Peter Hunt
Principal
CTP Insurance, Insurance
Review Panel Sidesteps the Post Hoc Ergo Propter Hoc Fallacy
31 March, 2025
In Brief
Just because the onset of a symptom commences after an accident doesn’t mean that the symptom was caused by the accident.
Facts
The Personal Injury Commission (PIC) published its decision in AAI Limited t/as GIO v Zjalic [2025] NSWPICMP 180 on 28 March 2025.
The Claimant’s vehicle was rear-ended on 6 October 2019. He alleged multiple injuries, including injuries to his neck, upper back, shoulders, arms, lower back, hips and legs.
In addition, the Claimant alleged that he developed digestive symptoms, stomach pain and acid reflux some 2.5 years post-accident. He argued that these symptoms were caused by the pain relief medication he took for his musculo-skeletal injuries.
The Claimant’s musculo-skeletal injuries were assessed at 9% WPI. In addition, the Claimant’s gastro-oesophageal reflux and constipation were assessed at 2% WPI.
The Insurer sought a review of the latter and argued that any impairment to the Claimant’s digestive system was not caused by the motor accident.
The Review Panel’s Decision
The Medical Review Panel conducted its own assessment and confirmed the diagnosis of upper gastrointestinal tract dysfunction and lower gastrointestinal tract dysfunction – constipation.
The MRP concluded, however, that any impairment caused by these injuries was not caused by the motor accident, for the following reasons:
- Panadeine Forte, as an opioid analgesic, could cause gastrointestinal symptoms.
- According to the Claimant’s own history, however, his gastrointestinal symptoms began some two years post-accident.
- The first reference of gastrointestinal symptoms in the Claimant’s contemporaneous medical records occurred more than three years post-accident.
- The constipating effect of opioids will generally occur within two of three days, or maybe a week, of commencing a regular dosage.
- Similarly, any GORD symptoms would commence within weeks or months of commencing the use of medication.
As such, the Review Panel revoked the primary Medical Assessor’s Certificate.
Why This Case is Important
The decision in Zjalic exposes the post hoc ergo propter hoc fallacy. Just because the onset of a symptom starts after an accident does not mean that the symptom was caused by the accident.
In this case, the Medical Review Panel accepted that the use of opioid medications can cause stomach troubles. The MRP was not satisfied, however, that the Claimant’s stomach problems were caused by the accident-related medication, in this case, given that those problems began two to three years after the Claimant started taking the medication. Given the significant temporal delay, it was more likely that the Claimant’s stomach problems arose independently of the accident.
If you have a query relating to any of the information in this case note please don’t hesitate to get in touch with CTP Insurance Principal Peter Hunt today.
