Ali v AAI Limited t/as GIO
[2025] NSWPICMP 613
•15 August 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Ali v AAI Limited t/as GIO [2025] NSWPICMP 613 |
CLAIMANT: | Syed Aalishan Ali |
INSURER: | AAI Limited t/as GIO |
REVIEW PANEL | |
MEMBER: | Jeremy Lum |
MEDICAL ASSESSOR: | Douglas Andrews |
MEDICAL ASSESSOR: | Michael Hong |
DATE OF DECISION: | 15 August 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; review of Medical Assessment Certificate (MAC); original Medical Assessor declined to make any psychiatric diagnosis after finding the claimant’s presentation to be inconsistent, unusual and inauthentic; Review Panel noted the claimant’s age (18 years) and while the given history was vague at times there was sufficient consistency to arrive at a diagnosis and for impairment to be evaluated; Held – Review Panel diagnosed a persistent depressive disorder caused by the motor accident; whole person impairment was assessed at 7% which is not greater than 10%; MAC revoked. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Review Panel assessment of the degree of permanent impairment Certificate issued under s 63(4) of the Motor Accidents Compensation Act 1999 1. The Review Panel revokes the certificate of Medical Assessor Doron Samuell dated (a) The Review Panel certifies the following injury was caused by the motor accident: (i) persistent depressive disorder. (b) The Review Panel finds that the above injury results in a whole person impairment of 7% which is not greater than 10%. |
STATEMENT OF REASONS
INTRODUCTION
Syed Aalishan Ali (the claimant) says he sustained psychiatric injury (nervous shock) when his brother, Mr Syed Shahzaib Ali, was tragically killed in a motor accident on
12 October 2016.The claimant made a claim for personal injury benefits with GIO (the insurer), the third-party insurer of the vehicle that he says caused the accident.
A medical dispute arose about whether the degree of the claimant’s whole person impairment (WPI) is greater than 10% WPI. Where there is a dispute about the degree of a claimant’s WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor/s for determination.
[1] Section 131 of the Motor Accidents Compensation Act 1999.
On 1 November 2023, Medical Assessor Doron Samuell determined that the claimant’s psychiatric injuries were not caused by the motor accident. An assessment of the degree of permanent impairment was therefore not required.
The claimant lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Samuell’s decision. This was allowed by the President’s delegate (Ms Catherine Freeman) and this Panel was convened to conduct the review.
MEDICAL ASSESSMENT UNDER REVIEW
Medical Assessor Samuell was asked to assess whether the psychiatric injuries of post-traumatic stress disorder, depression and anxiety were causally related to the motor accident and if so, to determine the degree of permanent impairment.
Medical Assessor Samuell noted that the claimant was 11 years old at the time his older brother was killed in the motor accident. The claimant was described as being close to his brother and the loss of his brother had the potential to cause serious psychological injury.
The Medical Assessor however, found the claimant’s presentation to be internally inconsistent, unusual and inauthentic. The claimant’s self-description was noted to be at odds with objective records and his health-seeking. The Medical Assessor stated that he had great difficulty in interpreting and understanding the impact that the claimant’s loss of his brother had on the claimant.
The Medical Assessor concluded that the claimant’s presentation was not credible and declined to make a diagnosis. A certificate was issued stating that the injuries referred for medical assessment were not caused by the motor accident.
SUBMISSIONS
Claimant’s submissions
The claimant says the Medical Assessor discounted the reports of Dr Rastogi and Dr Jungfer without a proper basis, particularly in circumstances where the Medical Assessor had “great difficulty in interpreting and understanding the impact of the brother’s loss had on [the claimant]”. It is further submitted that the inconsistencies observed were not properly put to the claimant.
It is contended that the claimant’s psychiatric symptoms satisfy the DSM 5 criteria for a recognised psychiatric condition. Specifically, that the motor accident caused a major depressive disorder with an impairment of 17% WPI, as found by Dr Jungfer.
