DETERMINATION OF REVIEW PANEL	
	
CITATION:	Adaya v AAI Limited t/as GIO [2023] NSWPICMP 320	
		
CLAIMANT:	Julie Adaya	
		
INSURER:	AAI Limited trading as GIO	
		
REVIEW Panel	 	
		
MEMBER:	Susan McTegg	
		
MEDICAL ASSESSOR:	Margaret Gibson	
		
MEDICAL ASSESSOR:	Clive Kenna	
		
DATE OF DECISION:	26 June 2023	
		
CATCHWORDS:	MOTOR ACCIDENTS –   Motor Accidents Compensation Act 1999; the claimant sustained injury in a motor vehicle accident on 10 April 2015; injuries referred for assessment were the cervical spine, lumbar spine; both hips, right shoulder, right leg and left shoulder; dispute as to causation of right hip and back pain; Medical Assessor (MA) Wijetunga assessed 1% whole person impairment (WPI) for right shoulder injury; Held – claimant’s presentation straightforward; whiplash injury to neck radiating to right shoulder girdle assessable as per Nguyen v Motor Accident Authority of New South Wales & Anor; Panel satisfied as to causation of right hip and right leg injury; Panel found the accident did not cause injury to the left shoulder or left hip; Panel found accident materially contributed to soft tissue injury to lumbar spine as per Norrignton v QBE Insurance (Australia) Ltd; Panel assessed diagnosis related estimates (DRE) cervicothoracic category 1 or 0% WPI for cervical spine; right shoulder movements within normal range and no assessable permanent impairment; normal range of movements and no current evidence of trochanteric bursitis so no assessable impairment of right hip; lumbar spine assessed as DRE lumbosacral category 1, 0% WPI; Certificate of MA revoked and certificate for 0% WPI issued.

DETERMINATIONS MADE:  	Review Panel Certificate
issued under Part 3.4 of the Motor Accident Compensation Act 1999
following a review under s 63 as to
WHETHER THE DEGREE OF PERMANENT IMPAIRMENT OF THE INJURED PERSON AS A RESULT OF THE INJURY CAUSED BY THE MOTOR ACCIDENT IS GREATER THAN 10%
The Panel revokes the Certificate of Medical Assessor Nelukshi Wijetunga dated 12 October 2022 and issues a new certificate determining that the following injuries were caused by the motor accident and give rise to a whole person impairment (WPI) of 0% which is not greater than 10%:
•	cervical spine – soft tissue injury;
•	right shoulder – referred pain as per Nguyen v Motor Accident Authority of New South Wales and Anor;
•	lumbar spine – soft tissue injury;
•	right hip – soft tissue injury, and
•	right leg – soft tissue injury
The Panel finds the following injuries were not caused by the motor accident:
•	injury to the left shoulder, and
•	injury to the left hip. 

	

REVIEW PANEL REASONS FOR DECISION
BACKGROUND
1.	On 10 April 2015 Julie Adaya (the claimant) was driving when the driver of the insured vehicle travelling in the opposite direction lost control and collided with the driver’s side door of her vehicle pushing it to the left (the accident). Neither police nor ambulance attended the scene. Bystanders assisted her from her vehicle. She was five minutes from home and one of the bystanders drove her home. Her vehicle was written off. 
2.	AAI Limited trading as GIO (the insurer) is the relevant insurer with liability to pay any damages to the claimant under the Motor Accident Compensation Act 1999 (the MAC Act).
3.	This dispute is in relation to whether the degree of permanent impairment sustained by the claimant as a result of the injury caused by the accident is greater than 10%. This constitutes a medical dispute within the meaning of the MAC Act.
1.	MEDICAL ASSESSMENT UNDER REVIEW
2.	Certificate of Medical Assessor Wijetunga
4.	The following injuries were referred to Medical Assessor Wijetunga for assessment: 
•	cervical spine – mechanical injury – neck – whiplash;
•	lumbar spine – lower back, disc injuries with annular tears;
•	hips – both hips – right trochanteric bursitis and CAM lesion, consistent with significant pain on hip compression testing;
•	right shoulder – radiating injury and discrete injury;
•	right leg – radiating injury, and
•	left shoulder (Nguyen).
5.	Medical Assessor Wijetunga reported there were no signs on clinical examination or symptoms in relation to the right leg suggestive of a discrete injury and any symptoms described were referred from the lower back.
6.	She reported Ms Adaya reported neck pain, lower back pain, right hip pain, right shoulder pain and right leg pain. She noted there is no history of right hip pain or lower back pain before 2017 although Ms Adaya reported she sought treatment from her acupuncturist for her right hip pain several months after the accident. She concluded in view of her pre-existing asymptomatic condition and the delayed onset of her symptoms for several months after the accident the lower back and hip were not related to the accident. 
