AAI Limited t/as AAMI v Hassan

DETERMINATION OF REVIEW PANEL
CITATION:	AAI Limited t/as AAMI v Hassan [2025] NSWPICMP 52
CLAIMANT:	Mustapha Ahmad Hassan
INSURER:	AAI Limited trading as AAMI
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	Gerald Chew
MEDICAL ASSESSOR:	Wayne Mason
DATE OF DECISION:	30 January 2025
CATCHWORDS:	MOTOR ACCIDENTS – Review of certificate and reasons of Medical Assessor Nagesh dated 7 August 2023 who found the claimant had suffered a post-traumatic stress disorder and major depressive disorder and assessed whole person impairment (WPI) at 14% after deducting one percent for pre-existing impairment; claimant involved in a motor vehicle accident on 28 November 2017 having previously been involved in another accident on 6 May 2011 with similar psychiatric disabilities arising from both accidents; between 2018 and 2022 the claimant had stress and anxiety brought about by being homeless from a difficult marital separation and caring for his son who suffered from schizophrenia and occasional violence; Panel concluded that the effect of the 2011 accident on the claimant’s psychiatric condition had ceased approximately eight months prior to the accident and the claimant’s condition post-accident in 2017 was due to that accident; the Panel found that following the accident the claimant developed Somatic Symptom Disorder and Persistent Depressive Disorder; the claimant was assessed as having a WPI of 7%; Held – certificate of Medical Assessor Nagesh revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Panel revokes the certificate and reasons of Medical Assessor Nagesh dated 7 August 2023. 2. The Panel finds that because of the accident on 28 November 2017 the claimant developed somatic symptom disorder and persistent depressive disorder. 3. The Panel finds the claimant has 7% whole person impairment.

STATEMENT OF REASONS

INTRODUCTION

The claimant was examined by Medical Assessor Nagesh (the Medical Assessor) on
26 June 2023 and a Certificate was issued on 7 August 2023.
The Medical Assessor certified that the claimant had suffered psychological injuries with a 14% whole person impairment (WPI) after a 1% deduction was made for pre-existing impairment.
The Medical Assessor diagnosed the claimant with post-traumatic stress disorder and major depressive disorder, as a result of the subject accident, which occurred on
28 November 2017.
The insurer has applied for a review of the Certificate.
The following injuries were referred by the Personal Injury Commission (Commission) for assessment:
(a) post-traumatic stress disorder, and
(b) major depressive disorder.

The accident

The claimant was involved in the accident the subject of this assessment on
28 November 2017. The claimant was a passenger in a vehicle which was collided into by another vehicle at an intersection. The claimant asserts injury to his back, neck, right shoulder, right thigh, head, right knee, right arm, chest, stomach, and psychological injury, as a result of the subject accident.
The claimant was also involved in a prior motor vehicle accident on 6 May 2011, where he sustained both physical and psychiatric injuries which were similar, but not identical, in nature to the injuries suffered in the accident on 28 November 2017.

Bundles of documents

The parties have each presented their respective bundles of documents upon which they rely. The Panel have read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel or a Panel Member has not read it, in much the same manner as parties not referring to or not specifically relying on a document in their own bundle and submissions.
The fact that evidence is not referred to in these reasons does not mean it has been overlooked and nor is it required that each piece of evidence be mentioned (WAEE v Minister for Immigration and Citizenship (2003) 75 ALO 630 at [46]).The Panel is not required to “analyse every piece of information from every opinion contained in a document with which he [it] was provided” – see Farr v Insurance Australia Limited t/as NRMA Insurance Ltd [2014] NSWSC 1435 at [46]. The Panel is to come to its own conclusion and to take its own history.

Insurer’s submissions

The insurer has lodged four sets of submissions in the review process. These were dated
17 January 2022, 25 October 2022, 24 May 2023, 30 August 2023 and a final bundle of all documentation and submissions on 23 August 2024. Submissions were also lodged on
27 July 2020 for the insurer’s WPI assessment application.

