Allianz Australia Insurance Limited v CZZ
[2025] NSWPICMP 738
•24 September 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Allianz Australia Insurance Limited v CZZ [2025] NSWPICMP 738 |
CLAIMANT: | CZZ |
INSURER: | Allianz Australia Insurance Limited |
REVIEW PANEL | |
MEMBER: | Belinda Cassidy |
MEDICAL ASSESSOR: | Paul Friend |
MEDICAL ASSESSOR: | Surabhi Verma |
DATE OF DECISION: | 24 September 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; insurer’s review of Medical Assessment Certificate (MAC) under section 7.26; threshold injury dispute; psychiatric injury; Medical Assessor (MA) diagnosed aggravation of an alcohol use disorder now in remission; pre-existing condition; issues of psychiatric impairment rating scale (PIRS) categories; Held – both MA’s re-examined the claimant and took detailed history of claimant’s alcohol consumption; Review Panel found accident caused or contributed to a psychological injury; MA’s diagnosed major depressive disorder and exacerbation of an alcohol use disorder; both of which were not threshold injuries; MAC revoked; no issue of principle. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 The Review Panel: 1. Revokes the certificate of Medical Assessor Hong dated 13 September 2024. 2. Certifies that the psychological or psychiatric injuries sustained by the claimant in the accident of 8 April 2022 are not threshold injuries for the purposes of the Act. A statement setting out the Panel’s reasons for the assessment is included with this certificate. |
STATEMENT OF REASONS
INTRODUCTION
[CZZ] was involved in a motor accident on 8 April 2022. He was on his way to work in the mines when his vehicle was hit from behind. The claimant says he injured his neck and back in the accident and that he developed psychological symptoms as a result.
[CZZ] made a workers compensation claim and the insurer in that claim has been paying [CZZ] benefits under the workers compensation scheme and has been arranging rehabilitation for him. [CZZ] made a claim for damages against Allianz, the third-party insurer of the vehicle the driver of which [CZZ] says caused his accident and injuries.
A medical dispute about whether the claimant’s injuries are threshold injuries or not (for the purposes of the entitlement to recover any damages) has arisen in the damages claim.
[CZZ] referred that dispute to the Personal Injury Commission (the Commission) for assessment.
On 21 February 2024, Medical Assessor Harrington determined the claimant’s physical (cervical and lumbar spine) injuries were threshold injuries.
On 13 September 2024, Medical Assessor Hong determined [CZZ] sustained an aggravation of alcohol use disorder, now in remission which is not a threshold injury.
The insurer then lodged an application with the Commission seeking a review of the Medical Assessor’s decision. On 18 November 2024 Ms Payne, a delegate of the President determined there was reasonable cause to suspect a material error in the assessment and has allowed the Review and on 14 May 2025 the President’s delegate convened this Panel to conduct the Review.
LEGISLATIVE FRAMEWORK
Jurisdiction
[CZZ]’s claim is governed by the provisions of the Motor Accident Injuries Act 2017 (the MAI Act). This legislation provides a scheme for the compulsory third-party insurance of all motor vehicles registered in New South Wales and a scheme of statutory benefits (under Part 3) and compensation by way of lump sum damages (under Part 4) for persons injured in motor accidents in New South Wales.
For those persons injured due to fault by the owner or driver of a vehicle, in the use or operation of that vehicle, a claim for damages can be made however, damages cannot be recovered if the claimant’s injuries are “threshold” injuries[1] within the meaning of the MAI Act.
[1] Section 4.4 of the MAI Act.
Threshold injury
A threshold injury is defined in s 1.6(1) of the MAI Act as a “soft tissue injury” and “a psychological or psychiatric injury that is not a recognised psychiatric illness.”
Section 1.6(4) provides that regulations may be made to exclude or include a specified injury as a threshold psychological or psychiatric injury. Part 1, cl 4(2) of the Motor Accident Injuries Regulation 2017 (the Regulation) says a threshold injury includes an acute stress disorder and an adjustment disorder.
Section 1.6(5) says that the Motor Accident Guidelines (the Guidelines) may provide the method of assessment for threshold injuries. The Guidelines[2] provide:
“[5.10] In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
[5.11]The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association.”
[2] The current version of the Guidelines is version 9.3.
The Guidelines provide the method of determining whether an injured person’s mental health disorder is a recognised psychiatric illness or not (thereby excluding unrecognised psychiatric illnesses from the recovery of damages). If the claimant has a disorder that is not recognised in the DSM-5-TR, that injury must be a threshold injury.
The method set out in the Guidelines (DSM-5-TR) also provides for the diagnosis of an adjustment disorder or acute stress disorder. While they are both recognised psychiatric illnesses, they are both threshold injuries in accordance with cl 4(2) of the Regulation.
Dispute resolution
If there is a dispute about whether an injured person’s injuries are threshold injuries or not, that matter is declared a medical assessment matter which may be referred to the Commission for determination.[3]
[3] Schedule2, cl 2(e) in the MAI Act.