7.	Medical Assessor Wijetunga diagnosed a whiplash injury to the cervical spine and found any right shoulder symptoms were referred from the neck in accordance with the Nguyen principle. She reported there was no radiation of pain to the left shoulder. 
8.	Medical Assessor Wijetunga assessed the claimant on 29 June 2022 and 19 October 2022 and issued a certificate dated 20 October 2022. She certified the following injuries were caused by the accident: 
•	cervical spine – whiplash, and
•	right shoulder – whiplash associated disorder.
9.	Medical Assessor Wijetunga assessed a 1% WPI arising out of the right shoulder injury.
10.	Medical Assessor Wijetunga certified the following injuries were not caused by the accident:
•	lumbar spine and right leg;
•	both hips, and
•	left shoulder.
3.	 REVIEW PROCEDURE
11.	The claimant filed an application for review of the medical assessment of Medical Assessor Wijetunga. 
12.	On 13 September 2022 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application referred the medical assessment to the Review Panel (the Panel).
13.	The Personal Injury Commission (Commission) commenced operation on 1 March 2021 and the Claims Assessment and Resolution Service was abolished by cl 3 of Part 2, Division 2, Schedule 1 to the Personal Injury Commission Act 2020 (the PIC Act).
14.	Under cl 14A(1)(a)(vii) of Schedule 1 of the PIC Act pre-establishment proceedings include proceedings that before the establishment of the Commission were required or permitted to be dealt with by a review panel for a medical assessment constituted under the MAC Act. 	
15.	Clause 14F(2) of Schedule 1 of the PIC Act states that the new review provisions apply in relation to a decision of a new decision-maker in completed pre-establishment proceedings, including the medical assessment the subject of this review which was completed before 1 March 2021. 
16.	The new review provisions provide that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission. The President’s delegate referred this application for review to the Panel. 
17.	The Motor Accident Permanent Impairment Guidelines (the Guidelines) were issued pursuant to s 44(1)(c) for the assessment of permanent impairment. The Guidelines are based on the AMA 4 Guides. The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.
18.	Part 5 of the PIC Act enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Medical Assessor.
19.	Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.
20.	The review is by way of a new assessment of all matters with which the medical assessment is concerned.
4.	RELEVANT LEGAL AUTHORITY
21.	Causation of injury is addressed in the Guidelines:
5.	“1.5	An assessment of the degree of permanent impairment is a medical assessment matter under Section 58 (1)(d) of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person’s impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues. 
6.	1.6	Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows: ‘Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following: 
7.	1.	 The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination. 
8.	2.	The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.’ 
9.	This, therefore, involves a medical decision and a non-medical informed judgement.
10.	1.7	There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question ‘Would this injury (or impairment) have occurred if not for the accident?’ may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
22.	In Norrington v QBE Insurance (Australia) Ltd Brereton J addressed the presence or absence of a contemporaneous record of complaint in the determination of causation stating at [31]:
“In the context of medical assessment under MACA, there is now a substantial body of authority that a panel which decides the question of causation solely on the basis of the existence or otherwise of contemporaneous evidence of complaint of injury fails properly to address the questions posed by s 58(1), and that this is jurisdictional error.” 
23.	In Norrington Brereton J followed the decision of the Court of Appeal in AAI Limited v McGiffen where the Court stated at [64]:
11.	“The question that the review panel was required to address was not simply whether there was any contemporaneous evidence of complaint about an injury to the lumbar thoracic spine. It included whether Mr McGiffen’s lumbar thoracic spinal injury was causally related to the ‘gait derangement’, itself caused by the accident. That is, was the accident a contributing cause of a lumbar thoracic spinal injury by reason of the gait derangement caused by the accident.”
24.	Even more recently in Kinchela v Insurance Australia Group Ltd t/as NRMA Insurance Justice Walton set aside the decision of a Medical Review Panel. In considering the question of causation in relation to an amputated toe Justice Walton concluded that the question was not whether there was any contemporaneous evidence or corroborative evidence to support the injury but whether the motor vehicle accident materially contributed to that injury. 
12.	MATERIAL BEFORE THE REVIEW PANEL
25.	The Panel issued a Direction to the parties on 9 February 2023 (the first Direction) which required each party to file an indexed, paginated bundle of documents. 
26.	In response to this direction the solicitor for the claimant uploaded to the portal an index labelled AD1 and a bundle of documents paginated from pages 1 to 875 and labelled AD2. The solicitor for the insurer uploaded to the portal a bundle of documents paginated from pages 1 to 21 and labelled AD3.
