Al Taleb v AAI Limited t/as GIO
[2024] NSWPICMP 516
•30 July 2024
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Al Taleb v AAI Limited t/as GIO [2024] NSWPICMP 516 |
CLAIMANT: | Rajaa Al Taleb |
INSURER: | AAI Limited t/as GIO |
REVIEW PANEL | |
MEMBER: | Elizabeth Medland |
MEDICAL ASSESSOR: | Thomas Newlyn |
MEDICAL ASSESSOR: | Sharon Reutens |
DATE OF DECISION: | 30 July 2024 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; whether the claimant suffered a threshold injury; claimant alleges psychological injury as a result of her son being seriously injured in a motor accident; Medical Assessor found the claimant to suffer an adjustment disorder with mixed anxiety and depressed mood, persistent as a result of the motor accident; the claimed injury of post-traumatic stress disorder was not found; Held – Medical Assessment Certificate confirmed; diagnosis of adjustment disorder is deemed a threshold injury. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION 1. The Review Panel affirms the certificate of Medical Assessor Friend dated 13 March 2022. |
STATEMENT OF REASONS
Rajaa Al Taleb (the claimant) alleges psychological injury arising from a motor vehicle accident involving her son that occurred on 13 May 2020.
She subsequently lodged a claim for statutory benefits upon AAI Limited t/as GIO, the insurer of the vehicle considered at fault (the insurer). The claimant seeks payments of statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act).
A dispute has arisen between the parties as to whether the claimant has suffered a psychological injury caused by the motor accident and whether any such injury is a “threshold” injury (previously known as “minor” injury) for the purposes of the MAI Act.
A threshold injury determination is an important one in terms of an injured person’s entitlements under the MAI Act. If a determination finds that the motor accident has caused a non-threshold injury then the gateway to ongoing statutory benefits and an entitlement to claim damages is opened.
An application was lodged with the Personal Injury Commission (Commission) seeking a determination of the dispute.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter including whether “the injury caused by the motor accident is a threshold injury for the purposes of the Act”.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor.
The dispute about whether the injury caused by the motor accident is a threshold injury, is a medical dispute, as defined by s 7.17 of the MAI Act, and a medical assessment matter: Schedule 2, cl 2(e) of the MAI Act.
Medical Assessor Paul Friend issued a certificate and reasons dated 13 March 2022, which certified the claimant as suffering an adjustment disorder with mixed anxiety and depressed mood and that such injury is a minor injury (now known as “threshold” injury) for the purpose of the MAI Act.
THE REVIEW
The claimant sought a review of the medical assessment in accordance with s 7.26 of the MAI Act. On 25 May 2022 the President’s delegate determined that there was reasonable cause to suspect the medical assessment was incorrect in a material respect. As such the review application was accepted and referred to a Review Panel (the Panel).
Section 7.26(5A) of the MAI Act provides that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission.
The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act.
Rules 127 and 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128 of the Rules.
The Panel met via Microsoft Teams on 29 March 2023 and determined that a re-examination of the claimant was required. A medical examination was arranged to take place on
18 August 2023 with Medical Assessor Newlyn and Medical Assessor Reutens via Microsoft Teams. The examination did not go ahead as scheduled due to the claimant being unable to connect to the session.
A further re-examination was arranged to occur on 24 November 2023, however, due to unforeseen circumstances a Medical Assessor was not able to attend the appointment. Arrangements were then made for a re-examination to occur on 27 February 2024 with Medical Assessor Newlyn and Medical Assessor Reutens. The examination took place as arranged.
RELEVANT STATUTORY PROVISIONS
The term “threshold injury” is defined in s 1.6 of the MAI Act. It provides that a threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness: s 1.6(1)(b).
Section 1.6 also provides that the regulations may exclude or include a specified injury from being a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (Regulation) further defines threshold psychological or psychiatric injury to include acute stress disorder and adjustment disorder. For the purposes of cl 4 ‘acute stress disorder’ and ‘adjustment disorder’ have the same meanings as in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in May 2013: cl 4(3) of the Regulation.
Part 5 of the Motor Accidents Guidelines (Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by a motor accident is a threshold injury for the purposes of the MAI Act. 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:
“General provisions for assessment
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 Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. 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)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.”
