Allianz Australia Insurance Limited v Abana
[2025] NSWPICMP 146
•6 March 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Allianz Australia Insurance Limited v Abana [2025] NSWPICMP 146 |
CLAIMANT: | Sam Adam Abana |
INSURER: | Allianz Australia Insurance Limited |
REVIEW PANEL | |
MEMBER: | Hugh Macken |
MEDICAL ASSESSOR: | John Baker |
MEDICAL ASSESSOR: | Gerald Chew |
DATE OF DECISION: | 6 March 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Review of medical assessment; degree of permanent impairment; major depressive disorder of mild severity; psychosocial history; migrated to Australia 2007; claimant never worked in paid employment in Australia; non-proficient in English; prior medical history cardiac angioplasty; lower inverted disc prolapse; not treated with any psychiatric medication prior to the motor accident; relevant conditions since the accident; current symptoms include depressed mood, insomnia, and diminished ability to concentrate; not prescribed anti-depressant medication; medical documentation examination contrary to Review Panel findings; continuing functioning; causation and reasons; Held – psychological symptoms could be caused by severity of the motor accident the claimant experienced; whole person impairment 7%; negligeable effect in somatic relief and functional improvement; Medical Assessment Certificate revoked. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Panel revokes the Certificate of Medical Assessor Abhishek Nagesh dated 2. The following injuries were caused by the motor vehicle accident and give rise to a whole person impairment of 7% which is not greater than 10%: · major depressive disorder – of mild severity. |
STATEMENT OF REASONS
INTRODUCTION
Sam Adam Abana (the claimant) is a 78-year-old man who was involved in a motor vehicle accident on 6 August 2018. Following the accident and, following the resolution that the claimant had suffered a non-threshold injury, the claimant sought a concession from the insurer that he had suffered injuries which gave rise to a permanent impairment of greater than 10%. The insurer declined to make this concession which was confirmed following a review.
Thereafter the claimant sought an assessment of the degree of permanent impairment in respect to both physical and psychological injuries.
In respect to physical injuries the claimant was assessed on 31 August 2023 by Medical Assessor Neil Berry who determined that the claimant had sustained physical injuries which gave rise to an impairment of 7%. On 4 July 2023 the claimant was assessed by Medical Assessor Abhishek Nagesh who, in a certificate dated 11 September 2023, determined that the claimant sustained a permanent impairment of 13%, consequent on a persistent depressive disorder. The insurer sought a review of this certification primarily on the basis that there was a failure on the part of the Medical Assessor to distinguish between the impact of the physical pain symptoms on the claimant’s capacity for social and recreational activities and the psychological impact.
The matter was considered by President’s delegate, Tajan Baba who, in a Certificate dated 30 October 2023 determined that there was a reasonable cause to suspect that the medical assessment was incorrect in a material respect.
The matter was then referred to this Review Panel.
Following the issuing of Directions for the provision of all material previously uploaded to the Portal the Panel met on 24 October 2024 at 4.00pm to consider the appropriate steps to be taken. It is the Panel’s view that there is a requirement to re-examine the claimant in respect to the psychological injuries identified as anxiety and depression.
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission).
Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application.
The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
STATUTORY PROVISIONS/GUIDELINES
Section 57 of the MAC Act defines a “medical dispute” as a disagreement or issue to which Part 3.4 of the MAC Act applies.
Sections 58 and 60 of the MAC Act together with cls 1.5-1.7 of the Guidelines set out the procedures for referral to one or more Medical Assessors and the principles to be applied at such assessments.
The claimant was re-examined alone with MS Teams. Medical Assessor Gerald Chew and Medical Assessor John Baker were present for the re-examination. An Arabic interpreter assigned by the Commission attended the assessment and translated from English to Arabic. The claimant had travelled to his solictor’s office alone as it was familiar to him and he was in the videoconference room for the re-examination alone.
Psychosocial history and pre-accident history
The claimant reported that he was a 78-year-old man who lived with his wife aged 81 years in the family home. The claimant and two sons to this union the eldest aged 49 years who worked as an accountant and was married with two children living in Australia. The second son was aged 47 years and was a teacher in Iraq. His second son had no children and was single.
