AAI Limited t/as AAMI v Chimata
[2024] NSWPICMP 116
•29 February 2024
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | AAI Limited t/as AAMI v Chimata [2024] NSWPICMP 116 |
| CLAIMANT: | Sagar Chimata |
INSURER: | AAMI |
| REVIEW PANEL | |
| MEMBER: | Hugh Macken |
| MEDICAL ASSESSOR: | Wayne Mason |
MEDICAL ASSESSOR: | Thomas Newlyn |
| DATE OF DECISION: | 29 February 2024 |
| CATCHWORDS: | MOTOR ACCIDENTS – Review of medical assessment; assessment of treatment and care - causation; domestic assistance does not relate to the injury caused by the motor accident; domestic assistance is not reasonable and necessary in the circumstances; psychotropic medication does not relate to the injury; is not reasonable and necessary in the circumstances; Held – Lexapro and other anti-depressants relate to the injury caused by the motor accident and is reasonable and necessary in the circumstances; claimant has not consulted a psychiatrist; mental state examination and current functioning; persistent depressive disorder; post-traumatic stress disorder in partial remission; pain disorder and domestic assistance; certificate revoked and new certificate issued. |
| DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION The Review Panel revokes the certificate of Medical Assessor Michael Li Ying Hong dated The following treatment and care: · psychotropic medication (including Lexapro and other antidepressants) for the balance of the claimant’s life expectancy, RELATES TO THE INJURY caused by the motor accident and is reasonable and necessary in the circumstances. The following treatment and care: 1. 6-15 hours of domestic assistance each week from the 29 June 2016 motor vehicle accident to the date of the Personal Injury Commission’s assessment; 2. 0-25 hours of domestic assistance each week from the date of the medical assessment until 2024; 3. 0-15 hours of domestic assistance each week from 2024 and for 1 year, 2 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy; 4. 0 – 4 general practitioner reviews each year for 1 year, 2 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy; 5. psychotropic medication (including temazepam and other benzodiazepines) for 3 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy, and 6. 0–22 sessions of psychiatric treatment, DOES NOT RELATE TO THE INJURY caused by the motor accident and is not reasonable and necessary in the circumstances. |
STATEMENT OF REASONS
INTRODUCTION
The claimant is a 47-year-old man who was injured in a motor vehicle accident which occurred on 29 June 2016.
Following the accident an application for personal injuries was lodged with the then Motor Accident Commission and documents were exchanged between the claimant’s solicitors and the insurer and their solicitors. During the course of the exchange of these documents the insurer was advised that a claim for domestic assistance, medical reviews, psychotropic medications and psychiatric treatment was being made. Consequent on this on 3 June 2021 the insurer lodged with the Dispute Resolution Service an application for seeking a determination from the Personal Injury Commission (Commission) as to whether the treatment and care being sought by the claimant was related to either the alleged physical and/or psychiatric injuries caused by the subject accident and/or whether it is reasonable and necessary in the circumstances.
In relation to the psychiatric injuries the insurer sought an assessment of the degree of permanent impairment consequent on the psychiatric condition – post-traumatic stress disorder and major depressive disorder suffered by the claimant in the accident.
These matters were then subject of certificates including a certificate from Medical Assessor Paul Friend dated 27 February 2021 which determined that the claimant had suffered a whole person impairment consequent on post-traumatic stress disorder in partial remission and major depressive disorder with melancholic features of 19%.
Subsequent to this certificate the claimant was examined by Medical Assessor Michael Li Ying Hong in respect to the claim for domestic assistance, psychotropic medication, general practitioner (GP) reviews and psychiatric treatment.
In a certificate dated 18 July 2022 Medical Assessor Michael Li Ying Hong determined that all the matters referred to him for assessment were treatment and care requirements which related to the injuries caused by the motor accident and such treatment and care is reasonable and necessary in the circumstances.
The insurer sought a review of this determination and certificate primarily on the grounds that the Medical Assessor failed to provide sufficient reasons, failed to adequately consider the relevant material and did not afford procedural fairness by allowing a late report of Dr Kumar dated 10 June 2022 to be considered with all other material included in the insurer’s application and the claimant’s reply.
The claimant submitted a reply contending that the Medical Assessor had provided sufficient reasons in his certificate, considered all relevant material and, finally, that the report of
Dr Kumar is not determinative in the assessment, nor was there any submission which dealt with the materiality of any prejudice suffered by the insurer.