Insurer’s submissions
The insurer says the school records and the medical reports of Dr Rastogi, Dr Jungfer and
Dr Newlyn do not suggest a permanent impairment of greater than 10%.
REVIEW OF THE EVIDENCE
General observations
On 26 February 2025, the Panel issued a direction to the parties requesting indexed and paginated bundles of the information they relied upon. The Panel advised that unless documents are uploaded to the review file, the Panel would not be able to read and consider those documents. The parties responded with the claimant’s bundle comprising of pages 1-140 and the insurer’s bundle comprising of pages 1-95.
The Panel has read the documentation relied upon by the parties. The relevant material is referred to in the re-examination report and the Panel’s findings below.
RE-EXAMINATION REPORT
At the initial teleconference on 6 May 2025, the Panel determined that the claimant be re-examined. The re-examination report of Medical Assessors Andrews and Hong is below:
“Who attended the assessment
Mr Ali was assessed via an audiovisual link; the connection quality was adequate to do a comprehensive assessment.
Mr Ali, an 18-year-old Pakistani man, was at home. He said everyone else in the family was also at home. Doctors Andrews and Hong were in their offices.
History
Psychosocial history and pre-accident history
The Panel started by asking Mr Ali how he was before the accident.
Mr Ali said that before the accident, in early 2016, he was often out and was happy. He was living his best life. He thinks he was probably in year 5 and said that he played soccer and cricket, and went to the carnivals. On the weekend, as a family, they went out to the park. They often dined together. His life revolved around his family.
He said that he and his brother loved cars, so they sometimes go to a friend's house to see their cars.
Academically, Mr Ali stated that he wasn't very smart. He was in the middle of the class and said he wasn't getting into trouble at school.
The family was reasonably well off, and they had drivers who drove them everywhere. They also had cleaners and cooks. There was no governess and his mother was the person who parented the children. He grew up with his parents and was the youngest of five siblings. There was no developmental trauma identified.
In terms of general medical history, he does not have a specific illness. He said he has consulted his GP regarding insomnia and chest pain.
He does not have drug or alcohol problems.
Mr Ali does not have a pre-injury psychiatric history.
History of the motor accident
The accident happened on the 12th of October 2016 when Mr Ali was 11 years old. His brother was 23 and passed away in a car accident in Australia.
At the time, Mr Ali was 10 or 11 years old, and he said he remembered everything. He was outside playing, and he went home, and was given the news that his brother was no longer alive and had been killed in an accident. A couple of weeks later, his brother's body was returned home. He said they were very close. His brother was the eldest in the family and expected to take over the family business.
He remembered seeing his brother's body in the coffin, and his face was all bruised. He said he couldn't believe it. He said he often pictures this, and he thinks that his brother is still alive somewhere.
In 2017, the whole family moved to Australia, he said to get justice. The Panel asked him what that meant and how they would get justice. He said the whole family has been ruined by his brother's death, nobody looks at anybody and nobody talks to anybody at home. He couldn't explain further what he meant by getting justice.
History of symptoms and treatment following the motor accident
The Panel asked Mr Ali about his mental health since the accident, and took a history that his mental health has been "the same in the past nine years" since his brother passed away.
The Panel asked about his symptoms at the nadir, or the worst of his symptoms. He said that everything comes back in his head. He wants to sleep but cannot. He wants to eat but cannot. He showers but does not get satisfaction from it.
The Panel asked Mr Ali how long these severe symptoms go on for. He said one or two hours and he would be okay. The Panel asked him what would cheer him up during that time, and he said getting his brother back alive, and he could not think of other strategies that could help him. The Panel asked him how he copes when distressed, he said he is Muslim and he prays for his brother. He never goes to the mosque.
He sometimes wakes up and sees his brother standing in front of him and thinks that he has come back to life.
Current symptoms
Mr Ali said he has not enjoyed anything since his brother passed away, and the Panel mentioned to him that he does enjoy playing video games and also watching TikTok videos.