The claimant said he was born in Missan, Iraq. He was the third sibling of 10 children to the union between his parents. Both his parents have passed. His eldest sister was aged 82 years and recently visited Australia. The claimant said four of his six sisters are alive and two had died. He said he had a further three siblings in Australia. He had one brother in Sydney. He said part of his family moved to live in Holland and part in Australia. He had telephone contact with his extended family, and they would rarely visit. The claimant said that his father worked as a jeweller. When the claimant’s father died the claimant reported that his brother did not perform the necessary family duties and traditions regaining the burial. The claimant had not spoken to his brother since as he did not assist with the costs and ritual for his father’s burial. This loss of contact occurred about four years ago, before this re-examination on report of the claimant.
The claimant reported he completed his high school education in Iraq prior to completing a diploma in accounting at the Baghdad University. The claimant said at about 20 years of age he completed his compulsory national military service. He said he was deployed into the distribution and management of food supplies to the soldiers on the front line the claimant was not in a combat position, and he was never at risk of trauma from war.
The claimant then found employment in the National Bank of Iraq. He worked in this role for many years, raising his sons to adulthood. The claimant reported that his eldest son joined him to work in the same bank prior to the family leaving Iraq. He worked 30 years as a Bank Manager for the Rafandan Bank in Iraq. He then worked a further 13 years at various banks before leaving Iraq. His younger son was a school teacher in Iraq.
The claimant reported that he was a member of the John the Baptist Church. He said that in discussion with his wife and extended family they decided to leave Iraq and seek refugee status with the UNHCR in Jordan. The family lived in rental accommodation in Jordan whilst the visas were organised. After 18 months the claimant and his family immigrated to Australia in 2007.
Since arriving in Australia the claimant had never worked in paid employment. He said he enjoyed keeping himself busy and so he organised to become a Justice of the Peace. He said he still held a current Justice of the Peace certification however he does not act in this volunteer role since the motor accident in August 2028. The claimant said he was asked by a local church leader where he attended to assist in the nursing home caring for aged and disabled people. He said he had assisted with this role and would usually attend two days per week before the motor accident. The claimant said that he had attempted to learn English however due to him only been exposed to an English-speaking culture for a short time compared to this Arabic language banking role, he found he preferred Arabic. The claimant reported he was not proficient in English before or after the motor accident.
The claimant confirmed the following medical history, cardiac angioplasty prior to carotid stenting in 2009. Hypertension treated with antihypertensives, Micardis 40mg daily and Tenormin 50mg twice daily. He had a surgical repair of a left hydrocele. The claimant reported that he had a lower intervertebral disc prolapse due to him lifting. He had a CT scan of his lumbar spine on 23 September 2014 which showed “spinal canal narrowing” at L4/L5.
The claimant reported that he was not treated with any psychiatric medication prior to the motor accident. He reported that he had not suffered from any trauma, abuse or neglect as a child. He said he had not been in combat during his compulsory military national service. The claimant reported that there was no family history of psychiatric illness.
The claimant reported he rarely drank alcohol and no more than a small (330ml) bottle of beer if his son visited. He said that he did not smoke tobacco and was not allergic to any medication. The claimant reported that he did not gamble or belong to a club that had poker machines.
History of the motor accident
He was asked why he was delayed in completing the application regarding the motor accident. He replied that he was uncertain how to proceed, as English was not his first language, and he had declined further action to be taken against the driver by the NSW Police.
The claimant said he had attended his church and participated in a funeral. He was walking home after the service. He was walking in the carpark of the Macquarie Centre Fruit shop he said he was hit by a car’s rear vision mirror. The claimant was hit on the right shoulder. He said he was right hand dominant. The claimant sustained physical injuries to his right shoulder, right elbow, right wrist, his low back and right hip because of the motor accident.
Immediately after he was hit and fell to the ground the claimant started yelling at the driver of the vehicle. The claimant said that he was unable to get the driver’s licence of the man who was driving the car. He said he did write down the number plate of the vehicle. The claimant said he was angry and had raised his voice demanding the man provided his information. The driver left. The claimant said the fruit shop owner did not assist either.
The claimant unsure what to do decided he was steady on his feet and so he walked home.
History of symptoms and treatment following the motor accident
The claimant reported that he began to suffer pain in his right shoulder, neck, back and right hip. He said he was unable to sleep the night of the motor accident. The next day he attended his local general practitioner. The claimant’s general practitioner told the claimant first he had to report the motor accident to the police. The claimant went to the police station and provided his statement about the events in this motor accident.
