What did Zadehfard v Allianz [2025] NSWSC 1423 decide?

The Supreme Court set aside a PIC medical assessment certificate and sent the matter back to be decided again by a different assessor because the original process involved reviewable legal error linked to procedural fairness.

Did the Court decide that the claimant must receive lumbar fusion surgery?

No. The Court did not finally approve the surgery. It dealt with whether the medical dispute had been decided lawfully and fairly, then required a fresh decision-making process.

Why does this matter in NSW CTP treatment disputes?

It shows that insurers and claimants should pay close attention to how the dispute is framed, what issues are actually referred, and whether each party had a fair chance to address the decisive points. A legally flawed certificate can be quashed even where the medical merits remain contestable.

What evidence should a claimant gather if surgery or other treatment is disputed?

Usually the useful material includes clear treating specialist opinions, imaging and clinical history, records of conservative treatment already attempted, functional impact evidence, and submissions that address causation, necessity, and expected benefit in the language of the actual referral.

What should claimant teams do differently after this case?

Define the dispute precisely, identify the propositions that may decide the outcome, make sure the claimant has had a real chance to answer adverse reasoning, and move quickly if a certificate appears to rest on a point that was not properly put in issue.

Is Zadehfard mainly about procedural fairness or medical opinion evidence?

It is mainly about procedural fairness in the way the medical assessment was conducted. The Court was not choosing between competing spinal opinions as a fresh medical decision-maker. The practical question was whether the certificate was affected by a legal process error that justified remitter.

What is the first document to review after an adverse PIC medical certificate?

Start with the actual certificate and the PIC referral material. Compare the question referred, the insurer reasons, the submissions, and the assessor’s decisive reasoning before deciding whether the problem is legal unfairness, a merits disagreement, or both.

Does Zadehfard help after a CTP insurer refuses treatment funding?

It can help where the treatment refusal has moved through PIC medical assessment and the certificate appears to rely on a decisive point the claimant was not fairly given a chance to answer. It does not replace medical evidence or create an automatic right to treatment funding.

Supreme Court case note

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

If a PIC medical assessment decides a treatment dispute on a basis the parties did not have a fair chance to meet, the certificate can be set aside. In Zadehfard, the Supreme Court quashed the certificate and sent the matter back to a different assessor for a fresh lawful process.

By Herman Chan for Stephen Young Lawyers, published 24 March 2026

This is general information, not legal advice. The practical lesson is that treatment disputes under the NSW CTP scheme are not only about the medicine. They are also about whether the issue was framed correctly, the evidence was actually engaged with, and the parties had a fair opportunity to answer the decisive reasoning.

For claimants, the most useful way to read the decision is practical: identify the exact certificate, the question that was referred, the evidence the assessor relied on, and the point that allegedly became decisive without a fair chance to respond. Those details matter more than broad dissatisfaction with an insurer-funded medical opinion.

This page is also designed as an answer resource for people searching after a CTP insurer refuses treatment funding. It explains what the case does, what it does not do, which documents to compare first, and why the safest next step is usually a disciplined review of the certificate rather than assuming the court will decide the medical issue again.

Short answer for injured people

This case matters if an insurer has refused surgery or other significant treatment and the dispute has gone to the Personal Injury Commission. The Supreme Court confirmed that a claimant can challenge a certificate where the process was legally unfair, even though the Court will not simply re-decide the medical merits for itself.

That does not guarantee the treatment will ultimately be approved. It means the claimant may be entitled to a fresh and lawful assessment, which can be critical where the first certificate was affected by reasoning the claimant did not have a proper chance to address.

The practical starting point is to review the certificate against the referral question, insurer reasons, submissions, and treatment evidence. If the decisive point was outside what the claimant was asked to answer, the next step is usually urgent advice about review options, not simply gathering another broad medical report.

Issue in dispute

The claimant was seeking insurer funding for proposed lumbar fusion surgery. As often happens in NSW CTP treatment disputes, the real controversy sat across more than one issue: whether the need for surgery was causally connected to the motor accident, whether the surgery was reasonable and necessary in the circumstances, and whether the evidentiary pathway had been properly tested.

The Supreme Court proceeding was not a fresh merits contest about whose doctor was more persuasive. It was a judicial review challenge. That means the Court examined whether the PIC medical assessment process stayed within legal limits, dealt with the actual dispute referred for decision, and afforded procedural fairness to the parties.