Submissions dated 17 January 2022

The insurer says that as a consequence of the prior accident on 6 May 2011, the claimant alleges that he sustained, amongst others, the following injuries:
(a)    claustrophobia;
(b)    post-traumatic stress disorder;
(c)    major depressive disorder;
(d)    pain disorder, and
(e)    psychiatric and/or psychological injury.
The insurer submits the particularised disabilities from the prior accident on 6 May 2011 strike a resemblance to those disabilities particularised in the current claim arising from the accident on 28 November 2017.
The insurer submits there is evidence of relevant and substantial pre-existing impairment which, pursuant to the Motor Accident Guidelines (the Guidelines), ought to be taken into account when determining the claimant’s WPI in the context of this claim.
Specifically, the insurer refers to the records of NRMA pertaining to the prior accident including all the records of New Granville Medical Centre, the claimant’s general medical practice and the records of Dr Kahil, the claimant’s treating orthopaedic surgeon.
The insurer says that the records of New Granville Medical Centre note the following medical history:
(a) 23 November 2016 – anxiety.
The insurer says that as a consequence of the prior accident, the claimant alleged that he sustained the following injuries:
(a)    major depressive disorder;
(b)    pain disorder, and
(c)    psychiatric and/or psychological injury.
In the consultation notes of Dr Singanamala on 26 November 2011, it was noted "Somatic symptoms of depression. Needs Efexor and referral to Dr Latif".
The insurer refers to a medico-legal report of Dr Mahmoud, clinical psychiatrist, dated
28 June 2013 which details the following:
(a)    After the prior accident, the claimant experienced pain in his neck, right shoulder, right arm, low back and right knee with associated numbness in the left arm and lower limb. This was reported to be present every day for most of the day and caused significant distress and impairment in social, occupational and day to day areas of functioning.
(b)    The claimant reported that as a result of his pain, he had difficulty falling asleep and maintaining good sleep.
(c)    The claimant described himself as sad every day, lost interest in pleasant activities, neglected appearance, was unable to do things that he used to before the prior accident, was unable to work, felt tired most of the day, felt lazy, unmotivated, worthless and helpless, stopped contributing to household chores, was abused by his wife verbally and psychologically and reported sexual dysfunction, among a variety of other issues.
(d)    In providing a diagnosis, Dr Mahmoud considered that the claimant qualified for a diagnosis of major depressive disorder and pain disorder as a secondary diagnosis.
(e)    Further, Dr Mahmoud provided an assessment of WPI as follows:
Self-care and personal hygiene              - Class 2
Social and recreational activities             - Class 3
Travel   - Class 2
Interpersonal relationships and social functioning     - Class 3      Concentration, pace and persistence       -Class 3
Adaption  - Class 3
Total of 17% WPI.
The insurer noted that on 21 January 2014 the claimant was recorded as "also tense and anxious. Will see Dr Abu- Arab (Psychologist). Family problems and marriage on verge of breakdown. To continue on analgesia and Endep".
In an application for disability pension on 23 January 2014 it was noted,
"Persistent neck pain, right shoulder pain, lower back pain, left knee pain, headaches…impact on functional movements, physical performance, behaviour, relationships, Major Depressive Disorder. Treatment psychological counselling and antidepressant.”
On 4 September 2015 it was noted "Not sleeping well. Living alone, separated from second wife. No payment from Centrelink. Applying for his children to come from Syria. Depressed and feeling down."
On 30 March 2017 the claimant was noted to be,
"Severely depressed, in tears and showing suicidal thoughts. Kicked out of his residence, sharing with a friend and slept in the car last night. Tearful and stressed. Counselled and comforted. Written a letter to housing commission. Reason for contact: Stress."
The subject accident occurred on 28 November 2017. Regarding this, the insurer noted that the claimant signed his claim form on 24 May 2018, with injuries particularised to the back, neck, right shoulder, right thigh, head, right knee and leg, right arm, chest, stomach, ancillary to psychological/psychiatric sequelae.
The insurer says that in a report dated 26 July 2018, Dr Boland, physiotherapist, provided a substantive overview of the claimant’s pre-existing pathology and complaints, ultimately concluding that the claimant’s presentation was consistent with chronic pain syndrome.
Dr Boland said that it was impossible to provide a specific diagnosis based on the interaction between the claimant’s chronic pain syndrome, his previous injuries, history and the limited reliability of examination findings. Further, the physiotherapist said that conclusions regarding neurological status were considered to be impossible to make as neurological examination did not reproduce neurological symptoms.
In respect to psychiatric evaluation, Dr Vickery for the insurer reported on 19 August 2019 that there was no psychiatric diagnosis in relation to the injuries sustained in the subject accident, with a pre-existing diagnosis of somatoform chronic pain disorder provided. The insurer says that these conclusions were reaffirmed in Dr Vickery’s supplementary report dated 11 April 2021.
The insurer submits that, noting the above, from a psychiatric perspective, Dr Vickery considered that the claimant’s injuries from the subject accident did not warrant any percentage of WPI. Further, the insurer submits that he determined that the claimant’s relevant complaints and alleged reduction in functioning was a consequence of his pre-existing condition and had no causal nexus to the subject accident.

Submissions dated 25 October 2022

The insurer submits that the records produced by Dr Abu-Arab provide evidence of the purpose of the claimant’s psychological treatment. In this regard, the insurer notes that there was no mention made of the subject accident in Dr Abu-Arab’s clinical records, which canvass the period 6 March 2018 to 21 February 2020, and multiple stressors unrelated to the subject accident were noted including the claimant’s homelessness, traffic violations and financial hardship. The insurer submits that these records demonstrate that the cause of the claimant’s psychological complaints and symptoms were stressors unrelated to the subject accident.
The insurer referred to records produced by Centrelink which include multiple pre-accident Job Capacity Assessment Reports. The insurer noted that these indicate that the claimant suffered from depression, which commenced in 2011.
The insurer referred to records produced by Excelsior Family Medical Centre which are updated general practitioner (GP) records. The insurer says that these provide evidence of the claimant’s current complaints and his ongoing treatment for the period 26 March 2021 to 8 July 2022. The claimant reported to his GP that his son was threatening him, which was causing him to be anxious, which the insurer submitted is a significant stressor unrelated to the subject accident.

