AAI Limited t/as AAMI Limited v Jacobs [2024] NSWSC 371
Catchwords: ADMINISTRATIVE LAW – Judicial review – whether time should be extended to allow judicial review of the first of three decisions – extension of time not granted – where judicial review of the following two decisions also fails
Supreme Court
New South Wales
Amendment notes
Medium Neutral Citation:
AAI Limited t/as AAMI Limited v Jacobs [2024] NSWSC 371
Hearing dates:
5 April 2024
Date of orders:
11 April 2024
Decision date:
11 April 2024
Jurisdiction:
Common Law
Before:
Elkaim AJ
Decision:
1. The amended summons
is dismissed.
2. The plaintiff is to pay the first defendant’s costs of the proceedings.
3. No other order
is made
as to costs.
4. I will hear the parties if any amendments to the
costs
orders are requested within 14 days .
Catchwords:
ADMINISTRATIVE LAW – Judicial review – whether time should be extended to allow judicial review of the first of three decisions – extension of time not granted – where judicial review of the following two decisions also
fails
Legislation Cited:
Motor Accident Compensation Act
1999
(NSW), ss
63 , 131
Uniform Civil Procedure Rules 2005 , Pt 59,
r 59.10
Motor Accident Permanent Impairment Guidelines
(2018),
cll 1.5, 1.6, 1.18.1, 1.203, 1.218
Cases Cited:
Campbelltown City Council v Vegan
(2006) 67 NSWLR 372;
[2006] NSWCA 284
Insurance Australia Group Limited t/as NRMA Insurance v Keen
(2021) 399 ALR 765;
[2021]
NSWCA 287
Lederer v Insurance Australia Limited Trading as NRMA Insurance
[2022] NSWSC 322
Minister for Immigration and Multicultural Affairs v Bhardwaj
209 CLR 597; [2002] HCA 11
Plaintiff M64-2015 v Minister for Immigration and Border Protection
(2015) 258 CLR 173; [2015] HCA 50
Rodger v De Gelder
[2015] NSWCA 211
Wingfoot Australia Partners Pty Ltd v Kocak
( 2013) 252 CLR 480; [2013] HCA 43.
Category:
Principal judgment
Parties:
AAI Limited t/as AAMI Limited (Plaintiff)
Rianna Jacobs (First Defendant)
Jeremy Lum in his capacity as the Delegate of the President of the Personal Injury Commission of New South Wales (Second Defendant)
Yu Tang Shen in his capacity as a Medical Assessor of the Personal Injury Commission (Third Defendant)
The President of the Personal Injury Commission of New South Wales (Fourth Defendant)
Representation:
Counsel:
Mr B Jones (Plaintiff)
Mr M Robinson SC (First Defendant)
Dr J Lucy (First Defendant)
Solicitors:
Moray & Agnew (Plaintiff)
Gajic Lawyers (First Defendant)
Crown Solicitors Office of NSW (Second, Third & Fourth Defendants)
File Number(s):
2024/40534
Publication restriction:
Nil
Decision under appeal
Court or tribunal:
Personal Injury Commission
Jurisdiction:
Motor Accidents Division
Date of Decision:
04 September 2023
Before:
Yu Tang Shen
File Number(s):
M10563464/23
JUDGMENT
The plaintiff is an insurance company.
The first defendant has brought a claim for compensation arising out of a motor
vehicle
accident on 18 June 2017.
The claim
was made
under the
Motor Accident Compensation Act
1999
(NSW) (the MACA).
There is a dispute between the plaintiff and the first defendant about the extent of the first defendant ’ s whole person impairment (WPI).
A WPI is important because it plays a significant part in the assessment of the quantum of damages to which an injured person might
be entitled .
Without a n
WPI
in excess of
10% a clamant is not entitled to non-economic loss :
s 131 of the MACA.
The WPI dispute
was referred
to the third defendant for an assessment of the first defendant ’ s WPI.
The third defendant concluded
that
the
first defendant ’ s
WPI was 17%.
A certificate to this effect was issued on
8
September 2023.
The plaintiff disagreed with this assessment and, pursuant to s 63 of the MACA,
requested a
review of the assessment.