27.	In response to a Direction issued by the Panel the claimant uploaded to the portal the following additional documents:
•	AD4 – letter from acupuncturist Tibor Horvath dated 23 September 2020 re attendances.
•	AD5 – handwritten notes of Tibor Horvath which the claimant asserts shows treatment to the right hip from 22 October 2014.
•	AD7 – a report Tibor Horvath dated 1 May 2023.
13.	Personal injury claim form
28.	 In the personal injury claim form dated 12 May 2015 the claimant listed her injuries as “shoulder & arm – right”.
29.	The medical certificate completed by Dr Martin on 30 April 2015 reports:
14.	“initial whiplash injury right side of body. Still getting nerve pain in right shoulder, upper arm & forearm”.
15.	Treating medical records 
16.	Sydney Adventist Hospital 
30.	The emergency care discharge summary dated 13 April 2015 states:
17.	“23F nursing student present with some right sided neck and shoulder pain after an MVA 2 days ago. Also complaining of right arm and hip pain.
18.	She had no midline neck tenderness on exam with normal movement of upper limbs and neck. X-ray of the c-spine showed no acute injury.
19.	I think she has a whiplash type injury.” 
20.	Clinical notes of Rouse Hill Family Medical Practice
31.	On 11 April 2015 Dr Jason Martin recorded: 
21.	“MVA yesterday
22.	hit on right side of car including her door
23.	no pain at the time
24.	woke up this morning with pain in right side of her body 
25.	has whiplash”.
32.	On 30 April 2015 Dr Martin recorded:
26.	“3 weeks after accident she is still complaining of right shoulder, elbow and forearm pain, burning pain radiating down arm
27.	No pain in neck but sometimes on shoulder blade
28.	Intermittent but quite regular
29.	Had a CT s-spine at the hospital where she works and it was NAD”.
33.	On 29 May 2015 Dr Chaudry reported she still had ongoing right arm and shoulder pain and on 11 July 2015 Dr Martin reported neck pain. 
30.	Clinical notes of Castle Towers Medical Centre
34.	On 26 March 2014 Ms Adaya was diagnosed with hypothyroidism.
35.	On 1 April 2014 it was noted “back pain persists”.
36.	Ms Adaya consulted Dr Tan on 18 June 2015 in respect of depression. No mention was made of her involvement in the accident. There were further attendances on 29 separate occasions up to and including 14 February 2017 when no mention was made of injury sustained in the accident. 
37.	On 22 February 2017 Dr Ahmed reported “also hip pain” and “no injury”. 
38.	On 13 June 2017 Dr Tan referred Ms Adaya to Westmead Hospital for an assessment and management re left sacroiliac joint and buttock pain. He recorded:
31.	“low back pain for yrs 
32.	constant presence 
33.	rad to L ankle 
34.	used to be R sided, but now L sided for the past 1 month
35.	Panadeine works
36.	No paraes/weakness.”
39.	On 22 February 2018 Ms Adaya consulted Dr Ali for sternum pain which she stated she had experienced on and off for many years. 
40.	On 9 September 2021 Dr Ali had a phone consultation with Ms Adaya in regard to pain in both hips, more on the right side. On 11 September 2020 Dr Ali recorded lower back pain going into the right buttock and thigh. 
41.	On 24 September 2020, 20 October 2020 the claimant consulted Dr Ali regarding hip pain. On 20 October 2020 Dr Ali referred Ms Adaya to Dr Hale re her hip pain.
42.	On 26 October 2020 Dr Ahmed diagnosed an L5 disc prolapse and noted Ms Ahmadi was to see an orthopaedic specialist that day. 
43.	On 2 November 2020 Dr Ali diagnosed lower back pain and prescribed Mobic. 
44.	On 17 February 2021 Ms Adaya participated in a phone consultation with regard to lower back and right hip pain.
45.	On 5 March 2021 Ms Adaya was seen about right hip bursitis.
46.	On 8 February 2022 Ms Adaya saw Dr Ali in respect of hip and back pain and depression. Dr Ali reported the pain in the lower back and hip was ongoing. On 27 May 2022 Dr Bhalla prescribed cannabis for the claimant’s chronic pain. On 10 June 2022 Dr Bhalla reported even with an increase in the CBD oil to 1.5mls twice a day there was no significant improvement in the claimant’s pain. 
37.	Clinical notes of Dr Roberta Chow
47.	Ms Adaya saw Dr Roberta Chow on 5 July 2021. She recorded the following history:
38.	“Back pain with right lateral thigh ‘hip’ pain
39.	Back/hip went out last yr when she was working as a community nurse
40.	Had to lift and carry things
41.	No obv opting event – just went out
42.	Hip often clicks and is very painful
43.	Car accident 2016
44.	Was studying nursing and had two small children
45.	But – restarted case in 2019 – with Briden’s lawyers
46.	Diagnosed with whiplash inj at the time of the original injury
47.	Had right neck and right hip pain at the time
48.	Went and had physio for 9 months
49.	Then the case was closed though pain had not fully resolved…”
48.	Dr Chow recommended laser therapy and acupuncture, to pace her activities, avoid aggravating factors, use heat and graduated exercise. She prescribed Lexapro and Allegron. 
