| DETERMINATION OF REVIEW PANEL | |
| CITATION: | AAI Limited t/as AAMI v Kumari [2025] NSWPICMP 548 |
| CLAIMANT: | Parveen Goyal nee Kumari |
| INSURER: | AAI Ltd t/as AAMI |
| REVIEW PANEL | |
| PRINCIPAL MEMBER: | John Harris |
| MEDICAL ASSESSOR: | Ron Gill |
| MEDICAL ASSESSOR: | Christopher Rikard-Bell |
| DATE OF DECISION: | 28 July 2025 |
| CATCHWORDS: | MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; review of Medical Assessment Certificate (MAC); motor accident; assessment of whole person impairment (WPI) for psychiatric impairment; claimant rear seat passenger; claimant presented with significant ongoing pain which had been excluded from any assessment (clause 1.215 of the Motor Accident Permanent Impairment Guidelines); no other relevant principles in assessment of impairment; Held – claimant’s degree of permanent impairment assessed at not greater than 10%; MAC revoked. |
| DETERMINATIONS MADE: | MEDICAL ASSESSMENT – PERMANENT IMPAIRMENT WHETHER THE DEGREE OF PERMANENT IMPAIRMENT OF THE INJURED PERSON AS A RESULT OF THE INJURY CAUSED BY THE MOTOR ACCIDENT IS GREATER THAN 10% The assessment made by the review panel under s 63(4) of the Motor Accidents Compensation Act 1999 is as follows: 1. The Review Panel revokes the certificate of Medical Assessor Canaris dated 29 May 2024 · Persistent Depressive Disorder (Dysthymia) with Anxious Distress |
REASONS
BACKGROUND
Ms Kumari (the claimant) was injured in a motor accident on 27 March 2014. The claimant was a rear seat passenger in the insured vehicle making a right hand turn which was
T-boned by another vehicle.[1][1] Claimant’s bundle, p 143.
AAI Ltd trading as AAMI (the insurer) is liable to pay Ms Zilic any damages under the Motor Accidents Compensation Act 1999 (the MAC Act).
The present dispute between the parties is whether the degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%. This constitutes a medical dispute within the meaning of the MAC Act.[2]
[2] See ss 57 and 58 of the MAC Act.
Section 44(1)(c) of the MAC Act provides that the State Insurance Regulatory Authority may issue guidelines with respect to the assessment of the degree of permanent impairment of an injured person as a result of an injury caused by a motor accident.
The Motor Accident Permanent Impairment Guidelines (the Guidelines) were issued pursuant to s 44(1)(c) for the assessment of permanent impairment. The Guidelines adopt the fourth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA 4). Where there is any difference between AMA 4 and the Guidelines, the Guidelines are definitive.[3]
[3] Clause 1.2 of the Guidelines.
The present application is a review of a medical assessment pursuant to s 63 of the MAC Act. The medical assessment the subject of this review was conducted by Medical Assessor Mason on 29 May 2024 (the medical assessment). Medical Assessor Canaris assessed the permanent impairment caused by the motor accident at 19%.
The application for referral of…
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Details
- Case
- [2025] NSWPICMP 548
- Decision Date
CaseChat Overview and Summary
In the case of AAI Limited trading as AAMI v Kumari, the claimant, Ms Parveen Kumari, was a rear-seat passenger in a car involved in a motor vehicle accident on 27 March 2014. Following the accident, Ms Kumari experienced significant ongoing pain and psychological distress. She sought to have her Medical Assessment Certificate (MAC) reviewed under the Motor Accidents Compensation Act 1999, asserting that her degree of permanent impairment had not been accurately assessed. The court was required to determine whether Ms Kumari's degree of permanent impairment was greater than 10%, as assessed by the Medical Assessors.
The primary legal issue before the court was whether the assessment of Ms Kumari's whole person impairment (WPI) for psychiatric impairment was in accordance with the provisions of the Motor Accidents Compensation Act 1999 and the Motor Accident Permanent Impairment Guidelines. The court examined the evidence presented by Ms Kumari regarding her physical injuries, psychological symptoms, and the impact on her daily functioning. The court also considered the psychiatric assessment and the Psychiatric Impairment Rating Scale (PIRS) scores assigned to various aspects of Ms Kumari's life.
