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Case study 17 - causation of injuries following a significant accident

Overview

The Medical Assessor found a diagnosis of multiple soft tissue injuries which meets the definition of a Minor Injury.

Summary

This case summary seeks to clarify the causation of injuries following a significant accident.

Introduction

The claimant’s motor vehicle was hit from the side and forced through a safety fence and came to rest below the roadway after hitting a tree. Airbags were deployed and the ambulance attended while bystanders assisted the claimant out of their vehicle.

The claimant has been receiving physiotherapy and psychological treatment since the injury.

The claimant ceased their role (light level of physicality) and subsequently returned to part time work 7 months post motor accident, and full time 9 months post motor accident.

The claimant reported having ceased leisure activities including yoga and walking.

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

The claimant was observed to have moderate and symmetrical restriction in the cervical spine, without muscle spasm, guarding or radicular symptoms.

The assessment of upper extremities identified full range of motion in both shoulders although there was reported pain in the extremes of movement. No muscle wastage was noted in the upper extremities, nor neurological abnormalities.

The claimant’s thoracic spine was noted to have moderate and symmetrical reduced range of motion, without spasm, guarding and no radicular symptoms.

The lumbosacral spine was noted to have mild and symmetrical reduced range of motion, without muscle spasm or guarding, nor radicular symptoms.

Review of Documentation

The discharge summary from hospital identified a CT scan of the cervical spine and brain which showed no evidence of traumatic injury.

MRI report of the left hip from 6 months post injury reported inflammatory changes and a labral tear was not reported.

Dental report from 6 months post injury identifies a recommendation to replace a defective cracked filling in a tooth with a crown.

Diagnosis

The claimant sustained soft tissue injuries to the neck, chest, lumbar spine based on the available information. There is not a plausible mechanism of injury for the tooth injury. Further tooth cracks to restorations are common and occur frequently when placed for a long time.

There are no injuries to either shoulder and therefore no specific injuries could be defined.

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 list of injuries (cervical spine, lumbar spine, chest, and left thigh) that are caused by the MVA, are considered soft tissue injuries and as such as considered minor injuries.

There is no evidence based on the submissions, imaging studies and clinical assessment that the “injuries” to both shoulders, and teeth were caused by the MVA.

The following injury is a minor injury

  • Cervical Spine – Soft tissue injury
  • Chest – Soft tissue injury
  • Lumbar Spine – Soft tissue injury
  • Left thigh – Soft tissue injury

The following injury was not caused by the motor accident

  • Both shoulders
  • Teeth