Mandoukos v Allianz Australia Insurance Limited

1. [1]

   LEEMING JA: I agree with Stern JA.

2. [2]

   KIRK JA: I agree with Stern JA.

3. [3]

   STERN JA: The primary question of substance raised in this appeal is whether decisions of a medical assessor (the third respondent, “the Medical Assessor”) and a delegate of the President of the Personal Injury Commission of New South Wales (the second respondent, “the Delegate”), under the Motor Accident Injuries Act 2017 (NSW) (“the Act”), in its form at the relevant time, are affected by jurisdictional error. Mr Mandoukos contends that they were, and that the primary judge erred in dismissing his application for judicial review, having regard to the approach taken in both decisions to the question whether the cervical spine injury sustained by Mr Mandoukos during a motor accident on 8 January 2019 was a “soft tissue”, and thus a minor, injury within the meaning of s 1.6 of the Act: Mandoukos v Allianz Australia Insurance Limited [2023] NSWSC 1023.

4. [4]

   More particularly, Mr Mandoukos contends that the Medical Assessor fell into jurisdictional error because he failed to consider the significance of the fact that on 1 July 2020, nearly 18 months after the motor accident, and on account of ongoing symptoms resulting from the motor accident, Mr Mandoukos underwent a cervical foraminotomy operation, during which a piece of bone was probably disturbed or removed from his cervical spine. He claims that the “disruption or disturbance or removal of bone” during the foraminotomy procedure is part of his injury resulting from the motor accident, and that the surgery itself took Mr Mandoukos’ injury outside the definition of minor injury in the Act. This is so even if the foraminotomy procedure relieved his symptoms and did not itself cause any adverse symptoms, because it “affects the structural integrity of his body as it was before the accident”. Moreover, he contends that the Medical Assessor erred in not recognising this as the operation note was included in the material before him, albeit that this contention was not explicitly advanced to the Medical Assessor.

5. [5]

   As regards the Delegate’s decision, he submits that it suffers from jurisdictional error because the foraminotomy procedure, and the disturbance or removal of bone during that surgery, necessarily took Mr Mandoukos’ injury outside the definition of minor injury in the Act. Thus, if he had properly understood his statutory task, the Delegate should have been satisfied that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect.

6. [6]

   During the hearing of the appeal senior counsel for Mr Mandoukos confined his grounds to jurisdictional error and abandoned his earlier reliance upon error of law on the face of the record. It is thus unnecessary to consider whether the Medical Assessor or Delegate are a “tribunal”, or whether or to what extent the reasons of the Medical Assessor and Delegate constitute the “face of the record”, under s 69 of the Supreme Court Act 1970 (NSW): see eg the observations of Basten JA in QBE Insurance (Australia) Ltd v Miller [2013] NSWCA 442 at [37] and in Dominice v Allianz Australia Insurance Ltd [2017] NSWCA 171 at [9]. Further, the question whether it was open to Mr Mandoukos to challenge both the decision of the Medical Assessor, and that of the Delegate, was not raised either at first instance or on appeal. It was thus unnecessary for this Court to consider whether that course was appropriate.

7. [7]

   At the hearing of the appeal, senior counsel for Mr Mandoukos also abandoned any reliance upon a contention, which had been advanced before the primary judge, that Mr Mandoukos had made a substantial and clearly articulated argument before the Medical Assessor that the foraminotomy procedure itself rendered his injury “non-minor”. Senior counsel accepted that there was no contention before the Medical Assessor to that effect.

8. [8]

   Neither the Medical Assessor nor the Delegate took part in the proceedings below or on appeal. The only active respondent was the first respondent, Allianz Australia Insurance Limited, the compulsory third-party insurer of the vehicle at fault in the motor accident (the “Insurer”).

9. [9]

   Unless otherwise stated, all references to the Act in this judgment are to the Act in its form as between 10 and 15 June 2022, as the parties agreed that that is the relevant version of the Act given that the certificate of the Medical Assessor was dated 14 June 2022.

10. [10]

    For the reasons set out below this appeal should be dismissed.

What was the dispute referred to the Medical Assessor?

1. [11]

   In order to understand what dispute was referred to the Medical Assessor for assessment it is necessary to traverse some key elements of the factual and procedural background.

2. [12]

   After the motor accident on 8 January 2019 Mr Mandoukos lodged a claim for compensation, alleging that he sustained injuries to his right knee, cervical spine and psychological injury in the form of post-traumatic stress disorder: J[4]. On 1 May 2019 the Insurer determined those were minor injuries for the purposes of the Act. This determination was confirmed on internal review on 31 May 2019. On 19 September 2019 Mr Mandoukos filed an application in the Dispute Resolution Service of the State Insurance Regulatory Authority (“DRS”), the precursor to the Personal Injury Commission (the “Commission”).

3. [13]

   By this application Mr Mandoukos referred a “medical dispute about a claim” to the DRS for assessment pursuant to s 7.20(1) of the Act as it then was. Under the heading “What is the dispute/issue” the solicitor for Mr Mandoukos wrote:

4. [14]

   In support of his application, Mr Mandoukos submitted a number of documents, including medical reports from Dr McKechnie and an occupational health physician instructed by the Insurer, Dr Costa (whose clinical notes were also relied upon), and reports of MRI scans of his cervical spine, both prior to and after the motor accident on 8 January 2019. It is clear from these reports that the issue as regards his cervical spine was as to a disc bulge at C5/6 with some foraminal narrowing, nerve root impingement and some end plate osteophytes, and as to whether he had signs and symptoms of radiculopathy. There was also an issue as to the extent to which the disc bulge and other radiological findings pre-dated 8 January 2019.