Submissions of the insurer dated 24 May 2023

By way of further brief summary, the insurer again referred to the opinion of Dr Vickery who provided an updated account of the claimant’s alleged psychiatric injuries.
The claimant reported no past psychiatric history, however, Dr Vickery noted that records from New Granville Medical Centre indicated that he was diagnosed with depression on
28 November 2012 and anxiety on 23 November 2016. Further, in a report of Dr Akkerman, psychiatrist, dated 13 March 2012, the claimant was diagnosed with post- traumatic stress disorder and assessed as suffering from 26% WPI.
Dr Vickery noted the claimant’s son was a significant personal stressor and referenced the clinical note of Dr Ibrahim, GP, dated 5 April 2022, wherein it was recorded: “His son has schizophrenia. Threatening him. Advised to bring him for involuntary admission. Not taking his medication. He is his carer/sponsor him.”
Dr Vickery diagnosed the claimant with somatic symptom disorder with predominant persistent pain, which had a guarded prognosis. The insurer referred to the opinion of
Dr Vickery who said that there was no relationship between the claimant’s current complaints and the subject accident.
The insurer noted that Dr Vickery discussed that somatic symptom disorder with chronic predominant persistent pain is a somatoform related disorder and is not utilised in the assessment of WPI.
However, following on from this, Dr Vickery determined that the claimant’s somatic symptom disorder with chronic predominant persistent pain was pre-existing with an assessment of 26% WPI.
Regarding the subject accident, Dr Vickery assessed 0% WPI.

Submissions dated 30 August 2023

These submissions relate to the insurer’s application for a review of the certificate and reasons of the Medical Assessor.
The insurer says, when making these submissions, that throughout the course of its application for assessment of the claimant for WPI, the insurer has lodged three sets of submissions dated 17 January 2022, 25 October 2022, and 24 May 2023. The insurer says that none of these submissions were referred to by the Medical Assessor at any point in his certificate. The insurer says that the Medical Assessor’s failure to consider and/or adequately consider the insurer’s submissions is evidenced by paragraphs 3 and 4 of the Medical Assessor’s certificate, wherein it was noted:
“The applicant makes a submission that he has sustained a psychological injury which is a non-threshold injury as a result of the subject accident on 28 November 2017 and his whole person impairment from the psychological injury exceeds that of 10%.
The respondent makes a submission that the whole person impairment from the psychological injury sustained by the claimant does not exceed that of 10% and the respondent makes a submission that the claimant has a pre-existing condition of depression and anxiety sustained from his previous motor vehicle accident.”
The insurer points out that the Medical Assessor is in error as it is the insurer who is the applicant in respect to the present application. Secondly, the insurer noted that the subject accident falls under the Motor Accidents Compensation Act 1999, in which the non-threshold injury requirement does not exist. Finally, the insurer has submitted that the claimant has the following pre-existing conditions of relevance to the assessment of psychiatric WPI:
(a)    post-traumatic stress disorder;
(b)    major depressive disorder;
(c)    pain disorder;
(d)    depression, and
(e)    anxiety.
The insurer says that its submission was not limited to depression and anxiety, which the Medical Assessor does not acknowledge.

Insurer’s submissions on review

The insurer has submitted that the claimant has the following pre-existing conditions of relevance to the assessment of psychiatric WPI:
(a)    post-traumatic stress disorder;
(b)    major depressive disorder;
(c)    pain disorder;
(d)    depression, and
(e)    anxiety.
The insurer reiterated that its submission was not limited to depression and anxiety.
The insurer submits that a supplementary report of Dr Vickery, dated 11 April 2021, reaffirmed the conclusions reached in his earlier report dated 19 August 2019, that there was no psychiatric diagnosis in relation to the injuries sustained in the subject accident, with a pre-existing diagnosis of somatoform chronic pain disorder provided.
A refresher report of Dr Vickery was prepared and dated 20 January 2023, following his re-examination of the claimant on behalf of the insurer on 10 January 2023. Dr Vickery’s report included an updated qualified psychiatric opinion in relation to causation of the claimant’s alleged psychological injuries and an assessment of WPI.
The claimant reported no past psychiatric history, however, Dr Vickery noted that records from New Granville Medical Centre indicated that he was diagnosed with depression on
28 November 2012 and anxiety on 23 November 2016. Further, in a report of Dr Akkerman, psychiatrist, dated 13 March 2012, the claimant was diagnosed with post-traumatic stress disorder and assessed as suffering from 26% WPI.
Dr Vickery diagnosed the claimant with somatic symptom disorder with predominant persistent pain which was pre-existing.
The insurer accepts the Medical Assessor has considered some of the relevant material, but says the only specific reference to the objective material was a clinical note dated
30 March 2017, in which it was noted that the claimant was ‘severely depressed, in tears and showing suicide thoughts’.
The insurer submits that in the case of that clinical note, the Medical Assessor seemingly accepted the claimant’s self-report that his symptoms were in ‘complete remission’ without reference to any contemporaneous records, notwithstanding the background of significant and lasting pre-existing psychological issues arising from the 2011 accident.
The insurer says that the balance of the Medical Assessor’s certificate was largely a reiteration of the claimant’s complaints, without specific reference to the opinions of other medical practitioners. The insurer submits that given the claimant initially denied suffering from any mental illness, which was clearly inconsistent with the available evidence, it considers the Medical Assessor ought to have at least verified the claimant’s complaints with objective contemporaneous evidence, if any, and disclosed that in his path of reasoning.
The insurer submits that the dispute in question relates to the assessment of psychiatric WPI arising from the subject motor vehicle accident, and it is the insurer’s position that the degree of WPI arising from this was nil and certainly not greater than 10%. The insurer submits that its position is supported by qualified medical evidence from, among others, Dr Vickery, whose reports were clearly not considered by the Medical Assessor, particularly the reports dated 11 April 2021 and 20 January 2023. The insurer says that Dr Vickery’s opinions relied upon established facts.
The insurer submits that irrespective of the claimant’s self-report to have had no residual symptoms from the previous accident at the time of his involvement in the subject accident, there are relevant causation issues in this matter supported by qualified evidence and informed by objective evidence, and the Medical Assessor was under an obligation to consider and comment upon those opinions to disclose his actual pathway of reasoning.
The insurer submits that the Medical Assessor did not consider relevant material, specifically the insurer’s further submissions, and failed to respond to a substantial argument, thereby denying the insurer procedural fairness.