On 1 November 2023 the second defendant
refused the request .
The plaintiff then asked the second defendant to effectively review the decision that
he
had made
on 1 November 2023 .
The second defendant , on 6 December 2023,
again said
‘ No ’ .
The fourth defendant is the president of the Personal Injury Commission of New South Wales.
Each of the second, third and fourth defendants have filed submitting appearances.
On
1 February 2024,
the plaintiff filed a summons in this court seeking judicial review of the decisions that had
been made
by the second and third defendants.
An amended summons
was filed
on 21 March 2024.
Judicial review proceedings
are
governed by Pt 59 of the Uniform Civil Procedure Rules 2005
(NSW)
(the UCPR) .
Rule 59.10 says proceedings for a judicial review must
be commenced
within three months of the date of the decision.
The rule allows for an extension of time . S ub- rule (3)
sets out some considerations that a court should
take into account
in
deciding if
an extension
should be granted .
The amended summons seeks judicial review of the decisions made on 4 September 2023, 1 November
2023,
and 6 December 2023.
The filing of the summons on 1 February 2024 is obviously more than three months beyond the decision made on 4 September 2023.
Accordingly ,
the plaintiff seeks an order extending time for the commencement of the proceedings against the third defendant.
The extension of time
was opposed .
Objection to the plaintiff’s
affidavit
of Ms Frances Allen dated 2 April 2024
The plaintiff initially relied on ly
on the
affidavit
of Ms
Johanna Ellem
dated
29 February 24
The first defendant
relied on
the
affidavit
of Ms
Sareeya Misiano
dated
14 March 2024
On
1 5 February 2024,
a direction was made that the plaintiff was to file and serve any
affidavits
on which it intended to rely by 29 February 2024.
The plaintiff ’ s
affidavit
did not deal
with the extension of time.
The plaintiff ’ s opening written submissions also did not consider the extension.
The first defendant ’ s opening written submissions make it
very clear
that the extension of time is opposed ,
and it is a very real issue.
No doubt prompted by the first defendant ’ s submissions the plaintiff now wishes to rely on
an affidavit
of Ms
Frances
Allen which addresses the time issue.
The first defendant opposed reliance on this
affidavit , but if admitted, challenged various paragraphs in the affidavit .
I indicated during the hearing that I would give leave to the plaintiff to rely on the
affidavit .
T he first defendant ’ s submissions were to the effect that the
affidavit
did not make any real difference .
As to the paragraphs that were objected to, the basis was that they contained hearsay material and , in particular, did
not reveal the source of the instructions.
There is an overwhelming inference that the source of the instructions is the plaintiff, namely the insurer giving the solicitor instructions on how to proceed .
Once again, senior counsel for the first defendant said that the contents of the paragraphs were of little significance .
I formally allow ed
them to remain in the
affidavit .
Should time
be extended
in respect of the 4 September 2023 assessment ?
As I have said, the amended summons attacks three decisions.
The review of the second decision is just in time (the last day).
The review of the third decision is in time.
Theoretically therefore, if I did not extend time in respect of the
4
September 2023 decision, the summons could proceed in respect of the other two decisions.
In opposing the extension of time ,
the first defendant relied heavily upon the decision of the NSW Court of Appeal in
Insurance Australia Group Limited t/as NRMA Insurance v Keen
(2021) 399 ALR 765 ;
[ 2021 ]
NSWCA 287 .
Leeming JA said, at [64]:
“That is not an end to the matter . There is to my mind a difficulty in the insurer waiting for a full three months from the decision of the proper officer, only then to bring judicial review proceedings which
were principally directed
to the operative decision, that of the medical assessor .
The three-month period stated in UCPR r 59.10 reflects the fact that proceedings for judicial review should be determined quickly .
It will often be the case, as here, that there are no issues of disputed fact in the judicial review proceedings, which can and should be determined promptly, especially where
the decision is merely an intermediate step in the determination of a claimant’s ultimate entitlement .
Many
provisions reflect the need for timeliness.
One is that an application under s 63 must be made
promptly (in 2019, the period was
30
working days; it is now 28 days: s
63(7)) .
