Abed v Insurance Australia Limited t/as NRMA Insurance
[2025] NSWPICMP 555
•30 July 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Abed v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 555 |
CLAIMANT: | Howraa Abed |
INSURER: | Insurance Australia Limited t/as NRMA |
REVIEW PANEL | |
MEMBER: | Gary Victor Patterson |
MEDICAL ASSESSOR: | Wayne Mason |
MEDICAL ASSESSOR: | Gerald Chew |
DATE OF DECISION: | 30 July 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of threshold injury; claimant was injured in a motor accident when her vehicle was struck in the rear at the entrance to a roundabout; Medical Assessor (MA) certified that the claimant is suffering from an adjustment disorder with mixed anxiety and depressed mood as a result of the accident which is a threshold injury; claimant’s review application granted as the MA’s reasons do not indicate if he considered whether the documented and reported symptoms met a criteria for major depressive disorder; Held – Review Panel found the claimant does not meet the full diagnostic criteria under DSM-5 for post-traumatic stress disorder (PTSD); Review Panel made three other diagnoses caused by accident that are non-threshold injuries for the purposes of the Act; MAC revoked. |
DETERMINATIONS MADE: | CERTIFICATE REVIEW PANEL ASSESSMENT OF THRESHOLD INJURY Certificate issued under s 7.23(1) of the Motor Accident Injuries Act2017 (the Act) 1. The Review Panel revokes the certificate dated 8 December 2022 and issues a new certificate determining that: (a) the following injuries caused by the motor accident: · specific phobia of driving and travelling in a motor vehicle; · agoraphobia, and · somatic symptom disorder with predominant pain; is not a THRESHOLD INJURY for the purposes of the Act. |
(b)
STATEMENT OF REASONS
INTRODUCTION
Howraa Abed (the claimant) was injured in a motor accident on 6 March 2020 when her vehicle was struck as it was entering a roundabout on North Liverpool Road. Another vehicle suddenly entered from the left, causing the claimant to make an emergency stop, which led to the impact from the insured vehicle. The claimant was the seat belted driver of her vehicle. Her airbags did not deploy. Ambulance officers attended the scene but the claimant was not conveyed to hospital. Her husband took her home.
The claimant says that, subsequent to the accident, she developed pain in her neck and back, for which she consulted her GP. The claimant also says that she developed psychological problems for which there were several sessions with a psychologist. The claimant has not been referred to a psychiatrist. The claimant denies any problems with her mental health prior to the subject accident. The claimant says that she is not aware of any family history of mental illness. The claimant says that she has some ongoing anxiety that another motor accident might occur. She describes occasional nightmares related to driving. She says that she avoids driving.
The claimant has tertiary qualifications as a pharmacist. The claimant has worked as a consultant pharmacist and in a clinical pharmacy. The claimant has been involved in academic teaching and research. The claimant has a Doctorate of Philosophy in Pharmacology. The claimant also has a Diploma in Early Childhood Education. The claimant is self-represented in these proceedings.
NRMA (the insurer) indemnifies the owner and/or the driver of the at-fault vehicle for liability to pay to the claimant any damages and/or statutory compensation benefits under the Motor Accident Injuries Act 2017 (the MAI Act).
The insurer denied liability to pay statutory benefits beyond 26 weeks on the basis that all of the claimant’s alleged injuries relevantly are threshold injuries for the purposes of the MAI Act. That decision was confirmed upon internal review.
ASSESSMENT UNDER REVIEW
As there is a dispute between the claimant and the insurer about whether the psychological injury caused by the motor accident is a minor (now threshold injury) under Schedule 2, cl 2(e) of the MAI Act, the claimant was referred for assessment by Medical Assessor Alexey Sidorov, who certified as follows:
The following injury caused by the motor accident:
· Adjustment Disorder with Mixed Anxiety and Depressed Mood
is a MINOR INJURY for the purposes of the Act.