5. [15]

   Thus, as regards the cervical spine injury, the medical dispute about a claim was whether the injury as at 19 September 2019 was a minor injury. The dispute, as regards the cervical spine, was thus whether the changes apparent on MRI and the neurological symptoms from which Mr Mandoukos suffered were caused by the motor accident on 8 January 2019 and whether they were such that the cervical spine injury resulting from the motor accident was more than a minor injury under the Act (noting that the definition of minor injury in s 1.6 was in the same form between 19 September 2019 and 15 June 2022).

6. [16]

   Following that referral, under s 7.20(2) of the Act as it then was, the DRS arranged for “the dispute” to be dealt with by a medical assessor. On 19 November 2019 Mr Mandoukos was assessed by Dr Raymond Wallace. Relevantly, he identified that there was a dispute between Mr Mandoukos and the Insurer as to whether Mr Mandoukos’ injury was a minor injury. Mr Mandoukos’ injuries to his cervical spine and right knee were identified under the heading “Minor injury dispute to be assessed”. Consistent with the medical evidence submitted by Mr Mandoukos, to which I have already referred, Dr Wallace assessed the changes apparent on MRI, Mr Mandoukos’ symptoms and the findings on examination with a view to determining whether Mr Mandoukos’ cervical spine injury was or was not a minor injury under the Act. One issue in that regard was the extent to which Mr Mandoukos’ cervical spine pathology and symptoms were consequent upon the motor accident on 8 January 2019 as opposed to an earlier motor accident on 1 December 2010. A further issue was whether there was evidence of radiculopathy, given that under reg 4 of the Motor Injuries Regulation 2017 (NSW) (the “Regulation”) that may result in an injury not being a minor injury under the Act.

7. [17]

   Dr Wallace issued a certificate dated 25 November 2019 as to the matters referred for assessment, pursuant to s 7.23(1) of the Act (which was relevantly in the same form between November 2019 and 15 June 2022): J[6]. Dr Wallace found that Mr Mandoukos suffered an injury to his cervical spine which was caused by the motor accident but that it was a “minor injury” within the meaning of the Act.

8. [18]

   On 14 April 2020, on “merit review”, a medical review panel upheld the decision of Dr Wallace: J[8].

9. [19]

   On 1 June 2020, Mr Mandoukos had a further MRI scan, which was reported as showing at C5/6 “foraminal narrowing with right and potentially left C6 root impingement.” In a letter reflecting Mr Mandoukos’ attendance on 11 June 2020, Dr Simon McKechnie reported that he had offered Mr Mandoukos a right C5/6 foraminotomy and that:

10. [20]

    On 1 July 2020 Mr Mandoukos underwent the C5/6 foraminotomy, performed by Dr McKechnie. At the hearing of the appeal, for the first time, it was explained by senior counsel for Mr Mandoukos that the notation “R/O medial 1/3 facet” in the operation note for the foraminotomy on 1 July 2020 indicated that, during surgery, there was “removal of” 1/3 of the medial facet, being bone. Whilst there was no evidence to support this explanation of the operation note, this explanation was not disputed by counsel for the Insurer. For the purpose of considering the issues on appeal, I will thus assume that the operation note should be read in this way. The meaning of that notation was not, however, explained to the primary judge, notwithstanding that during submissions his Honour asked whether the operation report described “precisely what” a foraminotomy involved and it was a live issue before the primary judge whether that procedure involved the removal of bone. Further, Mr Mandoukos’ written submissions on appeal were premised upon there being no evidence before the Court as to whether or not the foraminotomy which Mr Mandoukos underwent on 1 July 2020 involved the disturbance or removal of bone.

11. [21]

    On 28 October 2020 Mr Mandoukos applied to the “proper officer of the Authority” under s 7.24(2) of the Act, which was not relevantly altered between October 2020 and 15 June 2022, for the medical dispute to be referred again for medical assessment, seeking that his injury to the cervical spine be classified as non-minor. This was refused on 8 February 2021: J[17].

12. [22]

    On 30 July 2021 Mr Mandoukos lodged an application for the medical dispute to be referred again for medical assessment under s 7.24(2) of the Act: J[18]. In the online portal application form, under the heading “Further Application Information”, Mr Mandoukos referred to “submissions attached”. In the submissions filed together with the application, Mr Mandoukos’ solicitor contended:

13. [23]

    It is plain from that submission that, as at that time, the medical dispute was whether or not Mr Mandoukos had suffered from radiculopathy (impairment caused by dysfunction of spinal nerve root or nerve roots, see Motor Accident Guidelines (version 8.2) effective from 8 April 2022, cl 5.7), such that under reg 4 of the Regulation his cervical spine injury would not be a minor injury under the Act. The relevance of the additional medical information, including as to the foraminotomy procedure, was that it supported Mr Mandoukos’ contention that he suffered radiculopathy which was surgically treated.

14. [24]

    The material lodged in support of that application included the MRI of Mr Mandoukos’ cervical spine dated 1 June 2020 (see above at [19]), the operation report of Dr McKechnie dated 1 July 2020 (see above at [20]), and a report dated 8 June 2021 from Dr McKechnie which contained the following:

15. [25]

    As the primary judge found, and as was conceded on appeal by senior counsel for Mr Mandoukos, the submissions on behalf of Mr Mandoukos in this further application did not contend that the surgery performed by Dr McKechnie was itself an injury or formed part of the injury caused in the motor accident: J[20]. Rather, as is clear from the extract from his submissions at [22] above, there was no suggestion, or claim, that the surgery itself was itself a component, or part, of the injury suffered by Mr Mandoukos. In these circumstances, there was clearly no medical dispute between Mr Mandoukos and the Insurer as to whether any disturbance or removal of bone during the foraminotomy on 1 July 2020 meant that his cervical spine injury resulting from the motor accident on 8 January 2019 was a minor injury under the Act.