The claimant said that he suffered from an injury to his right shoulder. He said he had lost the ability to raise his right dominant arm above 45 degrees in relation to his torso. He reported pain in his right shoulder. He said he was assessed and the decision from his investigation as that surgical repair of the injury would not help. He did not have any surgical treatment. The claimant reported he had pain in his shoulder. He was also found to have a haematoma of his left wrist and a full thickness tear of his right supraspinatus tendon on 9 August 2018. He said the nuclear medicine bone scan showed an acute fracture of his right trapezoid bone on 28 October 2018.
The claimant said that he also had trouble with pain in his wrists which resulted in him having neurological investigation of both median nerves in August 2023. The result demonstrated dysfunction of both median nerves which was consistent with the claimant complaint of pins and needles and pain in his hands.
The claimant reported that on request of the senior church member who had first asked him to work at the nursing home the claimant attempted to return to complete volunteer work. He reported that due to pain in his back he was unable to perform the essential lifting that would be asked for by the staff. He stopped working as a volunteer at the nursing home. The claimant reported he would use traditional herbal medication for his physical injuries. He said the traditional medication was help for his physical condition.
The claimant reported that his psychiatric and psychological symptoms commenced within a few days after the motor accident. He reported that he had difficulty sleeping. He said he developed depressive ruminations about his health. He said he had become irritable and had lost interests in socialising with his friends. He reported that he would enjoy walking with a close friend from his church. His friend would park close to the claimant’s home before the accident, and they would walk to and from church together. After the motor accident the claimant stopped attended the church as frequently as he was too low in his energy and was too irritable towards others. His friendship ceased.
The claimant reported that his relationship with his wife was strained as he would do less around the home. The claimant withdrew from sharing time with his wife. His sleep became poor as he was fearful of not recovering from this psychological injury. The claimant reported that his interest in following his younger son’s career and daily life also reduced. Suffered depressive illness. The claimant said his eldest son would bring his grandchildren to the family home after church every second Sunday. The claimant reported that at the time of the re-examination he was attending church no more than once every two months, for the main parts of the liturgical year. The claimant reported that whilst the presence of children in the home raised his mood, his mood quickly became depressed again on their departure. He reported that his concentration would become rapidly fatigued since the motor accident, he was less able to interact and engage with his children. He described his concentration as becoming poor and that his grandchildren only spoke English, so he was reliant on their mother to tell him in Arabic what the grandchildren were talking about and what their English sentences meant.
The claimant reported that he felt hopeless and worthless as he could not even understand his grandchildren. The claimant reported that he would wake most nights from sleep and worry and ruminate about his capacity to recover from his injuries sustained in the motor accident. He said he would not return to sleep and have low energy most mornings.
The claimant reported that he had attended his general practitioner and was referred to a psychologist for about four months of cognitive behavioural therapy. He was not referred to a psychiatrist. He was not referred to psychiatric hospital for treatment. He said after about four months he felt the psychologist had little more to assist him with and so the sessions were concluded.
The claimant had not been admitted to a psychiatric hospital and on direct questioning at the re-examination regarding the use of other treatments for depression that were not pharmacotherapy, or inpatient and psychological treatment, the claimant said he would choose not to use these evidence-based alternative treatment such as rTMS.
The claimant had returned to Iraq on two occasions to visit his extended family. He said he had always travelled with the support of his sister, and cousin and never travelled alone even if the destination was well known to him.
Details of any relevant injuries or conditions sustained since the motor accident
The claimant was asked by direct enquiry whether he had experienced any prior motor accident. He confirmed that he had not had any other motor accidents. He was asked specifically about any subsequent motor accident. The claimant confirmed that the accident was the only accident in which he was involved.
The claimant was by direct enquiry asked to speak about his life, development and involvement in the Iraq military. The claimant confirmed that he did not have a combat role as part of his national military service and was not physically or psychologically injured during his service.
Current symptoms
The claimant reported that he developed the following major depressive disorder symptoms because of motor accident:
· depressed mood most of the day, nearly every day, as evidenced by the claimant’s feelings of hopelessness and worthlessness;
· markedly diminished interest in volunteer work with loss of interest in his self-care and personal hygiene;
· insomnia nearly every night with initial and middle insomnia where he would wake from sleep ruminating about depressive themes and not been able to return to sleep;
· diminished ability to concentrate with difficulty listening and attempting to speak English with his grandchildren who only knew English with loss of interest in teaching his grandchildren Arabic;
· fatigue with loss of energy nearly every day with loss of motivation to leave his home, and
· loss of appetite with the claimant missing meals and losing interest in sharing meals with his wife.