49.	Ms Adaya saw Dr Chow on 8 July 2021, 12 July 2021, 15 July 2021, and on 19 July 2021 when she reported at the end of her first week in a new job:
50.	“has been able to stand and do more
51.	Even when on her feet all day long
52.	Less clicking than before
53.	Previous level of function – overall have improved…”
50.	On 29 July 2021 Ms Winney reported “hip and thigh are feeling much better with the lasers” and on 2 August 2021 she reported “going well. Not any back pain now just heaviness on top of thigh”.
51.	On 11 February 2022 Rachael Hughes reported Ms Adaya had returned for laser, not having attended since August 2021. She reported her back was starting to get sore. On 8 March 2023 Ms Hughes reported improvement with less pain in the hip and groin. 
54.	Reports of Dr David Hale, orthopaedic surgeon
52.	Dr Hale saw the claimant on 22 October 2020. He reported she had been plagued with intermittent right buttock pain and leg pain since the accident. He reported she was struck on the right side of the body which affected her right hip as well as right shoulder. On examination he noted the hip movements were pain free. He concluded the pain was arising from the lumbar spine.
53.	Dr Hale reviewed Ms Adaya on 26 October 2020. He reported the MRI showed dehydration of the disc at L4/5 and L5/S1 associated with disc protrusion and annular tears but no root compression. He recommended non-operative management.
54.	Dr Hale reviewed the claimant on 9 April 2021. He reported Ms Adaya continued to experience low back pain radiating to her right leg. He considered her symptoms were arising from her lumbar spine. 
55.	Tibor Horvath, accupuncturist
55.	Mr Horvath provided a report dated 1 May 2023 in which he stated Ms Adaya had been receiving care since 22 October 2014 for pelvic issues relating to ovarian cysts. He stated from 2015 onwards she attended his practice following a car accident in respect of back pain which extended down to her right hip. He reported she found the acupuncture treatment combined with mobilisation, mild stretching and mild corrective exercises was beneficial for her. He reported on occasions she requested appointments on short notice due to the severity of the pain in her lower back and hip area. 
56.	Subsequent to the accident Mr Horvath states he saw Ms Adaya on 17 September 2015, 17 October 2015, 27 October 2015, 13 April 2016, 6 December 2016, 13 December 2016, 1 September 2020 and 12 September 2020. Mr Horvath reported he is now retired. 
56.	IMAGING
57.	X-ray lumbar spine and right hip, 23 February 2017 – the report concludes:
57.	“There is minimal curvature of the upper lumbar spine convex to the left. Disc and vertebral body heights are preserved. The sacroiliac joints are unremarkable.
58.	No evidence of joint space narrowing in the right hip. There is slight cam deformity at the junction of the femoral head/neck, which could predispose to femoro-acetabular impingement.”
58.	X-ray left foot and ankle, 14 September 2017 – noted that she suffered an inversion injury to the ankle.
59.	CT left hip, 6 August 2019 – the report concludes:
59.	“Suspicion of left femoral CAM lesion/femoroacetabular impingement but unclear if there is a clinical history to go with these findings”.
60.	CT pelvis and both hips, 10 September 2020 – the report has the following comment:
60.	“Features of cam-type FAI at both hips (left worse than right)”.
61.	X-ray and MRI, lumbar spine, 22 October 2020 – the report commented:
61.	“The dominant abnormality is a central and bilateral paracentral L4/5 disc protrusion. No overt nerve root compression identified”.
62.	MRI right hip, 1 March 2021 – the report comments: 
62.	“Mild trochanteric bursitis. Probable degeneration of the labarum anterosuperiorly but without a definite tear at this stage”.
63.	On 17 March 2021 Ms Adaya underwent an ultrasound guided right trochanteric steroid and local anaesthetic injection.
63.	Medico-legal reports
64.	Report of Dr Robin Mitchell,30 April 2021
64.	Dr Robin Mitchell, occupational health physician assessed the claimant for the insurer. He reported in the accident she was struck on the right side of the body sustaining painful injuries to her right shoulder and right hip, with intermittent right buttock pain from that time.
65.	He reported Ms Adaya attended the Sanitorium Hospital and a CT scan of the neck apparently indicated whiplash injury. 