The matter was referred to the President’s delegate Ratula Gupta, who, in a decision dated 28 September 2022 agreed with the insurer that the Medical Assessor did not provide sufficient reasons or engage with the insurer’s submissions and their various evidence which links psychological injury to the claimant’s physical incapacity and injury. Accordingly, he concluded that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect.
The medical assessment conducted by Medical Assessor Michael Yi Ling Hong on
12 July 2022 was referred to this Review Panel for determination under s 63 of the Act.
Causation and Treatment disputes to be assessed
The following disputes were referred to Medical Assessor Michael Yi Lin Hong for assessment:
· whether all psychological injuries result in a need for domestic assistance from the date of the 29 June 2016 motor vehicle accident to the date of the MAS assessment, and whether this assistance is causally related to the injury sustained in the 29 June 2016 motor vehicle accident;
· whether 6-15 hours each week of domestic assistance arising from the psychological injuries caused by the motor vehicle accident and relating to assistance, from the date of the 29 June 2016 motor vehicle accident to the date of the MAS Assessment is reasonable and necessary in relation to the injury sustained in the 29 June 2016 accident;
· whether all psychological injuries result in a need for domestic assistance from the date of the medical assessment until 2024, and whether this assistance is causally related to the injury sustained in the 29 June 2016 motor vehicle accident;
· whether 0-25 hours each week of domestic assistance arising from the psychological injuries caused by the motor vehicle accident and relating to assistance, from the date of the medical assessment until 2024 is reasonable and necessary in relation to the injury sustained in the 29 June 2016 motor vehicle accident;
· whether all psychological injuries result in a need for domestic assistance from 2024 and for 1 year, 2 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy, and whether this assistance is causally related to the injury sustained in the 29 June 2016 motor vehicle accident ;
· whether 0-15 hours each week of domestic assistance arising from the psychological injuries caused by the motor vehicle accident and relating to assistance, from 2024 and for 1 year, 2 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy is reasonable and necessary in relation to the injury sustained in the 29 June 2016 motor vehicle accident;
· whether psychotropic medication (including Lexapro and/or Temazepam) for 3 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy, is related to the psychiatric injuries caused by the 29 June 2016 motor vehicle accident;
· whether psychotropic medication (including Lexapro and/or Temazepam) for 3 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy, is reasonable and necessary in the circumstances;
· whether 0 – 4 GP reviews each year for 1 year, 2 years, 5 years, 10 years and/or the balance of the Claimant’s life expectancy, is related to the psychological injuries caused by the 29 June 2016 motor vehicle accident;
· whether 0 – 4 GP reviews each year for 1 year, 2 years, 5 years, 10 years and/or the balance of the Claimant’s life expectancy for the psychological injuries, is reasonable and necessary in the circumstances. Whether 0 – 22 sessions of psychiatric treatment is related to the psychiatric injuries caused by the 29 June 2016 motor vehicle accident, and
· whether 0–22 sessions of psychiatric treatment is reasonable and necessary in the circumstances.
All Review Panel members confirmed they had no previous involvement with this matter or the above injured person. All Review Panel members also confirmed that there was no conflict or any other reason they would be unable to approach this review with an open mind.
Assessments under Review
Medical Assessor Michael Li Ying Hong had certified the following in relation to the treatment dispute:
· the disputed treatments, as listed on the certificate, relate to the injury caused by the motor accident, and
· the disputed treatments, as listed on the certificate, are reasonable and necessary in the circumstances.
The claimant was examined by Team videoconferencing by Medical Assessor Tom Newlyn and Medical Assessor Wayne Mason. The claimant was at his rented house in Pendle Hill. His carer and partner were present during the assessment interview.
He is divorced and has rented the house since 2017.
The claimant said, “My partner’s dog passed away over a year ago.”
Psychosocial history and pre-accident history
Medical History before the motor accident
The claimant was 178 cm tall.
The claimant weighed 107kg on 14 February 2024, resulting in an overweight BMI.
The claimant said, “I lost weight after the heart attack. I gained 15 kg in the first few months after the accident. The heart attack forced me to diet. My diabetes is worse because I am less active. Before the accident I was 111 kg.” He said this weight was not excessive although his BMI at 111kg is in the overweight range. When asked about the weight entries in Dr Muni Kumar’s GP record at Joyce Street Medical Practice the claimant said that Dr Kumar had never weighed him. Further Dr Kumar was not interested in doing CTP paperwork. The claimant changed GP to Dr Raymond Morsingh at Wentworthville Medical Centre because he and his companion were angry with Dr Kumar.