Medical Assessor Sidorov stated that, even though the claimant described some anxiety related to driving a motor vehicle or riding in a motor vehicle, she did not meet the full diagnostic criteria for Post-Traumatic Stress Disorder as per DSM-5.
THE REVIEW
The claimant sought a review of Medical Assessor Sidorov’s certificate on the basis that the assessment was incorrect, within the meaning of s 7.26 of the MAI Act, in a material respect. The application was not made within time. An application was made to extend time for the making of an application for review. The President’s delegate was satisfied that there were exceptional circumstances and that demonstrable and substantial injustice would be caused by refusal of the application for extension of time.
There are no submissions in support of the application for review. The only supporting material is a letter from the claimant briefly describing her symptoms and a letter from her treating psychologist who states that the claimant “has the following conditions all of which are linked to the motor vehicle accident:
· Post-Traumatic Stress Disorder (PTSD)
· Specific Phobia Driving and/or travelling in a car
· Major Depressive Disorder
· Chronic Pain (severe)
· Nocturnal insomnia”.
The treating psychologist says that the claimant has been particularly affected by the ongoing consequences of the motor accident.
The claimant’s application for review was opposed by the insurer. The insurer submitted that the certificate evidences that the Medical Assessor took a history from the claimant, describes the ongoing issues, undertook a mental state examination, describes the current functioning and provided reasons for a diagnosis of Adjustment Disorder, and reasons why the claimant did not fit the criteria for post-traumatic stress disorder. The insurer submitted that the Medical Assessor discharged his obligations and there is no reviewable error within the Medical Assessor’s certificate.
President’s delegate Catherine Freeman issued a Determination of an Application for Review of a Medical Assessment on 4 April 2023 which stated the satisfaction of the President’s delegate that there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect. The basis of that decision was stated to be that Medical Assessor Sidorov’s reasons do not indicate whether he gave consideration to whether the extent of the claimant’s reported and documented symptoms met the criteria for a diagnosis of major depressive disorder. The President’s delegate refers to the report from the claimant’s treating psychologist which suggests that the claimant was “likely” suffering from post-traumatic stress disorder. The Panel notes that, as stated previously, Medical Assessor Sidorov specifically excluded post-traumatic stress disorder.
Accordingly, the review application was accepted, and referred to the Panel, which is to determine whether any psychiatric condition caused by the motor accident is a threshold injury, for the purposes of the MAI Act.
STATUTORY PROVISIONS
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. The matter is determined at first instance by a Medical Assessor and, on review, by a Review Panel consisting of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
Part 5 of the Personal Injury Commission Act 2020 (the PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a Panel, reviewing a decision of a Medical Assessor.[1]
[1] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the 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 proceedings solely based on the written Application.[2]
[2] Rule 128 of the PIC Rules.
The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[3]
[3] Section 7.26(6) of the Act.
All members of the Review Panel had no previous involvement with the claimant or with this matter.
THRESHOLD INJURY
The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2022 with various amendments commencing on 1 April 2023. From that date, the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.
The definition of what constitute a minor injury has not been amended and continues to apply to a threshold injury.
Any reference in these reasons to “minor injury” is a reference to a “threshold injury” and any reference to the word “minor” referring to the injury alleged to have occurred in the accident is a reference to “threshold”.
A threshold injury is defined in s 1.6 of the MAI Act[BG1] and includes a “soft tissue injury” or “psychological or psychiatric injury that is not a recognised psychiatric illness”.
Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. [BG2] The Guidelines contain the procedure for assessing whether an injury caused by the accident is a threshold injury for the purposes of the MAI Act[BG3] .
Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:
“5.3 The assessment will determine whether the injury related to the claim is a soft-tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.4 Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
a.comprehensive accurate history, including pre-accident history and pre-existing conditions;
b.a review of all relevant records available at the assessment;
c.a comprehensive description of the injured person’s current symptoms;
d.a careful and thorough physical and/or psychological examination;
e.diagnostic tests available at the assessment.
Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
BUNDLES OF DOCUMENTS
The parties have presented their respective bundles of documents upon which they rely. The Review Panel (Panel) has 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, nor taken it into consideration. The same principle applies to parties not referring to, nor specifically relying upon, 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. It is not required that each piece of evidence be mentioned. The Panel is not required to “analyse every piece of information from every opinion contained in a document with which it was provided”. The Panel has come to its own conclusions and has taken its own history.
MATERIAL BEFORE THE REVIEW PANEL
The claimant relied upon the following material which the Panel has considered:
(a) Report dated 16 January 2023 by Ms Sharalee Williams, psychologist, to whom it may concern.
Ms Williams says that, since the subject accident, the claimant presented with symptoms of the following psychological conditions:
·Specific Phobia – travelling in a car or driving
·Panic Disorder (panic episodes when exposed to driving-related stimulate
·Depressive Disorder
·Post-Traumatic Stress Disorder
Ms Williams says that the ongoing and cumulative effects of the accident on the claimant have been substantial and have negatively impacted every area of her life (Ms Williams’ emphasis).
(b) Letter dated 27 October 2021 from Buang Eun Kim, treating physiotherapist.
The reporter says that the claimant has significant limited range of motion in her lumbar spine and cervical spine in all movements due to severe pain. It was hard to have muscle manual test due to severe pain. She has severe tenderness in lumbar and cervical spines with palpation.
(c) Letter dated 31 July 2021 from Ms Sharalee Williams.
Ms Williams summarises the ongoing treatment provided to the claimant and says as follows:
“Since the time of the accident, Ms Abed has experienced ongoing pain, especially in her neck and back, along with diminished movement and function. This has negatively impacted her life in numerous ways. Ms Abed has reported that she has been experiencing low mood and anxious distress due to her pain and reduced ability to complete many activities….. Her sleep has also been significantly affected by the cumulative effect of the pain and associated stressors. Long-term fatigue further diminishes Ms Abed’s ability to tolerate pain, continuing a negative cycle of poor coping and functioning….. Ms Abed’s emotional and mental well-being will undoubtedly be enhanced by her physical recovery.”.
(d) Medical Certificate dated 16/01/2025 from Dr Hung Ma that claimant is unfit to continue her usual occupation from 16/01/25 to 16/04 25.
The insurer relied upon the following material which the Panel has considered:
Description
Date
Page
Insurer’s submissions (see previously)
21.03.2023
2
Certificate of Medical Assessor Sidorov (see previously)
08.12.2022
4
Insurer’s submissions in response to threshold injury dispute
24.03.2022
11
· The insurer disputes that the claimant sustained a non-minor psychological or psychiatric injury from the subject accident.
· The insurer notes that the claimant reported symptoms of depression since 2012.
· The insurer submitted that, in terms of psychological injuries, the symptom of depression does not meet the diagnosis for a recognised psychiatric illness as outlined in the DSM-V. Therefore, any symptoms the claimant may have satisfied the criteria of a minor psychological injury.
| 27. | Certificates of Capacity/Certificates of Fitness | 17.04.2020 | 13 – 15 |
| Letter of Dr Simonil Bhavnigri | 21.12.2012 | 16 |
Not relevant for the Panel’s consideration as it relates to a condition not the subject of the review.
| 28. | Referral to neurologist, Dr Alan McDougal | 21.01.2013 | 17 |
Not relevant for the Panel’s consideration as it relates to a condition not the subject of the review.
| 29. | Radiology report – MRI brain | 24.04.2009 | 18 - 19 |
CLINICAL INDICATIONS – Calcified splenium lesion managed conservatively incidentally discovered during work up for chronic headache. Stable throughout MRI follow up. Investigation for neurocysticercosis negative. Progress.
Comment – the lesion is comparable to the description from the previous report.