His motivation to be active is low.
He said generally, he only gets four hours of sleep, and the Panel asked him why he cannot sleep more. He couldn't explain it and said sometimes, he gets chest heaviness and cannot sleep, and had seen his GP about it.
Mr Ali doesn't know what his weight is and doesn't think his weight changed in 2025. He said he's about five feet seven and probably grew a little bit the last two years.
He said he never had a problem with anger before, but he has become irritable and sometimes speaks with a raised voice when angry at his brother. He never acts out physically.
He reported having problems with his concentration "sometimes".
Current and proposed treatment
In terms of treatment, Mr Ali has never had any treatment other than seeing a GP for sleeping pills. He said he takes the sleeping pill maybe once or twice a week, and generally, his brother gives it to him.
The Panel asked Mr Ali why he never sought treatment, and there was no specific answer. The Panel asked him whether he wanted psychological and psychiatric treatment now. He said he had been asked the same question many times (by IMEs and Medical assessor), but again he could not express whether he wanted any treatment.
The Panel asked him whether he had discussed what he has been feeling with a GP. He said he had, and she is also Muslim and tells him to pray.
There are no proposed treatments.
CLINICAL EXAMINATION
Mental State examination
He said he did not sleep well last night, and looked like he just woke up. He had long, uncombed hair and a full beard. He wore a T-shirt and said he had slept in it. He was more alert and focused as the assessment proceeded, and he was assessed for 1 hour and 5 minutes.
There was no psychomotor slowing or abnormal movements. He was moderately restricted in his affect range and he did not smile or laugh. He spoke spontaneously and fluently. He was not thought disordered.
Mr Ali appeared to be reticent about the interview. He gave vague responses to many questions, including saying he didn’t know what his parents or sisters did vocationally. When asked about whether he would accept a referral from his GP to a psychologist or psychiatrist, he responded that he had already answered all the questions. Pressed about the possibility of treatment for himself, he said they couldn’t do anything. He noted that his mother rarely spoke.
The Panel looked for perceptual disturbance, loosening of thought process, delusions and mood elevation. The Panel did not find any evidence of abnormality. He denied hallucinating or psychotic symptoms.
Current functioning
Mr Ali is 18 years old and living with his parents, brother and sister, and altogether there are five people at home.
Mr Ali has never had a driver's license and never uses public transportation, either in Pakistan or in Australia. He said somebody always drives him. He had drivers when he was overseas, and since coming to Australia, he said an aunt (a family friend who lives next door and not a blood relative) did the school drop off when he went to school. Since he finished school, he said his brother drives him places and to the college. The Panel confirmed, he has never been out by himself his whole life. The Panel asked him whether he could go out by himself. He said he doesn't need to because somebody would drive him.
Mr Ali reported that everybody cleans up at home. His brother wants him to clean up, but they have an argument after that, because he doesn't feel like it.
Mr Ali said he spends all his time watching TikTok. The Panel asked him about playing video games. He said he had a car racing game on Xbox, but it is an old version. He doesn't have a new version and so he is not playing right now. Mr Ali said he doesn't watch movies, doesn't use social media, and has never been one to read books.
Sometimes the aunt comes over, and they have no other relatives in Australia.
He said for the whole day today, he has not spoken to anybody, except his father in relation to this assessment.
Day-to-day, Mr Ali said he talks with his brother sometimes, but his brother wants him do something and then they have an argument. He said the relationship with his sister is okay, but they're not particularly close. He said everybody eats at different times at home and not together. They do not do anything together. He is not close with his father or mother, and they do not talk much.
He said he only showers once a week and his brother gets angry with him, but he doesn't want to shower more.
Mr Ali said that nobody celebrates anything at home. If it's somebody's birthday, someone may say “happy birthday”, but apart from that, they don't do anything else to celebrate it. He said he doesn't know whether his parents work, but they're mostly at home. His brother works in security. His sister works, but he doesn't know what she does. Mr Ali's sister does a lot of the cooking, and they also get takeaway food. He said his parents do not seem to want to talk to anybody at home.
