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Case study 6 - insurer correctly assesses minor injury

This case study looks at a specific example of injuries sustained in a motor vehicle accident and whether those injuries meet the definition of a soft tissue injury.

Introduction

The claimant was a front seat passenger in a vehicle stopped at traffic lights. The vehicle was hit on the driver’s side by another car.

The claimant reported a brief loss of consciousness. Bystanders provided assistance and the claimant was transported to hospital via ambulance. The claimant was assessed and discharged that same day.

The claimant subsequently saw a General Practitioner. There was pain in the right side of the neck, lower back, right leg and right knee felt laterally.

The claimant underwent 18 sessions of physiotherapy and 1 session with a psychologist. In addition, analgesic medication was prescribed.

The Assessment

There is a dispute about whether the injury is a minor injury under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act)

Clinical Examination

Cervical Spine

  • Range of motion was moderately and symmetrically reduced without muscle spasm or guarding
  • No radicular symptoms

Lumbar Spine

  • Moderately and symmetrically reduced range of motion without muscle spasm or guarding
  • No radicular symptoms

Upper Extremity

  • Full range of motion in all joints including the shoulders
  • No neurological abnormalities
  • Sternoclavicular joint was slightly prominent

Lower Extremity

  • Full range of motion in all joints
  • No neurological abnormalities

Review of Documentation

Certificate of Capacity listed multiple soft tissue injuries

General Practitioner report diagnosed an exacerbation of pre-existing osteoarthritis of the neck, lumbar spine and both knees

Ambulance report noted no loss of consciousness and a normal Glasgow Coma Score. It noted no evidence of a significant head injury.

Hospital discharge summary noted a transient loss of consciousness as well as right shoulder pain and headache. Investigations showed no intracranial abnormality.

Diagnosis

Soft tissue injury to the cervical spine, right shoulder, lower back, left chest and right knee

Soft tissue injury to the face and head without evidence of significant brain injury

Resolved facial haematoma

Based on the history provided by the claimant and the medical information available to the medical assessor, the following injuries were determined to be caused by the motor accident

  • Cervical spine – soft tissue injury
  • Right shoulder – soft tissue injury
  • Lumbar spine – soft tissue injury
  • Left chest – soft tissue injury
  • Right knee – soft tissue injury
  • Face – soft tissue injury (resolved)

The following injuries were not caused by the motor accident

  • Left shoulder injury
  • Right leg injury
  • Left knee injury
  • Disc injury L4/L5 and L5/S1
  • Mild brain injury

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 a minor injury

  • Cervical spine – soft tissue injury
  • Right shoulder – soft tissue injury
  • Lumbar spine – soft tissue injury
  • Left chest – soft tissue injury
  • Right knee – soft tissue injury
  • Face – soft tissue injury (resolved)