What happened: The ACT tribunal upheld NRMA's decision to assess a cyclist's whole person impairment at 6%, rejecting arguments that the figure should have been 13%
Who's involved: NRMA (Insurance Australia Ltd) as CTP insurer; a cyclist injured in a 2023 collision
What's at stake: $11,320 in quality of life benefits - and whether the claimant could access common law damages at a higher impairment threshold
Why it matters: The ruling clarifies that shoulder symptoms caused by a cervical spine injury cannot be scored separately under the standard medical guides - a double-counting trap for assessors and claims teams alike
Where it stands: Decided by ACAT on September 8, 2026; insurer's decision affirmed
A cyclist's neck never stopped hurting after she was knocked off her bike at an intersection in Canberra in February 2023. Two and a half years later, the question of exactly how much that pain was worth landed before the ACT Civil & Administrative Tribunal - and the answer hinged on a technical disagreement between two doctors that swung the impairment figure from 0% all the way to 13%.
The insurer, NRMA, accepted liability for the collision and referred the cyclist for an independent medical examination under the Motor Accident Injuries Act 2019. The examiner, a rheumatologist, found no muscle spasm and symmetrical range of motion in the cervical spine. The result: 0% whole person impairment. Nothing to pay beyond treatment and care.
The cyclist arranged her own assessment, as the Act allows. Her examiner, a pain specialist, found a different picture entirely - asymmetry in the cervical spine, jerky and uneven movement in the shoulders, and limited range of motion on both sides. He scored 5% for the cervical spine injury, added 1% for its impact on everyday tasks like yard work and gardening, then scored another 7% for loss of movement in both shoulders. Total: 13%.
That gap mattered enormously. At 6%, the cyclist was entitled to $11,320 in quality of life benefits. At 13%, she would have crossed the 10% threshold that opens the door to a common law damages claim - a far larger potential payout.
When NRMA sent the private examiner's report back to the independent examiner for review, as the legislation requires, the independent examiner moved. She revised her original 0% upward to 6%, accepting the cervical spine findings. But she refused the additional 7% for the shoulders. Her reasoning: both she and the private examiner agreed the shoulder pain came from the neck injury. Scoring it separately would mean counting the same injury twice.
The tribunal agreed.
The decision, published on October 7, 2026, turned on a technical but important question: which chapter of the American Medical Association's assessment guides should be used to score the shoulder symptoms?
The spine chapter already accounts for pain and restricted movement that radiates into the shoulders and arms - muscle guarding, asymmetric range of motion, nerve-related complaints. The upper extremities chapter covers injuries to the shoulders and arms themselves, not symptoms referred from the spine.
The private examiner had used both chapters. The tribunal found that was the error - not the independent examiner's refusal to follow suit.
The cyclist also argued the independent examiner should have physically re-examined her before issuing her revised assessment. The tribunal rejected this. The Act requires the insurer to send the private report to the independent examiner for review; it does not require another face-to-face appointment. The process is designed to be done on the papers.
A third challenge targeted the insurer's offer letter. The cyclist argued that NRMA had not clearly determined her impairment, as required by the Act, and had not provided adequate reasons for the $11,320 figure. The tribunal acknowledged the letter was brief - it described the offer as "based on" the independent examiner's revised 6% - but found it did what was necessary.
The tribunal drew on the ACT Supreme Court's recent decision in Stewart v Kirk, which confirmed that the statutory scheme gives the independent examiner the final say on impairment. The insurer's job is to adopt that figure and explain the process that produced it.
Previous ACAT decisions had pushed for more detailed written reasons from insurers. The tribunal flagged that its view on what counts as adequate may shift if future court decisions sharpen the standard.
For CTP claims teams running impairment assessments under similar statutory schemes, the practical takeaway is the double-counting question: when shoulder or limb symptoms trace back to a spinal injury, they belong under the spine chapter of the medical guides, not both.