In terms of education and employment history, he said that since he came to Australia, he had only attended one school, Punchbowl Boys School and completed year 12 in 2023. He said his ATAR was probably 35, and he wasn't focusing very well and was missing classes. Some days, he woke up and did not want to go to school, so he stayed home. The Panel notes that he attended school full time until he finished year 12, with occasional absences only.
The Panel asked about disciplinary infraction and suspension, and he had trouble remembering the incident related to pornographic material, and said he has not had other issues. He was not referred to a psychologist after that.
Mr Ali said he has never actively participated in any sports or extracurricular activities in Australia, and that he didn’t really talk a lot when he was at school. He had two friends and they met at the library during school hours, but they never met outside of school. Since he left school, he has not been in contact with them. He thinks they live far away but doesn't know where they are.
He reported that he has been going to college every Saturday and doing a diploma in construction design. His brother drives him, and it's a 15-minute drive from home. He started in 2024, and he is expected to finish it next year. He said he is behind in some assignments, but has never asked for an extension. He repeated some assignments and said that on Saturday, he goes to study for an hour and a half with around 6 students in the class, and the teachers help him during the lessons. He has not failed the course so far.
He has never worked in his life.
REVIEW OF DOCUMENTATION
Summary of relevant documentation
Personal Injury Commission certificate by psychiatrist Medical Assessor Dr Doron Samuell 1/11/23, concluded all injuries were not caused by the subject accident and no WPI was done. He was 17 and attending Punchbowl Boys in year 12 at that time.
Dr Richa Rastogi IME psychiatrist’s report dated 23/8/18, Mr Ali's symptoms included concentration and memory problems, flashbacks of brother, he has given up soccer, has been reclusive, quiet and withdrawn, “dumb and stupid”, and developed problems with confidence. No past psychiatric history and no family history of mental health problems. There is no relevant general medical history. She diagnosed grief disorder and Adjustment disorder. She provided a PIRS with ratings 131 232, the final WPI is 6%.
Dr Patricia Jungfer, IME psychiatrist provided a report dated 22/2/21, diagnosed Major depressive disorder. He was 10 at the time of the subject injury, when his brothers passed away.
The police assessed the subject accident as a major traffic crash.
Mr Ali's school file:
·Mr Ali was 10 or 11 years old at the time of the subject accident, and was studying in Pakistan.
·School reports year 7, 8 and 9 (year 9 in 2020, only 1 report due to the COVID pandemic).
·School counsellor/psychologist, Howard Colin, discussed suspension 24/10/18. Attendance 58%, porn material and took photo of a female teacher.
·2018, no unexplained absences. Second half, with 2 unexplained absences. Grades were C, D and Es, 1x B.
·2019, 2 and 1 unexplained absences in the two terms. Grades 2x B, and others were DCEs.
·2020, year 9, different rating scheme, but overall seemed improved.
·The claimant was in year 12 in 2023, when assessed by Dr Doron Samuell.
Dr Thomas Newlyn IME psychiatrist's report dated 21/8/18, wrote there is no past psychiatric history. He concluded Mr Ali has no clinical disorder at that time. Further report 4/2/21, noted his daily routine, school, and social media use. He has lost friends as the family moved. He likes video games. As a family they do not go out, as his father said not to spend money. Mr Ali never does the assignments. He fears cars. He was at a developmental stage where he was more irritable now, but there is no clinical disorder. He wrote on 23/8/23 again, based on a file review.
PIC review panel decision, related to Mr Ali's sister, Syeda Adnan 19/2/24, concluded she does not have a psychiatric diagnosis. Dr Samson Robert’s PIC certificate was revoked.”
RELEVANT LEGISLATION
Permanent impairment
The assessment of the degree of permanent impairment is to be made in accordance with the Motor Accident Permanent Impairment Guidelines (the Guidelines).[2]
[2] See s 44 of the Motor Accidents Compensation Act 1999.