Another is the duty of an insurer
“to endeavour to resolve a claim, by settlement of otherwise, as justly and expeditiously as possible”: s 80(1) .
The Legislature
regarded
that duty as of sufficient importance to deem it to be a condition of the insurer’s licence: s
80(2) .
All
of
this sits uneasily with an entitlement to delay the commencement of proceedings for judicial
review.”
The position here is
perhaps more
‘ difficult ’
for the plaintiff
than in
Keen
.
The primary attack, from a judicial review aspect, made in the present matter is against the decision of the medical assessor which
was made
on
4
September 2023 .
The
intervening
period is almost 5 months .
It is also notable that the plaintiff waited to the very limit of the r 59.10
time period
following the dismissal of the review application on 1 November 2023.
This action brings into play the observations
made
in
Keen
at [65] and [66]:
“65.
The insurer needed an extension of time before the primary judge .
That may arise in blameless circumstances . A timely application for review may
be refused
by the proper officer with the disappointed litigant only learning the outcome more than three months after the medical assessor’s decision. Ordinarily, if litigation
is commenced
promptly thereafter, there will be a proper basis for the requisite extension of time.
But in the present case, the insurer delayed for three whole months after the adverse decision of the proper officer, only then to approach the court for an extension of time to review the decision of the medical assessor.
66.
If a claimant or an insurer takes that course, it would be appropriate to provide an evidentiary account for the delay .
If the delay is of the insurer, then it would be appropriate for the insurer
in the course of
providing that evidence
to explain how the course it has taken complies with the duties to which it is subject.”
It is clear from Ms Allen ’ s
affidavit
that the first defendant did not
‘ suddenly ’
find out about the rulings, but instead was giving instructions and gathering advice through the process .
The type of explanation called for on the part of an insurer in
Keen
,
at [66], is
absent .
There is no explanation of
“ how the course it has taken complies with the duties to which it is subject. ”
The
explanation given is
essentially no
more than a timetable of events that occurred.
The first defendant pointed out that the accident occurred in 2017
and that
a
significant time
has passed which should have prompted more speedy action on the part of the insurer .
Although the date of the accident is not irrelevant,
I accept the plaintiff ’ s submission
that the more relevant starting date is
14 March
2023 when the first defendant submitted a dispute concerning her WPI.
Notwithstanding the chronological point just made ,
it nevertheless remains the case that an insurer has a statutory obligation to act expeditiously .
The considerations listed in r 59.10(3), to the extent they are relevant, also do not assist the plaintiff:
t he plaintiff has a distinct interest in challenging the decision .
This consideration would normally operate in favour of the plaintiff .
However, in this matter the consideration operates against the plaintiff because, being aware of its interest, it should have acted promptly .
As pointed out by the first defendant, the plaintiff
“ is a sophisticated party that regularly brings judicial review applications in relation to motor accident decisions ” ;
a lthough, as I have said above, the application in respect of the WPI dispute commenced in 2023, the history of the matter does go back to 2017 ;
t he plaintiff would have become aware of the decisions very soon after they
were made , if not on the day they were made ; and
a lthough there is
a general public
interest in claims being resolved expeditiously, I
do
not regard public interest
a s relevant to this matter .
Primarily therefore ,
because of the plaintiff ’ s ina dequately
explained delay, and the delay itself, I am of the view that the re
should not be an extension of time.
This conclusion theoretically obviates the need to deal with the complaints in respect of the first decision .
However ,
in case I am wrong on the extension, a nd to the extent that a judicial review of the second decision is still viable, I make the following comments
about the first decision .
The decision of the medical assessor made on
4
September 2023
The principles for judicial review were set out by the High Court in
Plaintiff M64-2015 v Minister for Immigration and Border Protection
(2015) 258 CLR 173; [2015] HCA 50 at [23]-[2 5 ]:
“23 .
It is necessary to make
some
preliminary observations in relation to the constraints within which the plaintiff's challenge to the validity of the Delegate's decision falls to be determined .
These constraints are aspects of the scope of judicial review of administrative action, which
is confined
to the legality of the Delegate's decision .