66.	Dr Mitchell reported Ms Adaya started to develop low back pain in 2020 having difficulty standing for long periods of time without experiencing discomfort.
67.	Dr Mitchell reported Ms Adaya continued to have right shoulder pain radiating down the whole of the right arm and lower back pain with radiation into the right hip. She also described a clicking sensation in the right hip all of the time. 
68.	Dr Mitchell found the claimant had normal range of movement of the cervical, thoracic and lumbar spine and of both shoulders. Dr Mitchell diagnosed a soft tissue injury to the lumbar back and right hip which he concluded was caused by the accident where following the accident the claimant developed pain down the right side of her body. 
69.	Dr Mitchell assessed a 0% WPI in respect of injury to the lumbar spine and right hip. 
65.	Dr John Davis, 27 May 2021
70.	Dr Davis occupational physician assessed the claimant on 26 May 2021. He reported the day after the accident Ms Adaya consulted her general practitioner (GP) who diagnosed a whiplash injury and referred her to physiotherapy. He reported one week after the accident she reported an onset of severe right-sided neck and shoulder pain. 
71.	He also reported since the accident, she has suffered variable pain, mainly affecting her lower back and right hip with radiation through her right buttock and postero-lateral thigh with occasional numbness. She also reported ongoing right shoulder symptoms.
72.	He noted dysmetria of the cervical and lumbar spine with reduced range of movement of the right shoulder of flexion 160°ׄ, abduction 170° and reduced range of movement of the right hip with flexion to 105° and internal rotation to 25°.
73.	He diagnosed the following:
•	mechanical injury to the cervical spine;
•	disc injuries with annular tears in lumbar spine, and
•	right trochanteric bursitis and cam lesion consistent with significant pain on hip compression testing.
74.	He assessed her as having 15% WPI.
66.	SUBMISSIONS
67.	Claimant’s submissions 
75.	The claimant provided submissions dated 18 November 2022 in support of the review. The claimant submitted when addressing causation in both hips Medical Assessor Wijetunga failed to have regard to the discharge summary from Sydney Adventist Hospital which referred to hip pain. 
76.	The claimant also submits that Medical Assessor Wijetunga erred in assessing causation of the right hip, having found it was asymptomatic she failed to explain how it could have deteriorated to its current condition without any attribution to the accident. 
77.	The claimant submits the low back would also be found to be causally related to the accident where the right hip is attributable to the accident. 
68.	Insurer’s submissions
78.	The insurer provided submissions dated 8 December 2022 in response to the review application. In respect of the right hip injury the insurer submits:
“The claimant initially commenced her claim by completing a Personal Injury Claim Form (PICF) dated 12 May 2015 where she listed injuries to her right shoulder and right arm. Attached to the PICF was a medical certificate by her then-general practitioner Dr Jason Martin (of Rouse Hill Family Medical Practice) dated 30 April 2015 where Dr Martin diagnosed whiplash injury to the right side of body, nerve pain in right shoulder, upper arm, and forearm. The claimant subsequently attended Castle Towers Medical Centre and her first consultation occurred on 18 June 2015 where the subject accident was not mentioned. There is clearly no reference to a right hip injury in these documents which were all before the Assessor.”
79.	The insurer notes that Medical Assessor Wijetunga addressed with the claimant the absence of any history of a right hip injury and clearly addressed the requirements of clause 1.41 of the Guidelines which provides:
“Where there are inconsistencies between the medical assessor’s clinical findings and information obtained through medical records and/or observations of non-clinical activities, the inconsistencies must be brought to the injured person’s attention; for example, inconsistency demonstrated between range of shoulder motion when undressing and range of active shoulder movement during the physical examination. The injured person must have an opportunity to confirm the history and/or respond to the inconsistent observations to ensure accuracy and procedural fairness.”
80.	The insurer notes there are no submissions regarding an alleged error in the assessment of the lumbar spine and even if the assessment of a 3% WPI for the right hip as per the opinion of Dr Davis is allowed the claimant will still not exceed the 10% threshold. 
69.	EXAMINATION 
81.	Ms Adaya was assessed by Medical Assessor Gibson at her rooms at St Leonards on 9 June 2023
70.	Pre-accident medical history
82.	Ms Adaya was diagnosed with hyperthyroidism in 2014 and prescribed thyroxine. She had various gynaecological problems the years, but most of these issues have now settled. 
83.	When asked about the entry in the clinical notes from Castle Towers Medical Centre of 1 April 2014 noting "back pain persists," she could not recall any specific spinal injury. She added that she may have had a "muscular thing" when she was a student nurse, but she could not recall having had any investigations or any specific treatment and there was no ongoing spinal symptoms. 
84.	Ms Adaya confirmed, that prior to the accident, there had been no significant episodes or ongoing episodes of low back pain and there had been no issues with either hip.