Current and proposed treatment
The claimant was treated by his general practitioner and was not prescribed any antidepressant medication. He said he had ceased attending his clinical psychologist and that psychological treatment had stopped before this re-examination. The claimant reported he had no future treatment plans to manage his psychological injury due to this motor accident.
The claimant reported that he did continue to use tradition and herbal medication for his physical injuries.
The claimant continued to attend his general practitioner about once every two to three months for follow up. At the time of this re-examination the claimant had no other treatment or support.
Medical documentation
The report of Dr Vickery dated 13 December 2021, following an examination of the claimant on 24 November 2021 diagnosed an adjustment disorder and a phobic reaction to crossing the road on his own. He stated:
“There was no apparent melancholic depression, paranoid delusional ideation or formal thought disorder.”
Whilst these more severe psychological disorders were excluded the report did not provide reasons why some other type of less severe disorder could not be affecting the claimant.
The notes of the claimant’s treating general practitioner identify an adjustment disorder (stress/anxiety/depressed). This was identified on 31 August 2018 with the same observations noted on 24 October 2018. The Panel noted this material although the Panel’s examination of the claimant gave rise to a different diagnosis.
Mental state examination
The claimant presented as an irritable depressed and tearful man. His speech varied in rate from slow to faster when he had outbursts of agitation and frustration. His effect was reactive with him having mood congruent tearfulness when he spoke about his depressive ruminations, such as “I’m hopeless and worthless.” The claimant reported a depressed mood and was psychomotor agitated. He was orientated in time, place and reason. The claimant’s concentration, persistence and pace were reduced. His concentration was frequently disrupted by intrusive distressing depressive thought about loss of self-worth, and loss of hope for his future. He was no longer interested in assisting people with the voluntary Justice of the Peace service he had performed prior to the onset of this primary psychological injury.
The claimant reported that he had psychological reasons for not attending the nursing home since the motor accident. He reported he experienced overwhelming depressive emotions when he saw a resident in need and was soiled. He said he found attending the nursing home to cause him to be emotionally depressed and he had stopped in part because of the deterioration in his depressed mood.
The claimant did not report auditory hallucinations or depressive nihilistic delusions. He would frequently wander off topic and return to ruminating about his losses, hopelessness and loss of self-worth within the context of not working as a volunteer or contributing to his community.
The claimant’s judgment was fair. He reported that he did not have suicidal thoughts. He was insightful into his condition.
Current functioning
Self-care and personal hygiene
The claimant lived with his wife in rental accommodation. He spends most of his day at home. His wife would prepare the meals. He would skip meals on occasions as his appetite was poor. He could live independently as he would be able to sustain his personal hygiene and self-care without needing to be prompted or supported. He was unkempt and he reported if his energy was too low, he would miss showering. If he expected he would enter the community he would shower and wear clean clothes. The claimant had a mild impairment, Class 2 for this table of functioning.
The claimant reported that his physical injury and inability to raise his right dominant hand over 45% above the shoulder did restrict his capacity to provide more physical assistance to his wife in maintenance of the home. The claimant reported that he was physically restricted in lifting due to his back injury and shoulder injury. This also restricted his capacity lifting heavy items within the home. These physical restrictions and restrictions due to pain were not included in the psychiatric impairment rating scale (PIRS) in compliance with current guidelines.
Social and recreational activities
The claimant reported that he had reduced his walking with his friend to and from church and other events. The claimant reported that he had less interest in walking with his friend and wife than he had before the onset of this psychological injury. He reported that he would be visited by his eldest son every second Sunday. He reported that he was less interested in his grandchildren as he could not speak sufficient English to fully engage in play with them. He said he was able to follow the descriptions of what the children were telling him using his daughter-in-law’s interpretation of the children’s language and behaviour. He said he did not attend social or recreational events outside the family home. He was not interested in any televised programs. He spent little time with his wife sharing time together. He had a vacation on two occasions to Iraq and visited extended family whilst visiting.
Travel
The claimant reported he had no car. He said he has stopped driving after the motor accident. The claimant reported that he was able to travel in his local and familiar areas alone. He could travel to his medical appointments alone. He had travelled back to Iraq since the motor accident twice with the support of his extended family on each trip. The claimant was assessed as Class 2 mild impairment for travel.
