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Case summary: Allianz Australia Insurance Limited v Yangzom [2025] NSWCA 104 – pain, injury and the limits of medical review under the Motor Accident Injuries Act 2017 (NSW)

Published on August 8, 2025 by Julia Harrison

The New South Wales Court of Appeal recently handed down its decision in Allianz Australia Insurance Limited v Yangzom [2025] NSWCA 104. The case involved a challenge to a medical assessment conducted under the Personal Injury Commission’s (PIC) dispute resolution process. At the heart of the matter was whether pain and numbness in certain body regions – in this case, the arms and buttocks – could support a finding of permanent impairment, and whether the Medical Assessor’s reasoning was legally adequate. For claimant lawyers, this decision is an important reminder of how courts interpret medical assessments under the Motor Accident Injuries Act 2017 (NSW), particularly in cases where symptoms are present but not clearly linked to diagnosed injury.

Background

The claimant was injured in a motor vehicle accident and sustained injuries to her cervical and lumbar spine. She also reported pain and numbness in her arms and buttocks. A medical assessment was arranged through the PIC to determine whether her level of whole person impairment (WPI) met the greater than 10% threshold for a claim for damages.

The Medical Assessor found that there was no assessable impairment in the arms or buttocks, and that the claimant’s overall impairment was below 10%. The claimant sought a review of this decision, but a Delegate declined to refer the matter to a Review Panel. The claimant then commenced judicial review proceedings in the Supreme Court of New South Wales.

The primary judge allowed the application, finding that the Medical Assessor had failed to properly consider whether the reported symptoms were linked to the spinal injuries and had failed to give adequate reasons for concluding that there was no assessable impairment in the affected areas. The insurer appealed.

Issues on Appeal

The Court of Appeal considered the following key issues:

• Whether the Medical Assessor erred in concluding that there was no assessable impairment in the arms and buttocks.
• Whether the reasoning in the medical certificate met the legal standard for adequacy.
• Whether the primary judge’s interpretation of the certificate was correct.

Decision

The Court of Appeal unanimously allowed the appeal and dismissed the claimant’s application for judicial review. The Court found no jurisdictional or legal error in the Medical Assessor’s report and concluded that the reasoning was adequate when considered as a whole.

Pain is not automatically an injury

One of the central findings of the case was that pain alone does not constitute an “injury” within the meaning of the Motor Accident Injuries Act. While pain is recognised as a form of impairment, it must be connected to a diagnosable injury in order to be taken into account in a WPI assessment.

The Court confirmed that an assessor must first determine whether there is an injury in a particular body region before considering whether that injury gives rise to an impairment. The presence of pain or symptoms like numbness does not, by itself, establish that there is an underlying injury in the relevant region.

The Medical Assessor’s reasoning was sufficient

The claimant argued that the Medical Assessor’s conclusion lacked sufficient explanation, particularly in relation to the arms and buttocks. The Court rejected this, stating that the certificate must be read fairly and as a whole, rather than parsed line by line.

The Court interpreted the Medical Assessor’s comment that “the presence of pain in a body region is not indicative of an injury to that body region” as a medically sound statement namely, that pain is not necessarily evidence of injury. The Court accepted that the Medical Assessor had considered the symptoms in the context of the spine injuries and had concluded that they did not result in permanent impairment in any other part of the body.

Although the Assessor noted the claimant experienced “chronic pain,” the Court inferred that this pain must have related to areas other than the arms and buttocks, since no impairment was assessed in those regions.

Judicial review principles reaffirmed

The Court emphasised that in judicial review, the task is not to determine whether the Assessor made the correct clinical decision, but whether they exceeded their powers or failed to perform their task in accordance with law.

The Court applied the principle that a decision-maker’s reasons should be given a “beneficial construction” and that minor gaps may be filled by necessary inference. It concluded that the Assessor’s reasoning was legally adequate and did not warrant intervention.

Other grounds rejected

The Court also addressed and dismissed several additional grounds raised by the claimant:

• Use of an earlier version of the Guidelines – the Assessor referred to an older version of the Guidelines, but this did not lead to legal error and was not central to the primary judge’s reasoning.
• Lack of notice about inconsistencies – the claimant argued that inconsistencies in her presentation were not put to her, but the Court found that the Assessor had in fact noted and recorded her responses.
• Failure to perform repeated range of motion tests – the claimant alleged noncompliance with protocol, but the Court found the requirement did not apply because the measurements were inconsistent due to pain.
• Failure to address radiological evidence – the Medical Assessor did not discuss an MRI report of the cervical spine. The Court inferred that the report, which showed only degenerative changes, was considered clinically insignificant by the Assessor, especially given that another specialist had described the findings as “reassuring.”

Key takeaways for claimant lawyers

• Pain is not enough – the presence of pain or symptoms in a body region will not be sufficient to support an injury finding unless those symptoms are tied to a diagnosable injury. When preparing for assessment, it is essential to ensure that complaints are supported by clinical evidence.
• Certificates are read holistically – Courts will not invalidate a medical certificate just because some elements of reasoning are brief or implicit. If the certificate, read as a whole, allows a clear understanding of the decision, it is likely to withstand challenge.
• Judicial review is not an appeal on the merits – disagreement with the medical findings is not enough. Unless there is a clear legal error or a failure to carry out the statutory task, courts will not interfere.
• Prepare evidence carefully – this case highlights the importance of ensuring that medical complaints and claimed impairments are clearly supported by medical evidence that links symptoms to injuries.

Please note that this article does not constitute legal advice. If you are seeking professional advice on any legal matters, you can contact Carroll & O’Dea Lawyers on 1800 059 278 or via our Contact Page and one of our lawyers will be able to assist you. If you or a loved one have been injured, use our Personal Injury Claim Check now.