The court found that Ms Kumari's degree of permanent impairment, when assessed in accordance with the guidelines, did not exceed 10%. The court noted that while Ms Kumari experienced significant pain and psychological distress, the assessment of her impairment was not influenced by any other relevant principles outlined in the guidelines. Consequently, the court concluded that the degree of impairment was accurately assessed, and the MAC was correctly issued.
As a result of the court's decision, the claimant's application to revoke the MAC was dismissed. The court upheld the assessment of Ms Kumari's whole person impairment at not greater than 10%, affirming the MAC issued by the Medical Assessors. The court found no basis to revoke the MAC, and the claimant's appeal was unsuccessful.
The primary legal issue before the court was whether the assessment of Ms Kumari's whole person impairment (WPI) for psychiatric impairment was in accordance with the provisions of the Motor Accidents Compensation Act 1999 and the Motor Accident Permanent Impairment Guidelines. The court examined the evidence presented by Ms Kumari regarding her physical injuries, psychological symptoms, and the impact on her daily functioning. The court also considered the psychiatric assessment and the Psychiatric Impairment Rating Scale (PIRS) scores assigned to various aspects of Ms Kumari's life.
The court found that Ms Kumari's degree of permanent impairment, when assessed in accordance with the guidelines, did not exceed 10%. The court noted that while Ms Kumari experienced significant pain and psychological distress, the assessment of her impairment was not influenced by any other relevant principles outlined in the guidelines. Consequently, the court concluded that the degree of impairment was accurately assessed, and the MAC was correctly issued.
As a result of the court's decision, the claimant's application to revoke the MAC was dismissed. The court upheld the assessment of Ms Kumari's whole person impairment at not greater than 10%, affirming the MAC issued by the Medical Assessors. The court found no basis to revoke the MAC, and the claimant's appeal was unsuccessful.
Orders
Orders of the court
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Background
Background to the litigation
The claimant was medically examined by both Medical Assessors on 10 July 2025. The examination report is as follows.Background and History of the Presenting ComplaintMs Parveen Kumari is a 40-year-old woman who lives in Sydney, NSW with her husband and their daughter who is 20 months old. She is not employed currently and has not been working since the accident. She is not in receipt of financial assistance and is dependent on his husband. She did not report monetary issues. Ms Kumari worked part-time in retail at Woolworths (in the delicatessen section) and had previously worked at Subway. She was working at Woolworths for two to three years. She said that she was offered to do twice manager role but was not keen to take this offer as was keen to explore IT jobs. Ms Parveen Kumari was involved in a motor vehicle accident on 27 March 2014. She was a rear-seat passenger in a car driven by her friend. The accident occurred when the driver of her vehicle attempted to turn right at an intersection and was struck by an oncoming vehicle, directly hitting the passenger side door where Ms Kumari was seated.The collision was severe enough that the vehicle required cutting open to extricate Ms Kumari, who immediately reported experiencing intense pain in her right shoulder and back. Emergency services attended promptly, and Ms Kumari had to be extricated from the vehicle by cutting open the car door.She was then transported by ambulance to a nearby hospital, where she was admitted overnight due to her injuries.Medical evaluation confirmed physical injuries, including a right sided fractured clavicle, she had bruises on her face and legs. She had neck pain as well. Following her overnight hospital stay, Ms Kumari was discharged home and was followed by the general practitioner. Her right arm was in sling and had a right frozen shoulder. She was referred for physiotherapy session. She as attending two to three session per week and found it helpful. She reported substantial physical limitations and psychological distress almost immediately following the accident.She said that her movement improved, however, said there were limitations. She said that this has had a lasting impact on her. She spoke about the psychological impact. She said that she felt dependent on her husband. She said that she was dependent on him financially, was preparing meals, showering, taking to appointments. She saw a psychologist and had a few sessions and said that it was hard for her to open to people as she had to re-live the accident. She continues to feel scared to leave the house. She does not want to leave the house. She needs the husband to be with her. she said that he has been with her husband the max for an hour for grocery and appointment. She avoids social crowds and gatherings. When she is amongst people, she feels that people are judging her and reported interpersonal perception sensitivity. The last time she socialised was with her parents and met relatives. She said that she was happy to go out with them. We brought to her attention the attendance to the cricket matches, this was indoor and with the husband. She said that she never attended the gym for dumbbell activities and said that she had never attended gyms. We brought to her attention the international travels, she had three trips overseas in total and was not sure. She went to USA and India. She was