Allianz Australia Insurance Limited v Angus
[2025] NSWPICMP 808
•20 October 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Allianz Australia Insurance Limited v Angus [2025] NSWPICMP 808 |
CLAIMANT: | Michael Angus |
INSURER: | Allianz Australia Insurance Limited |
REVIEW PANEL | |
MEMBER: | Elizabeth Medland |
MEDICAL ASSESSOR: | Gerald Chew |
MEDICAL ASSESSOR: | Steven Yeates |
DATE OF DECISION: | 20 October 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of medical assessment by Review Panel; whether psychological injury caused by the motor accident gives rise to a whole person impairment (WPI) that is greater than 10%; claimant suffered psychological injury from previous motor accident; Held – Review Panel found the claimant suffered an adjustment disorder prior to the motor accident; subject motor accident caused post-traumatic stress disorder WPI assessed at 4% (8% current, 4% pre-existing WPI); certificate revoked; new certificate issued. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION ASSESSMENT OF WHOLE PERSON IMPAIRMENT Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 The Review Panel: 1. revokes the certificate of Medical Assessor Michael Hong dated 23 February 2024, and 2. certifies that the following injuries caused by the motor accident give rise to a permanent impairment of 4% and is not greater than 10%: · post-traumatic stress disorder; and · adjustment disorder. |
STATEMENT OF REASONS
INTRODUCTION
Mr Michael Angus (the claimant) alleges injury from a motor accident occurring on
2 August 2019.He subsequently lodged a claim under the Motor Accident Injuries Act 2017 (MAI Act) upon Allianz Australia Insurance Limited (the insurer), the compulsory third party insurer of the vehicle considered at fault.
The insurer is liable for payments of statutory benefits and/or damages under the MAI Act.
A dispute has arisen between the parties as to whether a psychological injury caused by the accident gives rise to a whole person impairment (WPI) greater than 10%.
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 gives rise to a WPI of greater than 10% is a medical dispute, as defined by s 7.17 of the MAI Act, and is a medical assessment matter: schedule 2, cl 2(a) & (e) of the MAI Act.
The threshold injury dispute was originally determined by Medical Assessor Hong who issued a certificate dated 23 February 2024, which certified the claimant as suffering a post-traumatic stress disorder and an adjustment disorder, giving rise to a WPI of 11%.
THE REVIEW
The insurer sought a review of the medical assessment of Medical Assessor Hong in accordance with s 7.26 of the MAI Act. On 27 May 2024 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 Personal Injury Commission (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 video conference on 19 March 2025 and determined that a
re-examination of the claimant was required. A medical examination was arranged to take place on 30 June 2025 with Medical Assessor Chew and Medical Assessor Yeates via Microsoft Teams.The Panel reconvened via videolink for a teleconference on 21 July 2025.
MEDICAL ASSESSMENT THE SUBJECT OF REVIEW
In an overall assessment of WPI, Medical Assessor Chew assessed a 15% WPI. A pre-existing WPI was assessed at 5%, leaving an 11% WPI caused by the motor accident.
The Medical Assessor confirmed his findings that the claimant developed symptoms consistent with an adjustment disorder after an earlier motor accident and at the time of the subject accident had some psychiatric impairment. The Medical Assessor found that after the subject accident the claimant developed symptoms consistent with post-traumatic stress disorder.
SUBMISSIONS
Insurer’s review submissions dated 21 March 2024
The insurer takes issue with the assessment of various categories of impairment. For example the insurer submits that the claimant’s loss of ability to participate in activities such as camping and other pursuits resulted from the first accident rather than the subject accident and therefore no increase in the social and recreational activities from the pre-existing impairment to the impairment related to the subject accident.
In respect of adaptation, the insurer submits that the claimant had not worked in any capacity since 2017 and therefore it is “inconceivable” that the claimant’s impairment in adaptation could now be greater than it was prior to the subject accident.