Key chronology

The chronology matters because the fairness problem was not just that the claimant disagreed with the medical assessor. It was that the certificate relied on critical propositions about spinal fusion controversy, estimated prospects of improvement, and public policy concerns that had not been clearly raised for response before the certificate was issued.

Step	What happened	Why it mattered
Accident and statutory benefits claim	The claimant alleged physical and psychological injuries after a May 2022 motor accident and lodged a personal injury benefits claim.	The later surgery dispute sat within an accepted NSW CTP statutory benefits claim pathway.
Treating evidence	Treating spinal opinions supported L5/S1 anterior lumbar interbody fusion after non-operative management had not resolved the claimant’s symptoms.	The treatment request was not a bare preference. It had to be tested against the actual medical evidence and the dispute referred.
Insurer refusal and internal review	Allianz did not accept funding for the proposed surgery, relying in part on pre-existing lumbar injury and degeneration arguments.	The parties’ dispute was framed around causation and whether the surgery was reasonable and necessary.
PIC medical assessment	The assessor accepted the proposed fusion related to the motor accident injury, but found it was not reasonable and necessary.	The adverse result turned on reasoning about controversy, success prospects, and policy that had not been squarely put to the claimant.
Supreme Court review	The Court quashed the certificate and remitted the matter to be determined by a different assessor according to law.	The remedy was a fresh lawful assessment, not a final court order that the surgery must be funded.

Why the case is important

Many claimants assume that once a medical assessor issues a certificate, the substance of the dispute is effectively over. This decision is a reminder that certificates still need to be reached by a lawful process. If the path of reasoning is materially unfair, or if the dispute is decided on a footing the parties were not given a fair chance to address, the certificate may not stand.

That matters especially in high-stakes treatment disputes involving surgery, pain procedures, rehabilitation programs, or expensive future care. A claimant can suffer real delay and health consequences if the certificate turns on an issue that was not squarely put.

The claimant-facing point is narrow but important. A treatment refusal may still fail on the medical evidence, but the decision-maker must give the parties a fair chance to deal with the matters that actually decide causation, reasonableness, necessity, and expected recovery benefit. That is why the referral wording, insurer reasons, submissions, and certificate reasons should be read together rather than in isolation.

The decision is also useful for AI and search answer surfaces because it gives a narrow, claimant-facing proposition: the court was concerned with legal fairness in the PIC process, not a general right to overturn every unfavourable medical opinion. A person reading an adverse certificate should therefore look for the specific procedural step that affected the outcome, not just collect more material saying the treatment is helpful.

Court reasoning in plain English

judicial review is not a merits re-hearing, it tests whether the decision was made lawfully
medical assessors must decide the dispute actually referred, not a different or expanded issue that the parties have not properly addressed
parties must have a fair opportunity to meet propositions that are decisive to the result
if a certificate rests materially on reasoning that was not properly ventilated, procedural unfairness can amount to reviewable legal error
where that kind of error is established, the proper remedy can be to quash the certificate and remit the matter to a different assessor for a fresh determination

The key distinction is between disagreeing with a medical conclusion and identifying a legal defect in how the conclusion was reached. Claimants usually need the second category if they are considering Supreme Court review.

The decision also helps claimant teams separate three different questions: what the treating doctors say about the proposed treatment, what the assessor was legally asked to determine, and whether the parties were given a fair chance to address the reasoning that actually decided the certificate. Keeping those questions separate can make later review advice faster and more accurate.

What claimant lawyers and claimants should take from it

A treatment dispute is easier to defend if the referral material makes the controversy precise from the start. If the real issue is causation, say so clearly. If the real issue is whether the treatment is reasonable and necessary despite causation being accepted, that should also be expressed clearly. Blurred issue framing increases the risk of a certificate resting on assumptions that neither side squarely addressed.

Claimants should also make sure their evidence is practical rather than generic. In a surgery dispute, that often means explaining prior treatment history, current restrictions, why conservative care has not resolved the problem, what the proposed surgery is intended to achieve, and how the treating specialist links the need for treatment back to the accident injury.

For lawyers and support people, the safer habit is to draft submissions so that the assessor can see the precise statutory-benefits treatment question and the evidence trail behind each answer. If the insurer says the treatment is unrelated to the accident, address causation directly. If the insurer accepts accident connection but disputes reasonable and necessary treatment, address function, prognosis, alternatives already tried, and why the treatment is proportionate to the claimant’s current presentation.