Clauses 5.10, 5.11 and 5.12 of the Guidelines refer to the assessment of threshold psychological or psychiatric injury. These clauses provide:
“Threshold psychological or psychiatric injury assessment
5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association.
5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury.”
ASSESSMENT UNDER REVIEW
In his reasons, Medical Assessor Friend states he had some concerns that the claimant did not realise the importance of providing a full account of her symptoms and a full account of her history. He found that the claimant’s account was inconsistent and at times lacking information.
Medical Assessor Friend diagnosed an adjustment disorder with mixed anxiety and depressed mood. He found that initially the stressor was the motor accident involving the son and his injuries arising therefrom. The claimant was found to be distressed by her son’s current condition, and she was particularly upset that she felt she could not leave the home because of her caring responsibilities. She felt distressed whenever she looked at her son.
The claimant did disclose previous psychiatric symptoms but advised that she was well and had ceased medication around a year prior to the motor accident. Medical Assessor Friend accepted that the claimant developed symptoms after she was confronted with her son being very ill in hospital and thereafter having ongoing disabilities.
SUBMISSIONS
Claimant submissions dated 17 December 2020
These submissions were lodged by the claimant’s then lawyers in support of the original application.
The submissions assert that the insurer’s claims officer, who originally denied ongoing liability on the basis that the claimant did not meet the criteria for a diagnosis of post-traumatic stress disorder, did so solely on a certificate of capacity dated 12 August 2020.
It is submitted that any psychiatric diagnosis should be made by a psychologist and/or psychiatrist rather than a general practitioner (GP). It was noted that at internal review the decision maker took into account a referral to psychiatrist, Dr So, however because liability was denied treatment with him did not occur. It is submitted that it was too premature to make the decision as to liability.
Insurer submissions dated 7 June 2021
These submissions are in reply to the claimant’s original application.
The submissions note that the insurer had approved an initial consultation with Dr So on 20 January 2021, with a report yet to be received.
The insurer submits that there was no medical evidence at the time of symptoms that suggest a non minor injury.
Claimant’s review submissions (undated)
The submissions suggest that Medical Assessor Friend recorded a history that satisfies the criteria set out in DSM-5 for a diagnosis of post-traumatic stress disorder. It is therefore submitted that Medical Assessor Friend’s diagnosis of adjustment disorder with mixed anxiety and depressed mood is demonstrably incorrect and inconsistent with the recorded findings.
It is further submitted that the certificate is in error due to “Medical Assessor Friend disturbingly criticised this clearly psychologically affected claimant for not being able to recall her past history in detail and for ending her first assessment session after 43 minutes on account of her concentration levels…” It is submitted that this amounts to impermissible criteria and instead supports the fact that the claimant is in a majorly depressed state.
The submissions assert that the Medical Assessor failed to put any inconsistencies he found to the claimant and has not provided her with a reasonable chance to respond in accordance with the requirements of cl 6.41 of the Guidelines.
Insurer’s review submissions in reply dated 10 May 2022
The insurer submits that Medical Assessor Friend took a comprehensive history and relying on his clinical expertise set out a clear path of reasoning in support of the diagnosis he made.
It is submitted that the claimant’s argument is merely a difference of opinion to that of a qualified medical assessor, and therefore essentially have no merit.
DOCUMENTATION
The Panel has considered all material provided in the claimant’s and insurer’s bundle of documents lodged in respect of the review.
Application for personal injury benefits dated 28 May 2020
The claim form discloses that a prior compulsory third party (CTP) claim had been lodged in 2007 and it further indicates prior injuries of “back, right hand, depression.”
The description of injury/accident is provided as follows:
“I’m told that my son was a passenger in vehicle been driven by his friend which was involved in a major accident. I was notified about the accident and attended the scene of accident and found that he was seriously injured and had suffered serious head injuries and was taken to Liverpool Hospital in a critical condition. I have suffered from nervous shock as a result of seeing him unconscious and in a serious condition.”
Certificate of Capacity dated 15 July 2020
This form was completed by the claimant’s GP, Dr Alsayed and he provided a diagnosis of post-traumatic stress disorder and notes the history of the claimant learning of her son’s serious motor accident. It is stated that because of his condition the claimant has gone through a lot of stress and has developed posttraumatic stress disorder.
