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Case study 5 - an insurer correctly assesses minor injury

This case study looks at possible radiculopathy in the cervical spine/lumbar spine, and injuries to the left shoulder, and knee, and if the related symptoms meet the criteria of a soft tissue injury as defined by the Motor Accidents Injury Act 2017.

Introduction

The Claimant was the driver of a vehicle which was hit from the passenger side (perpendicular). Emergency vehicles attended the scene, not an ambulance however. The claimant drove home from the accident and subsequently visited a hospital and their general practitioner (GP).

The claimant worked in an administrative role prior to the accident and has subsequently returned to suitable duties, the claimant noted that they are struggling to manage 4 hours, 3 days at this stage. The claimant noted having been referred to a physiotherapist and clinical psychologist, whom they attend 1-2 times a week each.

The Medical Assessment

There is a dispute as to whether the injury is a minor injury under scheduled 2 section 2(e) of the Act.

The claimant was assessed approximately 8 months post motor vehicle accident (MVA). The claimant noted injuries to the cervical spine, lumbar spine, left shoulder, and left knee.

On Examination

Cervical Spine (Cervicothoracic)

  • Moderate symmetrically reduced range of motion (70% of normal)
  • No muscle spasm, guarding nor radicular symptoms.

Thoracic spine

  • Symmetrically reduced range of motion (70% of normal range).
  • No muscle spasm, guarding or noted wastage.

Lumbar Spine

  • Moderately and symmetrically reduced range of motion (60% normal range)
  • No muscle spasm, guarding, nor radicular symptoms.

Upper extremities

  • Full range of motion, and no muscle wasting measured.
  • Reported pain in the left shoulder.
  • No neurological abnormalities detected in the upper extremities.

Lower extremities

  • Full range of motion was demonstrated in all lower extremity joints.
  • Pain was reported in the left knee. There was normal range of motion at the left knee without crepitus.
  • No neurological abnormalities were detected in the lower extremities.
  • The claimant had a normal gait.

The MRI of the cervical and lumbar spine reported not showing significant abnormality.

Diagnosis and reasons

The claimant sustained soft tissue injuries to the neck, back, left knee, and left shoulder in the identified MVA.

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.

There is no evidence of rupture/partial rupture of tendons, ligaments, menisci or cartilage in the listed injuries.