The claimant is right-handed.
Before the accident he had migraine headaches monthly to six weekly and had consulted Dr M Shareef Dowla.
Diabetes Mellitus type II was diagnosed in 2011. He was treated with metformin daily.
His first episode of gout in 2015 had resulted in an adverse reaction to a prescribed pain medicine and an Emergency Department visit to St Vincent’s Hospital. He was not treated with gout prophylaxis.
After the adverse reaction in 2015 to a “strong painkiller” with apparent cardiac effects he was taken to St Vincent’s Hospital Emergency Department from work. A cardiologist assessed him. Then he had yearly cardiac follow-up looking at blood tests, checking his cardiac function, and reviewing his diabetic control. He reported there were no heart problems identified before the 2022 heart attack.
He denied any gastrointestinal problems. He described himself as a good cook who ate a lot so he believed his weight of 111kg in 2016 not a problem. He said he was a soccer coach, he cycled and played tennis. He swam and camped.
He had not had any surgical procedures.
He was not allergic to medicine.
Education history
The claimant attended high school and university in India. He emigrated to Australia as a university student in 2000 and completed a graduate diploma in business computing at the University of Western Sydney. He began a Master of Information Systems course at the University of Wollongong that he did not complete.
Employment history
Before the claimant emigrated to Australia in 2000 he worked as a software engineer in India. In Australia he worked in business administration and management procurement. He worked in management from 2011 for Infosys Portland. After the accident he worked in the “operation space” from his home.
Psychosocial history
Family history
The claimant said he had less contact with his parents since his partner had moved in because they had disowned him because his behaviour was not culturally appropriate.
His younger sister lives in the USA. She talks with him less since the accident because of his relationship.
He said he has been an Australian citizen since 2004.
Developmental history
The claimant does not recall any significant childhood mental health symptoms.
No childhood sexual or physical trauma reported.
Relationship history
The claimant said that his wife and he separated in 2011 and divorced in 2012. He reported a lack of respect in the relationship and “negative propaganda”. She was unfaithful. After the separation they were cooperative about their son but now only had contact when it was necessary.
The claimant said his son only visits once a week. His son just finished high school. When he comes over he puts the bins out, vacuums, makes beds and does laundry. Before the motor vehicle accident he stayed three nights a week. The claimant said he used to be his son’s soccer coach and played tennis with him. He feels that he has stopped being a father to his son and that in response his son is a father to him.
His partner moved in to live with the claimant after the accident. They had been in a relationship for a year and half before the accident but because of their Indian culture they did not live together. The claimant reported that he could not be on his own after the accident because he needed help because of his broken shoulder, neck and back pain. His partner moved in to support the claimant. They planned to marry and have a business. Since the motor vehicle accident their relationship had changed and now she is more a support than a partner. The claimant said that because of his mood, irritation and anger she would not want to marry him. She slept in a separate room and they did not have an intimate relationship. She had her own physical problems with screws in her feet from an accident. She cut her wrists once after the 29 June 2016 motor vehicle accident and that affected the relationship. She worked as the finance controller for a food distribution company three days a week from home and was in the office two and a half days. Usually she did not have to stop work to care for the claimant. If he had a lot of pain episodes she would then have to help. At those times she may have to stay back to make sure he was not dozing off with the pain medicines.
Chemical dependency history
No use of alcohol, illicit drugs or cigarettes was reported.
Forensic history
The claimant reported anger management problems at present. He was easily irritated and angry. He recalled he pushed his partner once. He felt it harmed their relationship.
The claimant did not have a history of legal problems.
He did not have a gambling problem.
The claimant said he had not made any compensation claims before the 29 June 2016 motor vehicle accident.
Psychiatric history before the motor accident
The claimant denied significant psychiatric history before the motor accident.
Pre-accident functioning
The claimant reported normative behaviour in all domains of functioning. He worked full-time.