Referral of Dr Alsayed to Dr Eddie So, psychiatrist, dated 27 November 2020
The referral lists the claimant’s medical history that includes various ailments and physical injuries. It also notes “anxiety/depression” on 29 September 2008, “claustrophobia” in 2010, “shock” on 9 February 2014, “major depression” on 2 June 2020, 23 July 2020 and 8 September 2020.
She was noted to have been prescribed Celebrex with last script in November 2020.
The referral requests opinion and management of depression/anxiety disorder post the motor accident.
RE-EXAMINATION
The interpreter engaged by the Commission, Mrs Suzanne Stamiris, National Accreditation Authority for Translators and Interpreters, was present during the assessment.
History
Preamble
The claimant was 61 years of age at the time of the appointment. She was interviewed at her solicitors’ office in Liverpool using Microsoft Teams videoconferencing. She lives in a rented house in Yagoona with her son, Ahmad who accompanied her to the appointment but did not remain in the interview room.
Medical history
The claimant said she was unsure but believed she was 170cm tall.
She recalled that she weighed 75kg before the accident but now she weighs 100kg. She said that she was just sitting at home doing nothing.
The claimant is right-handed.
She reported taking medicine because she had high triglycerides.
She has a history of asthma.
She took medicine for reflux.
She had a kidney stone in the past.
She reported problems with her back that she attributed to discs.
She was diagnosed diabetes mellitus type II.
She recalled operations of a cholecystectomy and appendicectomy.
After a 2004 or 2005 car accident she recalled that a plate was inserted in her right wrist.
She has had kidney stone surgery.
She said that she sees a gynaecologist every six months to have a pessary inserted.
She reported allergy to tramadol.
Education history
The claimant completed a fourth-grade education in Lebanon.
Employment history
The claimant worked in a sewing shop in Lebanon for one year making shorts and dresses. The claimant could not recall how old she was when she worked in this job.
She said she sewed at home from age 14-15 for two years. This was during the Civil War.
She never returned to work in Lebanon.
She has not worked in Australia.
Psychosocial history
Family history
Born in Tripoli, Lebanon, she is the 10th of 11 with six brothers and four sisters. Her father and two brothers died in the Civil War. Although then a teenager, she said did not understand what was happening in the Civil War. She said she had a sister in Melbourne. There had been three in Australia. A sister and two brothers passed away in 2023. She said, “I visited my family in Lebanon last year with Ahmad for a holiday along with my daughter and her sons. It was a holiday to visit my sister who lives there. Everyone else had passed away.”
Developmental history
The claimant does not recall any significant childhood symptoms.
No childhood sexual or physical trauma reported. She denied war trauma symptoms.
Relationship history
The claimant emigrated to Australia in 1988.
After 1½ years she returned to Lebanon and married. She had three children: two daughters Mervat (born 1995), Fatoum (born 1992) and a son Omar (born 1991.) Her daughters live in Sydney and Omar lives in Darwin. Her ex-husband now lives in Melbourne.
Her second marriage was to a Syrian, the father of her son Ali 23 (born 2001). The marriage lasted two weeks ending in an Islamic divorce.
She married a third time to a man who needed citizenship. He left her as soon as he had the papers. At first she said they were married for one year. He did not reveal he had four children. Later he arranged a divorce that was registered in Australia. He is the father of her son Ahmad (born 2003). When Ahmad was 15 days old his father went to Syria. Immigration did not do anything about the deception. She raised Ahmad alone.
Later in the assessment the claimant said, “I worked to get Ahmad’s father back. I was with Ahmad’s father 4 years until he divorced me. The government supported me. Ahmad’s father is in Perth”.
There were no more relationships.
The claimant said one of her daughters had seen on Facebook that FACS (Family and Community Services) had children who needed care. She said she did all the paperwork to become a carer of two children. The care arrangement was to begin on 15 May 2020. Because of the accident it did not proceed.
Chemical dependency history
The claimant stopped smoking nine years ago.
No use of recreational drugs or alcohol reported.
Forensic history
The claimant does not have a history of legal problems.
The claimant said she made no compensation claims before the 13 May 2020 motor vehicle accident.
Psychiatric history before the motor accident
The claimant’s general practitioner listed anxiety and depression in 2008 but the claimant did not remember these problems.