Claimant’s submissions

The claimant submits that the Medical Assessor has provided his reasons adequately.
The claimant says that the Medical Assessor confirmed that the claimant had a history of post-traumatic stress disorder and depression after a motor vehicle accident in 2011, and that he had some depression associated with a relationship issue.

The claimant submits that it was the view of the Medical Assessor that the post-traumatic stress disorder and depression were in remission. The claimant says that there are no clinical notes post 2012 to suggest that the Medical Assessor is incorrect. The claimant says that this is the basis of the Medical Assessor’s disagreement with Dr Vickery and that nothing else needs to be said.
The claimant submits that it cannot be reasonably said that the Medical Assessor was not aware of the causation issue:
(a)    In his certificate, the Medical Assessor says: “Mr Hassan has a previous history of major depressive disorder and post-traumatic stress disorder which was diagnosed after the accident in 2011”. In the following paragraph he describes the claimant’s treatment and recovery from the condition.
(b)    The claimant’s pre-existing condition is again referred to in the certificate under the heading of “Diagnosis and reasons”.
(c)    Reference is also made to the Medical Assessor’s determination where he says “My rationale was prior to the motor vehicle accident, his depressive anxiety and Post-Traumatic Stress Disorder were in remission. I did question Mr Hassan about his depression on 30 March 2017 which was six months prior to the subject accident to which he stated that this was in the context of his divorce and, however, his symptoms improved, and at the time of the subject accident, his symptoms were in complete remission.”
(d)    That the Medical Assessor was aware that the claimant had a previous condition is underscored in the Certificate, in the assessment of the claimant’s pre-injury functioning. The claimant submits that so far as concentration is concerned, the Medical Assessor noted that post-traumatic stress disorder has a “chronic fluctuating course” and the claimant had a “past history of PTSD and chronic pain”.
The claimant submits that the substance of the decision is that the claimant was substantially in remission from his previous post-traumatic stress disorder. The claimant submits that the insurer has not highlighted any clinical document where it is said that the Medical Assessor failed to consider that position to be wrong. The claimant referred to the insurer’s submission that for the purposes of the Certificate, “the claimant noted no past psychiatric history”. However, the claimant submits that the Medical Assessor clearly noted that he raised this with the claimant, and accepted that he did, in fact, suffer symptoms after the 2011 accident.
The claimant notes that the insurer then refers to clinical notes in 2012 and 2016. The claimant submits that regarding the clinical notes of 2012, the Medical Assessor has accepted that the claimant had post-traumatic stress disorder and depression symptoms after the 2011 accident. The claimant submits that these can make no difference, even if they were not before the Medical Assessor. The claimant says that in regard to the single 2016 clinical note:
(a) the consultation was for anxiety, not depression or post-traumatic stress disorder. The Medical Assessor has not diagnosed anxiety from the subject accident, and
(b) the Medical Assessor took into account depression associated with marital issues.

59.The claimant submits that there is no doubt that the Medical Assessor had before him Dr Vickery’s report and knew that causation was an issue and he dealt with it.

The claimant submits that for all of the insurer’s complaints, there is a lack of detail as to what the Medical Assessor failed to take into account, or that it would have made a difference. As best as can be determined by the claimant, this is;
(a)    Dr Vickery’s updated reports, which do no more than re-state his previous determination;
(b)    clinical notes/reports from 2012, which confirm that the claimant had post-traumatic stress disorder following the earlier motor vehicle accident, a position accepted by the Medical Assessor. These documents can have no bearing on whether he was in remission at the time of the subject motor vehicle accident, and
(c)    an isolated clinical note in 2016. However, again, the claimant submits that the Medical Assessor was aware of isolated attendances in the short period before the accident. Further, the attendance referred to was in regard to anxiety, not post-traumatic stress disorder.
The claimant submits that there is no reason to suspect that there is an error.