History of the motor accident
The claimant said he was called into the office by his director. He had been working from home. After arriving at Wynyard station he began to cross the one-way street to the office. A car parked on one side of the street drove off and attempted to reverse into a parking spot on the opposite side of the street before the lights changed. The rear of the car collided with the claimant who fell under the car without the wheels going over him. Samaritans pulled him out and the driver checked how he was. Because he was in a rush to go to the meeting with his director he did not notice any signs of injury in his body. An hour after that meeting he began to fall off his office chair. He went home and later woke with severe pain. He thought he could have died in the accident. He felt he could not move. His partner came to the house to check on him. He recalled terrible pain.
When assessed by his GP and referred for imaging he was diagnosed with a “broken right shoulder, torn shoulder muscles, a back injury, a groin injury, a neck injury and an ankle injury”. His occipital nerve was injured resulting in occipital neuralgia. He had shoulder surgery. Now the movement in his right shoulder is restricted. He has had physiotherapy and scrambler therapy. He had spinal injections in his neck and lower back. He had hydrotherapy and physiotherapy. He consulted Mr Bulent Bill Ada, registered psychologist for treatment of anxiety and depression. He reports that he gets frequent migraine and has lower back pain. He describes the pain as terrible in the first two and a half hours of work. He purchased a massage chair he uses every hour after the first 2-3 hours of work. He spreads work through the day when he works in back-end support. His job used to be consulting but has become back-end support because of the pain symptoms. He said he had missed work deadlines. He said the generosity of his employer had kept him at work. He had begun to return to work a few hours a week in 2017 or 2018 and gradually increased his hours. When he tried 28 hours weekly he could not cope and reduced his hours to three days a week, seven hours a day. He said this work roster, “sort of works”.
History of symptoms and treatment following the motor accident
The claimant’s mental health symptoms began with panic attacks, palpitations, anxiety and depression “a few months” after the accident when he saw a car reversing in the parking lot when his partner was taking him to see his doctor. He began to get recollections of the accident. He had nightmares about himself or his son in an accident. He woke in a sweat and “had to be given temazepam”. Melatonin did not help. His partner managed his medicines. She packed medicines into time coded containers. She set reminder alarms and used video conferencing to supervise the claimant taking medicines. She used WhatsApp calls to check he was taking his medicines. He said, “I feel like a leech. I have had suicidal thoughts but I haven’t harmed myself.”
Details of any relevant injuries or conditions sustained since the motor accident
In January 2022 the claimant had a heart attack and needed two stents. He believes he had the heart attack because of the constant anxiety after the accident. The heart attack briefly stopped him walking. He felt he had recovered from the heart attack. He believed the heart attack had helped him learn to pay attention to his partner.
He reported that he burped a lot even though he took Nexium to control the symptoms.
Current symptoms
The claimant said that when he was not working he stayed in his room. He felt low, sad and did not feel like meeting anyone. He said that when he was in car parks he got chest pain and palpitations. He was anxious when he saw a car reversing. He was often anxious in the middle of the night although that had improved. He said he lived on the generosity of his employer. He thought he should not take up anyone’s time or space. He enjoyed seeing his partner and his son. However he felt that sometimes his son was a burden. He reported his depression felt better every time he had a session with Mr Ada. His mood was helped by hypnotherapy and EMDR but then went down over the next few days. Sometimes he might call Mr Ada before the next session. Mr Ada used VR glasses that helped the claimant unwind. He reported that the EMDR had helped him to go past the accident site when he went to his workplace in the city. The claimant felt he maintained his work ability and managed his pain. Earlier he received payments for domestic help but now they employed someone to come regularly. The claimant said some days he felt less depressed and overall was getting better.
Because of lower back pain and terrible migraines he often had to rest. He used to take triptan medicines for migraine but after his heart attack he was advised not to take them. He said the migraines can last up to two days and can occur three times a week. With his pain symptoms he may have to take eight tablets a day of Panadeine Forte and if that did not work he then may take Endone that made him drowsy and sleepy.