The insurer notes in respect of concentration, persistence and pace that the Medical Assessor found there to be no impairment prior to the accident. The insurer submits that the records of Bloomfield Hospital suggest that the claimant was a slow developer and academically slow and the Medical Assessor fails to address these underlying issues in the context of impairment assessment for this category.
In respect of social functioning, the insurer submits that an increase in assessment from category 2 for pre-existing to category 3 in respect of the subject motor accident does not take into consideration significant unrelated issues experienced by the claimant, including in respect of his relationship with his step-son.
In respect of self-care and personal hygiene, the insurer submits that evidence suggests that prior to the subject accident the claimant had been experiencing deficits in this area.
The insurer also submits that the Medical Assessor ought not have made an adjustment for the effects of treatment, noting that he was the only medical examiner that has done so. The insurer submits that the Medical Assessor failed to identify whether all of the criteria contained in cl 6.222 of the Motor Accident Guidelines had been met.
Claimant’s review submissions in reply dated 15 April 2024
The submissions note that in respect of social and recreational activities the history recorded demonstrates that whilst some activities were decreased after the first accident, the claimant did still continue to go on trips with enjoyment thereafter, and before the subject accident.
In respect of adaptability, it is submitted that it is evidence that prior to the subject accident he had a reduced capacity on account of the physical injuries and following the subject accident, the current incapacity is largely a result of the psychological impairment.
The claimant submits that “the mere fact that the claimant was not working prior to the subject accident is no indicative of the claimant’s actual level of impairment. The critical question is what his capacity for work was, both before and after the subject accident.”
Dealing with the insurer’s submissions in respect of concentration, persistence and pace, the claimant submits that the insurer is overstating the level of capacity required for the claimant to supervise his young daughter. The claimant submits that it would be erroneous to assume that because the claimant engages in it, he does so without impairment (Rutland v Allianz Australia Ltd [2014] NSWSC 1583 (per Garling J at [85]-[89]).
In respect of social functioning, the submissions note that the issue with the claimant’s step-son has now resolved and things had settled.
Lastly, in respect of self-care and personal hygiene the submissions note that Dr George had found the claimant had difficulties on account of his mobility rather than psychological impairment
DOCUMENTATION
The Panel has considered all documentation provided by the parties in their respective bundles lodged in compliance with Panel directions. This includes the insurer’s bundle lodged on consisting of 548 pages – “2025.02.28 Insurer’s bundle for review panel” and the claimant’s bundle consisting of 145 pages – “Angus – PIC Index & Bundle of Documents for Review Panel”.
The Panel has not referred to every document within these reasons, however, some documents have been summarised/referenced that are directly relevant to the findings of the Panel. It should be noted that the Panel’s certificate and reasons are provided in the context of all documentation having been considered.
The Panel has not considered documents that form part of the insurer’s application to admit late documents that included a report of Vocational Capacity Centre dated 28 March 2025. In a message sent to the parties via the Commission portal dated 30 June 2025, Member Medland advised that the Panel did not accept the application. Accordingly, the documents contained within the insurer’s application to admit late documents have not been considered by the Panel in making their determination.
Treating medical evidence
The claimant had previously suffered psychological issues and was admitted to Bloomfield Hospital in 1999. He was diagnosed with an adjustment disorder. He was noted to feel emotionally labile and fearful with aggressive thoughts. The Panel notes the claimant was the victim of a home invasion with a teenager and he developed some symptoms and saw a psychologist for a period afterwards.
Helen Rutland is the treating psychologist the claimant was referred to by general practitioner (GP), Dr Alkemade. Treatment occurred intermittently until 12 October 2021. In a report addressed to the claimant’s legal representatives, Ms Rutland describes the claimant emotionally deteriorating after the subject motor accident. She diagnosed post-traumatic stress disorder.
In a report to the GP dated 15 November 2019 the claimant is described as suffering symptoms consistent with significant avoidance behaviours, driving in particular. A sleep disorder is noted partly due to pain and partly due to ruminating thoughts.