Report of Associate Professor Matthias Jaoger
15.11.2011
20
Report of Dr Alan McDougal
16.01.2013
21 - 22
Not relevant for the Panel’s consideration as it relates to a condition not the subject of the review.
| 30. | Referral to Granville Physiotherapy | 17.04.2020 | 23 |
Not relevant for the Panel’s consideration as it relates to review for treatment of whiplash.
| Referral to psychologist, Thawidah Rangiah by Dr Hung Ma | 07.08.2020 | 24 | |||
| Referral regarding the claimant’s mental health plan | |||||
| GP Mental Health Care Plan | 07.08.2020 | 25 | |||
| 31. | Initial Assessment/Closure Report Momentum Rehab | 27.11.2020 | 26 - 36 | ||
Recommendation to close file as the claimant has not returned for medical treatment or re-assessments since April 2020, and declined to meet the MR consultant in person, or allow MR to contact employer, conduct home visits/ergonomic assessment. After significant liaison with the insurer following the conversation with the claimant’s treating doctor Dr Nahn, it has been agreed that Momentum Rehab will close this file. Ms Abed did not provide permission for Momentum Rehab to liaise with her employers, to attend her home to conduct a face-to-face assessment or provide any photos of her home or work environment. Momentum Rehab are therefore unable to make any appropriate relevant or conclusive recommendations regarding Ms Abed’s capacity for activities of daily living or return to work.
Reports of damage to vehicles involved in the subject accident.
EXAMINATION REPORT
The report of the Medical Assessors is as follows:
Psychiatric Re-examination Howraa Abed 30 June 2025
Gerald Chew & Wayne Mason
Brief Personal Details
Ms Abed is a 40-year-old woman who lives in a Western Sydney suburb. She is separated from her husband and is the mother of 3 children. Income consists of the single parenting payment; she receives no child support from her ex-husband.
Psychosocial History
Ms Abed was born in Dubai and described a normal birth and development. She is the youngest of 5 daughters. She has a sister in Sydney, a sister in Queensland and 2 sisters in Perth. Her father died in December 2020 at 73 years of age in Iraq from the pulmonary consequences of a COVID infection. Her mother died in Iraq in 2018 of colon cancer. She described a happy experience growing up in her family and said she was not subject to any form of abuse.
Ms Abed initially grew up in Dubai. She attended school there until year 3 when the family moved to Syria. She attended school in Damascus where she completed year 10. The family migrated to Australia in October 2010 with United Nations assistance because her parents could not return to Iraq at that time. She denied exposure to any trauma or persecution while living in Syria. On arrival in Perth she completed 3 months of English lessons and then resumed high school. She obtained the HSC equivalent with a score greater than 90% and commenced pharmacy studies at Curtin University Perth. She then transferred her studies to Charles Sturt University Wagga Wagga where she completed the pharmacy degree and commenced research work. She then went on to complete PhD studies at Charles Darwin University and obtained her doctorate in 2018.
Work history consisted of working in pharmacies from 2011. During her doctorate studies she also functioned as a tutor to pharmacy students and delivered lectures. In the year prior to the motor accident she had commenced a business as a consultant pharmacist which consisted of being referred patients by general practitioners. She would visit patients in their homes and provide advice to the general practitioner and regarding various drug interactions and side effects. She said the business was building up at the time of the motor accident but she was also doing some tutoring, online lecturing and some pharmacy shifts. The total number of work hours was not full-time.
Leisure activities prior to the motor accident mainly consisted of getting together with friends. She said she was part of quite a large group of friends who had similar backgrounds. She said she socialised a lot.
Ms Abed denied any past insurance claims for motor accident or worker's compensation matters and denied any history of problems with the law.