Shock was listed in 2014 but she did not remember what it could be about.
In 2019 Dr Eddie So, consultant psychiatrist prescribed the antipsychotic medicines Zyprexa (olanzapine) 10mg daily and quetiapine XR 150mg twice daily. The claimant said she stopped taking the medicines in 2019 because she no longer needed them. She said she had consulted Dr So because she was “down and emotional”. The claimant said, “I told my doctor my mental health was down. I don’t remember what made me sad. I had stopped the medicine and then restarted it after the accident. I am still taking the medicine the Chinese doctor gave me”.
Pre-accident functioning
The claimant reported she was excited, busy, happy and looking forward to caring for the two children as arranged with FACS.
She looked after the house, cooked for her family, and showered daily.
She had friends over and went out when invited. She said that since her son’s accident, she did not like contact with friends.
She took public transport. She did not drive.
She got on well with her children and friends.
She said that she did not speak good English and could not read much Arabic. She listened to the Quran on the radio.
She had never worked in Australia but had raised two sons alone.
History of the motor accident
When asked about the accident the claimant described the accident without prompting and with occasional redirection. She said words to the following effect,
“I cannot forget the accident. I don’t like to mention it. I picture it in front of me and cannot forget it. Yesterday Ahmad had scans at Liverpool Hospital. I told him where his room was and where I cried. He said he knew.”
[She was asked to refocus on the day of the accident.]
“It was during Ramadan and I cooked dinner for his brother and sister. He had bought a jumper for himself. He put it on after dinner. It was Puma brand. He said he would go out for a bit. I told him to be careful. My daughter went to bed. Later I heard her arguing on the phone saying she wanted to sleep. She said you are a liar. Then she came out and told me Ahmad had an accident.
She drove me to the accident. I was devastated, crying and wailing. My daughter told me to be calm and that Ahmad would be alright. When we got to the top of the street it was like the end of the world. Something horrible had happened. The police didn’t let me through. When we went to another street it was chaotic. A bus driver said I couldn’t get through.
I heard a person talking saying a passenger was dead. I told my daughter that my son was dead. I asked a policeman if I could go through to my son. I was told that I couldn’t. A man told me Ahmad was dead. Then I heard in English the driver was dead. I was crying and screaming so my son Ali put me in the car.Then my daughter said we should go to Liverpool Hospital. We waited there for the ambulance. I looked in every ambulance and my son was not there. When the ambulance came with him I couldn’t recognise him. I was told that I had to wait outside. After a time I was told I could see him before surgery. (She was increasingly distressed.) I was told that he was injured and would recover. I was asked not to be upset when I saw him. My daughter told me not to scream or fall apart. They took us to a room with my daughter and Ali. Ahmad’s face was enlarged. He didn’t look like my son. I was crying and screaming.
I collapsed on the floor and when I woke I said he was dead. I asked to go and arrange a funeral. My daughter told me he was not dead and I was taken to another room. I was made to sign paperwork.We waited until he was out of surgery. I said I would stay there because that was where my son was. After 5-6 hours I was told the operation was over. I waited 3-4 days there because it was during Covid and I could not go into his room. I felt that I would wait there in case my son needed me. I waited to see my son. My daughter-in-law Tara asked for me. I was able to see him the next day. I had told my sister he was dying and she came from Melbourne. I had 2 minutes to see him (the Claimant was more distressed). I saw him and said he was dead. My daughter said he was not dead. I stayed there until he woke and then I knew he was not dead. He is in hospital maybe 28 days to a month.
Ahmad’s dad used to ring him. I couldn’t stop it so I told him when his son was injured. He came and stayed 2 weeks in Sydney. His other children came as well.”
At this point the claimant’s son entered the room and the claimant said that although her son was walking his brain and mind were not all there. He still needed treatment. He has physiotherapy, saw a psychologist and had not returned to work. He had not fully recovered. He does not remember the accident. She said she talked to her son and treated him like a small child. He was often aggressive and angry. She told her daughter that he had lost his mind. Mother and son moved houses because the owner wanted the house they were renting back.