16. [26]

    On 22 November 2021, a delegate of the President determined that the medical dispute would be referred for further assessment under s 7.24 of the Act. Under the heading “Allocating matter for further assessment”, the delegate stated:

17. [27]

    As will be apparent from the analysis of the statutory scheme below, paragraph 7 of the delegate’s determination does not properly reflect the ambit of the further assessment under s 7.24 of the Act, but that is of no significance given the ambit of the referral set out in paragraph 8 of the determination.

18. [28]

    Following an assessment on 6 June 2022, by certificate dated 14 June 2022 the Medical Assessor assessed Mr Mandoukos as having sustained a soft tissue injury to his cervical spine caused by the motor accident and determined that this was a minor injury for the purposes of s 1.6 of the Act. The Medical Assessor considered whether or not the medical evidence, including the report of Dr McKechnie, indicated that Mr Mandoukos had neurological signs of radiculopathy. He did not consider whether or not the removal of bone during the foraminotomy procedure meant that Mr Mandoukos’ injury to his cervical spine was not a soft tissue, and thus not a minor, injury. That is readily understandable given that Mr Mandoukos made no contention to that effect before the Medical Assessor.

19. [29]

    The Medical Assessor found that the injury caused by the motor accident was:

The Application for Medical Review

1. [30]

   On 12 July 2022 Mr Mandoukos filed an application for review of the Medical Assessor’s decision pursuant to s 7.26(1) of the Act, which was in a relevantly identical form between June 2022 and November 2022). In the online portal application, Mr Mandoukos referred to “submissions attached” as setting out the error he alleged that the Medical Assessor had made. In the attached submissions, Mr Mandoukos contended that the Medical Assessor had fallen into legal error as:

2. [31]

   Mr Mandoukos submitted that the Medical Assessor had not considered Dr McKechnie’s reports, and that he satisfied the definition of radiculopathy as recorded by Dr McKechnie.

3. [32]

   On 10 August 2022, Mr Mandoukos submitted late additional documents “lodged in the interests of justice”. These included further submissions in which he contended :

4. [33]

   As the primary judge found, this was the first time that Mr Mandoukos had contended that the type of surgery involves the removal of bone and that that itself is part of his injury: J[31].

5. [34]

   On 9 September 2022 the Delegate declined the application for review on the basis that he “was not satisfied that there is reasonable cause to suspect that the medical assessment was incorrect in a material respect.” The Delegate found that he could not “be satisfied of reasonable cause to suspect that the Assessor failed to consider the documentation from Dr McKechnie.” The Delegate was also not satisfied that the Medical Assessor’s reasoning was incorrect in being satisfied that Dr McKechnie had found radicular symptoms but not radiculopathy “as defined in clause 5.8 of the Guidelines.”

6. [35]

   As to Mr Mandoukos’ contention that the surgery alone qualified as a non-minor injury, the Delegate found:

The primary judgment

1. [36]

   Mr Mandoukos contended before the primary judge that the decisions of each of the Medical Assessor and the Delegate suffered from jurisdictional error and/or errors of law on the face of the record.

2. [37]

   The primary judge accepted Mr Mandoukos’ contention that the Medical Assessor did not address whether the foraminotomy was itself an injury, but found that this was because Mr Mandoukos “never advanced a submission, or case, to that effect – nor anything remotely approaching it”: J[108]; see also J[112], [117]. Moreover, other than the operation report of Dr McKechnie, the primary judge found that there was no evidence before the Medical Assessor, nor before the Court, as to what is physically involved in a foraminotomy: J[112], and his Honour found that the operation report said “nothing about the specifics of what was involved, and the plaintiff did not submit to the contrary”: J[113]. Having regard to both of these factors, the primary judge found that the Medical Assessor’s failure to consider whether the surgery itself meant that Mr Mandoukos’ injury was not a minor injury was not a jurisdictional error and the Medical Assessor did not fail to apply the lawful test of causation: J[118], [120], [130]. The primary judge also held the reasons were legally sufficient given the case Mr Mandoukos ran before the Medical Assessor: J[134].

3. [38]

   As the primary judge had found that the decision of the Medical Assessor was in accordance with law and it would not have been open for any delegate to arrive at a decision inconsistent with that conclusion, it would not have been open to the Delegate to find that the decision of the Medical Assessor “was incorrect in a material respect” as required by s 7.26(2) of the Act. Thus, the primary judge held in these circumstances, it would be futile to remit the matter to the Delegate: J[138]-[139].

4. [39]

   The primary judge thus dismissed the amended summons.

The issues on appeal

1. [40]

   The grounds advanced in the amended notice of appeal filed by Mr Mandoukos on 6 December 2023 are:

2. [41]

   As was accepted by senior counsel for Mr Mandoukos, there is significant overlap as regards the matters of substance advanced in these six grounds. Consistent with the way in which oral submissions were advanced, the substance of those grounds is:

   1. (1)

      The primary judge erred in finding that the Medical Assessor was not required to take into account the nature and consequences of the foraminotomy procedure when considering whether Mr Mandoukos’ injury was a soft tissue, and thus a minor, injury (grounds 1-5). This ground encapsulates both of the issues that senior counsel for Mr Mandoukos identified, in oral submissions, as arising from the grounds: what constituted injury for the purpose of the Medical Assessor’s assessment, and was the Medical Assessor bound to take into account the removal of bone during the surgery as part of Mr Mandoukos’ injury; and

   2. (2)

      The primary judge erred in finding that dismissal of the grounds of review as regards the decision of the Medical Assessor were dispositive of the application for review as regards the decision of the Delegate (ground 6).