Chapter 7, Division 7.5 of the MAI Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as Medical Assessor Hong’s, further medical assessments and the review of medical assessments by this Panel.[4]
[4] Sections 7.20, 7.24 and 7.26 of the MAI Act.
Where there is evidence establishing that the accident caused a non-threshold injury, which merges at any time after the accident, a finding must be made that the accident caused a non-threshold injury even if the injury has healed, or the claimant has recovered from the injury, or the condition is in remission at the time of the medical assessment.[5]
[5] See Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6.
If the claimant has a pre-existing, non-threshold psychiatric condition (such as a post-traumatic stress disorder) and evidence establishes a later accident caused or materially contributed to that pre-existing condition worsening, that aggravation will be a “non-threshold” injury.[6] An aggravation of a pre-existing threshold psychiatric condition (such as an adjustment disorder) may be a new injury, but it will also be a threshold injury.
[6] See Todev v AAI Limited t/as GIO [2023] NSWSC 836 (Todev) and AAI Limited t/as GIO v Hoblos [2023] NSWPICMP 210 (Hoblos).
ASSESSMENT UNDER REVIEW
Medical Assessor Hong examined the claimant on 10 September 2024 and issued his certificate on 13 September 2024. The Medical Assessor confirms at [2][7] that he was asked to assess the “psychiatric condition – PTSD.”
[7] The numbers in square brackets are a reference to the section number in the Medical Assessor’s reasons.
The claimant gave a pre-accident history with no major incident other than a car accident as a P-plater.
The claimant said he first developed mental health issues in 2017 when working. The Medical Assessor asked him about a note in his general practitioner (GP) records of “long standing symptoms” which he could not explain or recall. He said he developed anxiety attacks when speaking due to having to lay off people. He was prescribed Escitalopram which he still takes. Medical Assessor Hong also noted a comment about 10 years of depression in the report of Dr Prickett, pain specialist.
The claimant denied any alcohol problem before the accident but could not explain a note in his GP’s records before the accident suggesting he reduce his alcohol consumption. The claimant conceded a police charge of driving under the influence in the early 2000s when he had drunk too much the night before and was breathalysed in the morning. The claimant said he drank too much after the accident for about three or four months which led to his relationship breakdown, but he has now cut down and has maybe two beers a week.
The claimant gave a history of the accident, said he got out of the car, exchanged details with the other driver, went to work and then later went to hospital.
The claimant outlines his physical symptoms of neck and back pain and injections which have been ineffective or of limited benefit.
The claimant said he got depressed because his partner left him because he was not working and could not help around the house. He says that in July 2023 she returned, and they have reconciled. Intimacy was an issue due to back pain.
Medical Assessor Hong has a history of an apprehended violence order taken out against the claimant at the end of 2022 which he says was because of the accident. He conceded there was some history of depression and relationship issues before the accident. He saw a Dr Smith once at the request of the insurance company.
The claimant complains of low mood due to pain, anxiety and worries about finances. He had no panic attacks for years. His memory is fine, but he has diminished concentration. He has sleep issues and takes temazepam which is ineffective. He thinks he is bigger in the stomach and is more short-tempered.
The claimant was taking Escitalopram, Pariet, Panadol and Nurofen but was not having current psychological treatment.
The claimant was in uniform and engaged well. He reported driving but struggles to drive distances. He looked after himself and did some chores around the house a bit more slowly. He reported being in a new job since May 2024 as a mechanic fitter diagnosing and identifying problems with sub-contractors who do the fixing. He is able to focus at work.
Medical Assessor Hong noted Dr Prickett’s diagnosis of Kinesio phobia which “is an excessive irrational and debilitating fear of movement or physical activity.” Medical Assessor Hong did not consider the claimant’s anxiety was at a significant level and considered he had an adjustment disorder now in remission
Medical Assessor Hong then noted in 2016 an entry in the GP notes of the claimant drinking two standard drinks four days a week and then on 1 December 2022 “domestic dispute drinking too much.”
Medical Assessor Hong noted the pre-accident depression and alcohol disorder and considered the claimant aggravated a pre-existing alcohol use disorder which was a
non-threshold injury.
ISSUES FOR DETERMINATION
Insurer’s submissions
Review submissions
The insurer submits at [2.1] – [2.8] that the claimant’s psychiatric injury referred for assessment was a “PTSD” and that it was not open for the Medical Assessor to consider an alcohol use disorder noting that neither of the parties submitted such a disorder was involved or was caused by the accident.
The insurer submits at [2.9] – [2.17] that in relation to the diagnosis of an alcohol use disorder the Medical Assessor did not explain how the criteria in the DSM-5-TR were met. The insurer says the claimant does not fit the criteria in any event as there is limited evidence of the claimant’s alcohol use.
Original submissions
In the submissions lodged with the application for medical assessment, the insurer noted at [1] the claimant was able to self-extricate, exchange details and continue on his journey to work.
The insurer accepts at [2] the claimant reported some psychiatric symptomatology after the accident but suggests this is related to the physical symptoms and is consistent with an adjustment disorder.
The insurer submits at [2.3] that the claimant had a history of psychiatric symptoms including in May 2017 long standing anxiety aggravated by work incidents and family issues. Medication was prescribed and counselling provided. In June and August 2021 there were reports of panic attacks.
