant sustained soft tissue cervical and lumbar spine injury which caused negligible symptoms after early 2014; surgery not related to this accident; Panel accepted claimant would have required some assistance after the accident to the end of February 2014; Certificate of Assessor Bodel revoked.

Decision date: 3 March 2023 | Panel Members: Member Belinda Cassidy, Dr Geoffrey Stubbs and Dr Ian Cameron | Treatment Type: Surgery, Domestic Assistance and Child Care Assistance

Fox v AAI Limited t/as GIO [2023] NSWPICMP 79

Motor Accidents Compensation Act 1999;medical dispute about whole person impairment (WPI) and review under section 63 of Medical Assessor (MA) Home’s decision that claimant had a WPI not greater than 10%; insurer’s application for review; claimant’s vehicle hit from behind in a roundabout; claimant alleged injury to neck and right shoulder; claimant had earlier injury in 2014 to the neck and a C5/6 fusion but which was not causing symptoms; MA found 18% upper extremity impairment (UEI) from which he deducted 4% on the basis of an impairment found in the left shoulder resulting in a finding of 8% WPI; insurer conceded claimant injured right shoulder leading to development of adhesive capsulitis and current presentation; primary issue methodology of impairment assessment and whether there should be a deduction for the contralateral joint; Held –  claimant sustained soft tissue injury aggravating the previous injury which had recovered leaving no impairment; the claimant’s shoulder movements were inconsistent on examination; measurements suggested impairment of 13% WPI; consideration of clauses 1.40 and 1.50 and how to deal with inconsistency; the Panel was satisfied the claimant had an impairment and that 13% was a plausible finding; consideration of clause 1.51 and adjustment for contralateral uninjured shoulder; left shoulder displayed near normal range of motion and therefore no deduction made; claimant’s scarring assessed in accordance with TEMSKI at 0%; Certificate of MA Home revoked.

Decision date: 9 March 2023 | Panel Members: Member Belinda Cassidy, Dr Wing Chan and Dr Margaret Gibson | Injury module: Spine and Upper Limb

Djenadije v Insurance Australia Limited t/as NRMA Insurance [2023] NSWPICMP 80

Claimant injured in a motor vehicle accident on 13 August 2018 when the left side of his car impacted with a car pulling out from the curb; claimant suffered injuries to his cervical spine, lumbar spine and both shoulders; review of certificate of Medical Assessor (MA) Assem dated 20 December 2021; minor injury dispute relating to shoulders only and whole person impairment (WPI) assessment; claimant had significant injuries for work-related accident in 1995 with ongoing treatment and also suffering an unexpected crash tackle in April 2016 falling heavily on his right shoulder and with subsequent treatment; in December 2018 claimant had an ultrasound of his shoulders revealing a partial-thickness insertional tear at the articular surface; Panel not satisfied that this was causally related to the accident due to initial low-speed injury; opinion that an acute rotator cuff tear would have been accompanied by significant symptoms but none were documented until one month post-accident and finally that there was no indication that the right shoulder was more severely injured than the left; Held – the Panel was not satisfied that any tear of the claimants shoulders arises from the accident; Panel determined that the claimant had a total 6% WPI for both shoulders due to soft tissue impingement and not an acute tear; Panel determined that the claimant had suffered a minor injury to both shoulders.

Decision date: 9 March 2023 | Panel Members: Member Alexander Bolton, Dr Paul Curtin and Dr Margaret Gibson | Injury module: Spine, Upper and Lower Limb

AAI Limited t/as Suncorp Insurance v Guedes [2023] NSWPICMP 81

Motor Accident Injuries Act 2017; claimant was a driver in a stationary car hit from behind by a semi-trailer; injuries reported to cervical and lumbar spine and left shoulder; Held – original Medical Assessment Certificate set aside; Review Panel issued a new Certificate; claimant’s injuries caused by the motor accident and gave rise to a permanent impairment which is not greater than 10%; soft tissue injury to the cervical and spine; injury to the left shoulder not caused or aggravated by the motor accident and not give rise to a permanent impairment.

Decision date: 10 March 2023 | Panel Members: Member Ray Plibersek, Dr Thomas Rosenthal and Dr Geoffrey Stubbs | Injury module: Spine and Upper Limb

CIC Allianz Insurance Limited v Tunks [2023] NSWPICMP 82

Motor Accident Compensation Act 1999; the claimant suffered injury in a motor vehicle accident on 14 June 2016; dispute as to whether psychiatric counselling attendances on 18/4/19 and 24/1/19, 0-12 GP consultations for the next 0-10 years, 0-12 consultations with a psychiatrist for next 0-4 years, 0-12 consultations with a psychologist for next 0-4 years, one off pain management program, inpatient admission to a psychiatric unit for a period of 4-6 weeks and 0-30 tablets of anti-depressant medication per month for next 0-5 years was caused by the accident and was reasonable and necessary; section 58; Held – diagnosis of post-traumatic stress disorder and major depressive disorder caused by the accident; certificate of Medical Assessor Paisley revoked; Panel certified psychiatric counselling attendances with psychiatrist on 18 April 2019 and 24 January 2019, four GP consultations per year for the next two years for the psychological injuries, 12 consultations with a psychologist per year for the next two years, 12 consultations with a psychiatrist per year for the next two years and a therapeutic dose of anti-depressant medication per month for the next two years constituted evidence based treatment; treatment reasonable and necessary and caused by the accident; Panel unable to stipulate future dosage of anti-depressant medication; Panel certified admission as an inpatient into a psychiatric unit for a period of 4-6 weeks not reasonable and necessary in the circumstances; treatment dispute in relation to one-off pain management program for a three week period does not relate to the psychiatric injury.

