AAI Limited t/as GIO v Adnan
[2025] NSWPICMP 151
•10 March 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | AAI Limited t/as GIO v Adnan [2025] NSWPICMP 151 |
CLAIMANT: | Syeda Fizza Adnan |
INSURER: | AAI Limited t/as GIO |
REVIEW PANEL | |
MEMBER: | Hugh Macken |
MEDICAL ASSESSOR: | Atsumi Fukui |
MEDICAL ASSESSOR: | Gerald Chew |
DATE OF DECISION: | 10 March 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Review of medical assessment; whole person impairment (WPI); persistent complex bereavement disorder; major depressive disorder; psychological injury following death of son; pre-accident medical history; deterioration of psychological conditions; issues as to consistency of presentation; activities of daily living; claimant no longer participates in religious cultural festivals; student visa; whole family invited by the insurance company to come to Australia; documentation displaying deterioration of condition; difficulties with examinations; conflicting medical material; psychiatric treatment descriptions; limited psychiatric treatment; Held – the injury caused by the motor accident gave rise to a permanent impairment of 7%. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The following injury caused by the motor accident give rise to a permanent impairment of · persistent complex bereavement disorder. |
STATEMENT OF REASONS
INTRODUCTION
SYEDA FIZZA ADNAN (THE CLAIMANT) IS A 48-YEAR-OLD WOMAN WHO SUSTAINED A PSYCHIATRIC INJURY WHEN INFORMED OF HER SON’S DEATH IN A MOTOR ACCIDENT WHICH OCCURRED ON 12 OCTOBER 2016. THE CLAIMANT LODGED AN APPLICATION FOR PERSONAL INJURY BENEFITS AND, IN DUE COURSE, SOUGHT A CONCESSION FROM THE INSURER THAT HER INJURIES EXCEEDED 10% WHOLE PERSON IMPAIRMENT. THE INSURER DECLINED TO MAKE THIS CONCESSION.
THE INSURER PROVIDED FURTHER SUBMISSIONS DATED 29 NOVEMBER 2024 ADDRESSING THE ALLEGED INCONSISTENCIES OF THE CLAIMANT AS THEY RELATE TO FINANCIAL MATTERS, MENTAL HEALTH SYMPTOMS, AND ACTIVITIES AND CREDIT ISSUES.
THE CLAIMANT PROVIDED FURTHER MATERIAL WHICH ADDRESSED THE FINANCIAL MATTERS, MENTAL HEALTH SYMPTOMS AND ACTIVITIES AND CREDIT ISSUES RAISED BY THE INSURER.
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission).
Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application.
The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
STATUTORY PROVISIONS/GUIDELINES
Section 57 of the MAC Act defines a “medical dispute” as a disagreement or issue to which Part 3.4 of the MAC Act applies.
Section 58 and s 60 of the MAC Act together with cls 1.5-1.7 of the Guidelines set out the procedures for referral to one or more Medical Assessors and the principles to be applied at such assessments.
Who attended the assessment
The claimant attended at the Commission’s Medical Suites at 1 Oxford Street, Darlinghurst on 20 February 2025 and was assessed by Medical Assessor Atsumi Fukui and Medical Assessor Geral Chew. An Urdu interpreter engaged by the Commission, Sholeh Kholghi, National Accreditation Authority for Translators and Interpreters number CPN6ZT34H, was present for the duration of the assessment.
HISTORY
Psychosocial history and pre-accident history
Ms Adnan is a 48-year-old married woman who lives in Greenacre with her husband and four children. She has two sons aged 18 and 27 and two daughters aged 22 and 24 years old. Her deceased son, Shahzaib, was the oldest child and would be 29 years old.
Ms Adnan was born in Karachi, Pakistan. She is the youngest of 10 children in the family. Her father died from a heart attack five years ago and her mother has been ill and bedridden since her father died five years ago. She stated that no medical diagnosis has been given for her mother’s condition. She has four brothers and five sisters. Three brothers and three sisters live in Karachi, Pakistan. She has a brother and a sister in the USA and one sister lives in Islamabad, Pakistan.
Ms Adnan is a Muslim and practised religion in Pakistan and read the Koran. She was married at age 18 and became pregnant straight away with her oldest son, Shahzaid. She stated that she had a “special bond” with her eldest son because she “did everything” with him and that he was “like a friend”. She cared for her children and managed domestic tasks while also supporting her husband in his business.
She denied a past psychiatric history. There was no significant history. She does not consume alcohol or any other substances.