Dr Smith diagnosed the claimant with major depressive disorder and alcohol use disorder, but he noted some months elapsed after the accident before complaints were made and it was not clear whether Dr Smith had all the relevant documents.
The insurer had referred to the GP’s note of depression and anxiety, psychologist
Mr McDonald recording severe anxiety and depression and Mr Pinchebeck’s diagnosis of an adjustment disorder.
Claimant’s submissions[8]
[8] The numbers in square brackets are a reference to the paragraph number in the submissions.
The claimant submits at [4] that the insurer’s reply to the original application said that that the claimant’s injury “is consistent with a diagnosis of an adjustment disorder being a threshold injury.” The claimant submits at [6] that what was referred for assessment was whether the claimant had a threshold psychiatric injury or not.
The claimant submits at [7] that it was open to the Medical Assessor to come up with his own diagnosis. The claimant acknowledges at [10] that while neither party provided medico-legal evidence about any condition he has made findings that are “logical, reasonable and clearly open to him.”
The claimant lodged further submissions on 22 July 2025 with the claimant’s bundle. While the claimant acknowledged the psychological injury was specified as a post-traumatic stress disorder in the application, it was a matter for the Assessor to determine the actual psychological injury. The claimant noted he had been referred to a psychiatrist for treatment but never attended Dr Saker.
Procedural matters
The Panel issued directions to the parties on 28 May 2025 seeking bundles of documents relevant to the assessment. The insurer’s bundle was due on 27 June 2025 and the claimant’s was due on 18 July 2025. The Panel also advised the parties that:
“[6] The Panel notes that the Medical Assessors on the Panel are required, in accordance with the Guidelines, to determine if the claimant has a psychological or psychiatric injury caused by the accident and then make a diagnosis of that injury.
[7] The Medical Assessors may, in their clinical judgment, diagnose a condition that is the same as, or different to, the diagnosis of the original Medical Assessor or the diagnoses of the treating doctors or medico-legal experts or the particular diagnosis that may have been included in the application or reply form and submissions.
[8] Having made a diagnosis, the Panel will then proceed to undertake an assessment of whether that disorder is caused by the accident and whether the disorder is a threshold injury or not.”
The insurer’s bundle comprising 62 pages was lodged on 27 June 2025. The claimant’s bundle comprising 50 pages was lodged on 23 July 2025.
The Panel met on 6 August 2025 and reported to the parties the same day. The Panel noted that the Panel was undertaking an assessment de novo. In doing so the Panel is required to determine if the claimant has a psychological or psychiatric injury and then make a diagnosis of that injury. The Panel noted that the Panel might diagnose a condition that is different to the original Medical Assessor’s diagnosis or the disorder that was referred or that is the subject of any medico-legal or treating reports.
The Panel invited final submissions. The insurer provided final submissions dated
12 August 2025 and the claimant did not respond other than to confirm he would be attending the re-examination.
The insurer noted:
(a) the first reference to alcohol consumption was on 24 February 2017 in the contest of stress at work. The claimant told his GP he was trying to stop drinking alcohol;
(b) on 4 April 2017 the claimant’s GP reports he used to drink and by June 2-17 of that year he advised he had ceased drinking beer;
(c) after the accident in December 2021 the GP reports the claimant had been involved in dispute with his wife and he acknowledged he had been “drinking too much” and had “stopped drinking”, and
(d) Medical Assessor Hong reported that the claimant does not drink much now maybe two beers a week.
The insurer submits that the evidence does not establish the claimant satisfied the criteria for an alcohol use disorder.
REVIEW OF THE EVIDENCE
Claim form and claim documents
A workers compensation claim form was completed by the claimant on 13 April 2022. The claimant listed his neck and shoulders as the parts of his body injured. The form was received by the employer on 20 April 2022.
The insurer has provided a photograph of the claimant’s car which shows minor damage to the bumper, the door below the number plate and damage to the panel around the bottom of the rear window.
Treating medical records and reports
The claimant saw Dr Prickett, pain physician on 7 September 2022. He has a history of the claimant’s accident and notes the car was not written off.
The claimant reported neck pain with radiating left arm symptoms and headaches as well as lower back pain developing a week after the accident with radiation into the leg. The claimant disclosed some previous lower back pain but says he did not seek treatment for it.
Dr Prickett records the claimant’s treatment (physiotherapy and review by Dr Abson) and he reviewed the claimant’s MRI.
Importantly for the current Review, Dr Prickett records this:
“[CZZ] describes a long-term battle with anxiety for about 10 years. This has definitely been exacerbated with his challenges recently and he describes a moderately significant impact on his mental health. Formal assessment of his psychometrics outlined pain interfering with all aspects of his life to a moderately severe degree a PCS in the severe range, a moderate Kinesiophobia, a low self-efficacy belief. His depression anxiety and stress scores were in the low to severity range. [CZZ] did not describe using alcohol or cannabinoids as a coping strategy but recognises that he is struggling with the impacts of his pain on his day-to-day quality of life. He describes a motivation to return to the workplace especially with his work colleagues. He struggles with driving, and this is one of the potential barriers in him getting a reasonable return to work outcome.”