Social functioning
The claimant reported that his relationship with his wife was strained. He was not expecting separation, divorce or estrangement. There was no domestic violence within this primary relationship. The claimant reported that he remained in contact with his eldest son and his family. He reported that the relationship with his eldest son, daughter in law and grandchildren was not as enjoyable as it had been prior to the psychological injury. The claimant reported his relationship with his younger son was characterised by less frequent contact prior to the motor accident and that this pattern remained about the same after the motor accident.
The claimant reported that his friendship at his church with the church leader who organised volunteers for the nursing home was under strain as he would not be able to comply with her requests. He would become distressed when thinking about the prospect of her approaching him and then him saying, “no”, to her suggestions. The claimant was assessed as having a Class 2, mild impairment in relation to this table of functioning.
The claimant reported that he had lost contact with his brother around the time of his father’s death. He said that he had an argument about the expected cultural and family’s need for assistance in burying his father according to family tradition. He said his brother failed to support the family and this resulted in no communication between them the claimant reported that his loss of relationship was not due to the motor accident. For this reason this loss of relationship was not included in the PIRS in compliance with current guideline.
Concentration, persistence and pace
The claimant reported that he was pre-occupied with depressive themes or hopelessness and worthlessness. He stated his concentration was disrupted by intrusive thoughts and depressive rumination about his loses since the onset of this psychological injury. He said he was slower when reading Arabic text. He said he had lost interest in watching television. He could manage his own finances and complex tasks, such as reading. He was less able to read, listen and understand English than he had been prior to the motor accident. His interest in concentrating such that he could keep pace with English speakers had decreased due to his loss of interest and making frequent errors when attempting to comprehend English. He would usually progress slowly with any complex task due to his reduced concentration, persistence and pace. The claimant was assessed as having a Class 2 mild impairment for this table of functioning.
Adaptation
The claimant reported that he was too low in his energy to work in his prior role of Justice of the Peace. The claimant reported that he still held his registration as a Justice of the Peace. He no longer was interested in assisting people with this voluntary service.
The claimant reported that he had psychological reasons for not attending the nursing home since the motor accident. He reported he experienced overwhelming depressive emotions when he saw a resident in need and was soiled. He said he found attending the nursing home to be emotionally depressed and he had stopped in part because of the deterioration in his depressed mood. The claimant was assessed as having an erratic capacity in his adaption. He would be able to assist for no more than one to two days per fortnight in a lesser role using skills that were less stressful for less than 20 hours per fortnight. The claimant was assessed as having a Class 4 severe adaptation impairment.
The claimant reported that his physical capacity to physically assist residents at the nursing home had also decreased since the motor accident. He reported that he was unable to use his right dominant hand to feed the residents due to pain and reduced physical movement of his right arm at the shoulder. The claimant also reported he was physically unable to lift residents as he had before the motor accident due to his back in jury and right shoulder injury. He decided in part not to continue working for these physical reasons at the nursing home. The reduction in adaptation due to physical injury and pain from all causes was not included in the claimant’s capacity for adaptation.
Comments of consistency
The claimant’s presentation was similar to prior reports and documented examinations prior to this re-examination. The claimant provided updated information regarding his travel. The claimant’s presentation was consistent with his diagnosis psychological injury DSM-5-TR criteria the claimant’s DSM-5-TR F32.0 Major depressive disorder – of mild severity.
Diagnosis and reasons
Using DSM-5-TR criteria the claimant’s DSM-5-TR F32.0 Major depressive disorder – of mild severity.
Criterion A.
The following six symptoms have been present during the same two-week period and represent a change from previous functioning with the claimant experiencing a depressed mood as well as the following:
· Depressed mood most of the day, nearly every day, as evidenced by the claimant’s feelings of hopelessness and worthlessness. The claimant continued to report suffering from this symptom.
· Markedly diminished interest with inability to experience happiness in almost all activities for most of the day, nearly every day as evidenced by the loss of interests in social activities with his grandchildren. Loss of interest in volunteer roles with reduced interest in his self-care and personal hygiene. The claimant continued to report suffering from this symptom.
· Insomnia nearly every night with initial and middle insomnia where he would wake from sleep ruminating about depressive themes and nightmares about the motor accident with him not been able to return to sleep. The claimant continued to report suffering from this symptom.
· Diminished ability to concentrate with reduced persistence and pace, experienced by the claimant as depressive ruminations about his losses since the onset of his psychological injury. The claimant continued to report suffering from this symptom.
· Fatigue with loss of energy nearly every day. The claimant continued to report
suffering from this symptom.