History of the motor accident
Ms Adnan stated that the day she heard the news about her eldest son’s death was a very special day in Pakistan when everything is closed and there is no internet or Wi-Fi connection. During the night when the Wi-Fi came back on she stated that she saw a message that her husband had sent to call him as he was attending to his business in New York. Ms Adnan stated that she felt that something had gone wrong. Her son’s friend in Australia had sent a message to both her and her husband. Her husband called the friend who informed him that Shahzaid had been in a car accident but did not inform him that his son had died.
The family had to authorise someone to go to the hospital and represent the family in relation to their eldest son. They gave the friend the authority who was able to speak to the police and gain further information. The friend informed her husband that Shahzaid had been in a car with another person who was injured and that he was deceased. Her husband then spoke to Ms Adnan’s brother who informed her. Ms Adnan stated that she was in her bedroom sitting on the bed when she received the news. She stated that she saw an image of her son on the television in her room lying down with his clothes, watch and the head injury and that the image was confirmed by her husband who witnessed her son’s body.
Ms Adnan became very distressed and tearful recounting the incident.
History of symptoms and treatment following the motor accident
Ms Adnan was an extremely poor historian who repeatedly spoke about how she has lost her son yet did not volunteer information about how she has been managing or functioning since her loss. She therefore had to be asked specific questions to which she provided vague responses or refused to answer.
Ms Adnan stated that the whole family took student visas to come to Australia legally and arrived in Australia in 2018. She stated that no one told them that it would take so long to deal with the insurance matter following Shahzaib’s death. Shahzaib came to Australia in 2015 on a student visa and was studying at a university in Armidale when he was killed in a motor vehicle accident on 12 October 2016. She stated that her husband came to Australia in 2017 to receive Shahzaib’s university degree. She then stated that the whole family left everything in Pakistan to come to Australia.
Ms Adnan stated that during 2018, after arriving in Australia, she “didn’t do anything”. During 2019 she attended an English course and stated that she may have commenced a cookery course around 2020 or 2021. She stated that she progressed through the stages of the cookery course as required and acknowledged that she gained a Certificate for the commercial cookery course. She attended The Wells Institute in the city which involved one day of compulsory face-to-face teaching and remainder of the classes were online including homework. When asked how much online study she was required to undertake she stated “it’s up to the teacher” but stated that she did 1 to 1.5 hours maximum per day. She stated that she “failed a lot” because of her poor English, poor attendance and poor technical/computer knowledge. She has been continuing the online course as required but the face-to-face teaching had finished in March 2024. She stated, “I’m going through all this for my son”. She stated that she did not know that insurance claim would take so long.
Ms Adnan was asked about travelling to the college for her class. She stated that she was sometimes accompanied by her son but she also travelled independently if her son was not available to accompany her. She stated that she travelled to the city by taking a bus to the train station then taking the train to the city.
Ms Adnan stated that she attended a psychologist and a psychiatrist initially but she is unable to afford a psychiatrist or a psychologist. She is not prescribed any medication. She sees her local general practitioner as needed.
Current symptoms
Ms Adnan kept repeating, “I lost my son”, “just give me my son”, “no one is giving justice”. When asked about what she meant by the “justice” she did not respond. She stated that she suffers every day and that she wakes up and “he’s in front of me”. She stated that she sees him. She stated, “he’s a part of me I live with it”, “he’s with me, every second with me”.
Current and proposed treatment
She is not receiving any form of psychological treatment or pharmacotherapy.
CLINICAL EXAMINATION
Mental state examination
Ms Adnan presented as reasonably kempt and clean. She was wearing a big shawl which was covering her head, shoulders and body over a top and pants. She was wearing sandals. Her hair was greying, and she was not wearing any makeup. She was wearing a mask as she entered the consulting room which she removed down to her chin. She was initially given the explanation for the purpose of the assessment, confidentiality and publication of the outcome on the Commission’s website. She questioned about the website and reluctantly agreed to proceed with the assessment.
Ms Adnan then turned to the interpreter tearfully and complained of having to repeat her story that she had lost her son and that it has been eight years. Her legs and hands were occasionally noted to be shaking. When she was tearful, she wiped her nose with her shawl. During the course of the assessment she frequently became agitated when she was asked direct questions which she evaded and did not answer. She had a few angry outbursts and at times started hitting the table with her hands. Her responses were vague, and she responded to questions with, “I lost my son”. She always spoke with her head turned towards the interpreter. When she was asked about her level of functioning she frequently became agitated and shouted and kept repeating how she has lost her son. She rarely made eye contact with the Medical Assessors except when she became angry, and it was evident that she did not like the questions being asked. When she was asked whether she cooks at home she stated that she was fed up with the question and became angry.
