The Claimant in Insurance Australia Limited t/as NRMA Insurance v Mangogna  NSWPICMP 509 alleged that they had sustained injuries in a motor vehicle accident on 8 January 2021.
The Insurer alleged that the Claimant had only sustained threshold injuries, as the accident had been minor and there was no contemporaneous evidence to verify a physical injury.
The matter proceeded to the Commission for determination of whether the Claimant had sustained:
A Medical Assessor determined that the accident had caused a non-threshold psychological injury. The Insurer did not seek a review.
A Medical Assessor also determined that the Claimant had sustained non-threshold physical injuries. The Insurer sought a review. The President’s Delegate was satisfied that there had been reasonable cause to suspect that the Medical Assessor’s assessment was incorrect in a material respect. The matter was referred to the Review Panel for assessment.
The Review Panel met and issued a Direction requesting submissions from the parties. The Review Panel specifically noted that the statutory question referred to the Panel was spent, because the Claimant already satisfied that she sustained a non-threshold psychological injury – and was therefore able to proceed with a claim under the MAIA.
The Review Panel invited the Insurer to consider whether it was still pursuing the review application and sought for a Notice of Discontinuance to be filed if the Insurer did not proceed.
The Insurer submitted that it had maintained its review application because it required a determination on causation of the physical injuries, which was fundamental to whether the accident caused an aggravation of the Claimant’s psychological injury. The Claimant’s alleged non-threshold psychological injury was linked to the physical injury.
The Review Panel determined that the proceedings were “lacking in substance” because there was an unchallenged finding that the Claimant had sustained a non-threshold psychological injury.
The Review Panel recommended that the Insurer’s review application be dismissed under section 54 of the PIC Act.
The Principal Member referred to the Insurer’s position that:
The Principal Member determined that:
The Application to dismiss the review of the medical assessment was rejected by the Principal Member.
The Personal Injury Commission’s 13 October decision in Insurance Australia Limited t/as NRMA Insurance v Mangogna  NSWPICMP 509 reminds us that a party has a right to seek review of a certificate if there is reasonable cause to suspect that a Medical Assessor’s assessment is incorrect in a material respect.
If the President’s Delegate was satisfied that there had been reasonable cause to suspect the medical assessment of the Medical Assessor of being incorrect in a material respect, then the matter would need to proceed to a determination by the Review Panel.
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.
On 18 October 2023 the NSW Personal Injury Commission released its decision in Alzate v Insurance Australia Limited t/as NRMA  NSWPICMR 51. The Claimant in this matter was unemployed on the date of her motor accident and was receiving parenting benefits through Centrelink.
On 24 February 2022, Richard Crookes Constructions Pty Ltd (RCC) subcontracted with Prestige Form Group NSW Pty Ltd (Prestige) to carry out formwork in connection with a construction. The formwork failed as concrete was poured into it by another of RCC's subcontractors. The concrete slab collapsed onto the ground below, causing damage to the floor underneath.