In particular, judicial
review is concerned with whether the Delegate's decision was one which he was authorised to make; it is not:
‘an appellate procedure enabling either a general review of the … decision … or a substitution of the … decision which the … court thinks should have been made.’
24.
First, the burden is upon the plaintiff to demonstrate that the Delegate's decision
was affected
by jurisdictional error .
The plaintiff must show that the approach adopted by the Delegate
‘manifest[ed] a legally erroneous view as to what it was about which [he] needed to be satisfied’,
so that the Delegate lacked legal authority to make the decision that
was made.
25.
It
is well settled
that in the context of administrative decision-making, the court is not astute to discern error in a statement by an administrative officer which was not, and was not intended to be, a statement of reasons for a decision that is a broad administrative evaluation rather than a judicial decision .
It is possible that error of law on the part of the Delegate might be demonstrated by inference from what the Delegate said by way of explanation of his decision; but it must be borne in mind that the Delegate was not duty-bound to give reasons for his decision, and so it is difficult to draw an inference that the decision has been attended by an error of law from what has not been said by the Delegate. Further,
‘jurisdictional error may include ignoring relevant material in a way that affects the exercise of a power’; but here the plaintiff does not show that relevant material
was ignored
simply by pointing out that it was not mentioned by the Delegate, who was not obliged to give comprehensive reasons for his decision . Further, the Delegate's letter
is
‘not to be scrutinised upon over-zealous judicial review by seeking to discern whether some inadequacy may be gleaned from the way in which the reasons are expressed’.”
The plaintiff ’ s complaints substantially emanated from two distinct areas of the assessment; the
assessors
treatment of causation and the assessors asserted failure to properly assess the first defendant ’ s pre-existing mental health status, including the application of that status in reduction of the assessed WPI.
Causation
T he plaintiff submitted that the words:
“ There is a plausible mechanism of injury from the circumstances of the physical injuries (pain) from the subject accident and the development of her psychiatric injuries
…”
w ere
not, at least as required by the
M otor Accident Permanent Impairment Guidelines
(2018) , a
compliant
expression of causation.
For example, cl l
1.5 and 1.6
of the guidelines
state:
“1.5
The
assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person’s impairment is related to the accident in question
is therefore implied
in all such assessments.”
1.6
Causation
is defined in the Glossary at page 3 16
of the AMA4 Guides as follows:
‘Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition .
To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical conditioning has, in fact, done so, it is necessary to verify both of the following:
1.
The alleged factor
could have caused
or contributed to worsening of the impairment, which is a medical determination.
2.
The alleged factor
did cause
or contribute to worsening of the impairment, which is a non-medical determination ’.”
The plaintiff complained that a
“ plausible mechanism ”
was not a verification that the accident
“
did
cause or contribute to worsening
of the impairment ”
(emphasis added) .
The argument ignores the words
“ or contribute ”
which, in my view, do fit within the scope of a plausible mechanism.
I
was next taken
to cl 1.18.1
of the guidelines
which calls upon the assessor to assess WPI in three stages:
f irstly, a review and evaluation of the available evidence, secondly an interview and a clinical examination and thirdly the preparation of a certificate applying the guidelines.
Then I
was referred
to cl 1.203
of the guidelines , which states:
“The assessment of mental and behavioural disorders must
be undertaken
in accordance with the psychiatric impairment rating scales (PIRS) as set out in these Guidelines. …
”
Emphasis
was placed
by the plaintiff on the word
“ must ” .
Bringing all these clauses together, the plaintiff asked:
w hy had the plaintiff ’ s submissions made to the assessor concerning causation effectively
been ignored ?
This included reliance upon the report of a biomedical engineer, Mr Griffiths, who gave an opinion that because of
“ the minor nature of the accident
…
it was not possible for the claimant to have sustained the injuries alleged in the subject accident. ”
I will have more to say about Mr Griffith ’ s report when dealing with the 1 November 2023 decision ;
w hy had the opinion of Dr Vickery, a psychiatrist,
been
misinterpreted ?
The
WPI
assessment did refer to a diagnosis of a Somataform Chronic Pain Disorder found by Dr Vickery, but ignored the fact that Dr Vickery did
not
at tribute the disorder to the accident ; and
w hy had the opinion of Dr Keller
been ignored ?