With regard to medical history, Ms Abed said her health was very good, she was coping with work and did not have any problems. She was questioned about a cerebral lesion in the corpus callosum. She said this was an incidental finding from an MRI scan done while at university because of headaches. She said it had not been a problem to her and she had received regular neurological follow-up but believes the last scan had been prior to her marriage. She was questioned about symptoms of dizziness which had bothered her in the past but did not do so now. She said she did not suffer from tinnitus. She said the diagnosis of postural orthostatic tachycardia syndrome (POTS) was related to the headaches years ago and she had not needed to see a cardiologist for many years. She said her current general practitioner is Dr Hung Ma of the Dellwood Medical Centre in Granville; she said most consultations were by telephone. When asked about surgery Ms Abed said her 3 children have been delivered by caesarean section.
Ms Abed denied both past and family psychiatric illness.
Current medications are largely for pain. Panadeine (paracetamol 500 mg/codeine 8 mg) 2 tablets 4 times daily. Extra paracetamol and Nurofen are used when needed. She also uses gels and rubs such as Voltaren gel. In addition she uses heat packs and hot baths or showers. To assist with sleep she uses Restavit (doxylamine 25 mg) at night or Polaramine (dexchlorpheniramine 2 mg). In addition she uses over-the-counter vitamin supplements such as St John's Wort. She noted she was not using any psychotropic medication such as an antidepressant, and antianxiety agent or an antipsychotic agent.
With regard to substance use, Ms Abed said she does not use cigarettes, alcohol, recreational drugs or coffee. She does not gamble.
History of the Motor Accident
On 6 March 2020 Ms Abed was returning from dropping her daughter at school. She was alone in the vehicle and was wearing a seatbelt. She had entered a roundabout when another vehicle illegally entered the roundabout on her left and she had to make an emergency stop. She was subsequently rear-ended by the vehicle behind her. She was not pushed into another vehicle. Airbags did not deploy and she did not hit her head or lose consciousness. She said she immediately experienced lower back pain but was able to exit the vehicle. She and the other driver moved out of the roundabout and pulled aside to exchange details. She said someone had called an ambulance and when they arrived she was in severe pain. The ambulance wanted to take her to hospital because of the pain but she had concerns regarding COVID. Her husband arrived and he then took her immediately to a medical centre in Liverpool.
History of Symptoms and Treatment
Ms Abed could not remember the name of the medical centre. She said the doctor gave her painkillers and ordered an x-ray or a scan but she was in too much pain and could not go for the scan. The pain consisted of lower back pain which radiated into both legs. It varied in intensity from 6/10 to 9/10 while not using medication. She also developed neck pain which spread into her upper back and both shoulders with an intensity of 10/10 without medication.
She then attended her own GP Dr Hung Ma in Granville who advised it was too early for physiotherapy and suggested continuing to use painkillers and heat packs. Ms Abed was not able to continue with her work as a pharmacy consultant because of pain and also because of the development of anxiety. The pain has continued to be a problem and persists 5 years later.
When asked about psychological symptoms Ms Abed said she lost trust in other drivers and was not able to drive. She said members of her family, friends and colleagues all encouraged her to resume driving on a gradual basis but she was unable to do this. She said they offered to accompany her but every time she attempted to get in a car she would scream with fear that she was going to be hit. When asked if she was able to travel as a passenger in a car she said she has to lie down on the seat and close her eyes. She tries to avoid as much as possible being a passenger in a car. She was asked if she would be able to drive her children to hospital in a medical emergency. She said she would be unable to do this and would have to call an ambulance. She went on to say friends and relatives take her children to and from school and she is in a state of panic until she knows they have arrived safely.
Ms Abed said she has become much more isolated. Because she cannot drive and is unable to travel as a passenger in a car she does not get together with her friends. However, she did acknowledge they continue to support her by transporting the children, visiting her home to help with heavier housework and by doing the cooking for her.
Ms Abed was asked if she is able to leave the house. She said she is unable to go out alone. Sometimes she will ask a friend to walk with her to the park in an attempt to gradually improve, but she could not do that alone. She said if she is exposed to motor vehicles during an attempt to go for a walk she screams and becomes tearful and has to immediately return home.