3. [42]

   It is convenient to address Mr Mandoukos’ contentions by reference to these two substantive grounds. The key contention underlying both of these grounds is that the Medical Assessor had a duty under the Act to consider, and determine, whether the nature and consequences of the foraminotomy procedure which Mr Mandoukos underwent on 1 July 2020, which involved the removal of bone, was such that his injury was not a soft tissue, and thus not a minor, injury within the meaning of s 1.6 of the Act.

4. [43]

   Before this Court, there was no dispute about the following matters.

5. [44]

   First, that the foraminotomy procedure was undertaken, with Mr Mandoukos’ consent, on 1 July 2020 on account of the symptoms he was then suffering, which symptoms were caused by the motor accident. In that sense, there was a causal link between the motor accident on 8 January 2019 and the foraminotomy procedure on 1 July 2020. As submitted by Mr Mandoukos, and not contested by the Insurer, this flowed from the finding of the Medical Assessor that the motor accident rendered his pre-existing degenerative cervical pathology symptomatic and that:

6. [45]

   Second, unlike the position before the primary judge, that it is apparent from the operation note prepared by Dr McKechnie (the treating surgeon) in respect of the foraminotomy on 1 July 2020 that bone was removed in that procedure. Having regard to this, ground 5 in the amended notice of appeal fell away.

7. [46]

   Third, that if the removal of bone in the foraminotomy procedure were part of the “injury” resulting from the motor accident, it would not be a soft tissue, and would thus not be a minor, injury under s 1.6 of the Act.

Construction of the relevant statutory scheme

1. [47]

   Having regard to the issues on appeal, it is necessary to give close consideration to the relevant elements of the statutory framework. In the course of doing so, I will deal with some the key issues arising as to statutory construction.

2. [48]

   The relevant statutory framework at the relevant time comprises the Act, the Regulation and the Motor Accident Guidelines (version 8.2) effective from 8 April 2022 (which again was the version agreed on by the parties) (the “Guidelines”). This legislative scheme applies as regards motor accidents occurring after the commencement of the Act, on 1 December 2017: s 1.8. Motor accidents that occur before that date remain subject to the Motor Accidents Compensation Act 1999 (NSW) (the “1999 Act”).

3. [49]

   As is apparent from the objects in s 1.3(1), the Act establishes a scheme of compulsory third-party insurance and provision of benefits and support relating to injuries sustained as a consequence of motor accidents.

4. [50]

   Section 1.4(1) of the Act includes a definition of injury:

5. [51]

   Neither personal nor bodily injury is itself defined. During the hearing of the appeal senior counsel for Mr Mandoukos submitted that any detrimental alteration to a person’s body “should comfortably meet the definition of injury in the Act”. He submitted, further, that “[i]njury necessarily connotes some harm, in ordinary English language”. In this regard he relied upon the decision of this Court in Dean v Phung [2012] NSWCA 223 at [30] (Basten JA, Beazley JA (as her Excellency then was) and Macfarlan JA relevantly agreeing). There, his Honour held that, in ordinary language, “an injury is a harmful consequence”. That was in a factual context in which the dispute was whether extensive dental surgical procedures could themselves be an act done “with intent to cause injury (for the purposes of s 3B(1)(a) of the Civil Liability Act 2002 (NSW)) in circumstances in which it was admitted that treatment was unnecessary but had been presented as necessary and the plaintiff suffered from significant pain, concern and disruption of his life. It should not, in my judgment, be construed as suggesting that any harmful consequence will, itself, necessarily be an injury. Read in context, that was plainly not what his Honour was intending to suggest. His Honour went to on observe that a harmful consequence would not ordinarily be used to describe “[s]omething which is done with a therapeutic intent, that is, to prevent, remove or ameliorate a disability or pathological condition, would not ordinarily be described”: at [30].

6. [52]

   In the context of workers compensation legislation, the “ordinary sense” of the word “injury” has been held to mean “some definite or distinct ‘physiological change’ or ‘physiological disturbance’ for the worse which, if not ‘sudden’, is at least ‘identifiable’”: Military Rehabilitation and Compensation Commission v May (2016) 257 CLR 468; [2016] HCA 19 at [75] (Gageler J); see also at [45] (French CJ, Kiefel, Nettle and Gordon JJ). In my judgment, whilst this definition was arrived at in a different legislative context, that understanding of the word “injury” provides guidance as to the ordinary meaning of “personal or bodily injury” in s 1.4 of the Act, at least as regards physical, as opposed to psychological or psychiatric, injury.

7. [53]

   Ultimately, the submission advanced by senior counsel for Mr Mandoukos was that the foraminotomy procedure fell within the definition of injury in the Act because:

8. [54]

   In circumstances in which, as here, the particular surgical procedure is not contended to have been other than reasonably necessary, and the Court was not taken to any evidence showing an identifiable detrimental impact upon Mr Mandoukos’ symptoms or functioning arising from the foraminotomy procedure, it may be doubted whether this submission should be accepted. That is particularly so given that the scheme of the Act is to provide treatment, care, compensation and financial support to those injured in motor accidents. However, having regard to my conclusions as to the ambit of the medical dispute referred to the Medical Assessor, as set out below, it is unnecessary to decide whether or not Mr Mandoukos’ contention is correct. Moreover, given that this is a matter which may ultimately turn upon a detailed factual assessment, it is undesirable for this Court to express any concluded view in circumstances in which there has not been any medical assessment of the impact of the surgery upon Mr Mandoukos.