Medical evidence

The Medical Assessor found the claimant had a 14% WPI as a result of suffering from the following injuries:
(a) post-traumatic stress disorder, and
(b) major depressive disorder.
The claimant initially denied to the Medical Assessor suffering from any mental illness, before the accident the subject of this claim however, when the Medical Assessor brought to his attention the previous diagnosis of depression, anxiety, and post-traumatic stress disorder, he agreed that he was suffering from post-traumatic stress disorder, depression and anxiety in the past. However, the claimant stated that his symptoms were in complete remission at the time of the subject accident.
The Medical Assessor said that the accident was sufficient to exacerbate the claimant’s pre-existing condition of post-traumatic stress disorder.
The claimant also met the criteria for major depressive disorder, where he had symptoms, which included depressed mood, anxiety, insomnia, fluctuating appetite, comfort eating, lack of energy and motivation, feelings of worthlessness, diminished ability to concentrate and fleeting suicidal thoughts. His depressive symptoms had developed in the context of his chronic pain, his inability to be active as before, and functional limitations.
The Medical Assessor said that the claimant’s diagnosed major depressive disorder was again an exacerbation of his pre-existing condition which was due to the subject accident.
The Medical Assessor said that the claimant’s diagnosed psychiatric conditions were triggered and exacerbated by the subject motor vehicle accident. His rationale for this was that prior to the motor vehicle accident, his depressive anxiety and post-traumatic stress disorder were in remission. The Medical Assessor questioned the claimant about his depression on 30 March 2017 which was six months prior to the subject accident to which he stated that this was in the context of his divorce and, however, his symptoms improved, and at the time of the subject accident, his symptoms were in complete remission.
The claimant’s WPI was assessed as follows:

Psychiatric diagnoses	1. Post-Traumatic Stress Disorder.	2. Major Depressive Disorder.
Psychiatric diagnoses	3.	4.
Psychiatric treatment description	Antidepressant medication, anxiolytic medication, cognitive behaviour therapy and supportive psychotherapy.

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	2	My rationale is Mr Hassan is able to do basic cooking, he can instruct his son to do the cooking, he relies on a cleaner to do the cleaning, he can do
some basic shopping, he does not require prompting to have a shower, but his inability to have a shower on a daily basis is due to his physical injury where he requires physical assistance. Hence, I have classed him as Class 2 – Mild Impairment where putting the physical injury aside and using my professional judgement, I am of the opinion he can live independently with some support.
2. Social and Recreational Activities	3	My rationale is Mr Hassan states that he rarely attends any social events, he has no interests or hobbies, and he does not find life pleasurable anymore. Going to a social event makes him anxious, hence, he actively avoids attending dinner parties, weddings or anniversaries.
3. Travel	2	My rationale is Mr Hassan can drive and travel independently where he drives with one hand, he can visit to the local shops and to his local GP, however, he cannot travel far away and to unfamiliar places without a support person.
4. Social Functioning	2	He has lost contact with the majority of his friends, he has no interest to form a new relationship. Hence class 2 mild impairment.
5. Concentration, Persistence and Pace	3	My rationale is Mr Hassan reports his attention, concentration, and memory recall to be poor. Before, he was able to read the Quran. Now, he is not able to read the Quran and he can barely manage a few pages. At the time, he describes his memory recall to be shocking where he forgets to take his tablets.
6. Adaptation	3	My rationale is Mr Hassan, prior to the motor vehicle accident, had applied for a job which was to work as a driver, and he had also obtained his license to work as a cement renderer. Because of his injury, he has not been able to return to employment. Also, his ability to handle stress has reduced. Putting aside part of his inability to work is due to his physical injury and, hence, I am of the opinion he meets category 3 where his ability to handle stress has reduced, and hence, I have classed him as Class 3 – Moderate Impairment.

List classes in ascending order: 2, 2, 2, 3, 3, 3

Median Class Value: 2.5 which is equal to 3.

Aggregate Score: 15

% Whole Person Impairment: 15%

15*%WPI = Percentage Whole Person Impairment.

The Medical Assessor provided a WPI assessment for the claimant’s earlier accident of
6 May 2011, as follows:

Psychiatric Impairment Rating Scale - Pre-existing/subsequent impairment

Psychiatric diagnoses	1. Post-Traumatic Stress Disorder.	2. Major Depressive Disorder.
Psychiatric diagnoses	3.	4.
Psychiatric treatment description	Pharmacotherapy and cognitive behavioural therapy.

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	1	Mr Hassan was independent with cooking, cleaning, and shopping, and he was having a shower every day.
2. Social and Recreational Activities	1	Mr Hassan states that he was sociable, outgoing, and he had no problems attending group social events.
3. Travel	1	He was able to drive and travel independently.
4. Social Functioning	2	He had separated from his previous wife in the past and he was still separated. He was not able to form another relationship.
5. Concentration, Persistence and Pace	1	My rationale is although Mr Hassan states that his attention and concentration were fine, I am of the opinion PTSD runs a chronic fluctuating cause and because of his past history of PTSD and chronic pain, there are some deficits with regard to his concentration where he would struggle with attention, concentration, and memory.

