NSW Supreme Court Confirms Accident-Related Surgery Can Be Recognised as an Injury

A recent NSW Supreme Court decision has provided important clarification for people injured in motor vehicle accidents who require surgery as part of their treatment. The decision confirms that, in some circumstances, the consequences of accident-related surgery may themselves be recognised as an injury under the Motor Accident Injuries Act 2017 (NSW).

Mandoukos v Allianz Australia Insurance Ltd [2026] NSWSC 911, a case conducted by Garling&Co on behalf of injured motorist Nicholas Mandoukos, is likely to have significant implications for injured motorists who undergo spinal surgery, orthopaedic surgery, joint reconstruction or other procedures following a road accident.

Our client, Mr Nicolas Mandoukos was injured in a motor vehicle accident in 2019. Following the accident, he developed ongoing neck pain and nerve symptoms affecting his arm. Despite treatment, his condition did not improve, and he ultimately underwent cervical spine surgery. The procedure involved the removal of bone from his spine to relieve pressure on an affected nerve.

There was no dispute that the surgery was necessary because of the injuries caused by the motor accident. The issue was whether the physical changes resulting from that surgery could themselves be considered an injury under the legislation.

Under the NSW motor accidents scheme, the way an injury is classified can have a significant impact on a person’s rights and entitlements.  For many injured motorists, the distinction between a threshold injury and a non-threshold injury can affect access to:

• Ongoing statutory benefits
• Medical and treatment expenses
• Weekly income support payments
• Common law damages claims
• Compensation for future economic loss
• Compensation for pain and suffering in eligible cases

The decision therefore raised an important question: if surgery is required because of injuries sustained in a motor vehicle accident, can the permanent physical changes caused by that surgery be recognised as an injury?

The Supreme Court found that the Personal Injury Commission Review Panel had approached the issue incorrectly.

Rather than focusing on whether the surgery improved symptoms or was undertaken for therapeutic reasons, the Court held that attention should be directed to the physical consequences of the surgery itself.

In Mr Mandoukos’ case, the surgery permanently altered his spine. Bone was removed, physiological changes occurred, and there was a clear physical impact on his body. The Court found on proper construction of the term “injury” it encompasses all bodily harm — including physiological change or permanent alteration — resulting from a motor accident, and this extends to include necessary medical treatment undertaken because of the accident.

The decision overturned the Review Panel’s earlier conclusion and provides important guidance for future disputes involving accident-related surgery.

Many people involved in motor vehicle accidents require surgery long after the accident has occurred.  This may include:

• Cervical spine surgery
• Lumbar spine surgery
• Spinal fusion procedures
• Joint reconstruction surgery
• Shoulder surgery
• Knee reconstruction
• Orthopaedic surgery
• Procedures involving the removal of bone or permanent anatomical changes

Before this decision, uncertainty existed about how the consequences of these procedures should be assessed in some motor accident compensation claims. The Supreme Court has now confirmed that where surgery is required because of accident-related injuries and results in permanent bodily change, those consequences cannot simply be ignored.

For injured people, surgery is rarely a choice. It is often undertaken only after months or years of pain, treatment and rehabilitation.

The Court’s decision reflects the practical reality that surgery can permanently alter a person’s body. The fact that a procedure is intended to improve someone’s condition does not change the physical impact of that surgery.

This decision helps ensure that motor accident compensation claims are assessed based on the real consequences of both the accident and the treatment required because of the accident.

If you have suffered injuries in a motor vehicle accident and have undergone surgery as a result, it is important to obtain advice about how your injuries may be classified under the NSW motor accidents scheme.

Garling&Co Lawyers acts exclusively for injured people and has extensive experience helping clients with motor vehicle accident claims, spinal injury compensation claims, serious injury disputes and Personal Injury Commission proceedings. Whether your injuries involve the neck, spine, back, nerves, joints or other orthopaedic injuries, obtaining early legal advice can help you understand your rights and entitlements.