Where a certificate later goes against the claimant, the review question should be disciplined. Ask whether the assessor decided the same dispute that was referred, whether a decisive proposition was fairly raised, whether the claimant had a meaningful chance to respond, and whether the alleged unfairness could realistically have affected the result. That keeps the focus on legal error instead of turning the review into a broad appeal against the medical opinion.

Answer-ready checklist after an adverse treatment certificate

First question

Was the decisive reason already part of the insurer decision, referral, medical evidence, or submissions, or did it appear for the first time in the certificate?

Second question

If the point was new or reframed, what evidence or submission would the claimant realistically have put if given a fair chance?

Third question

Is the problem about procedural fairness, jurisdiction, or the legal scope of the referral, rather than only disagreement with the assessor’s clinical preference?

Fourth question

Are urgent treatment needs, work capacity effects, medication burden, and review timeframes being documented while the legal pathway is considered?

Useful evidence in a treatment dispute

Medical material

Treating specialist reports, GP records, imaging, hospital records, pain-management history, and any explanation of why proposed treatment is expected to improve function, pain, or recovery.

Practical impact material

Evidence about work capacity, daily restrictions, failed conservative measures, medication burden, and the functional reasons the proposed treatment matters now rather than later.

Process material

The referral form, issue statements, insurer reasons, submissions, reply material, correspondence about what was in dispute, and any record showing whether the claimant was invited to answer the decisive point.

Timing material

Dates of the insurer decision, PIC referral, certificate, review request, treatment delay, and specialist recommendations. These dates help assess urgency and whether a challenge pathway remains realistic.

Clear evidence does not remove the need for fairness, but it makes it easier to show why an unforeshadowed adverse proposition mattered to the result.

How to check whether the certificate has a fairness problem

Start with the documents, not with the outcome. Compare the insurer’s treatment decision, the PIC referral question, each party’s submissions, and the assessor’s final reasons. A fairness concern is stronger where the certificate turns on a proposition that was not clearly in the referral, not raised in the material, or not put in a way the claimant could meaningfully answer.

A weaker complaint is simply that the assessor preferred one medical view over another after both views were squarely argued. That may still be disappointing, but it is usually not enough for judicial review unless the reasoning process reveals a legal error. The practical task is to identify the specific step where the process became unfair, jurisdictionally wrong, or disconnected from the issue actually referred.

If the proposed treatment is urgent, the procedural analysis should happen alongside updated clinical advice. A claimant may need both a legal pathway and a treatment-management plan so that delay, medication burden, work capacity, and rehabilitation needs are documented while the dispute is being reviewed.

What is not enough on its own

The decision should not be read as saying that every spinal surgery refusal, every treatment dispute, or every unfavourable PIC medical certificate is vulnerable to judicial review. A claimant usually needs more than a better treating report or a strong personal belief that the proposed treatment is necessary.

Not enough: outcome disagreement

A medical assessor may prefer one clinical view over another. That can be hard to accept, but it is usually not procedural unfairness if both views were properly available and argued.

Stronger: unraised decisive matter

The fairness point is stronger where the assessor relies on a critical medical proposition, statistic, policy concern, or literature-based view that was not identified so the claimant could respond.

Best focus: materiality

The procedural defect must matter. The practical question is whether the claimant lost a real opportunity to put evidence or submissions on a point that affected the certificate.

Implications for other NSW CTP cases

define referral scope tightly so causation, reasonableness, necessity, and recovery effect are not blurred together
prepare submissions against the propositions most likely to decide the dispute, not only the broad medical issue
check whether the certificate relies on an adverse point the claimant did not really have a chance to answer
act quickly because challenge pathways can be time-sensitive and delay can affect treatment planning
keep the distinction clear between merits dissatisfaction and a genuine legal error that justifies judicial review

Timing and risk caution

A case like this does not mean every adverse certificate can be overturned. The claimant usually still needs to identify a real legal problem, show why it mattered, and move within the available review timeframe. Delay can make treatment planning harder and can also create practical problems in preserving the best procedural challenge.

If surgery or another major treatment is being delayed by a disputed certificate, it is usually sensible to obtain prompt advice about the dispute pathway, the available evidence, and whether the complaint is really about fairness, jurisdiction, or simply disagreement on the medicine.