overseas for two weeks, three weeks, and a month respectively. She said that she was “okay at home with parents and was better than in USA and was looked after”. She spoke about her loss of functioning and said that IT was her dream job. She said that she cannot return to IT industry. She said that she feels like it is out of her league. She attempted to return to Woolworth for a day and struggled because of frozen right shoulder and has not returned to work since then. She must participate in online training before and after the accident to try to keep the job. She said that she tried to return to work in a call centre for ATO in 2016. She worked there for four to five weeks. The first four weeks was training, and in the fifth week she struggles on phones and left the job. Since then, she has not engaged in any form of vocational training. She said that she wants to work but finds it hard to face the world. She had been on IVF treatment and said that her relationship was strained and wanted to salvage the relationship and started IVF treatment more than two years ago. She was vague and confused with the dates. She said that she attended hospital once for IVF treatment and then rest of the appointments were online. She is feeling worthless and feels like that she is not doing much for her husband and her daughter. She does not feel good about the situation. She reported that she can enjoyment and a bit of happiness when she sees her daughter. She reported guilty thoughts and feels responsible for the situation. The daughter’s primary attachment is with her father, however, spends time with her. She has always been an emotionally sensitive person. Is easily moved to tears. She tends to catastrophise and tends to procrastinate. She said that she prefers routine and structure. She said that there is no change in life. She feels that she has no control over her situation. She alluded to being an organised person. She alluded to pervasive anxiety. The said that the stress is felt in shoulders and the body gets stiff. the pain symptoms are described as manageable. The stress is said to have no impact on her pain’s perceptions. She has infrequent flashbacks with associated memories and said she has smells and feels like it is fresh. Ms Kumari has no history of psychosis, mania, or hypomania.It is to be noted that Ms Kumari denied a second motor vehicle accident in February 2023, when explicitly asked. Risk ProfileMs Kumari has passive suicidal thoughts and are infrequent. She has never attempted suicide.There is no family history of suicide. She reported that her relationship with her husband is a protective factor for her.She has not engaged in self-harm or risk-taking behaviours.She is irritable with poor frustration tolerance levels. She is not impulsive. Physiological SymptomsMs Kumari’s sleep is described as poor. She sleeps intermittently for 5-6 hours at a time, with early and middle insomnia. She has nightmares and night terrors related to motor vehicle accidents occasionally. She feels tired because of the poor quality of sleep.Her memory is described as suboptimal. She struggles with organising herself and depends on her husband for appointment. Her concentration and attention are described as fluctuating. Her motivation and energy levels are reduced. She said that she couldn’t be bothered to do things. She said that she is not engaging in any day-to-day chores. Her self-care and hygiene are said to be poor, relying heavily on prompting by her husband. She said that she showers every three days. She said that she changes clothes every three days. She brushes her teeth every two to three days. She takes care about her presentation and grooming in front of people. She cannot drive and said that she travels with her husband. She does not take public transport. She said that she feels that people will be judged. She does not have a driving licence. She said the appetite is poor and has maintained her weight. Psychiatry HistoryMs Kumari has been diagnosed with Major Depressive Disorder, Social Anxiety Disorder, and Persistent Depressive Disorder (Dysthymia) with Major Depressive Episode and Anxious Distress.There is no pre-injury mental health history. She is not engaged with a psychiatrist currently or previously. She has engaged briefly with psychological treatment post-accident but ceased due to distress. She had seen psychologists intermittently, Ms Debra Starr. She is currently not engaged with a psychologist. She is not open to the idea of seeing a psychologist s feels “she wont be able to”.There is no family history of mental illness.There is no history of hospital admissions for psychiatric reasons.Medical HistoryMs Kumari’s medical history includes physical injuries from the accident, notably a fractured clavicle and subsequent "frozen shoulder" with ongoing pain. She had subclinical hypothyroidism due to pregnancy. She has no history of head trauma or seizures. She has no known allergies.Medication HistoryMs Kumari is not currently taking psychiatric medications. She takes pain killers as needed. Historically, she was prescribed escitalopram, which she discontinued due to side effects and fear of dependency. When I brought this to her attention, she said that she could not recall. Addiction HistoryMs Kumari does not consume alcohol. She does not use tobacco products. She denied illicit substance use. There is no history of excessive caffeine intake. There is no history of gambling-related issues.Salient Features of Psychosocial and Developmental HistoryMs Kumari’s primary emotional support comes from her husband, and they have a daughter. She has two siblings, in USA and Canada. The relationship