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Case study 34 - non-minor injury

Overview

This case study explores a dispute about whether an injury (cervical and lumbar spine) is a minor injury under Schedule 2 section 2(e) of Motor Accident Injuries Act 2017. The Assessor found the one of the claimant’s injuries was a Non-Minor Injury.

Introduction

The claimant was the driver of a motor vehicle that was stationary at traffic lights when it was hit from behind by another vehicle. The claimant could drive away from the scene, however the vehicle was later “written off”.

The claimant consulted a general practitioner on the day of the accident. There were symptoms to multiple body parts, particularly to the neck, right shoulder, lower back and legs.

The claimant reported that the lower back pain is worse when sitting and standing for extended periods. On occasions, the claimant experiences pain under both feet when standing for a long time. The claimant also described “electric” feelings in the right thigh occasionally. The neck symptoms have since resolved.

The claimant attended 14 sessions of physiotherapy treatment. Current medications include Endep 75mg at night, Brufen 25mg per day and Voltaren Rapid tablets as required.

The Assessment

There is a dispute about whether the injury is a minor injury under Schedule 2 section 2(e) of the Act.

Clinical Examination

The claimant walked with a normal gait.

Cervical Spine

  • Full range of pain free movement without muscle spasm or guarding
  • No radicular symptoms
  • Circumferences in the upper extremities were right 28 cm and left 27 cm. This is consistent with limb dominance
  • No neurological abnormalities in the upper extremities

Thoracic Spine

  • Mildly and symmetrically reduced range of motion (to 70% normal)
  • No muscle spasm or guarding
  • No radicular symptoms

Lumbar Spine

  • Moderately and symmetrically reduced range of motion (to 70% normal)
  • No muscle spasm or guarding
  • Symptoms in the lower extremities were not radicular at the time of assessment
  • Circumferences of the lower extremities were right 40cm and left 40cm. There were no neurological abnormalities in the lower extremities

Review of Documentation

The initial Certificate of Capacity issued by the General Practitioner notes ‘neck pain, lower back pain and headache’.

The treating specialist report identifies a disc prolapse rather than a disc bulge.

MRI of the lumbar spine showed a L5/S1 disc injury. The disc showed evidence of rupture.

Diagnosis

The claimant sustained soft tissue injuries to the cervical spine and lumbosacral spine. The injury to the cervical spine has resolved.

With reference to the lumbosacral spine, the preferred description is a soft tissue injury. However, upon review of imaging it is concluded that there was a disc rupture. This is a non-minor injury. The appearance of the disc rupture in the MRI, the nature of the motor accident and the claimant’s relatively young age make it unlikely to be a finding that was present prior to the subject accident.

Minor Injury

Section 1.6(2) of the Act

A soft tissue injury is (subject to this section) an injury to tissue that connects, supports or surrounds, other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.

Schedule 1 [2] clause 4 of the Motor Accident Injuries Regulation 2017:

  1. An injury to a spinal nerve root that manifests in neurological signs (other than radiculopathy) is included as a soft tissue injury for the purposes of the Act.

The following injury is not a minor injury:

  • Lumbar Spine – soft tissue injury