85.	There was no additional history of any motor accidents or work or other injuries. There was no relevant medical or surgical issues. 
71.	Relevant personal details
86.	Ms Adaya is in a long-term relationship. She and her partner were both relocating to Mount Isa. Indeed, they were leaving on the day of the medical examination. Ms Adaya had left her current job and will be taking up a full-time clinic nurse position in Mount Isa. Her partner is a builder.
87.	Ms Adaya was born in Mauritius and moved to Australia in 2007. She completed high school prior to studying nursing at university between 2010 and 2017. She said she had various unpaid nursing placements whilst studying, but she had also worked up to three days per week in a paid assistant in nursing position. The latter caring for a quadriplegic patient in his home.
88.	Once fully qualified, she worked part-time as a clinic nurse and part-time as an agency nurse. However, the combination of the two jobs approached a full-time work load, as she has had multiple part-time jobs. 
72.	History of the accident 
89.	On 10 April 2015 Ms Adaya was driving a 2001 hatchback sedan with her seat belt fastened at approximately 11.00pm. She was returning home from work. She was a few minutes from home, when a car travelling in the opposite direction lost control and collided with the driver’s side door of her car, which was then pushed to the left. She said she had attempted to steer her car to the left to avoid the impact.
90.	She said her first memory after the accident was of severe ringing in both ears and her hearing being temporarily poor. She also felt dizzy. She remembered having a lot of pain over her right chest wall and right shoulder region, due to the seat belt and bruising later developed. When asked, she said her body did not internally impact the inside of the car. When asked where the shoulder pain had been initially, she indicated the right trapezius and shoulder blade area.
91.	She was unable to get out of the car initially because her door was damaged, but bystanders arrived and helped her out via the driver’s side door. There was no air bag deployment due to it being a side impact.
92.	Police and ambulance were contacted, but no one attended, so one of the bystanders drove her home in her car. Both her car and the vehicle at fault were later written off. 
93.	The following day she visited Rouse Hill Medical Centre. She couldn’t recall the doctor's name. However, Medical Assessor Gibson pointed out the clinical notes of Dr Jason Martin of 11 April 2015 reported there was "no pain at the time, woke up this morning with pain in right side of her body, has whiplash." Ms Adaya stated the doctor had provided insufficient detail in relation to her symptoms, because she also had right-sided hip pain. When asked where the hip pain was located, she indicated the low back and right buttock, with extension "deep" into the right thigh and extending as far as the knee. Although she then added that initially there had been some spread as far as the right ankle, but this pain had resolved after she had received acupuncture and massage treatment. 
94.	When asked why the entry in the Personal Injury Claim Form of 12 May 2015 had mentioned right shoulder but not the back or hip, she said at the time she was probably more focused on these injuries as they were impacting her ability to work. 
95.	When asked about the initial certificate of Dr Martin on 30 April 2015, she said he did not sufficiently describe the location of the pain over the right side of her body which she maintains was right shoulder and right hip. 
96.	She said a few days after the accident, she was at work on her placement at the Sydney Adventist Hospital, and was still in a lot of pain, so her manager told her to go to Accident & Emergency. The hospital clinical notes of 13 April 2023 recorded complaints of right arm and hip pain. When asked about her recollection of her symptoms at that stage, Ms Adaya described diffuse pain over her right arm, weakness of her right hand and generalised right-sided body pain. She indicated pain being felt across the low back, around the entire hip and extending to the right thigh. She added she had been unable to pass her physical to gain permanent employment with the Sydney Adventist Hospital, as she lacked grip strength in her right hand and her drug test was showing codeine, which she was taking for pain at the time.
97.	The general practitioner referred her to a pain management doctor, Dr Roberta Chow. Dr Chow had provided laser therapy which Ms Adaya found helpful. 
98.	She had also had a steroid injection to her right hip at PRP radiology.
99.	Ms Adaya visited Dr David Hale, orthopaedic surgeon, on 22 October 2020. Medical Assessor Gibson read to Ms Adaya an extract from his report where he had recorded hip movements as pain free and concluded her pain was arising from the lumbar spine. Ms Adaya maintained he had told her the pain was coming from her right hip.
100.	The MRI scan performed on 26 October 2020 showed disc changes at L4/L5. 
101.	Ms Adaya was then referred to Dr Randolph Gray, spinal surgeon at Harbour Spine Surgeons. She thinks she saw him on one occasion for a very short period, when he basically told her there was nothing wrong with her. 
102.	She said she had had an MRI scan of her right hip at PRP at Norwest Private Hospital in 2022. An earlier scan undertaken in 2021 had shown trochanteric bursitis. However, the subsequent scan had failed to demonstrate abnormality.