She described nightmares related to the motor accident. These can be triggered if she leaves the house and is exposed to a noisy motor vehicle. She did not describe flashbacks of the motor accident.
Ms Abed was frequently tearful throughout the interview and was questioned regarding her mood. She said she is not happy because she is unable to resume the life she had before the subject motor accident. However she denied thoughts of suicide and said she had no intention of ending her life. She is able to enjoy time spent with her children. She also enjoys reading pharmaceutical literature and watching television. She noted her sleep was disturbed but this is mainly due to neck pain; she said she is woken whenever she attempts to turn over in bed. She said nightmares of the motor accident also wake her from sleep.
The panel asked if she had utilised any antidepressant medication. She said in the first few years after the motor accident her GP had prescribed sertraline 50 mg, duloxetine 30 mg and venlafaxine 37.5 mg at various times but she had not been able to persist for more than one month with these medications because of side effects and lack of response. She also added that she would prefer not to use psychotropic medication unless necessary.
Treatment has consisted of online consultations with psychologist Ms Sharilee Williams. Ms Abed was vague about the frequency of consultations but it appears to have been approximately monthly over a 3 or 4-year period. She said these consultations ended some time ago because Ms Williams had "taken a break". She said she found the sessions with Ms Williams helpful because she understood her but does not believe they have made a significant difference to her symptoms. More recently she has had one online session with psychologist Ms Eleanor Middleton only a few weeks ago and has plans for monthly consultations in the future. She said Ms Middleton has advised her to try to make very small gains.
Injuries or Conditions since the Motor Accident
Ms Abed initially said there had been no subsequent events. However she was reminded her father had passed away at the end of 2020. She said she naturally found this very distressing. She said it was made worse by the fact that family and friends in Australia did hold a memorial service for him but because of her symptoms she was unable to attend that service.
She was also reminded her husband left early in 2021. She acknowledged this was also distressing because she was on her own and having to look after the children without being able to drive or go out. In addition, and perhaps as a consequence, it has been necessary for her to move house. She is now living in Department of Housing accommodation in a more distant suburb. She said she was not able to participate in the move because of her physical symptoms and anxiety and she relied on family and friends to do it for her.
Current Symptoms
Ms Abed continues to experience disabling lower back pain and neck pain which significantly limits her physical activities. She remains unable to do heavy housework and cooking and relies on friends and family to do these things for her.
She experiences significant anxiety associated with motor vehicles. She is totally unable to drive. She is largely unable to travel as a passenger in a car. She said to do so she must lie down on the back seat and cover her eyes.
She continues to experience anxiety associated with being away from her home. She is totally socially avoidant and cannot join friends for any social activity. She is unable to leave her home alone because of severe anxiety. She has attempted to walk to the park with a friend but more often than not cannot do so.
She described distress and frustration because she is unable to continue to work as a pharmacist due to anxiety and is unable to earn money to support her family.
The psychiatrist panel members explored the possibility that she was depressed but concluded this is not the case. She said she is woken at night by pain. She is frustrated she is unable to work and function physically. She denied ongoing depressed mood and suicidal ideation. She is able to enjoy some activities such as being with her children, reading and watching television.
The panel members observed that Ms Abed was frequently distressed throughout the interview and needed to take a number of breaks to gather herself in order to be able to continue. These episodes of emotional distress were triggered by talking about the accident and the consequences of the accident.
Current and Proposed Treatment
Ms Abed proposes to continue monthly online psychological consultations with treating psychologist Ms Eleanor Middleton. She is not using psychotropic medication and has no desire to do so. She is not consulting a psychiatrist and cannot afford to do so.
Mental State Examination
Ms Abed is a 40-year-old right-hand-dominant woman who was located alone in her home in Western Sydney. She confirmed she was aware she could have a support person with her but had chosen not to do so. She was identified by her photograph on her NSW ID card. She was interviewed using the Microsoft Teams application with a good internet connection. The interview commenced at 9 AM and concluded at 10:45 AM.
