The Australian and New Zealand Institute of Insurance and Finance (ANZIIF) has drawn attention to a Victorian Supreme Court decision that clarifies the role of medical panels in assessing impairments unrelated to an alleged injury.
Legal insights from Wotton + Kearney, who acted for the defendant, have emphasised the ruling’s implications for insurers and claim management.
The court dismissed a judicial review brought by a claimant who challenged a medical panel’s findings under section 28LL(3) of the Wrongs Act 1958 (Vic). The panel had determined that the claimant’s knee impairment was due to pre-existing conditions, not the alleged fall at a Melbourne shopping centre in 2021.
The claimant argued that a fall at the shopping centre caused a left knee injury significant enough to meet the threshold for general damages under the Wrongs Act. However, the shopping centre operator referred the claim to a medical panel, citing the claimant’s long history of knee problems.
In its review, the panel concluded in August 2023 that the claimant’s knee issues were primarily the result of pre-existing conditions, including a prior knee replacement and a recent hospitalisation for an infection in the prosthesis.
Section 28LL(3) of the Act required the panel to disregard impairments not directly linked to the incident, leaving the claimant’s injuries from the fall below the statutory threshold for compensation.
The claimant sought judicial review of the panel’s decision, arguing that section 28LL(3) required a broader approach. He claimed the provision necessitated assessing not only impairments caused by the incident but also those indirectly related, such as post-incident swelling and complications.
According to the claimant, the panel’s interpretation overlooked this broader scope and resulted in jurisdictional error.
Wotton + Kearney, acting for the shopping centre operator, defended the medical panel’s determination as compliant with legislative requirements. The lawyers argued that the panel had followed the appropriate legal and evidentiary processes.
On Sep. 26, 2024, Justice Stephen O’Meara dismissed the application for judicial review, affirming the panel’s findings. The court rejected the claimant’s argument that section 28LL(3) imposed two distinct tests for evaluating impairments.
Instead, O’Meara ruled that the provision required a causal link between the incident and the impairment, which the panel had properly assessed.
The judgment found no evidence of error or noncompliance with statutory obligations by the panel. Justice O’Meara emphasised that the panel’s decision reflected the intended scope of section 28LL(3).
ANZIIF highlighted the ruling as a key precedent for medical panel determinations under the Wrongs Act, especially in cases involving pre-existing conditions. The decision underscores the importance of evaluating causation accurately and adhering to statutory guidelines.
For insurers and defendants, the judgment reinforces the utility of medical panels in ensuring claims are assessed within the parameters of the law. It also signals the need for clear documentation and precise legal arguments when disputes over impairment determinations arise.
The case serves as a reminder to insurers, legal practitioners, and claim managers to remain vigilant in analysing injury claims, particularly when pre-existing medical conditions complicate assessments. The ruling provides additional clarity on how section 28LL(3) should be applied, supporting robust claims management and defence strategies in future disputes.