Dr Keller, an occupational physician, pointed out that the first defendant had
“ an extensive prior history of neck, shoulder and back complaints
…
. ”
Further, in a later report he said:
“ Any possible minor soft tissue strains
attributable to the accident would have been expected to recover within days or weeks following the accident. ”
The plaintiff submitted that the answers to
all of
the above questions pointed to the assessor having
disregarded
all of the con trary
views so that the causation issues had not been properly dealt with.
The first defendant responded with th is
concession :
“Can I say this, your Honour, it is not a perfect decision. It is not fantastic reasoning but, as we said in the submissions, we know why the medical assessor here found for causation.”
In short , submitted the first defendant, the third defendant found
there had been physical injuries which in turn caused psychiatric injuries.
Both parties referred me to
a number of
authorities, and both drew my attention to the decision of the High Court in
Wingfoot Australia Partners Pty Ltd v Kocak
(2013) 252 CLR 480; [2013] HCA 43 .
The following paragraphs
[47] and [56]
are most relevant:
“47
The
function of a Medical Panel is to form and to give its own opinion on the medical question referred for its opinion. In performing that function, the Medical Panel is doubtless obliged to observe procedural fairness, so as to give an opportunity for parties to the underlying question or matter who will be affected by the opinion to supply the Medical Panel with material which may be relevant to the formation of the opinion and to make submissions to the Medical Panel on the basis of that material. The material supplied may include the opinions of other medical practitioners, and submissions to the Medical Panel may seek to persuade the Medical Panel to adopt reasoning or conclusions expressed in those opinions. The Medical Panel may choose in a particular case to place weight on a medical opinion supplied to it in forming and giving its own opinion. It goes too far, however, to conceive of the function of the Panel as being either to decide a dispute or to make up its mind by reference to competing contentions or competing medical opinions. The function of a Medical Panel is neither arbitral nor adjudicative: it is neither to choose between competing arguments, nor to opine on the correctness of other opinions on that medical question. The function is in every case to form and to give its own opinion on the medical question referred to it by applying its own medical experience and its own medical expertise.
56
…
. A Medical Panel explaining in a statement of reasons the path of reasoning by which it arrived at the opinion it formed is under no obligation to
explain why it did not reach an opinion it did not form, even if that different opinion is shown by material before it to have been formed by someone else.”
The first defendant, relying on
Wingfoot
,
and submitting that the assessor did not have to resolve every controversy,
pointed out that not only did the assessor have material before him from the plaintiff, but also a good deal
of material
to the opposite effect .
For example:
Dr Verma, an occupational physician like Dr Keller, concluded that the first defendant ’ s injuries
“ were caused/exacerbated by the incident on 18/6/2017 ” ;
Dr Sun, a
rehabilitation,
and pain physician found the accident had resulted in
a number of
soft tissue injuries
including to the first defendant ’ s neck, mid back, low er
back ,
and right shoulder ;
Dr Bodel, an orthopaedic surgeon, diagnosed
“ a musculoligamentous aggravation of underlying degenerative changes in the cervical spine and lumbar spines caused by the motor vehicle accident and a rotator cuff injury to the region of the shoulders on both sides. ”
He said, in terms:
“ The injuries were caused by the motor vehicle accident on 18 June 2017 ” ; and
p erhaps most
significantly, Dr Fukui, in an unchallenged psychological medical assessment for the Personal Injury Commission ,
found in an
“ Assessment of Treatment
–
Causation ”
that the use of antipsychotic medication (Seroquel) and psychiatric and psychological treatment all
“ RELATES TO THE INJURY
caus e d by the motor accident ” .
The plaintiff submitted that this case was akin to
Rodger v De Gelder
[2015] NSWCA 211 .