Dr Prickett recommended a multidimensional, multifaceted pain management program including referral to a psychologist.
Mr Bowd, exercise physiologist reported to Dr Prickett on 19 October 2022. The claimant reported constant neck pain, headaches and migrations and constant right sided low back and buttock pain. The claimant also reported “a decline in mental health with increased levels of anxiety and depression post injury. [CZZ] has become hypervigilant in cars, especially as a passenger.” He rated 50 on the Tampa scale for a high level of Kinesio-phobia and 23 on the DASS21 scale for moderate depression and stress and normal anxiety levels.
On 26 October 2022 the claimant was referred by Dr Tharmalingam to Dr Mason, psychologist for “opinion and management of his depression related to chronic pain.”
On 1 December 2022 the claimant was referred by Dr Tharmalingam to Dr Saker, psychiatrist for “opinion and management of his anxiety and depression.”
Dr Prickett reported again on 3 February 2023. This report focussed mainly on the claimant’s physical condition, but the claimant was said to report “distressing and intrusive symptoms, both at rest and exacerbated by activities.”
The claimant spoke with Mr McDonald of Life Matters on 13 July 2023. The claimant was having panic attacks in traffic or when attempting public speaking. He was extremely severely depressed and anxious and had severe level of stress. The probable diagnosis was given of post-traumatic stress disorder.
The first formal session occurred on 7 August 2023 with Mr Pinchbeck. The claimant reported disturbed sleep, persistent low mood and impaired physical function and reduced ability to participate in pleasurable activities. His relationship with his partner was affected and there had been some instability and an apprehended violence disorder. The claimant reported not consuming alcohol since late last year (2022). At the fourth session (on
23 August 2023) the claimant’s mood was elevated as he was working, the AVO had been dropped, and he was “becoming more comfortable with injury status.”
Records of Cameron Park Medical Practice
The notes of the Cameron Park Medical Practice start with an entry on 29 September 2016 when the claimant attended for several issues including back pain.
On 24 February 2017 the claimant attended Dr Tharmalingam for poor sleep and panic attacks and “trying to stop drinking alcohol.” Diazepam was prescribed.
In 2017 there are a number of references to “stress tests” in the context of cardiac investigations following an episode whilst driving.
On 28 April 2017 there is a reference by Dr Brennan to a K10 assessment and the first script for Lexapro 10 mg half a tablet daily to be increased to a whole tablet after 7 days. On
3 May 2017 Dr Brennan has a history of “long standing anxiety” and had been feeling nervous for years. He had poor sleep “unless drunk” and stress at work was getting to him. A mental health plan was developed and Temazepam (10mg) was prescribed for the evening.
On 4 May 2017 the claimant returned again as he was depressed and anxious and crying. He was having nightmares and flashbacks and trouble sleeping. He reported loss of pleasure of previous enjoyments, low energy, low libido and he was advised to continue medication and avoid alcohol and drugs.
On 4 December 2017 the claimant reported to Dr Tharmalingam that the Lexapro was working but was not enough and the dose was increased to 20mg. Lexapro continued to be prescribed in 2018, 2019 and 2020. On 23 June 2021 the claimant told Dr Tharmalingam he had run out of Lexapro and was getting panic attacks and did not go to work. A repeat script was provided.
On 6 August 2021 the claimant reported stress at work and said he was getting panic attacks and wanted to go on workers compensation. He was advised he needed to see a psychologist. There was a similar attendance on 10 August 2021. It appears a referral may have been given.
On 15 February 2022 the claimant sought repeat scripts for Lexapro 20mg.
The claimant’s next attendance was on 12 April 2022 after the accident. It was noted there was no loss of consciousness, a whiplash injury (headaches and neck pain) and no external injuries. On 22 April 2022 the claimant returned. While his headache was better, his neck pain was worse. On 2 May 2022 there were further complaints of neck pain and on
20 May 2022 “nothing changed.” On 25 May 2022 however the claimant was having pain in his shoulders as well as a flare up of his neck pain. On 27 May 2022 the physiotherapist recommended a cervical spine MRI. On 3 June 2022 the neck pain was a bit better.
On 9 June 2022 Dr Tharmalingam records worsening neck and lower back pain, and the claimant had numbness in his right leg and was having erectile difficulties. A lumbar spine MRI was requested and a referral to Dr Abson given.
Regular attendances occurred for neck, back and occasional complaints of radiating pain until 29 August 2022 when there was a reference to a referral to a pain clinic and “seeing a psychologist as well.” There are further references to physical injuries and treatment.
On 1 December 2022 there is a note about a domestic dispute that occurred. [CZZ] said he had drunk too much, police were called, and he was charged with assault. The claimant wanted a referral to a psychiatrist and was advised to stop drinking. He was having sleep issues. A referral to Dr Stuart Saker was given.
On 1 June 2023 the claimant requested a referral to a psychologist from Dr Tharmalingam.
The claimant reported on 22 April 2024 having a new job which he didn’t like, but he was doing light duties and his back pain was getting better.