The Guidelines (effective from 1 June 2018) applies to the Review. Psychiatric Impairment is assessed under the heading “Mental and behavioural disorders” and commence from page 44. These Guidelines apply to motor accidents that occurred between 5 October 1999 and 30 November 2017.
Causation of injury
It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychological or psychiatric condition.
Causation is dealt with at cls 1.5-1.7 of the Guidelines. An abridged form of the requirements is contained in cl 1.7 which states:
“1.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question ‘Would this injury (or impairment) have occurred if not for the accident?’ may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and 5E.
FINDINGS
The Review is a new assessment of all matters with which the medical assessment is concerned.
The evaluation should only consider the impairment as it is at the time of the assessment.[3]
[3] Clause 1.21 of the Guidelines.
The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[4] and Insurance Australia Ltd v Marsh.[5]
[4] [2021] NSWCA 287.
[5] [2021] NSWSC 619.
The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[6]
[6] Section 63(4) of the 1999 Act.
The Panel refers to the above joint re-examination report of Medical Assessors Andrews and Hong. The Panel reconvened on 11 August 2025 and discussed the re-examination report findings before collectively making the below determinations.
Diagnosis and reasons
Mr Ali had no prior psychiatric disorder. He reported he grew up in Pakistan in a reasonably wealthy environment, and enjoyed sporting activities at school.
He reported after his brother passed away, the whole family moved to Australia the next year, and he went to school, but struggled academically, and does not participate in any activities outside school, or any sports.
Mr Ali has not had psychiatric treatment and has not expressed any desire to have treatment at any point. As he does not intend to have treatment, the Panel considered Mr Ali's conditions to be entrenched and permanent.
Mr Ali meets DSM-5TR criteria for a persistent depressive disorder. He struggled to describe his inner experience but said he doesn’t enjoy anything. He has poor motivation, insomnia, low self-esteem, difficulty making decisions (engaging in life) and appears directionless (perhaps hopeless about his future).
To diagnosis persistent depressive disorder, criterion A to H have to be met, with the exception of criterion D. He fulfils the DSM-5-TR criteria for a persistent depressive disorder:
(a) He has depressed mood for most of the day, for more days than not, for at least two years.
(b) He described being depressed and also having the following symptoms:
(i)insomnia;
(ii)low self-esteem, and
(iii)poor concentration.
(c) During the two-year period, he has never been without the depressive symptoms above for more than two months at a time.
(d) The Panel noted he has not fulfilled the DSM-5-TR criteria for a concurrent major depressive episode.
(e) There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
(f) His psychological symptoms are not better explained by Schizophrenia or a related psychotic disorder.
(g) His symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).
(h) His symptoms cause impairment in social, occupational, and other important areas of functioning.
While the injuries referred for assessment included only the word “depression”, the Panel formed the view that there was enough scope to explore how depression was diagnosed under the DSM-5TR, which, the Panel found to be a persistent depressive disorder. It was also noted that both Drs Rastogi and Jungfer diagnosed major depressive illness/disorder.
Mr Ali does not meet criteria for a major depressive disorder. He does not have five or more symptoms as required by the DSM-5TR.
The nature of the accident and Mr Ali's described response are not consistent with the post-traumatic stress disorder criterion A description. Criterion C is not fulfilled as Mr Ali did not develop persistent effortful avoidant behaviour related to the accident, and he enjoys car-racing games. Mr Ali does not have post-traumatic stress disorder.
Consistency of presentation
As described in the re-examination report, the claimant did give vague responses at times and appeared to be reticent about the interview. However, in the view of the Panel, this fell short of the inauthenticity and lack of credibility found by Medical Assessor Samuell.