Ms Abed was cooperative with the examination and provided the information requested. She was highly intelligent with a good command of the English language and seemed to be fully insightful regarding her psychiatric condition. She was dressed in black robes with a black hijab.
While she was depressed in appearance Ms Abed was able to display a full range of appropriate affect. She denied suicidal ideation. She was clearly frustrated with herself and said she knew she was well-educated and she wanted to contribute to society but was unable to do so because of the anxiety arising from the subject motor accident. She frequently became distressed throughout the interview and needed to take a break for between 2 and 5 minutes on 4 or 5 occasions.
Ms Abed was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology.
Current Functioning
Self-care and personal hygiene: Ms Abed confirmed she is able to shower or have a bath and does so regularly although has some fear of falling in the shower, noting it is risky to shower if no one else is in the house. She is not able to cook or do heavy housework. She said friends and family members are on a roster to provide her with assistance with the house and the children.
Social and recreational activities: Ms Abed said she is unable to go out with her social group because it causes her too much anxiety. She said if she attempted to do so she would end up covering her face and screaming. She said she has nightmares if she attempts to leave the home. She said she does enjoy seeing the people who come to the house to help her out.
Travel: Ms Abed is unable to drive a car and is unable to travel as a passenger in a car. When asked if she can use public transport she said no because whenever she attempts to leave the house she becomes short of breath and panicky. She has not travelled by air. She relies on the support of friends and relatives to transport her children to and from school and to their other activities.
Social functioning: Ms Abed's husband left her after the motor accident because she was unable to participate in their marital relationship. She said he does not contribute to the financial support of the children. She is well supported by friends and relatives in her home but she is unable to go out to any social activities.
Concentration, persistence and pace: Ms Abed said this is interrupted by both pain and distress. She does enjoy reading pharmaceutical material and can watch television until pain interrupts. She is unable to persist with tasks because of pain. She is also slowed down because of pain.
Adaptation: Ms Abed is unable to work because of pain. However she is also unable to leave the house to do any work because of anxiety.
Consistency of Presentation
Ms Abed’s presentation was internally consistent, consistent with the documentation provided and consistent with the diagnosis the panel has made.
Summary
Ms Abed was involved in relatively minor motor vehicle accident on 6 March 2020, now 5 years ago. The motor accident was not life-threatening and does not meet DSM-5-TR Criterion A for post-traumatic stress disorder. Ms Abed developed significant cervical and lumbar pain following the subject motor accident which has restricted her physical activities. She also developed severe anxiety which has prevented her from driving and has resulted in her being unable to leave her home alone. It is the view of the panel that she has developed a specific phobia of driving and agoraphobia. The panel notes there were subsequent stressors consisting of the death of her father and the ending of her marriage.
Diagnosis and Reasons
Ms Abed presents with symptoms consistent with agoraphobia, a specific phobia of driving and travelling in motor vehicles, and a somatic symptom disorder with predominant pain.
DSM-5-TR criteria for agoraphobia are met as follows:
Criterion A. She has a marked fear or anxiety about using public transportation, being in open spaces, standing in a line or being in a crowd, and being outside of the home alone.
Criterion B. She avoids these situations because she is fearful of developing panic like symptoms and bursting into tears.
Criterion C. These situations almost always provoke fear and anxiety.
Criterion D. These situations are actively avoided or require the presence of a companion.
Criterion E. The anxiety is out of proportion to the actual danger.
Criterion F. The fear has lasted longer than 6 months.
Criterion G. The fear causes distress and impairment in social and occupational functioning.
Criterion H. It is not due to another medical condition.
Criterion I. It is not better explained by another mental disorder.DSM-5-TR criteria for specific phobia of driving and travelling in a motor vehicle are met as follows:
Criterion A. She describes marked fear and anxiety about driving or being in a motor vehicle.
Criterion B. These situations always provoke immediate fear and anxiety.
Criterion D. The fear, anxiety and avoidance is out of proportion to the actual danger.