On 8 May 2025 [CZZ] reported he was working for the local Council and was driving and doing computer work but he had a left knee incident. The claimant was still on the same dose of Lexapro.
Medico-legal reports
There are no medico-legal reports from either the claimant or GIO.
[CZZ]’s employer obtained a report from Dr Smith dated 26 October 2022 in the course of the workers compensation claim. Dr Smith refers to the documentation he was given, but it does not appear he had any pre-accident records.
The claimant reported the truck that hit him was driving at 60 kmph. [CZZ] reported leaving work because of neck, thoracic, lumbar spine pain and headache. The claimant reported his neck pain and headaches worsened and he experienced left leg sciatic symptoms, and he could not return to work.
Dr Smith has a history of the claimant’s mental health declining in the previous three months with substantial worsening in the last four to six weeks due to an increase in headaches and neck pain. He had sleep disturbance due to pain which also exacerbated his mood. He was teary and a lack of pleasure in experiences of life.
The claimant denied nightmares and could drive but pain prevented long drives. He thought about the risk of accidents but had always not trusted trucks.
The claimant denied any significant medical history other than gastro-oesophageal reflux disease and haemochromatosis.
The claimant conceded a period of anxiety and panic attacks in 2016 and 2017 however said he fully recovered and while he was prescribed an antidepressant he had no psychological consultations during this period. The claimant said he continued to take escitalopram.
The claimant reported drinking 6 to 10 beers every day which was a substantial increase and is a response to pain. He knew this was problematic but says it relieves his pain.
Dr Smith has a report of the claimant’s education, work and family life.
The claimant was having physical therapies and treatment but was not at that stage seeing anyone for his mental health issues.
Dr Smith diagnosed a major depressive and concurrent alcohol use disorder of moderate severity. He says both of these are related to the claimant’s physical injuries.
Later in answer to the insurer’s question 5 he says:
“My opinion regarding prognosis is guarded. I am of the opinion that [CZZ]’s mental illnesses are strongly linked to his physical disability and pain levels. [CZZ] presents as someone very proud of his physical abilities and has suffered relatively with his loss of functioning. His issues with chronic pain have influenced a pattern of excessive and problematic alcohol consumption for pain relief. As such, both of these conditions are heavily influenced by other factors and, in the event that either situation was able to be improved significantly, I would be of the opinion that [CZZ]’s prognosis from a mental health perspective would be positive. However, if [CZZ] were to plateau in his physical functioning and pain levels, I hold a more guarded and pessimistic prognosis regarding his mental illnesses.”
Dr Smith recommended psychological therapy and was pleased he was seeing a pain management team. He did not feel a psychiatrist was required at that time.
Associate Professor Kleinman examined the claimant for the purposes of [CZZ]’s workers compensation claim on 12 July 2022 and the third-party insurer relies on his report dated 27 July 2022.
The claimant denied any previous neck or back problems but a consistent prior medical history including anxiety for the last 10 years.
The claimant gave a consistent history of the accident noting that he saw the truck approaching him in his rear-view mirror. The early treatment is also consistent with the claimant confirming his neck was not radiographed at the hospital, he was given four days off work and no medication.
The claimant reported erectile dysfunction, occasional urinary incontinence when asleep but no faecal incontinence.
The claimant was taking Panadeine Forte and was having difficulties with some activities of daily living.
Associate Professor Kleinman diagnosed an aggravation of pre-existing degenerative changes and a prolapsed disc at C6/7 and L5/S1. He was concerned about the severe muscle wasting in the calf of the right leg only three months after the car accident.
Other assessments
Medical Assessor Harrington examined the claimant and assessed his physical injuries on
19 February 2024. At [2] the Medical Assessor confirms he was asked to assess radiculopathy in the cervical and lumbar spine.
Medical Assessor Harrington has the following history at [7] – [10]:
(a) the claimant was a heavy vehicle mechanic, and he was also renovating his house at the same time;
(b) he has been unable to resume the renovation and is working reduced hours;
(c) he had no previous trouble with his neck or back but did have pre-existing anxiety;
(d) the accident occurred on the New England Highway. The claimant was stopped behind a truck and was hit from behind;
(e) the claimant drove on to work but his neck became increasingly painful, and he went to hospital but was not admitted;
(f) a week later the claimant developed pain radiating into his shoulders, headache, back pain and leg pain, and
(g) the claimant saw his GP four days later, had physical therapies and was referred to Dr Abson in August 2022 and Dr Prickett for pain management including nerve blocks.
The claimant reported ongoing problems in his neck and lower back which caused restrictions of movement and difficulty driving. He did not report radiculopathy but did report headaches with visual disturbances and nausea. The claimant reported back pain with occasional radiation down the right leg. He could walk and mow the lawn (at a slower pace) and he has had to employ tradesmen to renovate his house. He is teaching his son to drive.
The claimant reported a change in mood, treatment for depression and the history of anxiety said to have been aggravated by the accident.
The claimant was not having any active treatment when examined.
Dr Harrington viewed the radiological images online.
