Case Note: Simon v QBE Insurance (Australia) Limited [2022] NSWPICMP 216
Case Note: Simon v QBE Insurance (Australia) Limited [2022] NSWPICMP 216


Review Panel:   Member Susan McTegg, Dr Mohammed Assem and Dr Margaret Gibson


Important Takeaway:
  • Neurological symptoms must correspond with pathology identified on radiological imaging.
     
Facts

The Claimant in Simon v QBE Insurance (Australia) Limited [2022] NSWPICMP 216 alleged injuries to his cervical spine, lumbar spine and both shoulders as a result of a rear-end collision on 14 November 2020. 

He had a pre-accident history of neck pain with neurological symptoms affecting both upper limbs. Following the accident, the Claimant experienced neck pain, and some weeks later developed numbness and tingling in his left upper limb.

An MRI revealed severe left C3/4 foraminal stenosis due to a facet joint osteophyte, with compression of the left C4 nerve root - but no other neural compromise.

The claim was the subject of a Minor Injury Dispute.  At first instance, Medical Assessor Jonathan Herald certified that the Claimant’s injuries were minor injuries for the purposes of the Motor Accident Injuries Act 2017. The Claimant’s Application for Review was successful.

The main issue in dispute was whether there was evidence of cervical radiculopathy under Clause 5.8 of the SIRA Motor Accident Guidelines, which relevantly provides:

“Radiculopathy means the impairment caused by dysfunction of a spinal nerve root or nerve roots when two or more of the following clinical signs are found on examination when they are assessed in accordance with ‘Part 6 of the Motor Accident Guidelines: Permanent impairment’.

  1. loss or asymmetry of reflexes (see the definitions of clinical findings in Table 6.8 in these Guidelines)
  2. positive sciatic nerve root tension signs (see the definitions of clinical findings in Table 6.8 in these Guidelines)
  3. muscle atrophy and/or decreased limb circumference (see the definitions of clinical findings in Table 6.8 in these Guidelines)
  4. muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution
  5. reproducible sensory loss that is anatomically localised to an appropriate spinal nerve root distribution.”

Review Panel Decision

Medical Assessor Assem conducted an examination of the Claimant. At that time, the Claimant complained of neck discomfort and stiffness with a shooting pain in his left arm and pins and needles involving the left 3rd, 4th and 5th digits.

Examination revealed a positive shoulder abduction test with a burning pain over the anterior trapezius region and lateral aspect of the left shoulder, consistent with a C4/5 dermatomal distribution.

There was also reduced sensation over the left 3rd, 4th and 5th digits, but it was reported that this did not correspond with the pathology at C3/4. The Claimant had global weakness involving the entire left upper extremity, but no other neurological abnormalities.

The panel noted that the Claimant’s positive root tension signs causing a reproduction of symptoms in the C4 dermatomal distribution were consistent with the pathology. However, the sensory symptoms in the ulnar border of the left hand were not.

The Panel was therefore not satisfied that the Claimant had demonstrated two of the criteria for cervical radiculopathy as required by Clause 5.8 of the SIRA Motor Accident Guidelines.

If you have a query relating to any of the information in this case note, or would like to speak with someone in Holman Webb’s Insurance Group in relation to a matter of your own, please don’t hesitate to get in touch with Partner Stephanie Davis today.


Recent Posts