Ms Adnan frequently stood up and changed posture, moved chairs and sat with her legs up. This was evident whenever she became agitated when asked questions she did not wish to answer. Her shawl had come down off her head with her frequent movements. Whilst
Ms Adnan was occasionally tearful and distressed, there was no evidence of a pervasively depressed mood. She stated that she understood English, but it was difficult for her to express herself in English and therefore spoke through the interpreter. There was no evidence of formal thought disorder. She described having visions of her son, but it was unclear if she was suffering a true perceptual disturbance. She denied thoughts of self-harm or suicidal ideation. Whilst her responses were somewhat vague and she provided minimal relevant information, she maintained her focus during the two hour assessment.
Current functioning
Ms Adnan stated that she tries to cook for herself and her children because one cannot live without food, so she has to cook. She also engages in housework with the rest of the family. She is enrolled in her cookery course at college. She stated that she had her Pakistani driver’s licence converted to an Australian driver’s licence but tries not to drive because she lost her son in a motor vehicle accident. However, she has travelled independently using public transport. She stated that she is generally accompanied by her son when she leaves her home but can travel independently to see her general practitioner and has done so to attend college in the city when she had face-to-face teaching.
Ms Adnan stated that when the family arrived in Australia they did not know anyone, but they have made some friends through Pakistani neighbours. She stated that she does interact with one or two Pakistani families who live in the same building but has not visited other people’s home for three years. She stated that she does not go to other families’ homes because she does not like to see other people happy because it makes her focus on her son and her loss. She no longer participates in religious or cultural events or festivals. She gets invited to cultural festivals, but she does not attend, and she does not have any celebrations in her home. She stated that since coming to Australia she has had difficulty reading or saying her obligatory prayers because of the decline in her focus. She avoids talking to her siblings even when they call her because she has nothing to say to them. She still talks to them every one to two months.
Comments on consistency
Ms Adnan was a reluctant historian, avoided responding to questions and frequently became agitated and at times had angry outbursts instead of responding to the questions posed. There were significant inconsistencies in her history in comparison to the history she provided to her psychiatrist and previous assessors.
Ms Adnan responded to questions by repeating how she has lost her son and that she has not been given “justice”. She complained about her suffering of having to be on a student visa and attending courses for the sake of her deceased son while not having residency status and access to medical treatment. Such claim is in contrast to the information provided by her immigration lawyers regarding the family’s financial status. She stated that she and her family have no status in Australia and that they are not treated well because they are not citizens.
Ms Adnan stated that the whole family was “invited” by the insurance company to come to Australia, that she was told that the insurance claim would be finalised within a year. She was asked why then she and her family are remaining in Australia because they do not have to keep staying in Australia to finalise the insurance claim. She seemed somewhat surprised by this question then became irritated and refused to answer the question. She repeated how the family wound up their business and came to Australia and that they had been staying on a student visa for eight years for the sake of her deceased son. It was explained to
Ms Adnan that medical assessments can be conducted by video that it is not necessary for claimants to be physically present in Australia. She still did not respond to the question and continued to repeat her phrase about having lost her son and it was evident that any meaningful response was not forthcoming.
Review of medical documentation
The documentation included in the late documentation which had been uploaded by the parties and the Commission. The Panel noted variable clinical presentation of the claimant. The report of Dr Newlyn dated 2 February 2021 states:
“Her behaviour has changed since my 2018 assessment with her emphasis on disability and memory impairment.”
He goes on to suggest:
“Comparing the presentation in 2018 to the presentation in 2021 Mrs Adnan does not present with symptoms of a known psychiatric disorder but rather a Folie A Famile.”
The report of Dr Rastagi dated 23 May 2020 also notes:
“Her condition has deteriorated since last review in 2018, with further functional impairments, loss of social functioning and cognitive impact leading to a too poor prognosis.”
This deterioration was anticipated by Dr Rastogi who, in his report dated 23 August 2018, noted:
“Given his [sic] likelihood of her depression worsening she may need reviews with psychiatrist in future. The claimant has not pursued her treatment from a psychiatrist, psychologist nor has she been prescribed any medication.”
The medical material bears out the difficulties the Panel had in assessing the claimant. The Certificate of Medical Assessor Christopher Rikard-Bell dated 24 May 2023 notes that the claimant’s responses have changed dramatically. This is noted in the differing prognosis identified in the reports of Dr Verma dated 21 January 2017 and 3 November 2020.