Gleeson JA said of the assessment in that case, at [109]:
“Here the Panel failed to respond to a substantial argument based on evidence relied upon by Mr De Gelder as to the causation of his thoracic spine injury by the motor accident. It may also be inferred that the Panel failed to apply itself to the real question to be decided in
carrying out
its statutory function under s 58(1)(d), because it misunderstood a significant body of evidence relevant to its non-medical determination. What the Panel did amounted to a jurisdictional error. The Panel’s decision recorded in its certificate is to be regarded as a purported and not real exercise of its statutory function in s 58(1)(d), leaving that statutory function unexercised, and the Authority and the Panel liable to the relief granted by the primary judge by way of judicial review:
Ex parte Hebburn Ltd; Re Kearsley Shire Council
(1947) 47 SR (NSW) 416 at 420 (Jordan CJ).”
However, the first defendant
said that
the third defendant had considered
“ the documents provided in the application and reply ”
and any
“ additional/late documents ”
and
reached
a conclusion that was open on the whole of the material .
The first defendant said this was consistent with this passage from
Lederer v Insurance Australia Limited Trading as NRMA Insurance
[2022] NSWSC 322, at 34:
“ It may
be accepted
that a failure to respond to a substantial clearly articulated argument may constitute a denial of natural justice .
However, this does not imply an obligation to consider every piece of evidence presented or every passage in a report.”
The plaintiff placed emphasis on [35] in Lederer:
“It is also uncontroversial that an assessor is required to provide reasons, and that the statement of reasons must explain the actual path of reasoning by which the assessor arrived at the opinion formed on the medical question under consideration, in sufficient detail to enable a court to see whether the opinion does or does not involve any error of law. What
is required
to discharge that obligation is informed by the battleground between the parties. This was explained (albeit in the context of a review panel) in
Campbelltown City Council v
Vegan
:
“Where it is necessary for the Panel to make findings of primary fact,
in order to
reach a particular conclusion as to the existence, nature and extent of any physical impairment, it may be expected that the findings of material facts will be set out in its reasons. Where facts are in dispute, it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. More importantly, where more than one conclusion is open, it will be necessary for the Panel to give
some
explanation of its preference for one conclusion over another.
That aspect may have particular significance in circumstances where the medical members of a Panel have made their own assessment of the applicant’s condition and have come to a different conclusion from that reached by other medical practitioners, as set out in reports provided to the Panel.””
The first defendant
in turn
pointed out that
Wingfoot
had been decided after
Campbelltown City Council v Vegan
(2006) 67 NSWLR 372;
[20 06] NSWCA 284
and that
the important element was that the third defendant
had considered the whole of the material before him (the battleground) and had subsequently reached a conclusion that was available to him.
In other words, i t is obviously not enough to simply consider one side ’ s material, but that does not mean that every dispute in the material needs to
be described
and particularly resolved .
This ,
albeit imperfect ,
assessment did look at both sides and did reach a conclusion , including specifically on causation.
Pre-existing condition
Turning now to the complaints about errors in assessing, or even ignoring, pre-existing conditions ,
I
was particularly referred
to the following:
t he notes of the general practitioner referred to counselling and CBT, the latter
presumably
being
cognitive behaviour therapy, on 21 February 2005, 2 March 2017 and 28 March 2017 ;
Dr Teoh, a psychiatrist, in his report of 30 March 2018 took a history that
“ She has not had any counselling ” ;
Dr Vickery, also a psychiatrist, in respect of the psychological/psychiatric history noted
“ Nil reported ” ;
t he third defendant
was given
the following history:
“ She denied any pre-existing psychiatric conditions, and denied any previous treatment ” ; and
t he third defendant
was provided
with a history that the first defendant had long-standing anxiety problems.
There are
a number of
questions
and
matters arising from
the general
practitioners ’
notes:
Dr Vickery, in his report dated 4 April 2023 does not seem to regard the CBT treatment as indicative of a previous psychiatric condition .
In addition, he attributes the
CBT
treatment in 2005 to
“ pain management ”
which seems inconsistent with the note which says the first defendant attended for
“ Bacterial Vaginosis ” ;
t he two CBT treatments in 2017 are
probably related
to domestic issues .
The first note refers to
“ stressed few issues with family ”
and the second says
“ Had a confrontation with the psychologist as her husband was assessed with the psych ” ; and
t here is no clue as to whether the CBT was
of a formal nature
or even amounted to little more than a
‘ chat ’
with the GP.