History of symptoms following the 13 May 2020 motor vehicle accident
The claimant said words to the following effect,
“After the accident I cried the whole time. Now if he fights with me I go to the backyard and cry. All I talk to the psychologist about is Ahmad. I stay awake with my son and go to sleep when he sleeps. I get anxious because my son doesn’t have proper sleep. I check on him. I think about the accident. We sleep next to each other. I look after him. I live with him and know how his head is. I have the same sadness as I have to look after him. He sits at home not doing anything. Ali has an electrician’s licence and Ahmad would have had a licence.”
History of treatment following the motor accident
The claimant’s general practitioner, Dr Aiman Alsayad, restarted the medicines that Dr So prescribed and prescribed the benzodiazepine Valium (diazepam).
She continued metformin for her diabetes.
She was referred for psychological counselling to Mr Medhat Metry, registered psychologist.
Details of any relevant injuries or conditions suffered after the 13 May 2020 motor vehicle accident
No relevant injuries or conditions have been sustained since the motor vehicle accident.
Current symptoms from the 13 May 2020 motor vehicle accident
The claimant said:,
“Ahmad has become my disease. I worry about him and don’t let my son touch anything. I try to engage him in my daily activities but he just stands there and doesn’t respond to me. I ask him to walk but he doesn’t want to. I live close to a park and I want to go out. I get dressed but stay sitting at home not doing much.”
The claimant said that since the accident she became angry and screamed at her children and grandchildren.
Current and proposed treatment
The claimant continues to take olanzapine, quetiapine and diazepam.
She sees her general practitioner regularly.
She sees Mr Metry every two to three weeks.
She did not expect a change in her current treatment.
Mental state examination
Appearance: the claimant wore a Hijab and black modest clothing.
Activity: the claimant sat in her solicitor’s interview room. She had to ask for help once when she muted the microphone. When speaking, she moved her hands to express her emotions. These movements often obscured her mouth making it difficult to interpret her words.
No psychomotor retardation or agitation observed.
Aggression: no hostile acts towards peers and property reported. She reported verbal aggression towards family members.
Impulse control: impulse control was poor.
Interaction: cooperative throughout the interview.
Eye contact: the claimant focused on the camera in the interview room.
Facial expression: the claimant showed a full range of expression. She was tearful in the latter part of her extended history of the accident and the immediate aftermath.
Language: rate: appropriate. Volume: average.
Coherence: the interpreter had problems with audio clarity because of an echo in the interview room that were solved by a minor change in position of the claimant. The claimant was often unclear about the meaning of her statements or the timelines were uncertain. The interpreter reported that sentences were often incomplete and that repeated questioning did not resolve the problem. Rechecking the meaning of statements did not result in clarity. These problems were resolved by the interpreter to the best of her ability.
Affect: sad. Affective reactions showed none of the lability described in her history. Suicidal thoughts were absent.
Phobias: none reported.
Obsessions: none observed or reported.
Dissociative: no behaviour observed or reported.
Preoccupations: none reported. No recurrent self-injurious behaviour patterns.
Perceptions: no anomalies reported.
Hallucinations: none reported.
Delusions: none reported.
Sensorium
Clear.
Orientation: intact for time, place, and person.
Memory: no short-term or long-term deficit.
Concentration: not impaired as shown by clinical observation.
Abstraction: abstraction was not assessed because the claimant’s first language is not English.
Current functioning
The claimant described her daily routine as caring for her son.
She said she showered every two days because she did not go anywhere. She did all the cooking. Sometimes her son or daughter brought food to the house.
She completed all the household chores. When shopping at the corner store she said she was gone for 10 minutes. When she left the house there was always someone at home with Ahmad. If Ahmad was out with his brother or sisters the claimant could go shopping. She might have a coffee at the shops before returning home.
She said she did not go out with former friends anymore. She had rid herself of them and could not be bothered to reconnect. Before the accident, she could go out with friends and now she couldn’t do anything unless Ahmad was with someone.
The claimant said that her children took out her out if it were an occasion. She felt good going out with them and could ask them to take her out. She called her older son to take his brother out.
Restriction reported from psychiatric symptoms. The claimant said she sometimes caught a bus, was driven by her children or walked. She felt good after a half-hour walk. She commented that her children had thought of the trip to Lebanon.
There was no change in her ability to focus after the 13 May 2020 motor vehicle accident. the claimant did not read English or much Arabic. She listened to the Quran on the radio.