9. [55]

   Minor injury is defined in s 1.6:

10. [56]

    Regulation 4(1) of the Regulation, headed “Meaning of “minor injury”” (which has not changed between the relevant times) provides:

11. [57]

    The Guidelines provide guidance as to what amounts to radiculopathy, requiring that two or more of a list of clinical signs be apparent. Given the issues arising in this appeal, it is unnecessary to consider whether or not the Guidelines go beyond the power conferred in s 1.6(5) of the Act.

12. [58]

    Part 3 of the Act makes provision for the payment of statutory benefits by the “relevant insurer” in respect of the death or injury to a person resulting from a motor accident in NSW: ss 3.1-3.2. Section 3.11(1)(b) provides that an injured person is not entitled to weekly payments of statutory benefits for any period of loss of earnings or earning capacity that occurs more than 26 weeks after the motor accident concerned if:

13. [59]

    Section 3.28 makes equivalent provision as regards statutory benefits for treatment and care expenses.

14. [60]

    Part 4 of the Act includes provision for damages to be assessed by the Commission in respect of the death of or injury to a person caused by the fault of the owner or driver of a motor vehicle. It applies both as regards the award of damages by a court and the assessment of the amount of damages by the Commission. Section 4.1 provides that a reference in Pt 4 to the “award of damages” includes reference to any such assessment of the award of damages. Section 4.4 provides:

15. [61]

    It is apparent from these provisions that the Act contemplates that two or more “injuries” may result from one motor accident. It will necessarily be a matter of fact and degree in each case whether what results from a motor accident is properly regarded as one, or more than one, injury. A range of matters may be relevant to, but not necessarily determinative of, that question. Such matters would include the nature of any harm or damage, the identifiable physiological change or disturbance relied upon, whether it is physical or psychiatric/psychological, the body part(s) involved (if any), and whether the harm or damage was sustained by reason of the immediate impact of the motor accident or from some later event, such as medical or surgical treatment or a fall, which itself resulted from the motor accident.

16. [62]

    Claims for statutory benefits or damages may be made under the Act: s 6.12, and “claim” is defined as either such claim: s 1.4(1). Under s 6.3(2), the general duties of claimants to act with good faith includes a duty to “promptly do all things reasonably necessary to facilitate the resolution of any dispute involving the claim”: s 6.3(2)(c). Under s 6.4(1), it is the duty of both “an insurer and a claimant to endeavour to resolve a claim as justly and expeditiously as possible”. Under s 6.20, liability for a claim may be admitted or denied, whether in full or “for only part of the claim”. As regards a claim for damages, under s 6.25(2), it is the duty of the claimant to give relevant particulars including full details of:

17. [63]

    It is apparent from these provisions that the scheme of the Act is to encourage resolution of claims, and of disputes that have arisen about claims, as between a claimant and an insurer.

18. [64]

    It is also apparent that the Act is premised on a distinction being drawn between injuries sustained in the motor accident on the one hand (of which there may be more than one), and permanent impairment arising from those injuries, on the other. That distinction is also reflected in the provisions in the Act which are predicated upon “the degree of permanent impairment of an injured person as a result of an injury caused by a motor accident” being greater than 10%: see eg s 1.7(1). Again, many factors may potentially be relevant to the distinction between an injury and permanent impairment arising from the injury.

19. [65]

    The Commission is established under Personal Injury Commission Act 2020 (NSW). Section 18 provides for delegation of the functions of the President. Section 33(1)(b) provides for the appointment of medical assessors for the purposes of the Act. Section 65(2)(a) provides that regulations may make provision for or with respect to the qualifications or criteria for the appointment of medical assessors. Regulation 6 of the Personal Injury Commission Regulation 2020 (NSW) provides:

20. [66]

    Having regard to this it may be assumed that any medical assessor is medically qualified. Beyond that, however, there is no statutory requirement for a medical assessor to hold any particular qualification to be able to act as medical assessor in any particular case. Thus, whilst senior counsel for Mr Mandoukos on appeal submitted that “one may assume…that the matter is being referred to someone appropriately qualified”, there was no evidence before the Court as to the specific qualifications either of the medical assessors to whom the dispute about Mr Mandoukos’ claim was referred.

21. [67]

    Part 7 of the Act is headed “Dispute resolution”. Division 7.5, within Pt 7, is headed “Medical Assessment”.

22. [68]

    Section 7.17 provides:

23. [69]

    Section 7.17 was in the same form as at 19 September 2019 when Mr Mandoukos first referred a medical dispute about a claim for assessment.

24. [70]

    Schedule 2, cl 2 declares a number of matters “to be medical assessment matters for the purposes of Part 7” of the Act. These include, at cl 2(e):

25. [71]

    The proper construction of subparagraph (a) of the definition of “medical dispute” in s 7.17 (sub-paragraph (b) not being relevant as to date there has been no assessment of Mr Mandoukos’ claim for damages) is at the heart of the issues arising on appeal.