Current and proposed treatment
Current treatment
Medicine:
Dr Ashraf Sakla, a Granville GP, now prescribes the claimant’s medicines:
· Lexapro [the serotonin reuptake inhibiting antidepressant medicine escitalopram] daily;
· Temazepam [a benzodiazepine sleeping medicine of medium length half-life] one tablet three or four times a week;
· Melatonin [a sleep-inducing neurohormone] one tablet as needed at night;
· Metformin [an oral blood glucose lowering medicine] twice a day;
· Jardiance [the oral blood glucose lowering medicine empagliflozin] daily;
· Trulicity [the injectable blood glucose lowering medicine dulaglutide] weekly;
· Rosuvastatin [a cholesterol lowering statin medicine] daily;
· Ezetimibe [an inhibitor of intestinal cholesterol absorption] daily;
· Aspirin [the antithrombotic platelet aggregation inhibiting medicine aspirin] daily;
· Ticlid [the antithrombotic platelet aggregation inhibiting medicine ticlopidine] twice a day;
· Metoprolol [a beta blocker antihypertensive medicine] daily;
· Ramipril [the antihypertensive ace inhibiting medication ramipril] daily;
· Propranolol [a beta blocker medicine used to prevent migraine] twice a day;
· Panadeine Forte [the combination analgesic medicine codeine and paracetamol] or Mersyndol Forte [the combination analgesic with a sedating antihistamine: codeine (an opioid analgesic), paracetamol (an analgesic) and doxylamine (an antihistamine) up to eight tablets a day four days a week;
· Endone [the synthetic opioid analgesic medicine oxycodone] twice a week;
· Tramadol [a synthetic opioid medicine] two or three times a day;
· Voltaren [the non-steroidal anti-inflammatory medicine diclofenac] is taken as needed for lower back pain, and
· Progout [the uric acid metabolism inhibiting medicine allopurinol] only used when there is gouty toe pain.
Behavioural
The claimant reported he had completed a 10 week online memory recall program that had helped but his memory was returning to what it had been before the course.
Psychiatry
The claimant has not consulted a psychiatrist.
Psychotherapy
The claimant said he had been consulting Mr Bulent Bill Ada since 2018. At the beginning counselling was weekly and is now fortnightly. Weekly counselling stopped in 2022 and the claimant thought the insurer would pay through 2024 or 2025.
Proposed treatment
Medication
No change in the psychopharmacology trial is proposed.
Psychotherapy
No change in psychotherapy proposed.
Clinical examination
Mental state examination
The claimant had long, unruly hair and an untrimmed beard. He reported the last time his hair was cut was when he had nits and lice.
He said he had been wearing his T-shirt and slacks for two and a half days.
He moved uncomfortably in the chair where he sat and stood once.
No psychomotor retardation or agitation observed.
He was cooperative with the Medical Assessors. He asked his partner one question soon after the assessment began but did not ask again after being reminded that she could not help.
His eye contact was good.
His facial expression was worried with a pained expression often.
He spoke rapidly and provided much more information in an answer than was asked. His answers were well-organised and he did not lose his train of thought.
His observed affect was anxious rather than depressed. He did not report current suicidal ideation.
He reported that his pain and disorganisation meant he needed the support of his partner to carry out his daily activities and safely take his medicines.
He did not have perceptual distortions or psychotic thoughts.
His memory was good in the context of a 90-minute assessment interview.
His focus and ability to concentrate were unimpaired in this assessment. No lapses of concentration were observed.
Current functioning
The claimant said that on the four days he did not work he spent most of his time alone in his room.
He said his partner:
“forces me to take a shower. It has been two and a half days since I showered. I don’t see the point. I don’t feel the need for it. In the beginning she helped me because of my severe pain. She helped me shower and change clothes. Now she forces me. I was spot on before. I was forced to have a haircut a beard trim when I had nits and lice. His partner had invited friends and their children over and I met with them. She forced me to come out a few times. His partner treated the nits after I had the trim. The nits proved the point about socialising. Perhaps I got the nits from one of the kids.”
He said:
“I was a really good cook before but with my pain and broken shoulder I couldn’t cook and move. I can’t cook. I lose track of what I put in, forget and mess it up. I can’t stand long enough to cook. The shoulder injury is better but my back injury prevents me from standing for long and prepping gets painful. It takes too long.”
The claimant does not complete chores. He has cleaning help fortnightly. He said, “his partner gets tired and we get someone to do the bathrooms. I can’t do bathrooms because of pain and I have pressure on my back. I can’t do lawn mowing or landscape work”.
He is not involved in his workplace and no longer regularly travels to the head office in the CBD.
He reported that his partner and he had common friends before the accident and used to have social get togethers. Now only one friend checks with them. The claimant said it was because he was a downer.
The claimant’s intrafamilial relationships are poor with his parents and sister because he lives with his partner.
He could not do the physical pursuits from before the accident.
He was not comfortable away from home and did not want to go out.
No sporting activities are now undertaken.