Criterion E. The fear, anxiety and avoidance has lasted more than 6 months.
Criterion F. Impairment in social and occupational functioning is severe.
Criterion G. The condition is not better explained by the symptoms of another mental disorder.DSM-5-TR criteria for somatic symptom disorder with predominant pain are met as follows:
Criterion A. Ongoing cervical and lumbar pain results in significant disruption of daily life.
Criterion B. Excessive thoughts, feelings and behaviours relate to the pain. There are disproportionate persistent thoughts about the seriousness of the symptoms, there is a high level of anxiety about the pain, and excessive time and energy is devoted to controlling the pain.
Criterion C. The condition has now been present for 5 years.DSM-5-TR criteria for post-traumatic stress disorder are not met because the motor accident was not a life-threatening event (Criterion A).
DSM-5-TR criteria for adjustment disorder with mixed anxiety and depressed mood are not met because the motor accident resulted in other psychiatric diagnoses.
Causation and Reasons
The panel notes the claimant was involved in a relatively minor motor vehicle accident and that it is unusual for such an accident to give rise to severe anxiety which has persisted for such a long time. Ms Abed reported no pre-existing psychiatric conditions. The panel also notes that she is a highly educated and intelligent person.
The panel accepts that the conditions specific driving phobia and agoraphobia were caused by the subject motor accident. This is in part because there is no alternative explanation for the conditions. Also, it is highly likely that fear of further physical injury has contributed to the development of such extreme avoidance symptoms.
The panel is satisfied that an incidentally discovered pre-existing cerebral corpus callosum lesion was not a contributor to the development of anxiety.
The panel also notes the possible contribution to her current psychiatric condition by the death of her father and separation from her husband within the year following the motor accident.
On the balance probability the panel concludes the motor accident was capable of giving rise to a psychiatric condition and did result in agoraphobia, specific phobia of driving and travelling in a motor vehicle, along with somatic symptom disorder with predominant pain.
Conclusion
The following injuries were caused by the subject motor accident:
·Specific phobia of driving and travelling in a motor vehicle
·Agoraphobia
·Somatic symptom disorder with predominant pain
Threshold Injury
The diagnosed conditions are non-threshold injuries.
FINDINGS
The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[4]
[4] Section 7.26(6) of the Act.
The Panel is not required to choose between medical opinions and is required to form its own opinions.[5] The Panel adopts the findings and opinions of the Medical Assessors who concur with one another.
[5] Allianz Australia Group Limited v Keen [2021] NSWCA 287 and Insurance Australia Group Limited v Marsh [2021] NSWCA 31.
What has been referred for assessment in these proceedings is psychiatric condition. The Panel notes that the Medical Assessors on the Panel are required, in accordance with the Guidelines, to determine if the claimant has a psychological or psychiatric injury, within DSM-5, caused by the accident, and then make a diagnosis of that injury.
The Medical Assessors may, in their clinical judgment, diagnose a condition that is the same as, or different to, the diagnosis of the original Medical Assessor or the diagnosis of the treating doctors or Medico-Legal experts, or the particular diagnosis that may have been included in the application or reply form.
The Panel notes that neither party provided any expert medical evidence in support of their respective cases.
The Medical Assessors have explained the basis and rationale of their assessments. They respectfully disagree with the diagnosis of an Adjustment Disorder with Mixed Anxiety and Depressed Mood made by Medical Assessor Sidorov because the subject accident resulted in other more appropriate psychiatric diagnoses.
The Medical Assessors agree with Medical Assessor Sidorov that the claimant does not meet the full diagnostic criteria for post-traumatic stress disorder as per DSM-5.
CONCLUSION
For the above reasons, the Panel concludes the certificate issued by Medical Assessor Alexy Sidorov dated 8 December 2022 should be revoked. The new Certificate appears at the commencement of these reasons.
[BG1]Referred to Act above
[BG2]Referred to Act above
[BG3]Referred to Act above
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