26. [72]

    Senior counsel for Mr Mandoukos submitted that “a dispute … about a medical assessment matter” in s 7.17 necessarily entailed that the medical dispute comprised “the whole of the relevant medical assessment matter” as regards the particular body part involved, here Mr Mandoukos’ cervical spine. Thus, he submitted, in the present case the “medical dispute” referred to the Medical Assessor on 22 November 2021 was as to whether any matter that in fact could be characterised as an injury to Mr Mandoukos’ cervical spine resulting from the motor accident on 8 January 2019, including the removal of bone during the foraminotomy on 1 July 2020, meant that the injury to his cervical spine resulting from the motor accident was not a minor injury for the purposes of the Act. This was so irrespective of the fact that as at the time of the Medical Assessment, Mr Mandoukos had not raised any dispute as to whether or not the injury to the cervical spine included the removal of bone during the foraminotomy procedure.

27. [73]

    That contention should be rejected. The phrase “about a medical assessment matter” in s 7.17 does not mean that the medical dispute necessarily encompasses the whole of the medical assessment matter. Rather, a dispute between a claimant and an insurer about a medical assessment matter, in s 7.17, is a reference to the dispute which has in fact arisen between a claimant and an insurer, albeit that, to fall within the definition of “medical dispute” in s 7.17, that dispute must relate to the subject matter of a medical assessment matter. That construction is consistent with one of the objects of the Act being to encourage “the quick, cost effective and just resolution of disputes”: s 1.3(2)(g). It is also consistent with the provisions set out above imposing an obligation upon the parties to do all things reasonably necessary to facilitate the resolution of any dispute involving the claim and providing for part only of a claim to be admitted.

28. [74]

    Were Mr Mandoukos’ proposed construction to be accepted, it would be incumbent upon a medical assessor under the Act to trawl through all material provided to identify whether there is any matter which, albeit not complained of or identified as such by a claimant, could fall within the ambit of personal or bodily injury as defined in the Act. Each and every instance of medical or surgical treatment would need to be interrogated by the medical assessor to ascertain whether it could itself be characterised as such an injury. Such a construction of the Act should not be adopted absent clear statutory language in support. The language of the Act falls well short of meeting that threshold.

29. [75]

    This is all the more apparent having regard to the breadth of the medical assessment matters declared under cl 2 of Sch 2. Thus, for example, cl 2(b) declares as a medical assessment matter:

30. [76]

    It is unlikely that Parliament intended that the whole of that matter be referred for medical assessment in circumstances where the dispute between the parties related only to only a limited aspect of that treatment or care.

31. [77]

    My conclusion as to the proper construction of s 7.17 is also consistent with the use of the word “about” in Pt 7 more generally. Thus, under s 7.19(2) a “medical dispute about a decision of an insurer may be referred for assessment” and under s 7.20(1) a “medical dispute about a claim” may be referred for assessment (whilst ss 7.19 and 7.20 were in a somewhat different form as at 19 November 2019 when the medical dispute was referred for assessment, those differences are not relevant to the issues arising in this appeal). In both instances, it is apparent that the medical dispute will not necessarily encompass the whole of the “decision” or “claim”. Rather, the word “about” denotes the subject matter in respect of which the medical dispute in fact arises.

32. [78]

    Thus, the medical dispute “about a medical assessment matter” will, in each case, be a question of fact depending upon the ambit of the dispute between the parties at the relevant time having regard to the competing claims made. Whilst it is of course possible that a dispute about a medical assessment matter might comprise the whole of the relevant medical assessment matter, that is not necessarily so.

33. [79]

    My preferred construction is also consistent with the construction of the somewhat analogous, and similarly worded, s 319 of the Workplace Injury Management and Workers Compensation Act 1998 (NSW) reached by this Court in Skates v Hills Industries Ltd [2021] NSWCA 142 and Scone Race Club Ltd v Cottom [2024] NSWCA 34. Section 319 provides:

34. [80]

    In Skates v Hills Industries Ltd, Basten JA held that the form for an application to resolve a dispute and the material submitted with it “defined the proper scope of the referral”: at [30]. Leeming JA (in additional reasons agreeing with the reasons and orders of Basten JA) observed:

35. [81]

    In Scone Race Club Ltd v Cottom, Basten AJA (Gleeson and Mitchelmore JJA agreeing) relied upon the reasoning of Leeming JA in Skates v Hills Industries Ltd at [44]. The Application to Resolve a Dispute had been amended such that it was limited to a right knee injury and did not extend to a claimed injury to the lumbar spine which the worker contended to be consequential upon the knee injury: at [36], [38]. The Court accepted the appellant’s contention, in those circumstances, that the claimed lumbar spine injury was not part of the medical dispute referred for assessment and that an Appeal Panel would have erred if it had considered documents which purported to rely upon the consequential spine injury: at [47]-[48], [53].

36. [82]

    Further, contrary to the contention of senior counsel for Mr Mandoukos, the conclusion I have reached as to the proper construction of s 7.17 of the Act, is not inconsistent with what was said by Allsop P and Giles JA (Basten JA dissenting) as regards the ambit of the jurisdiction of a review panel under s 63 of the 1999 Act in McKee v Allianz Australia Insurance Ltd (2008) 71 NSWLR 609; [2008] NSWCA 163 (“McKee”), which he submitted applied “with equal force…to the parameters of a referral to a medical assessor”. Section 63 of the 1999 Act relevantly provided (at the material time):

37. [83]

    The question for the Court was whether review by the review panel of a medical assessment on the issue of permanent impairment was limited to the grounds on which the assessment was said to be incorrect in the application for review: at [5]. Allsop P held that it was not and that the “matters concerned” in s 63(4) of the 1999 Act are “the matters referred for assessment, being the medical dispute referred for assessment”: at [7], see also at [27]-[30] (Giles JA). His Honour added that if consideration of the matters referred for assessment went beyond the evident dispute thrown up by the application for review procedural fairness would require “any and all necessary steps to ensure a fair hearing”: at [8].