In a report to an insurer dated 10 January 2020, Ms Rutland states that the claimant “may well have had symptoms” referrable to the first motor accident, however, the clinical results suggest the post-traumatic stress disorder was triggered by the subject accident. A good relationship with his partner is noted.
The GP records of Heritage Medical are noted. An initial consultation of 23 December 2021 notes a history of both motor accidents. In a report of the GP, Dr Alkemade dated
22 August 2022 to the claimant’s legal representatives, a summary of injuries from the first accident not soft tissue injuries progressing toe cervical radiculopathy. The subject accident is said to have resulted in an exacerbation of neck and upper arm symptoms with symptoms returning to baseline over four to six weeks and the doctor considered him to be then able to return to light duties. It is then stated: “in regards to MVA2 he continues to see a psychologist, and he is attending defensive driving courses to improve the symptoms of his post traumatic stress…”
Statements
The Panel has had regard to the various statements provided by the claimant in the bundle. The claimant notes that he has not worked since the first motor accident, however, just before the second accident in 2019, he was certified for restricted duties with the intention to start work again.
A statement of 24 October 2023 addresses the psychiatric impairment rating scale categories for assessment of impairment. He states that the psychological symptoms began after the first accident, yet increased significantly after the subject motor accident.
Medico-legal evidence
A report of Dr Allan is included in the insurer’s bundle, with the report addressed to the claimant’s legal representatives. After examination the doctor states:
“He describes prominent post-traumatic stress disorder symptoms developing after the initial accident with some worsening of those symptoms after the second accident. From his history, his level of impairment was significantly impacted prior to the second accident and whilst the second accident exacerbated his symptoms, I do not regard it as having exacerbated his overall level of function.”
Dr Allan attributes 70% of the claimant’s difficulties to the first accident and 30% to the subject accident.
The claimant relies on reports of psychiatrist, Dr Parsonage. In a report dated
1 November 2022, the doctor takes a history of both motor accidents. The doctor took a history of the claimant’s anxiety involving motor vehicles increased after the motor accident.
Following examination, the doctor acknowledges the complex history, however, states there was no evidence that indicates the claimant had an active ongoing psychiatrist disorder in the year prior to the first motor accident in 2018. The doctor opines that some post-traumatic stress symptoms developed but not such as to reach the diagnostic criteria and diagnosed an adjustment disorder. Dr Parsonage opines that after the subject motor accident the symptoms satisfied the criteria for post-traumatic stress disorder.
In respect of WPI the doctor assessed a 4% impairment in respect of the first motor accident, and an 11% impairment in respect of the subject accident (with an overall impairment of 15%).
In a further report dated 5 October 2023, the doctor assessed an overall impairment of 17% WPI, with 13% attributable to the subject motor accident.
The insurer relies on a report of Dr George dated 14 July 2022. Following examination, the doctor concluded the claimant is suffering from a persistent depressive disorder with elements of post-traumatic stress disorder following the first accident in particular. Also diagnosed is an adjustment disorder as part of the depressive disorder that relates to pain and limitation mainly following the first motor accident.
In an WPI assessment an overall assessment of 7% is made, with 6% referrable to the first motor accident.
In a report to McCabe Curwood lawyers dated 21 February 2023, Dr Bisht, following examination considered the claimant as fit for work for 20 hours a week. This conclusion was reached due to current level of functioning and his ability to look after his young children without assistance.
RE-EXAMINATION
The below is the clinical examination findings of the Medical Assessors following examination of the claimant via Microsoft Teams on 30 June 2025.
Psychosocial history and pre-accident history
The claimant is a 45 year old man who lives with his two children, a four-year-old daughter and seven-year-old son. His ex-partner who is of Filipino descent remains in the property and they continue to share household and parenting tasks. He said that they separated approximately one year ago. His seven-year-old son attends school and his four-year-old daughter attends preschool three days a week.
Mr Angus was previously in a relationship from 2007 to 2013 and there are two children from this union, a 16-year-old daughter and a 17-year-old son.