The claimant said he could drive to his physiotherapist. Since the COVID-19 pandemic his contact with Mr Ada was mostly virtual and there were few face-to-face meetings. He had driven a couple of times but his partner usually drove to the meetings.
The claimant said that he used to be an avid reader. He said that after 10 minutes he had lost the plot of what he was reading. His partner did the finances.
He works from home three days a week, seven hours a day on Monday Wednesday and Friday.
He paced himself on his work days.
His work pace had slowed.
His religious affiliation is Hindu. We pray at home. He said “my partner recently forced me to go to the temple in Westmead and I just wanted out. She goes regularly”.
Comments on consistency
There was consistency between the history of current psychiatric symptoms, presentation at the assessment interview and findings on mental status examination.
We have reviewed the documentation referred to me by the Medical Assessment Service and found no inconsistencies in the reports provided when compared with the history and examination obtained from the claimant today.
Panel deliberations
DSM-5-TR Psychiatric Diagnosis and Reasons
| F34. persistent depressive disorder. F43.1 post-traumatic stress disorder, in partial remission. |
| Criteria |
| 89. Because the claimant has had depressive disorder symptoms since the 2016 motor vehicle accident the DSM-5-TR diagnosis is persistent depressive disorder because the symptoms have been present for more than two years. 90. His post-traumatic stress disorder symptoms are in partial remission. 91. Both mental health disorders were caused by the 29 June 2016 motor vehicle accident. |
Review panel decision
Determinations
The Review Panel found the accident WAS a cause of the following claimed injuries:
| · persistent depressive disorder, and · post-traumatic stress disorder in partial remission. |
Treatment and Care – Causation
| 93. He has chronic intractable pain caused by the 29 June 2016 motor vehicle accident that has resulted in an inability to perform most tasks of daily living with any reliability. His significant opioid medicine use would also impact his ability to complete daily living tasks. |
Treatment – Reasonable and Necessary
| 94. The claimant’s pain disorder meant that he has needed domestic assistance from the 29 June 2016 motor vehicle accident but this assistance was not needed because of his mental health disorders. Evaluation of need for domestic assistance because of persistent pain is usually assessed by occupational physicians, orthopaedic surgeons and neurologists reviewing physical injury impairment. 95. A need for GP reviews is not a necessary outcome from the accident as again there has been a stable doses of his antidepressants for some years. The benzodiazepine sleeping medicine prescribed is more properly prescribed for brief periods. 96. As he has persistent depressive symptoms these may continue for his lifetime so a prescription of an antidepressant medicine such as Lexapro may be needed for life. Lifetime prescription of a benzodiazepine such as temazepam is not advisable and this medicine should not be funded. 97. The claimant has not consulted a psychiatrist since the accident and his mental health symptoms do not suggest a referral is needed at this time with his description of improved mood and decreased anxiety. |
The following treatment and care relates to the injuries caused by the motor accident:
· psychotropic medication (including Lexapro and other antidepressants) for the balance of the claimant’s life expectancy.
The following treatment and care does not relates to the injuries caused by the motor accident:
· 6-15 hours of domestic assistance each week from the date of the 29 June 2016 motor vehicle accident to the date of the MAS Assessment;
· 0-25 hours of domestic assistance each week from the date of the medical assessment until 2024;
· 0-15 hours of domestic assistance each week from 2024 and for 1 year, 2 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy;
· 0 – 4 GP reviews each year for 1 year, 2 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy;
· psychotropic medication (including temazepam and other benzodiazepines) for 3 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy, and
· 0–22 sessions of psychiatric treatment.
The following treatment and care is reasonable and necessary in the circumstances:
· psychotropic medication (including Lexapro and other antidepressants) for the balance of the claimant’s life expectancy.
The following treatment and care is not reasonable and necessary in the circumstances:
1. 6-15 hours of domestic assistance each week from the date of the 29 June 2016 motor vehicle accident to the date of the MAS Assessment;
2. 0-25 hours of domestic assistance each week from the date of the medical assessment until 2024;
3. 0-15 hours of domestic assistance each week from 2024 and for 1 year, 2 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy;
4. 0 – 4 GP reviews each year for 1 year, 2 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy;
5. psychotropic medication (including temazepam and other benzodiazepines) for 3 years, 5 years, 10 years and/or the balance of the claimant’s life expectancy, and
6. 0–22 sessions of psychiatric treatment.
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