Peter Hunt
Principal
CTP Insurance, Insurance
How to Assess a Brain Injury
17 February, 2025
In Brief
- Clause 1.160 of the Motor Accident Guidelines (MAGs) provides for four categories or impairment resulting from head and brain injury.
- For brain impairment arising from mental status / intergrative functioning disturbance or emotional / behavioural disturbance, clause 6.164 of the MAGs requires evidence of “significant impact to the head” and one or more significant, medically verified abnormality such as abnormal GCS score, post-traumatic amnesia (PTA) or brain imaging abnormality.
Facts
The Personal Injury Commission (PIC) published its decision in Antonio v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 60 on 14 February 2025.
The Claimant was riding his motorbike at Dee Why on 22 March 2019 and he was involved in a motor accident. Another vehicle collided with the rear of his motorbike whilst he was negotiating a roundabout.
The Claimant alleged a variety of injuries, including an injury to this head.
The primary Medical Assessor found that the injuries the Claimant sustained in the accident gave rise to 6% whole person impairment (WPI). Importantly, the Medical Assessor found that the accident did not cause any traumatic brain injury.
The Claimant lodged an application to review the primary medical assessment.
The Review Panel’s Decision
The Review Panel concluded that the motor accident did not cause any brain injury resulting in permanent impairment.
The Review Panel observed that clause 1.160 of the Motor Accident Guidelines (MAGs) provides for four categories for impairment resulting from head and brain injury:
- Section 4.1a of the AMA 4 Guides – aphasia and communication disturbances.
- Section 4.1b of the AMA 4 Guides – disturbances of mental status and intergrative functioning.
- Section 4.1c of the AMA 4 Guides – emotional or behavioural disturbances.
- Section 4.1d of the AMA 4 Guides – permanent disturbance in level of consciousness and awareness such as a coma.
The Review Panel found, at the outset, that section 4.1d of the AMA 4 Guides did not apply because there was no evidence of any loss of consciousness or awareness.
The Review Panel considered whether section 4.1a of the AMA 4 Guides applied but concluded that it did not because the Clamant demonstrated no comprehension or communication difficulties during a 100-minute re-examination.
The Review Panel then looked at sections 4.1(b) and 4.1(c) of the AMA Guides and noted that clause 6.164 provided that for those sections to apply, there must be:
- Evidence of a `significant impact to the head’, and
- One or more significant, medically verified abnormalities such as an abnormal GCS score, post-traumatic amnesia (PTA) or brain imaging abnormality.
The Review Panel concluded that the Claimant did not meet the requirements of clause 6.164 because the contemporaneous records revealed:
- No bruising to head.
- No head laceration.
- No abnormal GCS score.
- No PTA.
- No brain imaging abnormality.
Why This Case is Important
The decision in Antonio provides an example of how a head / brain injury should be assessed via a methodical application of the Motor Accident Guidelines and the AMA 4 Guides.
The Review Panel accepted that the Claimant may well have hit his head when he fell from his motorbike. The Review Panel, however, reviewed the evidence and applied the relevant guidelines on a dispassionate basis and concluded that the evidence failed to demonstrate any brain injury giving rise to permanent impairment.
If you would like to discuss this case note, please don’t hesitate to get in touch with CTP Insurance Principal, Peter Hunt, today.