with the sister is distant, her brother keeps a check on her. Her parents are in India and have a good relationship with them. She was born in Jalandhar, Punjab, India. She grew up locally. There is no history of developmental trauma. She finished year 12 at school in India. She completed a Bachelor's Degree in Computer Applications in India and a Master’s Degree in Information Technology in Australia.Shas previously worked in retail in Subway and briefly in a call centre for the ATO. Ms Kumari has no criminal records.Premorbid, she described herself as strong and independent person,Mental Status ExaminationOn mental state examination, Ms Parveen Kumari is a female of the stated age. She was appropriately dressed and groomed. She was easy to engage, and I was able to form a good rapport with her. There was no psychomotor agitation or retardation. Her body demeanour was anxious. Her speech had a staccato quality. The thought-form was goal-directed and was reserved in her answers. The thought content revolved around the accident and the impact on her psychosocial functioning. She spoke about the psychological impact and her loss of functioning and increased dependency. There was no evidence of any psychosis or perceptual disturbances. Her affect was anxious and depressed. Her mood was anxious and depressed. She was oriented to person, place, and time. The insight is best described as fair. Her judgement at the time of this review was reasonable.Psychiatric Impairment Rating Scale (PIRS):Self-care and Personal Hygiene (Class 2): Ms Kumari is able to adequately perform basic personal care tasks, including showering, changing clothes, and brushing teeth, although she does so irregularly (approximately every two to three days). She is capable of maintaining a presentable appearance, particularly when anticipating social interactions, but relies significantly on prompting and support from her husband to achieve this. There is no indication of a requirement for regular external or professional intervention, supervision, or community care to manage basic self-care, thus meeting criteria for mild impairment.Social and Recreational Activities (Class 2): Ms Kumari demonstrates notably reduced interest, motivation, and engagement in social and recreational activities. However, she retains some capacity to occasionally participate in limited social activities, such as attending indoor cricket matches, provided her husband accompanies her. Although she experiences anxiety and is reluctant to engage socially, her ability to occasionally partake in such activities, particularly within familiar family contexts, demonstrates mild impairment rather than a more severe withdrawal or permanent isolation.Travel (Class 3): Ms Kumari experiences significant anxiety and discomfort related to travel, even for short distances and routine tasks such as grocery shopping or medical appointments. She is consistently unable to travel independently and requires her husband’s presence for even brief and familiar outings. There are also clear limitations in her capacity to tolerate travel to unfamiliar environments or to manage routine journeys independently. These limitations and dependence clearly align with moderate impairment criteria per the guidelines.Social Functioning (Class 2): While Ms Kumari maintains existing relationships, notably her marriage and family ties, these relationships are clearly strained. The marital relationship is characterized by a carer-dependent dynamic rather than a traditional spousal partnership, reflecting ongoing stress, emotional strain, and reduced intimacy. However, there is no evidence indicating severe disruptions such as prolonged separation, complete breakdown, or the loss of essential relationships, thereby reflecting mild impairment consistent with guideline criteria.Concentration, Persistence, and Pace (Class 2): Ms Kumari displays suboptimal cognitive functioning, particularly in terms of memory, attention, and organizational skills. She has demonstrated noticeable difficulty sustaining employment or engaging in tasks requiring higher-level cognitive effort or sustained attention. Despite these challenges, she remains able to manage basic daily cognitive tasks with appropriate prompting and external support. She was able to complete 63 vocational module as well as a month data call centre training preparation for work course although she was not able to manage her anxiety to start the work. There is no indication that her cognitive deficits severely restrict all routine tasks or preclude basic intellectual activities entirely, thereby meeting criteria for mild impairment.Employability and Adaptation (Class 4): Ms Kumari has made multiple, well-documented unsuccessful attempts at returning to employment, including roles in retail and call centre environments. Her consistent inability to sustain employment or effectively engage in vocational activities, even in low-demand or modified roles, reflects significant psychological and functional barriers. Her work capacity is markedly reduced to potentially working only one or two days at a time, with significant impairment in consistency of attendance, work pace, and reliability. This profile clearly aligns with severe impairment according to the guideline criteria.Calculation:Median class: Class 2Aggregate score: 2+2+3+2+2+4 = 15Whole Person Impairment (WPI): 8%Clinical Summary
Evidence
Evidence Before The Court
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Decision
Reasons for decision
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Ratio Decidendi
Legal Principle Established
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