Sliding Doors – did an accident cause fractured ribs or not?

In Brief

• In assessing whether a claimant has sustained “threshold injuries”, pursuant to s 1.6 of the Motor Accident Injuries Act 2017 (MAIA), diagnostic imaging is helpful but no determinative.
• A PIC Medical Assessor may look at all the evidence – including the clinical opinion of hospital staff specialists – to determinate whether an accident caused above-threshold injuries.

Facts

On 8 December 2023, the Personal Injury Commission (PIC) published its decision in Ghaznawi v Allianz Australia Insurance Limited [2023] NSWPICMP 603.

The Claimant was injured in a motor accident on 3 February 2019 whilst boarding a bus. The rear doors closed on her, without warning and she was thrown onto her right side, hitting the side of the bus as she fell. The Claimant sustained a range of soft tissue injuries, but also alleged fractured right ribs.

The Insured determined that the Claimant only sustained threshold injuries given that there was no imaging to confirm the fractured ribs she alleged. An x-ray of the Claimant’s chest showed no rib deformity. The Claimant did not undergo a CT scan because she was pregnant.

A PIC Medical Assessor agreed with the Insurer that the Claimant only sustained threshold injuries because the Claimant’s rib fractures were not confirmed.

Medical Review Panel Reasons

The Medical Review Panel accepted that the Claimant sustained fractured ribs as a consequence of the accident because:

• There was clear contemporaneous evidence in the hospital records which confirmed that the Claimant sustained a significant and painful chest injury.
• The Claimant’s examining doctors diagnosed rib fractures given her severe pain, necessitating a strong opiate analgesia, and her signs on clinical examination.
• Rib fractures may be difficult to identify on a plain x-ray.
• The Claimant’s ongoing chest pain, post-discharge, further supported the rib fracture diagnosis.

The Medical Review Panel therefore confirmed that the accident caused non-threshold injuries in the form fractured ribs.

Key Learnings

The decision in Ghaznawi v Allianz Australia Insurance Limited  reminds us that the PIC Medical Assessors will look at all the evidence to determine what injuries a Claimant sustained.

In this claim, a CT scan would have provided strong evidence – one way or the other – regarding whether the Claimant fractured her ribs. The Claimant was not able to undergo a CT scan, however, because she was pregnant. A less conclusive x-ray did not confirm any fractured ribs.

That, however, was not the end of the matter. The Medical Review Panel looked at all the evidence – including the opinion of hospital staff specialists – and concluded there was sufficient clinical evidence to demonstrate fractured ribs.

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 Principal Peter Hunt