73.	Current complaints
74.	Cervical spine
103.	Ms Adaya said there was "nothing really", unless she was doing a lot of lifting or carrying using her right upper limb, which would "trigger" pain over the right side of her neck.
75.	Lumbar spine 
104.	Ms Adaya said there was constant low back pain, generally rated at 3/10 severity (0 being no pain, 10 being severe pain), and today rated at 1/10 severity. She added that she had travelled from home today and had taken the Metro and walked from the train station. The pain was felt across the low back and involved the entire lumbar spine. 
105.	Ms Adaya was uncertain as to whether the right hip symptoms related to her back or to her right hip. However, on further clarification, she insisted the back pain did not spread beyond her back.
76.	Left hip 
106.	Ms Adaya confirmed she had no ongoing symptoms

Right hip 
107.	Ms Adaya indicated she experienced constant pain all over the right hip region and into the right thigh, where it was felt deep in the muscle. She said the right hip clicks and locks at times and feels stiff.
77.	Right shoulder 
108.	Ms Adaya indicated she had pain in the trapezius and infrascapular region. She stated the pain was present some of the time and of marginal severity on the day of the medical assessment.
78.	Left shoulder 
109.	Ms Adaya had no symptoms.
79.	Right arm 
110.	Ms Adaya said there is only pain if she overuses the arm and then there is deep-seated pain felt in the upper arm extending as far as the elbow.
80.	Left arm
111.	Ms Adaya had no symptoms.
81.	Current treatment
112.	Ms Adaya attends a massage therapist in a shopping centre on a monthly basis (City Cave). She does her own acupuncture and laser therapy at home. 
113.	She had tried Mobic and Naprosyn but found these unhelpful. She takes Panadol or Nurofen for flare-ups of pain, averaging about 10 tablets a week.
82.	Planned treatment
114.	Ms Adaya said she would like to have more physiotherapy, but she lacks time. She would also like to continue massage therapy. 
115.	Ms Adaya had not visited Dr Chow for over a year. She said Dr Chow was only really doing the laser therapy which was costly and which she now does at home.
116.	There are no further plans to visit Dr David Hale, Orthopaedic Surgeon, nor Dr Randolph Gray.
83.	Physical examination 
117.	Ms Adaya was pleasant and cooperative. She became tearful at times when clarification was sought in relation to the clinical notes, but she accepted these enquiries were required as part of the assessment. 
118.	She was 164cm tall and weighed 68kg. She had a normal gait. She could walk on heels and toes. Trendelenburg sign was negative bilaterally.
119.	On examination of the cervical spine, there was full normal range of movement. There was no muscle spasm or guarding, and no asymmetry of movements. 
120.	On examination of the upper limbs, circumferential measurements were consistent with right hand dominance, therefore there was no muscle wasting. There was normal power, sensation, and reflexes bilaterally.
121.	On examination of both shoulders, movements were bilaterally normal and measured as follows:
Shoulder Movements	Active ROM Measured
RIGHT	Active ROM Measured
LEFT	
Flexion	180 °	180 °	
Extension	50 °	50 °	
Internal Rotation	80 °	80 °	
External Rotation	80 °	80 °	
Abduction	180 °	180 °	
Adduction	50 °	50 °	

122.	On examination of the lumbar spine, there was slight tenderness over the lower lumbar facets. Spinal movements were within normal range. There was no muscle spasm or guarding, and no asymmetry of movements. 
123.	On examination of the lower limbs, circumferential measurements were equivalent, therefore there was no muscle wasting. There was normal power, sensation and reflexes. Straight leg raise was to 80 degrees bilaterally. Neurotension signs were negative bilaterally. 
124.	Hip and knee movements were within normal range. There was no pain reported with movements of either hip.
125.	Hip movements were as follows:
Hip movements	Right 	Left 	
Flexion	120 	120 	
Internal Rotation	30 	30 	
External Rotation	40 	40 	
Abduction	30 	30 	
Adduction	20 	20 	
Consistency of presentation 
126.	Ms Adaya’s presentation was straightforward and there was no suggestion of embellishment or inconsistency. However, she was convinced her treating medical practitioners had failed to record the extent of her symptoms, whilst also conceding at the time she was probably more focused on her right shoulder and arm which was impacting her ability to work. 
84.	DIAGNOSIS AND CAUSATION 
127.	Ms Adaya is a 31-year-old right-handed registered nurse who was involved in the accident on 10 April 2015.
85.	Neck and right shoulder
128.	Initial complaints were of dizziness, tinnitus and chest and right shoulder girdle pain in relation to the seat belt. However, over the next few days, she had developed right-sided body pain. These symptoms were widespread so not documented at the time as being specific to the right shoulder and the right hip. And, over time there was no convincing evidence for any specific injury to the right shoulder. There was also no imaging available of the right shoulder, suggesting that the right shoulder had not been an area of concern for her treating doctors. 