The Panel also noted that Dr Newlyn’s finding of inconsistency of presentation drew heavily upon a comparison between other family members also interviewed. The Panel notes that only the clamant was interviewed as is appropriate in the Panel proceedings. Dr Newlyn also interviewed the claimant back in early 2021 with a further “file review” conducted in August 2023. The Panel prefers to rely on its own history and expertise on the day of the Panel assessment.
Noting the claimant’s age and lack of psychological mindedness, the Panel concluded that overall, there was sufficient consistency in the history to arrive at a diagnosis and evaluate impairment under the PIRS.
Causation and reasons
As mentioned, Mr Ali has no prior psychiatric disorder. He reported that he grew up in Pakistan in a reasonably wealthy environment and enjoyed sporting activities at school. He reported that after his brother passed away, the whole family moved to Australia the next year, and he has been the same since, and has anxiety and depressive symptoms.
There are no other stressors or contributing factors identified.
The Panel concluded there is more than a negligible contribution from the subject accident to Mr Ali's current psychological injury.
PERMANENT IMPAIRMENT
Psychiatric Impairment Rating Scale
| Psychiatric diagnoses | 1. Persistent Depressive Disorder | |
| Psychiatric treatment description | Nil | |
| PIRS Category | Class | Reason for Decision | |
| Self-care and personal hygiene | 3 | Mr Ali's self-care is poor; he only showers once a week and eats two meals a day, usually, but at different times of the day. His hair was long, and his beard was not well-kept, as observed during the assessment. | |
| Social and recreational activities | 2 | He plays video games and watches TikTok videos all day. He enjoys these activities on his own, without prompting or a support person and is actively engaged. He has no other activities as a family or within his social matrix, such as birthday parties, special events or religious celebrations. Before the accident, he had some social and recreational activities, and went to the park and ate out as a family. | |
| Travel | 2 | Mr Ali stated that he does not need to go out, and has never been out on his own in his entire life, and this has not changed since the accident. There is no psychiatric reason why he cannot go out on his own. The Panel accepted that he goes out less since the accident, as a result of motivation difficulties. | |
| Social functioning | 2 | Mr Ali has not dated. He had friends when he was at school, and only interacted with them during school. After leaving school, he has not had contact with them. His relationship with the neighbour next door, "aunty", is reasonable. His relationships with his siblings and parents, are distant, but there is no separation or domestic violence. | |
| Concentration, persistence and pace | 2 | Mr Ali reported having concentration difficulties. He studies at the college every Saturday for 1.5 hours and has been doing the diploma for 12 months, and there is no evidence he would not pass it. He said he does the assignments during class, and has assistance from the teacher and has not had extensions, but has repeated some assignments. He can focus on intellectually demanding tasks for 30 minutes. | |
| Adaptation | 3 | The Panel does not have any school reports from before the accident. Mr Ali was a student who moved to Australia with his family. He attended school full-time in Australia and completed year 12, but had reduced attendance and participation in class. He also did not participate in any extra-curricular or sporting activities in Australia. He reported that all extra-curricular activities ended once he came to Australia. He did not repeat a year and did not change schools. The school reports noted a reasonably consistent record with reduced attendance, but enough to graduate from high school. He has never worked. He has continued to be a student in the past 12 months. As he continues to be in his pre-accident age-appropriate life role as a student, less than 20 hours per week, the Panel rated 3. | |
| List classes in ascending order: 222 233 | |||
| Median Class Value: 2 | |||
| Aggregate Score: 14 | |||
| Whole Person Impairment: 7% | |||
*%WPI = Percentage Whole Person Impairment
Pre-existing/subsequent impairment
Mr Ali has no past psychiatric history. He has not sustained a subsequent injury. Apportionment is therefore not required.
Effects of treatment
There has been no treatment.
CONCLUSION – PERMANENT IMPAIRMENT
The degree of permanent impairment caused by the motor accident is 7% which is not greater than 10%.
The certificate issued by Medical Assessor Doron Samuell dated 1 November 2023 is therefore revoked. A new certificate is issued at the front of this determination.
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