The claimant acts as carer for her son Ahmad and completed all household chores.
Muslim. She prayed regularly. She said she felt better listening to the Quran on the radio.
Comment on consistency
In the referral to a Review Panel the President’s delegate wrote the claimant was not afforded procedural fairness with Medical Assessor Friend drawing adverse conclusions because she did not recall details of her life before the 13 May 2020 motor accident. In this interview, the interpreter reported to the medical assessors that the claimant gave unorganised and truncated answers that resulted in the interpreter having to repeat the question. Sometimes answers could not be reconciled with previous statements. Pre-accident functioning was reported much as to Medical Assessor Friend. The history of mental health symptoms after the motor accident was consistent enough to not need further review.
The various inconsistencies found were put to the claimant and she was given the opportunity to respond. However, her responses made little sense and therefore no adequate explanation was given that reconciled the inconsistencies.
The Panel’s deliberations
Injuries
In considering the symptoms the Panel agreed that following the 13 May 2020 motor accident the claimant developed psychiatric symptoms that have continued and were present at the assessment of 31 May 2024.
The Panel reviewed the injuries referred by the parties. The Medical Assessors, utilising their clinical judgment, following the examination and the considering the evidence, decided that the claimant’s symptoms do not fit the criteria for Post-traumatic stress disorder, and instead meet a diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood.
Prior psychiatric problems.
Dr Alsayad’s entries in his referral for psychiatric care dated 27 November 2020 list anxiety and depression in 2008 and shock in 2014. He did not list the mental health problem in 2019 the claimant reported resulted in referral to Dr So that year. The claimant could not recall details of the 2008 and 2014 mental health problems. She said she had recovered from the 2019 problem and was focused on preparing to provide daycare for two children before the motor vehicle accident. She was excited and happy planning to care for children.
Stabilisation
The Panel decided the claimant’s mental health disorder from the 13 May 2020 motor accident had stabilised.
DSM-5-TR psychiatric diagnosis and reasons
| 137. F43.22 Adjustment Disorder with Mixed Anxiety and Depressed Mood, Persistent. 138. V47.6 Car passenger injured in collision with a fixed object 139. Problems related to interaction with the legal system/crime – arrest; incarceration; litigation; victim of crime. | |
Criteria: | DSM-5-TR Diagnostic Criteria for Adjustment Disorders
Specify whether:
|
Comment: | Stressed by the 13 May 2020 motor accident that resulted in a severe injury to her son the Claimant’s initial response was a misinterpretation of her son’s medical state followed by developing a ‘helicopter parent’ role in the care and rehabilitation of her son. The Claimant did not develop criteria B intrusion symptoms or criterion C avoidance symptoms of PTSD. Her mood changes were typical of an adjustment disorder rather than criterion C of PTSD. Her parental concern for her son with changes in reactivity and arousal did not mean that she had criterion D of PTSD. She did not develop symptoms of a major depressive episode, as mentioned in the referral to Dr So on 27 November 2020. |
Causation and reasons
Causation: | Although the Claimant had consulted a psychiatrist in 2019 and was prescribed psychotropic medicines there was no contemporaneous evidence for a diagnosed psychiatric disorder in the months before the 13 May 2020 motor accident. After the accident, she had significant distress at the accident scene. She began a fulltime carer role after her son returned home and remains his carer. She described anxiety and depressed mood related to concerns about caring for her son and about his future. The problem of caring for her brain-injured son has caused the Adjustment Disorder to persist. |
CONCLUSION
The Panel found the accident was the cause of the following claimed psychiatric injuries:
· Adjustment Disorder with Mixed Anxiety and Depressed Mood, Persistent
The Panel found the accident was not a cause of the following claimed psychiatric injury:
· post-traumatic stress disorder.
Threshold injury
The Panel’s findings in relation to the threshold injury are the same as the findings set out in the certificate of Medical Assessor Friend, who found that the claimant had developed an Adjustment Disorder after her son’s accident.
Pursuant to s 1.6 of the MAI Act and Part 1, cl 4 of the Regulation, Adjustment Disorder with Mixed Anxiety and Depressed Mood is deemed a threshold injury for the purposes of the MAI Act.
Accordingly, the Panel has determined that this certificate is to be confirmed.
0
0
0