38. [84]

    As is apparent, McKee does not support Mr Mandoukos’ contention that the ambit of a “medical dispute” in s 7.17 of the Act is not limited to the actual medical dispute between the parties which is referred for assessment. Rather, the analysis of the powers of the review panel is premised upon the desirability of the review panel reviewing the entirety of the “medical dispute” referred to the medical assessor, being (under the 1999 Act) the “disagreement between the claimant and the insurer” about particular matters: at [7] (Allsop P) and [24] (Giles JA), before confirming or revoking the medical assessor’s certificate.

39. [85]

    Section 7.20 of the Act relevantly provides:

40. [86]

    Under s 7.23(1) and (7) of the Act the medical assessor or assessors to whom a medical dispute is referred is or are to give a certificate “as to the matters referred for assessment” and the certificate is to set out the reasons for any finding by the medical assessor or assessors “as to any matter certified in the certificate in respect of which the certificate is conclusive evidence.” Certificates of a medical assessor are of considerable significance given that, under s 7.23(2), in any court proceedings or in any proceedings in connection with a merit review or claims assessment under the Act, they are:

41. [87]

    Section 7.24 provides for “a medical dispute referred for assessment” at any time to be referred again for assessment by a court, a merit reviewer or by the Commission or to be referred again for assessment by the claimant or insurer on grounds prescribed by the regulations, which is to be done by application to the President: s 7.24(4). It was in a relevantly identical form as at 21 November 2021 when the medical dispute in this case was referred again for medical assessment. Under s 7.24(5):

42. [88]

    In Motor Accidents Authority of NSW v Mills (2010) 78 NSWLR 125; [2010] NSWCA 82 the Court considered s 62(1) of the 1999 Act which at the time provided that a “matter referred for assessment under this Part may be referred again on one or more further occasions …”. Giles JA (Tobias and Handley JJA agreeing) held that the “matter” referred again under s 62(1) was necessarily the matter that had been initially referred for assessment under the Act: at [74]. Thus, a different, or lesser, matter could not be referred under s 62(1). Given that s 7.24(1) of the Act provides that a “medical dispute referred for assessment…may be referred again for assessment”, which is relevantly similar language to that considered by the Court in Motor Accidents Authority of NSW v Mills, the decision in that case is highly persuasive authority to the effect that the medical dispute referred back to a medical assessor under s 7.24(1) is the medical dispute that had previously been referred for assessment under Div 7.5 of the Act. Moreover, that reflects the language of a medical dispute being referred “again” for assessment. That construction should be adopted. If a new medical dispute arises, that would need to be by further referral under s 7.20(1) of the Act.

43. [89]

    Further, a second referral of a medical dispute under s 7.24 is subject to s 7.25, which provides that the assessment of a medical dispute by way of a further medical assessment can be made on the basis of any agreement by the parties as to the degree of permanent impairment or whether a particular injury was caused by the motor accident. It is of some significance as to construction that there is no provision equivalent to s 7.25 when a medical dispute is referred for assessment for the first time under s 7.20. Again, this is consistent with the definition of medical dispute in s 7.17(a) only encompassing that which is actually in dispute between the parties. Thus, s 7.25 recognises that the ambit of a medical dispute may be diminished by agreement between the time of a first, and second, referral for assessment.

44. [90]

    A submission was advanced in writing on behalf of Mr Mandoukos to the effect that cll 6.5-6.7 of the Guidelines, contained in Pt 6 relating to “Permanent Impairment” and/or the common law principles of causation supported a construction that the Medical Assessor was statutorily obliged to consider for himself whether or not the foraminotomy was itself an “injury” resulting from the motor accident even if this was not in any way raised by Mr Mandoukos. Having regard to my preferred construction of “medical dispute” in s 7.17 of the Act (and even if, as submitted by Mr Mandoukos relying on Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [35], those clauses of the Guidelines were relevant to the assessment of minor injury, as opposed to impairment) this submission should be rejected. Unless a matter falls within the ambit of the medical dispute referred to the medical assessor, there was no obligation upon the medical assessor to consider it as part of his assessment.

45. [91]

    Section 7.26 of the Act relevantly provides:

46. [92]

    In Meeuwissen v Boden (2010) 78 NSWLR 143; [2010] NSWCA 253 (“Meeuwissen”), considering s 63(3) (now s 63(2B)) of the 1999 Act which is in relevantly similarly language to s 7.26(5), Basten JA (Beazley JA and Sackville AJA agreeing) described the role of the proper officer under s 63(3) of the 1999 Act as “that of a gate-keeper”: at [23], and held that the language of then s 63(3) was “inconsistent with the proper officer being expected (let alone required) to carry out an assessment or calculation, as opposed to identifying possible error”: at [22]. His Honour also identified that “what must be incorrect in a material respect is “the medical assessment” and not the certificate which results from the assessment”: at [19].