Mr Angus is reliant on Centrelink payments for income. He said that he received the Disability Support Pension around 5 years ago, but this has recently changed to the single parenting payment. He has not worked at all since the first motor accident.
Mr Angus was born and raised in New South Wales (NSW). His mother lives in NSW. His father died in 2006 of lung cancer. His father was a smoker. He said that he stopped smoking for a period because of his father’s cancer. He is the youngest of four siblings. His siblings are three, four and seven years older than him. He was not aware of any family history of mental health issues or addiction issues other than his older brother who uses cannabis and his paternal uncle who suicided. He described a “good” childhood growing up in farms and paddocks. He enjoyed playing football from the age of 6-18. He said that he was an “average” student at school and left half-way through year 10. He then attended TAFE doing an automotive course however he described an incident with his boss at the time who was “shot in the head”. He did not witness any part of this.
Mr Angus then described a varied work history working in checkouts for Big W from the age of 16-18. He described labouring at a gardening place which was disrupted in 1998 by a workplace injury resulting in hernia and surgery. He was off work for a year after this. He then worked in various other jobs including at a bakery, in abattoirs and for Electrolux.
Prior to the first motor accident he had been working as a cleaner in various places – at McDonald’s from 2013 to 2015. From 2015 to the time of the first accident he had been working as a cleaner in a caravan park.
Mr Angus’s medical history includes the 1998 workplace hernia. He described developing “RSI” from packing meat boxes in 2006 requiring right wrist surgery. He also described injuring his ankle three times at work as a cleaner in a caravan park in 2016 and 2017.
Mr Angus described smoking on and off since 2009. He drank alcohol on and off and said that he drank approximately two to three drinks of Jim Beam every one to two nights. He said that he had trialled cannabis oil for a period which was not effective. He denied being a regular illicit drug user. He admitted to using cannabis from the age of 18-21. He denied any gambling issues.
Mr Angus said that he had a driving under the influence charge when young but no other criminal history. He has never been to jail.
Mr Angus reported a psychiatric history dating back to the age of 18. He was a victim of a home invasion age 18 and was attacked and hit across the head. He developed significant symptoms including flashbacks, nightmares and anger issues. “I wanted to get the guy”. He was admitted to a psychiatric hospital – Bloomfield for around one month. He said that eventually the anxiety and nightmares and symptoms settled over the next two years. He did not have any further psychiatric follow up.
Mr Angus described significant mental health symptoms in 2013 in the context of the breakdown of his relationship. He said that she had been having an affair with his brother. An AVO was involved at this time. He said that he developed significant depressive and anxiety symptoms including suicidal ideation. He did not receive any treatment at this time, and he said that the symptoms resolved over time. His relationship remains poor with his ex-partner and his brother who is in jail.
The first motor accident occurred on 6 January 2018. He was returning home and was slowing down to enter a rest area when he was struck from behind near the right rear side. He was driving a Toyota Corolla hatchback and had been slowing down from 100km/h and estimated he was travelling around 60km/h. His partner and two children were in the car. They were all seat belted. Airbags did not deploy. He was hit by a blue hatchback estimated to be travelling at 100km/h. The impact caused him to lose control of the vehicle, and the front of the vehicle hit a tree (second impact). He said that in particular, he immediately felt pain in the back of his neck and lower back. There was also pain from the seatbelt. His vehicle was written off. He travelled by ambulance to hospital where he stayed for around three to four hours. He said that the pain persisted. He developed significant depression and anxiety. He was unable to drive for 6 months. He said that he was unable to turn his head properly. He said that they had planned to get married, but the accident stopped this. He said that he was more socially withdrawn. He described that it was also stressful and difficult with a young baby at home. He was able to contribute to some housework at reduced pace including some vacuuming. He helped feed the baby. He was unable to go fishing. He required surgery on his neck in November 2018.