129.	Ms Adaya pointed out her main symptoms were her right shoulder and arm although, in the opinion of the Panel the pain originates in the right shoulder girdle and arises from the neck.
130.	The Panel finds evidence of a whiplash injury to the neck, with right sided intrascapular and trapezial pain secondary to the neck pain, and therefore assessable for impairment purposes in accordance with the principle in Nguyen v Motor Accident Authority of New South Wales and Anor.
86.	Right hip and right leg
131.	There was contemporaneous evidence of a soft tissue injury to the right hip noting the complaint recorded in the Sydney Adventist Hospital notes. Whilst there is a lack of further complaint thereafter until 2017 the Panel notes the impact was to the driver’s side door and accepts the claimant sustained injury to the right hip and right leg caused by the accident. There was imaging evidence of right sided trochanteric bursitis, but the bursitis has now resolved. Nevertheless, she is still reporting right hip and thigh pain.
132.	The Panel finds the claimant sustained a soft tissue injury to the right hip and right leg caused by the accident. 
87.	Left shoulder and left hip
133.	There was no contemporaneous evidence of left shoulder or left hip injury. On examination there were no current left shoulder or left hip complaints. This was consistent with the clinical findings of Medical Assessor Wijetunga. 
134.	The Panel finds the claimant did not sustain injury to the left shoulder or the left hip caused by the accident. 
88.	Lumbar spine
135.	The lumbar spine was not specifically mentioned in the early period after the accident, 
136.	The accident occurred on 10 April 2015. There is no mention of the lumbar spine in the records of Sydney Adventist Hospital, in the Personal Injury Claim form dated 12 May 2015, in the clinical records of Dr Martin of 11 April 2015 and 30 April 2015, or in the clinical records of Dr Chaudry of 29 May 2015 and 11 July 2015. Ms Adaya consulted Dr Tan on 18 June 2015 and on 29 further occasions up to an including 14 February 2017 without mention of injury sustained in the accident. Whilst acupuncturist Mr Horvath stated Ms Adaya had attended his practice in respect of back pain extending down to the right hip from 2015 although her first attendance on Mr Horvath following the accident was not until 17 September 2015. In his referral to Westmead Hospital on 13 June 2017 Dr Tan recorded “low back pain for yrs”. 
137.	The Panel notes Ms Adaya attended Castle Towers Medical centre on 1 April 2014 when it was reported “back pain persists”. The Panel accepts whilst there had been some prior low back symptoms, there was no evidence this had been an ongoing issue by the time of the accident.
138.	Having regard to the caution required to be exercised when addressing the absence of a contemporaneous record of complaint as per the line of authority in decisions such as Norrington and Kinchela the Panel is satisfied having regard to the claimant’s attendances on Mr Horvath, the claimant’s presentation when examined, and her subsequent complaints of back pain and treatment by Dr Chow that the accident materially contributed to a soft tissue injury to the lumbar spine. 
89.	ASSESSMENT OF PERMANENT IMPAIRMENT
90.	Cervical spine 
139.	Ms Adaya had no significant clinical findings. There was no muscle wasting, muscle spasm, guarding or asymmetry and no radicular complaints. There was also no evidence of radiculopathy and therefore she would satisfy the criteria for DRE Cervicothoracic Category I, 0% WPI.
91.	Right shoulder
140.	The right shoulder movements were within normal range and there is no assessable permanent impairment. 
92.	Right hip
141.	There were no clinical findings that would give rise to any assessable impairment, as there was a normal range of movements and no current evidence of trochanteric bursitis.
93.	Lumbar Spine
142.	Ms Adaya had no significant clinical findings, in particular no muscle spasm, guarding or asymmetry. There were no radicular complaints. Lower limb neurology was normal, therefore there was no radiculopathy. Thus, Ms Adaya would satisfy the criteria for DRE Lumbosacral Category I, 0% WPI.
94.	CONCLUSION
The Panel revokes the Certificate of Medical Assessor Nelukshi Wijetunga dated 12 October 2022 and issues a new certificate determining that the following injuries were caused by the motor accident and give rise to a whole person impairment (WPI) of 0% which is not greater than 10%:
•	cervical spine – soft tissue injury;
•	right shoulder – referred pain as per Nguyen;
•	lumbar spine – soft tissue injury;
•	right hip – soft tissue injury, and
•	right leg – soft tissue injury
The Panel finds the following injuries were not caused by the motor accident:
•	injury to the left shoulder, and
•	injury to the left hip.