Review Panel: Principal Member John Harris, Dr Ian Cameron and Dr Trudy Rebbeck

Important Takeaways

• The Panel accepted that further tearing of an already degenerate lateral meniscus caused by the accident was a partial rupture of the meniscus, and that such injury was not a minor injury for the purposes of the Motor Accident Injuries Act 2017.

Facts

The Claimant in Venizelou v AAI Ltd [2021] NSWPICMP 215 fell when the Insured bus she was travelling on broke suddenly on 4 February 2020. It was accepted that she fell directly onto her left knee.  

Pre-accident records revealed that the Claimant attended her GP on multiple occasions in 2017 for left knee complaints. In August 2017 the Claimant attended an Orthopaedic Surgeon when a total knee replacement was recommended. However, the Claimant did not undergo surgery and did not complain of left knee pain again until 18 November 2019 when there was a reference to bilateral knee pain. 

Post-accident records revealed that the Claimant complained of left knee pain and bruising within days of the accident.  An MRI performed post-accident showed:

• moderate degenerative changes in the ACL and PCL;
• a macerated lateral meniscus with a large radial component;
• moderate to severe chondropathy in the patellar femoral compartment; and a
• likely old tear of the medial meniscus.  

The Claimant alleged that following the accident, her symptoms were such that she decided to proceed with the total knee replacement - whereas before the subject accident she had hoped to put the surgery off for 5 years. 

At first instance Assessor Woo determined that the Claimant sustained only minor injuries. The Claimant’s Application for Review was accepted.

The Review Panel Decision

As far as the Minor Injury Dispute was concerned, the issue for determination by the Review Panel was confined to whether the Claimant’s left knee injury was a minor injury.

The Review Panel were also tasked with determining whether a knee replacement undertaken on 19 July 2021 was reasonable and necessary.  The Review Panel determined that a physical examination was not required, particularly given that the Claimant was recovering from surgery. 

The Panel considered it relevant that at the time of the accident, the Claimant was:

• independent in care;
• able to walk for several kilometres;
• in full-time employment; and
• was not taking pain medications for her left knee. 

The Panel also noted that the Claimant fell onto her left knee in the subject accident, and was prescribed Naprosyn immediately following the accident.  She also continued to complain of a severe increase in pain in the left knee with swelling, locking, reduced range of movement and loss of function. 

The Panel considered the onset of locking significant. They also considered the Claimant’s treating orthopaedic surgeon’s finding that there had been an increase in malalignment between April and May 2020 to be significant.

They noted that locking was often due to an internal derangement of the knee, allowing for the probability that in addition to an aggravation of the existing arthritis, there had also been some new internal mechanical damage. 

The Panel accepted that a direct fall onto a degenerate knee could easily further tear a degenerate lateral meniscus - and that the fall did cause further tearing, which was not a minor injury.

If you have a query relating to any of the information in this case note, or would like to speak with someone in Holman Webb’s Insurance Group in relation to a matter of your own, please don’t hesitate to get in touch with Partner Stephanie Davis today.