Finally, the Certificate of Medical Assessor Christopher Rikard-Bell dated 24 May 2025 which well expresses some of the difficulties in assessing the claimant. He states:
“I am unable to make an assessment or form a view as to whether Mrs Adnan is intentionally fabricating a psychological condition, however, it does appear to be consistent and significant as she has not recovered well from the death of her son in the motor vehicle accident of 12 October 2016.”
This report is at odds with the report of Dr Newlyn of 20 August 2018 which states:
“Mrs Adnan has no clinical psychiatric disorder and therefore her condition is stable.”
The report of Dr Newlyn dated 2 February 2021 which noted avoidant behaviours during assessment confirms the earlier diagnosis that the claimant does not have a psychiatric disorder and does not need treatment. That is, the report noted that the history obtained was inconsistent with a diagnosis of a clinical psychiatric disorder.
The Panel was not greatly assisted by the medical material which identified significant inconsistencies, and a presentation which was varied over the years since the accident and, in particular, noting the claimant has had minimal medical assistance and certainly none in recent years.
DETERMINATIONS
Diagnosis and reasons
Ms Adnan lost her eldest son who was studying in Australia by himself from a motor vehicle accident which occurred in 2016. Ms Adnan was distressed and tearful whenever she spoke about the loss of her eldest son. She was preoccupied about her eldest son and spoke about having had a special bond with her first-born child and she sees him when she wakes up. She claimed she suffers every day because she has “lost everything”.
Diagnostically, Ms Adnan presents with persistent complex bereavement disorder in relation to the loss of her eldest son who was expected to take over the family business. However, there was no evidence of major depressive disorder. There was no evidence of pervasive depressed mood. She demonstrated a range of emotions. She was easily irritated and angered when asked questions she did not wish to answer. At one stage she made a comment that she was not suffering from any psychiatric condition.
Causation and reasons
Ms Adnan has been suffering from persistent complex bereavement disorder in response to the loss of her eldest son from the subject motor accident. The subject accident is clearly related to her current condition.
Degree of permanent impairment Psychiatric Impairment Rating Scale
The determination as to permanent impairment is made in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Fourth Edition) and Part 6 of the Motor Accident Guidelines.
| Psychiatric diagnoses | 1. Persistent Complex Bereavement Disorder | 2. |
| 3. | 4. | |
| Psychiatric treatment description | Brief period of contact with a psychologist and a psychiatrist with a brief trial of pharmacotherapy, self-ceased due to alleged financial constraints. | |
| Category | Class | Reason for Decision |
| 1. Self-care and Personal Hygiene | 2 | Ms Adnan presented as reasonably kempt although she was not particularly well-groomed. She was not wearing any make-up. She cooks for herself and her children. |
| 2. Social and Recreational Activities | 3 | Ms Adnan stated that she no longer attends any social engagements when invited and does not engage in cultural festivals and does not visit friends. She denied engaging in any social or recreational activities. Ms Adnan and her family are socially isolated. |
| 3. Travel | 2 | She is able to travel independently using public transport if necessary although she prefers to be accompanied by her son when she goes out of her home. |
| 4. Social Functioning | 2 | She maintains relationship with her family and shares household tasks with them. She stated that she does not speak to her siblings overseas as frequently as she used to but maintains contact every one to two months. She denied socialising with her neighbours but has limited social contacts since they arrived in Australia. |
| 5. Concentration, Persistence and Pace | 2 | Ms Adnan was able to focus during the two-hour assessment. She reported a decline in her focus and concentration that she does not read the Koran and has difficulty saying her prayers. Her reports from the English college and the cookery course demonstrate that she has achieved high marks and that she was a good student. Therefore there is no evidence of significant cognitive impairment. |
| 6. Adaptation | 3 | She maintains the requirements with attending college for her student visa. She continues to do cooking and housework with the support of her family. |
| List classes in ascending order: 2, 2, 2, 2, 3, 3 | ||
| Median Class Value: 2 | ||
| Aggregate Score: 14 | ||
| % Whole Person Impairment: 7% | ||
*%WPI = Percentage Whole Person Impairment
Apportionment – pre-existing/subsequent impairment
Ms Adnan stated that she was fully independent prior to the subject motor accident as she cared for her family with cooking and housework, drove a car, supported her husband in his business. There was no pre-existing or subsequent impairment from a psychiatric perspective.
Effects of treatment
Nil.
CONCLUSION – PERMANENT IMPAIRMENT
The Panel assesses the degree of permanent impairment caused by the motor accident at 7% whole person impairment.
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