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Key takeaways

A Medical Appeal Panel (MAP) has confirmed that insomnia caused by pain from radiculopathy secondary to injury does not satisfy the requirements for an assessment under cl 5.10 of the SIRA Guidelines for the Evaluation of Permanent Impairment (SIRA Guidelines).

A sleep disorder (such as insomnia) is only assessable under cl 5.10 if it is a genuine ‘primary sleep disorder’ caused directly by an injury to part of the brain that regulates sleep, not simply because a worker is in pain and unable to sleep following an injury.

Sleep disturbance due to pain does not attract a separate assessment of permanent impairment, but may be assessable under the body system causing pain.

Brief facts

The worker sustained an accepted injury to the lumbar spine on 21 July 2019 whilst employed by Sydney Waterproofers Pty Ltd (the Respondent).

He underwent multiple lumbar spine surgeries in January 2020 and October 2023 and continued to suffer ongoing chronic back and leg pain as a result. He also developed insomnia.

The worker made a claim for lump sum compensation for injury to the lumbar spine, scarring and ‘consequential sleep and respiratory disorder injuries’.

The Respondent’s insurer disputed the worker’s entitlement to lump sum compensation, and disputed that the worker suffered a neurological injury or respiratory condition that would give rise to an assessment under the AMA5 Guides (AMA5) and SIRA Guidelines.

The worker commenced proceedings in the Personal Injury Commission (PIC), at which time the parties agreed, by consent, that the worker was entitled to 27% WPI for the lumbar spine and scarring. The consent orders also confirmed an agreement that the worker did not have a sleep disorder due to a respiratory condition.

The matter was referred to a PIC Medical Assessor (MA) for a binding assessment with respect to ‘insomnia’. In December 2025, MA Grainge accepted that the worker suffered from insomnia but assessed 0% WPI on the basis that pain-related impairment must be assessed under the body system where the injury occurred (in this case, the lumbar spine), rather than as a separate sleep disorder.

The worker appealed the Medical Assessment Certificate (MAC) on the basis that his insomnia was caused by a neurological injury (namely, radiculopathy at the S1 nerve root) rather than pain. He argued that the insomnia was therefore assessable under the neurological chapter under Table 13.4 of the AMA5 and cl 5.10 of the SIRA Guidelines.

The worker also sought an assessment of obstructive sleep apnoea under the respiratory system, despite the parties’ prior agreement, reflected in the consent orders, that he did not have a sleep disorder due to a respiratory condition.

Judgment

The MAP accepted that the worker’s S1 nerve pathology amounted to a neurological injury.

The MAP then considered the meaning of a ‘primary sleep disorder’, adopting and endorsing the reasoning in Arch-Systems Fabrications Pty Limited v McCann [2026] NSWPICMP 320. The MAP interpreted a ‘primary sleep disorder’ as ‘a sleep disorder resulting directly as a result of a neurological injury’.

The MAP considered that an assessable ‘primary sleep disorder’ under cl 5.10 of the SIRA Guidelines requires impairment of the parts of the brain that regulate sleep. It was determined that insomnia caused by pain radiating from a peripheral nerve root injury is, at most, a secondary condition, not a primary sleep disorder.

The MAP also rejected the worker’s submission that chronic insomnia is, of itself, a neurological condition. It agreed with the opinion of Medical Assessor O’Neill in Carrasco v RKDOIG Pty Ltd [2026] NSWPIC 319 that in neurological circles, insomnia is regarded as a symptom, not a primary neurological condition.

The MAP confirmed the original MAC and agreed that no further medical examination was required.

Implications

This decision adds to a growing line of authority addressing the basis upon which sleep and arousal disorders are assessable under the AMA5 and SIRA Guidelines.

It confirms that insomnia resulting from pain associated with radiculopathy secondary to injury does not satisfy the meaning of ‘primary sleep disorder following neurological injury’ under the SIRA Guidelines.

More broadly, the decision clarifies the distinction between an assessable primary sleep disorder and sleep disturbance caused by pain.

When determining claims for sleep disorders, insurers should focus on the wording of cl 5.10 of the SIRA Guidelines and whether the worker satisfies the definition of ‘primary sleep disorder following neurological injury’.