· Loss of appetite.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
This criterion is met by the claimant not been able to return to reliably work in his chosen roles as volunteer Justice of the Peace or Assistant at the Nursing Home which he could do prior to the motor accident.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.
The claimant does not have any history relating to substance misuse or other medical conditions that affect his depressed mood.
D. This criterion is met as the onset of the initial symptoms of his primary psychological injury included depressed mood and other symptoms resulted in slow deterioration his mental state, that was not related to any physiological effects of a substance or to another medical condition.
E. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
This criterion is met as the claimant does not have a history of any of these conditions.
F. There has never been a manic episode or a hypomanic episode.
This criterion is met as the claimant does not have a history of any of these conditions.
The claimant’s psychological symptoms were more severe and more numerous than required for a diagnosis of adjustment disorder. Major depressive disorder is the second most common trauma related condition. The claimant’s major depressive disorder has not fully resolved since the motor accident to the date of the re-examination.
The contribution of pain to the claimant’s physical impairments were mild as these impairments were capable of been managed by conservative management and care. The physical impairments and pain from all causes were not included in the making of the psychological injury in compliance with DSM-5-TR F32.0 major depressive disorder – of mild severity. The Panel noted that the severity of the claimant’s major depressive disorder may have fluctuated from the time of onset to the date of this re-examination. Whilst prior to this re-examination the claimant may have had less severe psychological symptoms at the time of prior examinations as documented in the forwarded evidence with this referral, he was never in full remission or without major depressive disorder symptoms at any time from the date of the motor accident to the date of this re-examination.
For the above reasons the claimant meets all the criteria required to diagnose DSM-5-TR F32.0 major depressive disorder – of mild severity.
Causation and reasons
The claimant was independent in his lifestyle and capacity to perform his volunteer work in his chosen roles for a long term prior to the onset of this motor accident. The claimant was fit for his volunteer roles and had worked successfully in these roles without requiring further assistance, or encouragement. Prior to the onset of this motor accident, the claimant did not have any prior psychological injury or condition. He was interested and motivated to contribute to his community in a structured, reliable and well organised manner.
The claimant had grieved normally of his father’s death. He was not impaired by his normal grief. Disagreements around the passing of parents is frequently seen in psychiatric clinical care. Whilst the claimant did have loss of his relationship with his brother due to the lack of support provided by his brother to the claimant’s extended family. The claimant was able to separate and explain that this loss was not contributed in any manner because of the motor accident. The claimant was able to describe that the psychological injury because of the motor accident was different to the disagreement he had regarding his brother’s behaviour at the time of death of the claimant’s father. For this reason the normal grief experienced by the claimant does not contribute to the psychological injury. The intercurrent normal grief had fully resolved prior to this re-examination. In these clinical circumstances the contribution of normal grief would be zero in defining the diagnosis of DSM-5-TR F32.0 major depressive disorder – of mild severity in compliance with these diagnostic criteria.
The claimant was carefully re-examined regarding his experience and exposure to war whilst living in Iraq. The claimant did not suffer from any trauma in relation to his development and adult life prior to coming to Australia. He did not suffer from post-traumatic stress disorder for any reason prior to this re-examination.
The claimant’s defined psychological injury was definable by DSM-5-TR as DSM-5-TR F32.0 major depressive disorder – of mild severity. The psychological symptoms documented and reported by the claimant could be caused by the severity of the motor accident that the claimant experienced. This diagnosis provides the best diagnosis to define all of the claimant’s symptoms. The anxiety related symptoms described by other authors is best understood as psychomotor agitation which is clinically common in people who suffer from major depressive disorder
In the opinion of the Medical Assessors on behalf of the Panel the subject motor accident on 6 August 2018 did cause the psychological injury defined as DSM-5-TR as DSM-5-TR F32.0 major depressive disorder – of mild severity.
CONCLUSION – WHOLE PERSON IMPAIRMENT
The following injuries give rise to whole person impairment of 7%:
· DSM-5-TR as DSM-5-TR F32.0 major depressive disorder – of mild severity.