6. Adaptation	2	My rationale is Mr Hassan was not working at the time of the motor vehicle accident, but he had obtained a license as a cement renderer and was about to start a new job as a driver. He had not returned to his pre-injury role of cement renderer.
List classes in ascending order: 1, 1, 1, 1, 2, 2
Median Class Value: 1
Aggregate Score: 1+1=2, 2+1=3, 3+1=4, 4+4=8
Pre-existing % Whole Person Impairment: 1%

The Medical Assessor deducted 1% for pre-existing psychiatric impairment leaving a total WPI assessment of 14% for the subject accident.
Pre-accident notes show the following:
On 28 November 2012, New Granville Medical Centre notes show the claimant was “Complaining of swelling and numbness over left ankle and leg. Pain over mid back area with swelling noticed over right paraspinal muscle area. Wrist pain. Headache, anxiety and depression.”
On 11 July 2013 he was “Complaining of tightness over upper chest area and upper throat. Very anxious and depressed. Financial and marriage problems. Wife not supportive. Unable to find work due to pain over neck and right shoulder. Very upset an anxious. Arrange referral to Psychologist.”
On 6 November 2013 it was noted “Complaining of pain mainly over right knee, also neck and lower back. Do not know if pain aggravation due to work or from gym.”
In the Australian Government Job Capacity Assessment Report 17 June 2020, it was noted “Remarks: ‘Chronic pain syndrome – chronic musculoligamentous sprain injuries cervical and lumbosacral spine – chronic tendinosis right shoulder and chronic patellofemoral injury’ as noted in the Treating Doctor’s Report by Dr Latif dated 17 March 2015.”
“Onset: 8 May (sic) 2011 following a reported motor vehicle accident.”
“A medical report of Dr Latif dated 17 March 2015 gives a diagnosis of depression. It stated that treatment included counselling.”
In a report of Dr Kahil of 14 January 2014 it was noted “Mr Hassan was reviewed today. He continues complaining of neck pain, right shoulder pain and right knee pain.”
On 21 January 2014 it was noted “Complaining of neck pain, headaches and back pain. Seen by Dr Kahil – will perform knee surgery as suggested. Also, tense and anxious. Will see Dr Abu-Arab (Psychologist). Family problems and marriage on verge of breakdown. To continue on analgesia and Endep.”
In an application for Disability Pension on 23 January 2014 it was noted “Persistent neck pain, right shoulder pain, lower back pain, left knee pain, headaches.”
In the New Granville Medical Centre notes, it was recorded in the Past Medical History:
“28 November 2012 Depression
23 November 2016 Anxiety.”
In the consultation notes of Dr Singanamala on 26 November 2011 it was noted “Somatic symptoms of depression. Needs Efexor and referral to Dr Latif.”
Dr Akkerman provided a report dated 13 March 2012 and said “The diagnosis is Post-Traumatic Stress Disorder”. He assessed WPI at 26%
On 21 January 2014 “also tense and anxious. Will see Dr Abu-Arab (Psychologist). Family problems and marriage on verge of breakdown. To continue on analgesia and Endep.”
In an application for Disability Pension on 23 January 2014 it was noted “Impact on functional movements, physical performance, behaviour, relationships, Major Depressive Disorder. Treatment psychological counselling and antidepressant.”
In the consultation notes of Dr Latif on 16 March 2015 it was noted
“Family problems. Stressed.”
In a report by Dr Abu-Arab, psychologist, dated 28 June 2013 it was noted “Diagnosis: From a psychological perspective, I believe that Mr Hassan qualifies for the diagnosis of Major Depressive Disorder as first diagnosed and Pain Disorder as a second diagnosis.”
In the Australian Government Job Capacity Assessment Report dated 20 April 2015 it was noted “Symptoms: The treating doctor’s report noted insomnia, irritability, low self-esteem, anhedonia, social isolation, poor memory and concentration, impacts on cognitive, behaviour, personal relations.”
“Medical report noted multiple depressive symptoms such as insomnia, irritability, low self-esteem, despair, anhedonia, depressed mood and somatic pain.”
“Client reported social isolation anhedonia and low motivation which was confirmed by his Psychologist Mr Abouarab.”
On 4 September 2015 it was noted “Not sleeping well. Living alone, separated from second wife. No payment from Centrelink. Applying for his children to come from Syria. Depressed and feeling down.”
On 21 December 2015 it was noted “Reason for contact: Panic Attacks.
Prescription for Citalopram 10mg i nocte.”
On 23 November 2016 it was noted “Reason for contact: Anxiety. Counselled re relaxation techniques. Centrelink medical certificate.”
On 30 March 2017 it was noted “Severely depressed, in tears and showing suicidal thoughts. Kicked out of his residence, sharing with a friend and slept in the car last night. Tearful and stressed. Counselled and comforted. Written a letter to Housing Commission. Reason for contact: Stress.”
Following the accident on 28 November 2017, medical certificate dated 16 March 2020 of
Dr Ghannoum noted “depression and anxiety disorder, onset 2011. Current medication and Psychologist. Severe depressed mood, anxious and irritability”.
In handwritten consultation notes of 14 June 2018 it was noted “Homeless. Was asked to vacate house. Scared and stressed”. On 21 February 2020 it was noted “Financial hardship. Panic.”
In a report of 26 July 2018, Dr Boland, physiotherapist, said the claimant’s presentation could not be explained from the perspective of musculoskeletal diagnoses. Dr Boland said the claimant’s presentation was consistent, however, specific diagnoses were impossible based on the interaction between a chronic pain syndrome, this previous injury history and the limited reliability for examination findings.
In the correspondence of consultant orthopaedic surgeon Dr Kahil, on 17 July 2018, it was noted “Mr Hassan suffers from sleep apnoea.”
Dr Vickery in his report of 20 January 2023 diagnosed somatic symptom disorder with predominant persistent pain. He said that the prognosis was guarded. He said such a diagnosis was not utilised in the assessment of WPI. He said there was a 0% WPI due to the accident.
There are several other reports from Dr Powell, Dr Mitchell, Dr Boland and Dr Kahil which all deal with the claimant’s orthopaedic/physical injuries.

