AAI Limited t/as GIO v Adnan - [2024] NSWPICMP 89

DETERMINATION OF REVIEW PANEL
CITATION:	AAI Limited t/as GIO v Adnan [2024] NSWPICMP 89
CLAIMANT:	Syeda Ayesha Adnan
INSURER:	AAI Ltd t/as GIO
REVIEW PANEL
MEMBER:	Ray Plibersek
MEDICAL ASSESSOR:	Paul Friend
MEDICAL ASSESSOR:	Matthew Jones
DATE OF DECISION:	19 February 2024
CATCHWORDS:	MOTOR ACCIDENTS – Claimant’s brother killed in Australia in a motor vehicle accident; claimant lived overseas and later travelled to Australia.; claimant reported psychological injury caused by her brother’s death; original certificate found the claimant’s injuries were persistent depressive disorder with persistent major depressive episode and gave rise to a permanent impairment of 13%; Held – original medical certificate revoked; claimant did not sustain any psychological injury as a result of or caused by her brother’s death in the motor accident; claimant’s reported and demonstrated level of functioning, ability to support herself and to be independent in her day-to-day care, is not consistent with a psychiatric diagnosis; claimant did not meet criteria for a DSM-5 psychiatric diagnosis.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Review Panel revokes the certificate of Medical Assessor Samson Roberts dated 19 September 2022. 2. The Review Panel issues a new certificate determining that the claimant did not sustain any psychological injury as a result of or caused by her brother’s death in the motor accident on 12 October 2016.

STATEMENT OF REASONS

INTRODUCTION

On 12 October 2016 Shah Zaib, the brother of Syeda Ayesha Adnan (the claimant), was killed in a car accident in Australia. The accident was a head-on collision between two cars on the New England Highway at Kentucky New South Wales. At that time the claimant was living with her family in Pakistan and was 16 years old. After the accident the claimant has come to live in Australia and has reported psychological injuries which have been described as persistent depressive disorder with persistent major depressive episode.
The insured driver involved in the fatal accident was insured by AAI Ltd t/as GIO (the insurer) who had liability to pay to the claimant any damages and/or statutory compensation entitlements under the Motor Accidents Compensation Act 1999 (the MAC Act).
There is a dispute about whether the degree of permanent impairment sustained by the claimant as a result of psychological injury caused by an accident is greater than 10%. This constitutes a medical dispute within the meaning of the MAC Act.[1] The degree of permanent impairment is referred to in sub-s 58(1)(d) of the MAC Act.
[1] Sections 57 and 58 of the MAC Act.
The current dispute is about a determination made by Medical Assessor Samson Roberts in a certificate dated 19 September 2022.
Medical Assessor Samson Roberts’ certificate concluded that the claimant’s injuries caused by the motor accident were persistent depressive disorder with persistent major depressive episode and gave rise to a permanent impairment of 13%.[2]
[2] Claimant’s bundle AD 5, pp 9-21.
A delegate of the President of the Personal Injury Commission (Commission) determined there was reasonable cause to suspect an error in the certificate of Medical Assessor…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

Keep reading for free

Create a free CaseChat account to read AAI Limited t/as GIO v Adnan and more:

Read every judgment in full
Ask AI and get answers linked to paragraphs
See how each paragraph was cited in later cases
Download judgments as PDF or Word

Continue with Google

One click creates your free account or signs you in.

By continuing you agree to the Terms and Privacy Policy.

Details

Case: [2024] NSWPICMP 89
Decision Date: 19 February 2024

CaseChat Overview and Summary

AAI Limited, trading as GIO, was the defendant in a case brought by Adnan, the plaintiff, who sought compensation for psychological injuries he alleged resulted from the death of his brother in a motor vehicle accident that occurred in Australia. Adnan, who lived overseas at the time of the accident, later travelled to Australia and reported suffering from a psychological injury due to his brother's death. The original medical certificate identified the claimant’s injuries as a persistent depressive disorder with a persistent major depressive episode, resulting in a permanent impairment rating of 13%.

The court was tasked with determining whether Adnan's psychological injuries were indeed caused by the motor accident and if he met the criteria for a psychiatric diagnosis under the DSM-5. The key legal issue was whether Adnan's reported psychological injuries were genuine and consistent with his level of functioning and independence in his day-to-day life.

The court found that Adnan did not sustain any psychological injury as a result of or caused by his brother’s death in the motor accident. The court held that Adnan’s reported and demonstrated level of functioning, his ability to support himself, and his independence in his day-to-day care, were inconsistent with a psychiatric diagnosis. Additionally, Adnan did not meet the criteria for a DSM-5 psychiatric diagnosis. Consequently, the original medical certificate was revoked, and the court dismissed Adnan's claim for compensation.

The court's final order was to revoke the original medical certificate and dismiss Adnan's claim for compensation. The decision highlights the importance of consistency between reported psychological symptoms and the claimant’s actual level of functioning and independence in assessing the legitimacy of a psychological injury claim.

Orders