Psychiatric Impairment Rating Scale
Current PIRS
| Category | Class | Reason for Decision |
| Self Care and Personal Hygiene | 2 | The claimant lived with his wife in rental accommodation. His spends most his day at home. His wife would prepare the meals. He would skip meals on occasions as his appetite was poor. He could live independently as he would be able to sustain his personal hygiene and self-care without needing to be prompted or supported. He was unkempt and he reported if his energy was too low, he would miss showering. If he expected he would enter the community he would shower and wear clean clothes. The claimant had a mild impairment, Class 2 for this table of functioning. |
| Social and Recreational Activities | 2 | The claimant reported that he had reduced his walking with his friend to and from church and other events. The claimant reported that he had less interest in walking with his friend and wife than he had before the onset of this psychological injury. He reported that he would be visited by his eldest son every second Sunday. He reported that he was less interested in his grandchildren as he could not speak sufficient English to fully engage in play with them. He said he was able to follow the descriptions of what the children were telling him using his daughter-in-law’s interpretation of the children’s language and behaviour. He said he did not attend social or recreational events outside the family home. He was not interested in any televised programs. He spent little time with his wife sharing time together. He had a vacation on two occasions to Iraq and visited extended family whilst visiting. |
| Travel | 2 | The claimant reported he had no car. He said he has stopped driving after the motor accident. The claimant reported that he was able to travel in his local and familiar areas alone. He cold trave to his medical appointments alone. He had travelled back to Iraq since the motor accident twice with the support of his extended family on each trip. The claimant was assessed as Class 2 mild impairment for travel. |
| Social Functioning | 2 | The claimant reported that his relationship with his wife was strained. He was not expecting separation, divorce or estrangement. There was no domestic violence within this primary relationship. The claimant reported that he remained in contact with his eldest son and his family. He reported that the relationship with his eldest son, daughter in law and grandchildren was not as enjoyable as it had been prior to the psychological injury. The claimant reported his relationship with his younger son was characterised by less frequent contact prior to the motor accident and that this pattern remained about the same after the motor accident. The claimant reported that his friendship at his church with the church leader who organised volunteers for the nursing home was under strain as he would not be able to comply with her requests. He would become distressed when thinking about the prospect of her approaching him and then him saying, “no”, to her suggestions. The claimant was assessed as having a Class 2, mild impairment in relation to this table of functioning. |
| Concentration, Persistence and Pace | 2 | The claimant reported that he was pre-occupied with depressive themes or hopelessness and worthlessness. He stated he had his concentration was disrupted by intrusive thoughts and depressive rumination about his loses since the onset of this psychological injury. He said he was slower when reading Arabic text. He said he had lost interest in watching television. He could manage his own finances and complex tasks, such as reading. He was less able to read, listen and understand English than he had been prior to the motor accident. his interest in concentrating such that he could keep pace with English speakers had decreased due to his loss of interest and making frequent errors when attempting to comprehend English. He would usually progress slowly with any complex task due to his reduced concentration, persistence and pace. The claimant was assessed as having a Class 2 mild impairment for this table of functioning. |
| Adaptation | 4 | The claimant reported that he was too low in his energy to work in his prior role of Justice of the Peace. The claimant reported that he still held his registration as a Justice of the Peace. He no longer was interested in assisting people with this voluntary service. The claimant reported that he had psychological reasons for not attending the nursing home since the motor accident. he reported he experienced overwhelming depressive emotions is he saw a resident in need and was soiled. He said he found attending the nursing home to emotionally depressed and he had stopped in part because of the deterioration in his depressed mood. The claimant was assessed as having an erratic capacity in his adaption. He would be able to assist for no more than 1 to 2 days per fortnight in a lesser role using skills that were less stressful for less than 20 hours per fortnight. The claimant was assessed as having a Class 4 severe adaptation impairment. |
| List classes in ascending order: 2, 2, 2, 2, 2, 4 | ||
| Median Class Value: 2 | ||
| Aggregate Score: 14 | ||
| % Whole Person Impairment: 7% | ||
*%WPI = Percentage Whole Person Impairment
Psychiatric Impairment Rating Scale
Pre-existing impairment
· The claimant has not sustained a subsequent injury.
· The claimant does not have a past psychiatric history.
Apportionment
· Pre-existing impairment = 0%
Effects of Treatment
· In the opinion of the Medical Assessors’ the claimant’s treatment has had negligible effect in symptomatic relief and in functional improvement. Should the claimant be prescribed evidence based psychiatric medication or psychological treatment in the future the Medical Assessors are of the opinion that the psychological injury would be unlikely to improve. The Medical Assessors for these reasons have assessed treatment effect as 0%WPI.
Conclusion
Degree of permanent impairment caused by the motor accident is 7% whole person impairment.
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