Medical examination

The claimant was examined by Medical Assessors Mason and Chew on 2 December 2024. Their report follows:
“Psychosocial history and pre-accident history
The claimant is a 58 year old man who lives in a unit in Auburn with his 25 and 27 year old sons.
He was born in Lebanon. He had 4 sisters and 5 brothers however 1 brother has passed. His remaining siblings live in Lebanon. He initially reported no family history of mental illness however on further prompting recalled a son who had issues with drugs and psychosis and may have schizophrenia.
He denied any direct exposure to traumatic events or war in Lebanon. He left school after around ‘6^th grade’ and began working. He worked as a cement renderer. He said that because of political affiliations of a colleague he left Lebanon and moved to Australia in 2000.
He has been previously married twice. His first marriage which bore his 6 children ended prior to coming to Australia. His second marriage was from 2008 to 2015.
He denied any past psychiatric history before 2011.
He was involved in a significant motor accident in 2011. He said that at this time he was a passenger in a Toyota sedan and had been falling asleep. He said that he was wearing a seatbelt and airbags were not deployed. He said that he was involved in a 3 car pile-up and was taken to Concord Hospital. He could not recall if he was discharged the same day or the next day. He reported that after this accident he had issues with his shoulder, neck, back and knee. He also admitted that he developed some psychological symptoms and was on medication and saw a psychologist. He said however that he improved with treatment and by 2016 had got his licence back but had not yet returned to work.
History of the motor accident
The accident occurred in November 2017. He said he was the passenger in a Toyota Tarago van sitting behind the driver. He said that he was wearing a seatbelt. He said that they were travelling at low speed when the vehicle was t-boned on the driver’s side by a Ute the impact hitting the middle to front of the Tarago.
History of symptoms and treatment following the motor accident
He immediately experienced shoulder pain and difficulty breathing. He said that the previous pain from his 2011 accident returned in his shoulder, back and knee.
He said that in the context of the physical symptoms he ‘lost hope’, became depressed ‘better if I had been dead’. He said that he had lost friends and contact with family. He said ‘no one rings to say hello now because I ask for help when they do’.
Details of any relevant injuries or conditions sustained since the motor accident
He was asked specifically about any motor accident 6 May 2022. He denied that any accident occurred at that time.
His parents both passed away from ‘natural causes’, his father around 5-6 years ago and his mother 2-3 years later.
Current symptoms
He said that he struggled with feelings and sensations in his genitalia. He said that he struggled with control of his bladder. He reported that because of his physical problems he felt like he was not a ‘whole’ person and that life had little meaning and was not worth living. He said that he struggled to sleep without Valium.
Current and proposed treatment
His current medication include Valium, Endone and medication for blood pressure and ‘water retention’. He was unsure if he was taking an antidepressant and was unsure what all his medications were.
He has been attending a psychologist again for a few weeks.
He has seen a shoulder surgeon and is having investigations with a view to surgery.
CLINICAL EXAMINATION
Mental state examination
The assessment was undertaken using audiovisual technology. The quality of the connection was satisfactory. The claimant was unaccompanied in a room at his lawyer’s office in Burwood. He had driven there independently from his home in Auburn. The assessment was assisted by an Arabic interpreter. He spoke in Arabic and the entire interview was via the interpreter but for a couple of English words. The claimant was long-winded in his answers and also interrupted the flow of the interview and the interpreter redirected him on a number of occasions. He reported his mood as depressed. His affect was reactive. There was no abnormal psychomotor activity. He was animated at times in keeping with the content discussed at the time. There was no evidence of psychosis – there was no formal thought disorder, no delusions and no hallucinations. He reported feelings of hopelessness and worthlessness but no active suicidal ideation. He was oriented to time, place and person.
Current functioning
He said his daily routine generally involves smoking and having coffee at home.
He is able to attend to his hygiene independently but prefers to shower when his son is there as he is worried about his physical capability. He is able to attend to simple meals. He claims to have put on 40kg since the accident. The claimant is able to drive himself independently. He said that he cannot catch public transport because of the crowds of people. He is not working and in receipt of the Jobseeker payment from Centrelink. He said that he has not been on holiday. He maintains his Muslim faith however is not able to get into the traditional prayer position.
Determinations
Diagnosis and reasons
The claimant has a Somatic Symptom Disorder. He has a number of distressing somatic symptoms including ongoing lower back pain, dysfunction of his bladder and sexual dysfunction. He has a persistent worry and anxiety about his physical symptoms and their seriousness. This has persisted for well longer than 6 months.
The claimant has Persistent Depressive Disorder. He has a history of well over 2 years of predominantly depressed mood. Associated with this he has other features such as feelings of hopelessness, overeating and sleep disturbance. The panel prefers this diagnosis over Major Depressive Disorder as it reflects the chronic nature of his symptoms which are generally subthreshold for a Major Depressive Episode.
The Somatic Symptom Disorder was initially caused by the 2011 accident and there is evidence of continued worry about his physical symptoms however this did improve and was exacerbated significantly by the 2017 accident.
The Persistent Depressive Disorder is secondary to the Somatic Symptom Disorder which was caused by the 2011 accident and exacerbated by the 2017 accident.
He did not meet criteria for Post Traumatic Stress Disorder. In particular the description of the accident does not meet criterion A. He also did not report prominent intrusive symptoms.