The plaintiff submitted that the failure to
properly assess
a pre-existing condition is reflected in the third defendant ’ s completion of the table at [25] of the assessment .
Firstly ,
the table says there is
“ Nil ”
pre-existing psychiatric evidence and secondly ,
the table attributes a category number
without giving any reason for the decision.
The plaintiff submitted that the guidelines, at cl 1.218, require an estimate of
any
pre-existing impairment and then the subtraction of the value of that impairment from the overall WPI .
Table 11 however
attributes a Class I assessment, as has
been attributed
here, to:
“ No deficit, or minor deficit attributable to normal variation in the general population.
… ”
A finding of no pre-existing psychiatric condition is
in itself a
reason for a
C lass I rating.
It follows that no reason need
be given
if
the
rating is Class I.
Accordingly ,
I see no substance in the plaintiff ’ s complaint about the completion of the table.
The result of the above is that, if I had extended the time for the judicial review of the first decision, that review would not have succeeded.
The review decision
on 1 November 2023
I think the review decision can
be dealt
with
shortly .
The plaintiff submitted:
“The second defendant
was required
to refer the medical dispute concerning the first defendant’s WPI to a review panel if they had
‘reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application’
see s 63(2B) of MACA.”
My finding that the
assessment by the third defendant was not susceptible to judicial review means that there would have been no basis for a reference to the review panel.
The plaintiff submitted that the second defendant had
“ acted irrationally and answered the wrong question ”
in his decision at [19]:
“The insurer does not refer me to any requirement for an Assessor, who specialises in the assessment of psychiatric injuries, to make specific comment on the opinion of a bio-mechanical engineer with respect to whether the claimant could have sustained physical injuries in the subject motor accident .
The Assessor accepted that the claimant suffered pain from her motor accident-related injuries which caused the development of her psychiatric injuries . Thus, a causal nexus was
established
and the Assessor ’s reasons sufficiently convey this.”
It is important to make the following two observations about Mr Griffiths ’
report:
He seems to have reached his conclusions on the
slightest
of evidence .
As he states:
“At the time of preparing this preliminary report, I don’t have any physical evidence by way of photographs, repair assessments, or detailed descriptions, of the damage sustained by either vehicle.”
Mr Griffiths concluded:
“By the reasoning processes in Section 8, it is deduced that it would not have been possible to receive the injury alleged to the head, neck, right shoulder and arm, chest, upper and lower back or the legs in this incident.”
The conclusion reached by Mr Griffiths, as quoted in the previous paragraph, is not a conclusion that the first defendant
was not injured
at all .
It is only a conclusion that she did not receive the injuries that
are described
in the claim form and in answer to request s
for particulars .
While there would obviously be overlap, the alleged injuries
are
not necessarily the physical injuries
that form part of the causation train found by the third defendant .
Notably the third defendant refers only to the physical injuries as
“ pain ” .
I do not think the second defendant was irrational and I do not think he answered the wrong question.
Accordingly, the attack on the
second
review also fails.
The decision on 6 December 2023
On
28 November 2023,
the plaintiff wrote to the second defendant asking him to reconsider his decision .
He refused on 6 December 2023.
The refusal
was referred
to as the
Bhardwaj
decision (derived from
Minister for Immigration and Multicultural Affairs v Bhardwaj
209 CLR 597;
[2002] HCA 11 .
It may be that a
Bhardwaj
decision is not amenable to judicial review .
Whatever the case, on the findings I have made about the extension of time and the reviews of the two earlier decisions, there would be no basis for any judicial review of the decision on 6 December 2023.
Orders
The following orders flow from the above reasons:
The amended summons
is dismissed .
The plaintiff is to pay the first defendant ’ s costs of the proceedings.
No other order
is made
as to costs.
I will hear the parties if any amendments to the
costs
orders are requested
within 14 days .
**********
Amendments
11 April 2024
-
Incorrect spelling of Lum in Parties, Coversheet
15 April 2024
-
Para 30 first defendant replaced with plaintiff
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Decision last updated:
15 April 2024
Official source: https://www.caselaw.nsw.gov.au/decision/18ec650fec07a25a47640dc1