History of the subject motor accident
The accident occurred on 2 August 2019. Mr Angus had just left home with his mother and was less than a kilometre from home. He was driving a Hyundai SUV. They were both seat belted. Airbags were not deployed. He was turning onto the Princes Highway and was involved in a four car pile up with three impacts. A vehicle behind him rear ended him causing him to jolt forward and rear end the car in front. Another vehicle ran into the car behind him resulting in a third impact. His car was written off. He immediately felt pain, particularly in his neck and lower back which was an aggravation of the previous pain but also a new pain in the front of his neck. He was angry and upset. Four ambulances arrived and took others to hospital. He went to hospital driven by his partner and was there “most of the day” discharged later that evening.
History of symptoms and treatment following the motor accident
The pain has continued particularly in his neck and lower back. Mr Angus said he continued to struggle to turn his head. He said that the back pain caused sciatic pain down his leg.
He said that since October last year he had developed symptoms in his arm including pain, numbness and tingling which he attributed to his neck issues.
Mr Angus has attended psychology.
Mr Angus takes medication for pain including Targin, oxycodone and Lyrica. He is not prescribed any antidepressant or other psychotropic and is not interested in same.
Mr Angus described depressed mood, anxiety, irritability. He does not like being in a car and avoids driving or being a passenger when possible.
Details of any relevant injuries or conditions sustained since the motor accident
There were no subsequent relevant injuries or conditions identified.
CLINICAL EXAMINATION
Mental state examination
The assessment was undertaken using audiovisual technology. The quality of the connection was satisfactory. The claimant was unaccompanied in a room at his house. He was cooperative for the duration of the 90 minute interview. He required one break for a few minutes around 70 minutes. The claimant was often circumstantial in his answers and provided extraneous information. He reported his mood as depressed, anxious and irritable. His affect was reactive. There was no abnormal psychomotor activity. His speech was of normal rate, rhythm, volume and prosody. There was no formal thought disorder. There were no delusions and no hallucinations. There was no current suicidal ideation. He was oriented to time, place and person.
Current functioning
Mr Angus said that his hobbies are reduced for example he had not been fishing for two years. He enjoyed watching movies for example Fast and Furious but said he could only concentrate for around half an hour at a time. He enjoys “find a word” puzzle books.
In 2020/2021 he attempted a retail course but was unable to complete.
He completed his RSA and RCG around 2020. He worked as a waiter for around six weeks.
He was able to drive locally and for example regularly transported his children. He said that he had driven longer distances outside familiar local areas on around five occasions since the first accident. He was unable to recall precisely if any of these were between the accidents.
He has not travelled on an aeroplane since the first accident.
He reported that he was more socially withdrawn but that was partly due to not knowing many people in his local area.
He was independent with ADLs and contributed to household tasks and care for the children. He is in receipt of a parenting payment.
DETERMINATIONS
Diagnosis
The claimant has been previously diagnosed with post-traumatic stress disorder and adjustment disorder.
The Panel accepted he developed post-traumatic stress disorder following the subject motor vehicle accident. The criteria according to DSM-5-TR are outlined below:
(a) a traumatic event (the motor vehicle accident) that meets Criterion A;
(b) re-experiencing phenomena with nightmares and flashbacks;
(c) avoidant behaviours with avoidance of driving or driving with discomfort;
(d) negative cognitions with low mood;
(e) marked alterations in arousal with insomnia, irritability and hypervigilance;
(f) duration of more than one month;
(g) significant impairment of functioning, and
(h) not due to substance use or other medical condition.