Dr Harrington diagnosed aggravation of pre-existing changes in the cervical and lumbar spine with no evidence of cervical or lumbar radiculopathy.
He found the neck and lower back injuries to be threshold injuries.
RE-EXAMINATION FINDINGS – MEDICAL ASSESSORS VERMA AND FRIEND
[CZZ] was examined by video teleconference. He was present at his solicitor’s office at the time of the assessment. Internet connectivity was good, and the re-examination proceeded without issue for more than an hour.
History
Psychosocial history and pre-accident history
[CZZ] is 46 years of age and lives in Sydney with his 18-year-old son and 23-year-old daughter. He said that his daughter moved in with him in March 2025 after his partner left. He had a 50-50 shared custody arrangement for his son before the motor vehicle accident, which changed to full-time around December 2014. He has been single for the last three months since separating from his partner.
[CZZ] currently works full-time as a mechanical fitter for Newcastle Council. He reported that his work is less hands-on and more related to consultation, involving less manual labour.
He was born in Waratah and grew up with his parents and three older brothers.
He described his childhood as a “normal childhood.” He denied witnessing any trauma or abuse growing up. His father was a boiler maker, and his mother was a nurse. He completed Year 10 at school and then trained as a fitter before working at Commonwealth Steel.
He reported that he initially worked in heavy industries until 2005, after which he began working in mining. At the time of the accident, he was employed at GE north of Singleton. He said he worked as a heavy vehicle mechanic, maintaining earth-moving equipment and bulldozers, working full-time. He worked a “lifestyle roster” with 12.5 hour rotating shifts. He added that at the time of the accident, “things were normal”, and things were, “good.”
He was living in Rutherford, in the lower Hunter Valley at the time of the accident. It was about a one-hour drive to and from work.
He denied any mental health issues at the time of the accident. We asked about his past-history. He reported that in 2017, he was working with GE and had anxiety regarding public speaking and was diagnosed with anxiety. He was working as an operations manager at GE Mining and was in the process of closing workshops. He was tasked with closing three workshops and delivering weekly updates to 40 to 50 affected people each day. He said that he experienced anxiety just before these meetings with sweaty hands, sweaty forehead, feeling sick in the stomach and at times would be easily startled.
[CZZ] further reported that on one particular day he was returning from work after speaking to his colleagues in the morning. He experienced panic attacks — “butterflies in his chest, felt as if he was going to have a heart attack, cold sweaty hands and was breathing fast.” He was driving on the freeway and then pulled over before the next exit because the truck next to him was following him. He pulled into a service station where there were many people, but he had tunnel vision and could only see the drink fridge. His wife then took him to the John Hunter Hospital.
The hospital medicated him with Lexapro (Escitalopram) in 2017. He said that he “only really took it when he felt anxious.” He did not take the medications regularly initially and only started taking it daily in 2020 as he was doing more public speaking at that time. [CZZ] said that he continued to take Lexapro, in the same dose, to the present day. His mother who is a nurse, has told him to continue taking it.
We asked him about the entry in the Cameron Park Medical Centre clinical notes dated
6 August 2021. This states that he was stressed at work, was having panic attacks, and wanted to “go on Workers’ Compensation.” [CZZ] accepted that there was bullying and harassment at work which was common in coal mines. He said he did not lodge a Workers Compensation claim in relation to this episode.
We asked [CZZ] about his history of alcohol consumption. He stated that he started drinking at the age of 22 years. He had one conviction for driving under the influence of alcohol when he was 27 years old after a night of “boozing and partying.” [CZZ] reported that he used to have a few drinks as a young adult, but his alcohol consumption increased later in life and has fluctuated since then. He stated that there are times when he drinks excessively, but then he stops for about two to three months before resuming drinking.
We noted the entries in the Cameron Park Medical Centre clinical notes, regarding his alcohol consumption dated 24 February 2017, 4 April 2017 and 5 May 2017. [CZZ] said that he did not consume alcohol prior to workdays because he was breathalysed before each shift. He drank on non-workdays, consuming at least “20 standard drinks in 4 days.”
He currently drinks about a carton of beer (24 cans) every two days, but sometimes “runs out” on the second day. He stated that he is not under the influence of alcohol when he drives or goes to work. He has unsuccessfully tried to cut down his alcohol consumption.
He told us about the breakdown of the relationship with his partner in December 2023, after an argument. His partner damaged some of his property. He stated that he put his hand on her shoulder which caused her to telephone the Police. He was placed on an Apprehended Violence Order (AVO) and charged with assault. He subsequently stopped drinking for a month but then resumed.
[CZZ] says that his alcohol consumption has increased since the accident because he is struggling to cope with the pain from his physical injuries.
He has haemochromatosis. He had regular venesections, before the accident, but only once since the accident.
He denied any history of incarcerations or criminal convictions. The Apprehended Violence Order has reportedly expired, and the associated charge(s) were reportedly dismissed.
He has no family history of mental illness other than his brother who is treated for schizophrenia.