47. [93]

    The language of s 7.26(5) also requires consideration of what are, in a particular case “the particulars set out in the application”. In Insurance Australia Ltd v Marsh [2022] NSWCA 31 at [43] (“Marsh”), White JA (Basten and Macfarlan JJA agreeing) held that the “particulars set out in the application” referred to in (the relevantly similar) s 63(3) of the 1999 Act were “those matters stated in the attached submissions”: at [43]. White JA held that it is not reasonably arguable that the words in s 63(3) “having regard to the particular set out in the application” should be read as “having regard to all the materials before (or available to) the proper officer”, as was submitted by the respondent in this case: at [45]. His Honour added that this is not to say that s 63(3) is “to be read as meaning that the proper officer is to have regard only to the particulars set out in the application…[b]ut it does mean that the proper officer’s reasons will need to address the particulars set out in the application (in this case, the accompanying submission), and should be read in this light”: at [45].

48. [94]

    The key matter arising out of the analysis set out above, in the context of this case, is that the medical dispute referred for assessment under s 7.20, or referred again for assessment under s 7.24 of the Act, is the actual medical dispute between the claimant and the insurer about the relevant medical assessment matter. That conclusion is fatal to Mr Mandoukos’ appeal since all of his contentions are premised upon the Medical Assessor being obliged to consider whether the removal of bone during the foraminotomy meant that the injury to his cervical spine resulting from the accident was not a minor injury. There was no dispute as to that between Mr Mandoukos and the Insurer at the time of either the first, or second, referrals for medical assessment. It was no part of the medical dispute referred for assessment on either occasion.

Consideration of the grounds of appeal

1. [95]

   As set out at [41] above, the essence of Mr Mandoukos’ contention is that, under the Act, it was incumbent upon the Medical Assessor to give consideration to the foraminotomy procedure when assessing whether Mr Mandoukos had sustained only a minor injury. This was because a foraminotomy involved the removal of bone, and in those circumstances the medically qualified Medical Assessor was obliged to consider whether that meant that the injury to Mr Mandoukos’ cervical spine resulting from the motor accident was not a soft tissue, and thus not a minor, injury.

2. [96]

   It follows from my analysis of the Act, as set out above, that this contention must be rejected. The medical dispute referred “again for assessment” to the Medical Assessor under s 7.24 of the Act was the medical dispute which had been initially referred for medical assessment under s 7.20 of the Act on 19 September 2019. I have set that out at [15] above. It was aptly summarised in the referral for further medical assessment on 22 November 2021 as whether “cervical spine injury - radiculopathy caused by the motor accident” was a minor injury. It manifestly did not include any medical dispute as to whether the disturbance or removal of bone constituted part of the injury to Mr Mandoukos’ cervical spine resulting from the motor accident on 8 January 2019.

3. [97]

   In these circumstances, under the Act there was no obligation upon the Medical Assessor to consider whether the removal of bone during the foraminotomy procedure was such that Mr Mandoukos’ injury could not be a soft tissue, or minor, injury. As set out by White JA in Marsh at [40]:

4. [98]

   It follows that grounds 1 to 5 of Mr Mandoukos’ amended notice of appeal should be dismissed.

5. [99]

   In any event, even on the assumption that the removal of bone during the foraminotomy procedure could be a personal or bodily injury as defined in the Act (a question which, as set out at [54] above, it is unnecessary and inappropriate for this Court to determine) my provisional view is that that would be a “different” injury from the injury to Mr Mandoukos’ cervical spine sustained at the time of the motor accident. The foraminotomy procedure occurred some 18 months after the motor accident. It involved a mechanism, consensual surgical removal of bone, entirely separate from the impact of the motor accident. That is so even though it was performed by reason of Mr Mandoukos’ symptoms resulting from the motor accident. It is also of a different character from an assault or impact upon the body consequent upon the forces of the motor accident. Ultimately, however, if Mr Mandoukos seeks referral of a medical dispute as to whether the foraminotomy procedure has the consequence that the cervical spine injury he sustained in the motor accident is a minor injury, that question can be assessed by a medical assessor.

6. [100]

   In ground 6, Mr Mandoukos contends that the primary judge erred in treating the rejection of the grounds of review as against the Medical Assessor’s decision as dispositive of the application for judicial review as regards the Delegate’s decision. In this regard, Mr Mandoukos contends that the primary judge erred in concluding:

7. [101]

   I would accept Mr Mandoukos’ contention that the primary judge erred in this analysis. The question for the primary judge was whether, under the Act, it was open to the Delegate not to be “satisfied that there [was] reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application”, as provided in s 7.26(5) of the Act. That was not a question which turned on whether or not there was jurisdictional error in the decision of the Medical Assessor. As Basten JA held in Meeuwissen at [23] (Beazley JA and Sackville AJA agreeing) as regards equivalent provisions in the 1999 Act:

8. [102]

   However, Mr Mandoukos’ challenge to the decision of the Delegate must fail in any event. Given that the ambit of the referral to the Medical Assessor was confined by the parameters of the “medical dispute”, and the medical dispute referred did not include any question as to whether the disturbance or removal of bone during the foraminotomy was part of Mr Mandoukos’ injury, there can be no possible jurisdictional error in the Delegate’s conclusion under s 7.26(5). Indeed, senior counsel for Mr Mandoukos accepted during the hearing of the appeal that this would follow if the referral to the Medical Assessor was so confined.

9. [103]

   In these circumstances, ground 6 of the amended notice of appeal should be dismissed.

Conclusion

1. [104]

   Mr Mandoukos’ appeal must be dismissed. As neither party made submissions as to costs, there is no basis to do anything other than make the usual order that costs follow the event.

2. [105]

   Thus, the orders I propose are:

   1. (1)

      The appeal is dismissed.

   2. (2)

      Appellant to pay the first respondent’s costs of the appeal.