A diagnosis of Adjustment Disorder with mixed anxiety and depressed mood, Persistent (Chronic) was made according to DSM-5-TR outlined below:
(a) there is the development of emotional and behavioural symptoms in response to the identifiable stressor being the ongoing pain and physical injury from the motor accident;
(b) the symptoms are clinically significant as they cause him marked distress;
(c) the symptoms are related to ongoing pain from the physical injury and are therefore not entirely captured by the post-traumatic stress disorder diagnosis;
(d) the symptoms do not represent normal bereavement or prolonged grief disorder;
(e) the symptoms persist because of the persisting pain and physical symptoms, and
| Psychiatric diagnoses | 1. post-traumatic stress disorder | 2. |
| 3. | 4. | |
| Psychiatric treatment description | Psychological therapy | |
| Category | Class | Reason for Decision |
| 1. Self-care and Personal Hygiene | 2 | The claimant is able to live independently albeit with reduced pace and motivation for self-care. He contributes to household tasks and care of children. |
| 2. Social and Recreational Activities | 2 | The claimant has reduced social and recreational activities. He however still maintains some activities and for example has been fishing since the second accident. |
| 3. Travel | 2 | The claimant can drive independently when necessary to the shops and school for example but he finds it anxiety provoking. He has driven longer distances on only a few occasions when necessary. |
| 4. Social Functioning | 3 | He reports that he has separated from his wife. He has reduced socialisation with friends. |
| 5. Concentration, Persistence and Pace | 2 | He reported subjectively worse concentration. He concentrated well during the interview of 90 minutes duration. He has completed the RSA training course and can watch movies. |
| 6. Adaptation | 4 | He has been unable to return to work. His symptoms are such that he could not work more than 1-2 days at a time, less than 20 hours per week with reduced pace and erratic attendance. He was not able to sustain employment as a waiter. He is able to contribute to parenting and receives parenting payment from Centrelink. |
| List classes in ascending order: 2, 2, 2, 2, 3, 4 | ||
| Median Class Value: 2 | ||
| Aggregate Score: 15 | ||
| % Whole Person Impairment: 8 | ||
*%WPI = Percentage Whole Person Impairment
Pre-existing impairment from first accident
| Psychiatric diagnoses | 1. adjustment disorder | 2. |
| 3. | 4. | |
| Psychiatric treatment description | Psychological therapy | |
| Category | Class | Reason for Decision |
| 1. Self-care and Personal Hygiene | 2 | Mr Angus reported that he was independent with self-care and personal hygiene after the first accident, but symptoms |
| 2. Social and Recreational Activities | 1 | Mr Angus reported normal social and recreational functioning after the first accident with his capacities returning to the normal range. |
| 3. Travel | 1 | Mr Angus‘ travel was not limited by psychological symptoms after the first accident. |
| 4. Social Functioning | 1 | Mr Angus did not report issues in his relationships outside the normal range of functioning. |
| 5. Concentration, Persistence and Pace | 2 | Mr Angus described some subjective deficits in concentration. He had plans to complete a further training course and to change his profession. |
| 6. Adaptation | 2 | Mr Angus was able to work in his previous position for no more than 20 hours per week. This is consistent with the GP certification. |
| List classes in ascending order: 1,1,1,2,2,2 | ||
| Median Class Value: 2 | ||
| Aggregate Score: 9 | ||
| % Whole Person Impairment: 4 | ||
8-4 = 4%WPI = Percentage Whole Person Impairment
Effects of Treatment
Although the claimant remains on some treatment, his account did not reflect improvement in his condition. The Medical Assessors found that there was no treatment effect.
CONCLUSIONS
The above clinical examination findings of the Medical Assessors were discussed at the second Panel teleconference. It was agreed that the Panel as a whole, adopt the findings and incorporate same into these reasons.
The initial psychiatric injury was caused by the first motor accident (adjustment disorder) due to ongoing pain. The symptoms were materially worsened by the second (subject) motor accident, which satisfied Criterion A for post-traumatic stress disorder. The history, symptoms and signs elicited from the clinical examination satisfied the Medical Assessors. These include re-experiencing phenomena, avoidance behaviours, negative alterations in mood and cognition, sleep disturbance and functional impairment persisting beyond one month. The Panel noted a material worsening in Mr Angus’s functioning. This is consistent with the history and opinion of the treating psychologist. The global clinical impression formed by the Medical Assessors was that Mr Angus satisfied the criteria for post-traumatic stress disorder. The Panel formed the view that there was no other plausible explanation for his symptomatology and presentation.
The Panel findings differ from that of Medical Assessor Hong. The certificate of 23 February 2024 is revoked and a new certificate is provided at the beginning of these reasons.
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