History of the motor accident
[CZZ] described the 8 April 2022 accident which happened on his way to work. He said he was in his white Mazda. There was traffic on his way to Singleton and he slowed down because of a truck in front of him. He recalls hearing a screeching sound before seeing in the rearview mirror the truck that rear-ended him.
The airbags did not deploy. He reported that he got out of the vehicle and exchanged details with the other driver. The car was “sort of drivable," so he continued on to work. His vehicle was later repaired.
He confirmed that the police or ambulance were not involved.
After arriving at work, he experienced neck pain and he went to Singleton Hospital that afternoon, where he was investigated.
History of symptoms and treatment following the motor accident
[CZZ] reported that he started experiencing pain in his back, neck, headaches, and pain in his left arm. He added that later, the pain developed into sciatica in his back, and he began experiencing numbness and tingling in his legs and arms.
He rated his pain as “quite significant at 7-8 /10." He was unable to get out of bed, walk, or function properly, and could not stand in one position for long periods. He was unable to do household chores like washing or mowing and had to stop engaging in previously pleasurable activities such as working on his car “because of being in pain."
He received injections in his neck and back, but they did not work well. He was also prescribed Panadeine Forte, but he did not take it for long due to fear of becoming addicted.
He saw a physiotherapist and exercise physiologist, which helped him return to work. He said that going out of the house and seeing the physiotherapist, along with the social aspect of meeting the exercise physiologist, helped him to get back to work.
He reflected that he initially handled the injuries well, but he began to feel depressed because he could no longer do most of the things he previously enjoyed. He recalls spending most days in bed for months, as he could not get out of bed due to his depression.
He was not able to leave the house and became irritable, argumentative and agitated. He said he was not a nice person to be around. He often had conflicts with his ex-partner.
His appetite fluctuated, and he did not eat well and at times, he would only have one meal a day. He gradually lost weight from around 125kg to his current weight of 109kg.
He experienced panic attacks each time he drove and would constantly check the rearview mirror for approaching vehicles. He also felt neck pain whenever he looked over his shoulders while driving. He reported that he was gradually able to drive to Sydney, then started driving regularly, and after a few months, became more confident behind the wheel.
He said that to cope with his pain and mental health issues, he began drinking, and as a result, "sleep was not much of an issue, and I used to pass out." His sleep fluctuated from
eight to nine hours per night to not getting good sleep on other nights.
He said that he previously enjoyed being around people and working with other tradesmen. He never had a problem going to the supermarket, but after the accident, he no longer wanted to be around people and found it difficult to visit supermarkets.
He said that gradually he started having more conflicts with his ex-partner and “she used to yell and scream at me because I was no longer able to do the household chores that I had previously done.”
His ex-partner moved out in March 2025. They tried to keep the relationship going until June 2025, but he then decided that it was not worth it. He said he had difficulties trusting her and did not want to deal with the arguments, preferring to live alone so that no one could tell him what he should be doing.
[CZZ] reported that after the accident, he worked for three weeks. He was certified to work light duties but was not given light duties and so he ceased working.
He then did not work for about 18 months. His employers terminated his employment in July 2023. He was offered a job soon after through a customer he had worked with at GE. He began working at Motion in Rutherford as an estimator in August 2023. He did not like this work and left. He was unemployed for about three months, before commencing work at his current employers in July 2024.
Details of any relevant injuries or conditions sustained since the motor accident
[CZZ] denied having any subsequent injuries or any conditions.
Current state
Current symptoms
[CZZ] reported that he continues to experience similar symptoms as before.
He highlighted how it has been difficult for him to maintain a relationship. Despite being married for 19 years, he described himself as “hard to live with” particularly after the accident. He reflected that alcohol “was a big part” of his coping mechanism, as he has been trying to “drown” his difficulties.
He continues to experience neck pain, numbness in his arms, headaches, tingling, numbness in his legs, and pain in his lower back.
He reports ongoing low mood, lack of interest in activities, anhedonia, difficulty with attention and concentration, sleep disturbances, and fluctuating appetite, as before. He added that he was unable to continue working in the same capacity as previously and is now on half the salary he earned when working with Glencore. He has unpaid bills, including water and credit card bills, and is under significant financial stress.
He would prefer to be working with a different coal mine, but he cannot because it involves “heavy lifting, standing and physically I won't be able to do that.”
Current and proposed treatment
[CZZ] reported that he is currently taking Escitalopram at a 10mg dose. While completing these reasons the Panel has noted that the documents mentioned he is on a
20mg dose of Escitalopram. He is also taking Pariet for gastro-oesophageal reflux.
He started seeing a psychologist after the accident and denied seeing any psychologist before the accident. He said that his doctor had previously referred him to see a psychiatrist, but both psychiatrists he was referred to were not accepting new patients, so he ended up with Life Matters. He last saw a psychologist at Life Matters in 2024 and is not currently seeing any psychologist or psychiatrist.
Clinical examination
Mental state examination
[CZZ] was wearing his work uniform. He had a shaved head.
He engaged reasonably well with the assessment process. He became emotional towards the end when explaining his financial situation and how his salary had decreased since leaving the mines.
He reported feeling low and his affect was reactive. He provided a clear account of his symptoms and difficulties.
