Helen Huang
Special Counsel
CTP Insurance, Insurance
Is a flare up of pre-existing Crohn’s disease a threshold injury?
16 June, 2025
In Brief
- The onus is on the Claimant to demonstrate that a motor accident made a material contribution to the non-threshold injury they allege.
Facts
The Personal Injury Commission (PIC) published its decision in Nelson v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 380 on 13 June 2025.
The Claimant was involved in a motor accident on 11 June 2023 and alleged sustaining injuries to the cervical spine, thoracic spine, lumbar spine, abdomen and an aggravation to his pre-existing Crohn’s disease.
The matter proceeded to the Commission for a threshold injury dispute.
The original Medical Assessor determined all of the injuries were threshold injuries for the purposes of the Act.
The Claimant sought a review.
The Review Panel’s Determination
The Review Panel determined the injuries to the cervical spine and lumbar spine were soft tissue in nature and were, therefore threshold injuries.
The Review Panel determined the motor accident did not cause an injury to the upper back or the abdomen because the contemporaneous evidence included no history of any complaints in these areas and, on re-examination, there were no abnormalities affecting the upper back of abdomen.
In respect to the Crohn’s disease, the Panel accepted:
- Crohn’s disease is a chronic inflammatory intestinal disease characterised by periods of flares and remissions.
- The Claimant conceded he ceased previous treatment which led to a destabilisation of his Crohn’s disease.
- The flare up one month-post accident was unrelated to the accident because there were similar episodes of disease relapse associated with non-compliance in 2021 and later in 2024.
- The contemporaneous evidence demonstrated no significant change in the course of the Claimant’s pre-existing disease caused by the motor accident.
- There was no history of significant abdominal trauma in the post-accident period.
- The flare up of the Claimant’s pre-existing Crohn’s disease was most likely caused by the non-adherence to prescribed medication and the history of the disease.
The Panel did not deal with the question of whether Crohn’s fell within the definition of a threshold injury because the disease was not caused by the motor accident.
Why This Case is Important
The decision in Nelson takes it back to basics – the Review Panel concluded that the accident did not cause any non-threshold injury because a review of contemporaneous evidence failed to reveal any change to the course of the Claimant’s condition, caused by the motor accident.
If you have a query relating to any of the information in this case note, or would like to discuss a similar matter of your own, please don’t hesitate to get in touch with CTP Insurance Special Counsel Helen Huang today.