Decision date: 10 March 2023 | Panel Members: Member Susan McTegg, Dr Gerald Chew and Dr Samson Roberts | Treatment Type: Psychiatric Treatment, GP Consultations, Medication – Prescription, Pain Management Program and Psychological Treatment (Including Counselling)

QBE Insurance (Australia) Limited v Orlando [2023] NSWPICMP 83

Motor Accidents Compensation Act 1999;medical dispute and review under section 63 of Medical Assessor (MA) Woo’s assessment of 14% whole person impairment (WPI); injuries originally assessed were cervical and lumbar spine and right and left shoulder; error in recording of either findings or diagnosis related estimate (DRE) category in cervical spine; issue of assessment of right shoulder assessment and any reduction for pre-existing impairment; Held – Panel satisfied claimant sustained soft tissue injuries to his neck, lower back and both shoulders; claimant had two year history of shoulder symptoms, saw his GP, had scans and consulted an orthopaedic surgeon in the 3-4 weeks before the accident; claimant had full range of shoulder motion a year after the accident; Panel satisfied claimant’s right should injury was an aggravation of pre-existing condition and any aggravation had ceased; Certificate of MA Woo set aside and WPI of 10% found (DRE II in neck and back).

Decision date: 13 March 2023 | Panel Members: Member Belinda Cassidy, Dr Neil Berry and Dr Geoffrey Curtin | Injury module: Spine and Upper Limb

Workers Compensation Medical Appeal Panel Decisions

Allen v Dux Manufacturing Pty Ltd [2023] NSWPICMP 75

Rehearing following Supreme Court remittal; appeal from 4% whole person impairment (WPI) assessment for hernia and left leg thrombosis; whether adequate reasons given; whether incorrect criteria applied as to classification; Held – Medical Assessor failed to adequately explain his reasons; appellant re-examined; Medical Assessment Certificate revoked and fresh certificate for 5% WPI issued.

Decision date: 7 March 2023 | Panel Members: Member John Wynyard, Dr Paul Curtin and Dr Michael Long | Body system: Left Lower Extremity, Scarring and Digestive System

Burns v Stewart W Burns Pty Ltd [2023] NSWPICMP 76

Workplace Injury Management and Workers Compensation Act 1998; appellant submitted that the Medical Assessor (MA) erred in relation to the deduction he made pursuant to section 323; the appellant did not challenge the primary assessments by the MA; Panel agreed; no evidence of any pre-existing condition prior to the commencement of his employment in 1984; Held –Medical Assessment Certificate revoked.

Decision date: 7 March 2023 | Panel Members: Member Deborah Moore, Dr James Bodel and Dr David Crocker | Body system: Left and Right Upper Extremity and Scarring

Maclean v Pythid Pty Limited [2023] NSWPICMP 77

Workplace Injury Management and Workers Compensation Act 1998; appeal from 1/10th deduction pursuant to section 323; appellant worked as a bricklayer for at least 20 years; suffered injuries when he fell off a ladder; subsequent treatment revealed degenerative disc disease; no evidence that condition had been symptomatic; whether Medical Assessor (MA) applied the correct test for asymptomatic degenerative disease; Held – MA erroneously assumed that mere presence of degenerative disease required a 10% deduction; Elcheikh v Diamond Formwork (NSW) Pty Ltd (in liquidation) considered and applied; Medical Assessment Certificate revoked.

Decision date: 8 March 2023 | Panel Members: Member John Wynyard, Dr Mark Burns and Dr Drew Dixon | Body system: Cervical and Lumbar Spine, Left Lower Extremity and Scarring (TEMSKI)

Uniting (NSW ACT) v Miao [2023] NSWPICMP 78

Assessment of degree of impairment resulting from psychiatric injury; appellant alleged error in the assessment in one of the categories under the permanent impairment rating scale (PIRS), employability; the rating in this class was open to the Medical Assessor and the Panel could discern no error; Held – Medical Assessment Certificate confirmed.

Decision date: 8 March 2023 | Panel Members: Member Carolyn Rimmer, Dr Douglas Andrews and Dr Michael Hong | Body system: Psychological/Psychiatric

Motor Accidents Merit Review Decisions

Vlad v Insurance Australia Limited t/as NRMA Insurance [2023] NSWPICMR 15

Motor Accident Injuries Act 2017; merit review; dispute about statutory benefits under Division 3.4; costs of treatment and care, section 3.24; private hospital fees, sections 3.30 and 3.31; prescribed maximum payable for treatment at private hospital, section 8.9 and clause 34 of the Motor Accident Injuries Regulation; List of Medical Services and Fees published by the Australian Medical Association, the AMA list; clause 4.94 of the Motor Accident Guidelines; Held – the reviewable decision is affirmed.

Decision date: 10 March 2023 | Merit Reviewer: Katherine Ruschen

Ford v QBE Insurance (Australia) Limited [2023] NSWPICMR 16

Motor Accident Injuries Act 2017; merit review; dispute about payment of weekly benefits under Division 3.3; pre-accident weekly earnings (PAWE); meaning of PAWE, schedule 1, clause 4(1); whether prior PAWE decision in relation to a different accident is relevant; whether weekly payments of statutory benefits are earnings received as an earner for the purpose of PAWE Held – the reviewable decision is set aside.

Decision date: 13 March 2023 | Merit Reviewer: Katherine Ruschen

This publication is for information only. The publication is not legal advice.  The information provided is not a substitute for reading the decisions. The Commission does not accept liability for the information in this publication or for way the information is used.

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