Supreme Court case note

Zadehfard v Allianz [2025] NSWSC 1423: procedural fairness in treatment disputes

The Supreme Court quashed a PIC medical assessment certificate and remitted for redetermination by a different assessor, reinforcing fairness limits on how medical disputes are decided under MAIA.

This is a claimant-facing summary, not legal advice. The key point is process integrity: medical assessment outcomes remain reviewable where fairness failures materially affect the reasoning pathway.

Issue in dispute

The claimant sought insurer payment for proposed lumbar fusion surgery. The dispute traversed both causation and whether treatment was reasonable and necessary. The Supreme Court challenge focused on legality of process, not simply who had the better merits argument.

In practical terms, the question became whether the medical assessment was made on a procedurally fair footing and within the dispute actually referred for determination.

Court reasoning in plain English

judicial review is not a merits re-hearing; it tests legal validity of decision-making
parties must have a fair opportunity to meet decisive reasoning propositions
if a certificate rests materially on matters not properly ventilated, procedural fairness risk can invalidate outcome
where reviewable error is established, remitter to a different assessor may be required to restore lawful process integrity

Implications for other NSW CTP cases

define referral scope tightly — avoid vague issue framing that blurs causation vs reasonableness disputes
build evidence matrices around decisive propositions likely to determine outcome
challenge certificates that appear to rely on unforeshadowed or unanswerable decisional material
prepare judicial-review pathways early where fairness defect is outcome-critical and time-sensitive

Decision source

Full judgment: Zadehfard v Allianz Australia Insurance Limited [2025] NSWSC 1423.

Frequently asked questions

What did Zadehfard v Allianz [2025] NSWSC 1423 decide?: The Supreme Court quashed a PIC medical assessment certificate and remitted the matter to a different medical assessor, finding reviewable legal error grounded in procedural fairness concerns.
Was this a merits re-hearing about whether surgery should be approved?: No. The Court focused on legality and fairness of the decision-making process, not simply replacing the assessor’s medical merits view with its own.
Why is this important for NSW CTP treatment disputes?: It reinforces that assessors must decide the dispute as referred and on a procedurally fair basis. If decisive reasoning is outside what parties had a fair chance to meet, the certificate can be vulnerable on review.
What should claimant teams do differently after this case?: Define dispute scope precisely, force clear issue framing early, and challenge any certificate that appears to rely on unventilated or unforeshadowed decisional propositions.