Psychiatric diagnoses	1. Somatic Symptom disorder	2. Persistent Depressive Disorder
Psychiatric diagnoses	3.	4.
Psychiatric treatment description	Psychological therapy

Category	Class	Reason for Decision
1. Self-care and Personal Hygiene	2	The claimant is able to live independently and describes periods of being alone without his son’s for 2 weeks at a time. He worries about showering without someone in the house because of his physical condition. He is able to do basic shopping and cook basic meals.
2. Social and Recreational Activities	3	The claimant rarely attends social events. This is at least in part due to the worry about his physical condition.
3. Travel	2	The claimant is able to drive independently when necessary to the shops and GP for example. He drove independently to his lawyer’s office.
4. Social Functioning	2	He reports that he has lost friends as they are unwilling to talk to him as he asks for help continuously.
5. Concentration, Persistence and Pace	2	He subjectively reported poor concentration. He concentrated well during the interview of 90 minutes duration.
6. Adaptation	2	He has been unable to return to work, primarily because of physical capacity. He had not returned to work prior to the 2017 accident.
List classes in ascending order: 2, 2, 2, 2, 2, 3
Median Class Value: 2
Aggregate Score: 13
% Whole Person Impairment: 7

*%WPI ^{= Percentage Whole Person Impairment}
Pre-existing impairment from 2011 accident

Psychiatric diagnoses	1. Persistent Depressive Disorder	2. Somatic Symptom Disorder
Psychiatric diagnoses	3.	4.
Psychiatric treatment description	Psychological therapy, medication

Category	Class	Reason for Decision
1. Self-care and Personal Hygiene	1	He reported that he was independent with self-care and personal hygiene.
2. Social and Recreational Activities	1	He reported no deficit in his social or recreational activities.
3. Travel	1	He reported that he was able to travel independently.
4. Social Functioning	2	He separated from his wife in 2015.
5. Concentration, Persistence and Pace	1	He reported no issues with his concentration persistence and pace.
6. Adaptation	1	He reported that he had just obtained his licence and was in the process of obtaining work.
List classes in ascending order: 1, 1, 1, 1, 1, 2
Median Class Value: 1
Aggregate Score: 7
% Whole Person Impairment: 0

*%WPI ^{= Percentage Whole Person Impairment}
Effects of Treatment
Although the claimant remains on some treatment, his account did not reflect improvement in his condition nor did he ascribe any change in impairment to the treatment. The Panel found that there was no treatment effect.”

The Panel adopts the report of Medical Assessors Mason and Chew.

Causation/Reasons

The claimant had a well-documented pre-existing psychiatric disability arising from an accident in 2011. Dr Mahmoud provided a report of 28 June 2013 where the claimant referred to being sad every day, having lost interest in pleasant activities, neglected his appearance, was unable to do things that he used to do before the accident and felt unmotivated worthless and helpless, amongst other things. Dr Mahmoud diagnosed a major depressive disorder and pain disorder is secondary diagnosis. The claimant had ongoing treatment and on 30 March 2017, eight months before the accident the subject of this review, he received treatment for severe depression. At that time however he was having marital problems and was temporarily homeless.
Between March 2017 and 28 November 2017, the claimant did not undergo significant psychiatric treatment.
The claimant did receive treatment between March 2021 and July 2022 when he was suffering from anxiety brought about by the psychiatric condition of his son.
The panel must consider however, whether psychiatric injuries of which the claimant complains have been caused or materially contributed to by the subject accident.
As the claimant was not undergoing significant treatment for psychiatric disability after
March 2017 to the time of the accident and, for that matter from 2015, the Panel is satisfied that on the balance of probabilities, the subsequent psychiatric disability suffered by the claimant after the accident on 28 November 2017 was causally related to the accident. Whilst the claimant had undergone psychiatric treatment at various times this was discretely related to stress brought about by his son and his condition of schizophrenia and also his earlier accident in 2011. However, such treatment was not ongoing in the eight months prior to the accident.
The Panel is satisfied that the psychiatric disability and condition of somatic symptom disorder and persistent depressive disorder are causally related to the accident occurring on 28 November 2017. The claimant’s pre-existing condition is not entirely in remission as evidenced by the Panel’s pre-existing impairment assessment but nevertheless it was not significant.

Conclusion

As a result of the accident occurring on 28 November 2017, the claimant developed somatic symptom disorder and persistent depressive disorder.
The WPI assessed by the Panel as a result of the claimant’s psychiatric condition arising after the accident on 28 November 2017 is 7%. There is no deduction for the claimant’s pre-existing condition arising from the accident in 2011.

Determination

The Panel revokes the certificate and reasons of Medical Assessor Nagesh dated
7 August 2023.
The Panel finds that because of the accident on 28 November 2017 the claimant developed somatic symptom disorder and persistent depressive disorder.
The Panel finds the claimant has 7% WPI.

[2025] NSWPICMP 52

30 January 2025