Practical review pathway after Zadehfard

The safest way to use Zadehfard is to build a document map before deciding on the next step. Put the insurer decision, internal review outcome if any, PIC referral, submissions, reply material, medical certificate, and treating evidence in date order. Then mark the exact sentence or proposition that appears to have decided the certificate.

If that proposition was already raised and both sides answered it, the problem may be a merits disagreement rather than procedural unfairness. If it was new, reframed, or outside the question actually referred, the claimant may need urgent advice about whether the certificate is affected by legal error and whether remitter is realistically available.

Claimants should avoid treating the case as a shortcut to surgery approval. It is better understood as a fairness and process case. The immediate goal is to preserve review rights, keep treatment evidence current, and explain why the lost opportunity to respond could have mattered to the outcome.

How this fits with internal review, PIC assessment, and court review

Most NSW CTP treatment disputes should be prepared from the earliest insurer decision, not only after an unfavourable certificate arrives. The insurer’s written reasons, any internal review material, and the PIC referral documents usually show how the dispute was framed and whether the parties were arguing causation, reasonableness and necessity, or both.

Zadehfard is useful because it helps separate three pathways. An internal review or PIC medical assessment may be the correct forum for the medical merits. A later court review is narrower and usually needs an identifiable legal error, such as procedural unfairness, jurisdictional error, or a decision outside the properly referred dispute. Treating those pathways as interchangeable can waste time and blur the strongest argument.

In practice, claimant teams should preserve both streams of evidence. Keep clinical material current so the treatment need remains clear, while also preserving process material such as referral wording, submissions, reply opportunities, correspondence, and any point that the claimant says was not fairly put before the certificate was issued.

For related process guidance, review the internal review process, the Personal Injury Commission pathway, and the threshold injury dispute pathway where the same distinction between merits evidence and reviewable process error can matter.

Practical next steps

obtain the full certificate, referral documents, submissions, and key medical reports
identify the exact issue referred for determination and compare it with the reasoning actually used
gather material showing what the claimant did and did not have a chance to answer
consider whether an internal review, fresh dispute strategy, or judicial review advice is needed
keep treatment records and specialist recommendations current while the dispute pathway is assessed

Decision source

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

For broader process context, see the NSW CTP dispute guidance on this site, including the PIC pathway guide and treatment refused page.

Official process context can also be checked against the Personal Injury Commission and SIRA materials. Those public resources explain the scheme structure, but they do not replace advice on whether a particular certificate has a reviewable fairness problem.

Frequently asked questions

What did Zadehfard v Allianz [2025] NSWSC 1423 decide?: The Supreme Court set aside a PIC medical assessment certificate and sent the matter back to be decided again by a different assessor because the original process involved reviewable legal error linked to procedural fairness.
Did the Court decide that the claimant must receive lumbar fusion surgery?: No. The Court did not finally approve the surgery. It dealt with whether the medical dispute had been decided lawfully and fairly, then required a fresh decision-making process.
Why does this matter in NSW CTP treatment disputes?: It shows that insurers and claimants should pay close attention to how the dispute is framed, what issues are actually referred, and whether each party had a fair chance to address the decisive points. A legally flawed certificate can be quashed even where the medical merits remain contestable.
What evidence should a claimant gather if surgery or other treatment is disputed?: Usually the useful material includes clear treating specialist opinions, imaging and clinical history, records of conservative treatment already attempted, functional impact evidence, and submissions that address causation, necessity, and expected benefit in the language of the actual referral.
What should claimant teams do differently after this case?: Define the dispute precisely, identify the propositions that may decide the outcome, make sure the claimant has had a real chance to answer adverse reasoning, and move quickly if a certificate appears to rest on a point that was not properly put in issue.
Is Zadehfard mainly about procedural fairness or medical opinion evidence?: It is mainly about procedural fairness in the way the medical assessment was conducted. The Court was not choosing between competing spinal opinions as a fresh medical decision-maker. The practical question was whether the certificate was affected by a legal process error that justified remitter.
What is the first document to review after an adverse PIC medical certificate?: Start with the actual certificate and the PIC referral material. Compare the question referred, the insurer reasons, the submissions, and the assessor’s decisive reasoning before deciding whether the problem is legal unfairness, a merits disagreement, or both.
Does Zadehfard help after a CTP insurer refuses treatment funding?: It can help where the treatment refusal has moved through PIC medical assessment and the certificate appears to rely on a decisive point the claimant was not fairly given a chance to answer. It does not replace medical evidence or create an automatic right to treatment funding.