His speech was spontaneous and normal in volume and tone.
His thoughts were logical and goal directed.
Currently, he reports a low mood, a lack of interest in activities, and fluctuating appetite.
There was no evidence of manic, psychotic, or perceptual abnormalities.
He has insight into his condition, and his judgment is intact.
He did not report any thoughts of self-harm or harm to others, suicidal ideas, plans, or intent.
Current functioning
In terms of self-care and personal hygiene: [CZZ] showers and brushes his teeth every few days. He mentioned that when he was previously not working, he went about two weeks without showering. He wears deodorant since he does not shower regularly.
He does household chores like washing dishes, but only after procrastinating for about three weeks. He relies on Uber Eats and no longer cooks. He explained that initially, when he was in intense pain, he could not stand for long, and now it has become his habit not to cook.
In respect of driving, his workplace is about 5km from his home, and he tries to walk to and from work. He is able to drive to various sites around Newcastle, in the course of his workday. He currently drives around 20km each day. He said he only started this degree of driving about 12 months ago.
[CZZ]’s recreational activities included camping at least which he would do once a month, staying for four days at a time. He has not been camping since the accident because the tent is too heavy for him to lift. He previously enjoyed four-wheel driving but now fears that bumps could worsen his physical injuries and his pain so he has not tried it.
He also had an old Falcon car and would work on it. After the accident, he said whenever he tries to work on the car, he either feels dizzy or his pain worsens, so he no longer works on it.
He previously was gradually renovating his house, but ceased after the accident and pays others to do the work for him.
In terms of social functioning, [CZZ] prefers staying at home with his dog rather than socialising. It says he has lost trust in his work friends after tools were stolen from his workplace following his motor vehicle accident.
He has one friend he talks to on the telephone and sees about three to four times a year.
His daughter also struggles with depression and was sexually assaulted at her workplace, and they often discuss “being the best.” His son plays a lot of music, and he enjoys watching him—especially how “good he is”—and spends time with him.
As for his other social relationships, he said he separated from his partner because they argued daily about him not doing chores around the house. He can no longer do yard work, clean, or mow the lawn, often procrastinating on these chores.
There was a domestic violence incident where he was charged with assault which we have outlined elsewhere in these reasons. [CZZ] did not receive any conviction or jail time for this incident. However, the police did take out an AVO against both of them. He and his partner reconciled but have subsequently parted ways.
Comments of consistency
[CZZ]’s presentation was internally consistent. The relevant past psychiatric history was discussed.
CONSIDERATION OF THE ISSUES – THE PANEL
Causation and reasons
It is the clinical judgment of the Medical Assessors that [CZZ] had a clear history of anxiety before the accident for which he was medicated. The Medical Assessors are also satisfied that in their clinical judgment, on the basis of the history he gave (and the GP records) that the claimant had an alcohol use disorder at the time of the accident. The claimant was therefore, in the opinion of the Medical Assessors, particularly vulnerable to further psychological injury.
While the motor accident in September 2022 does not appear to have involved significant force or major damage to the claimant’s vehicle, it did cause him physical injuries.
The Medical Assessors note the decision of Medical Assessor Harrington who found the claimant did injure his neck and lower back in this accident. [CZZ] reported experiencing significant pain in his neck and back, which reduced his ability to do household chores and maintain his employment.
In the light of the above the Medical Assessors are of the view that the accident could have caused or materially contributed to the development of a psychiatric disorder.
The Panel has considered whether the accident did in fact cause or materially contribute to the development of a psychiatric disorder. The Panel notes that [CZZ]’s ongoing physical and psychological issues affected his relationship with his partner, leading to their separation. On the history provided the claimant increased his alcohol consumption to cope with his physical symptoms, drinking about 12 standard drinks per day at the time of the re-examination. [CZZ] was able to work for a few weeks after the accident, but his physical injuries meant, in the apparent absence of light duties that he could no longer work. While he has found work, it is not as remunerative as his pre-accident employment, and this has further affected the claimant.
[CZZ] has developed psychological symptoms after the accident, recognised by his treating doctors and for which he has been treated. The Panel is satisfied that the motor accident has caused or materially contributed to the claimant’s current mental state.
Diagnosis and reasons
It is the clinical judgment of the Medical Assessors based on a review of the documentation and an extensive interview with the claimant that the motor vehicle accident has caused or materially contributed to:
(a) an episode of major depressive disorder, and
(b) an exacerbation of a pre-existing alcohol use disorder.
The diagnosis of each of these will be considered in turn and the criterion addressed.
DSM-5-TR Major Depressive Disorder Criteria
A diagnosis of this disorder depends on there being five (or more) of the following symptoms present during the same two-week period and which are a change from previous functioning. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure (criterion A):
(a) depressed most of the day, nearly every day as indicated by subjective report or observation made by others – while [CZZ]’s functioning has improved and he is able to work there have been periods where he said he was unable to get out of bed due to psychological symptoms. He described ongoing feelings of sadness and difficulty adjusting to the change in his circumstances;
(b) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day - [CZZ] described being unable to pursue his previous hobbies and weekend activities and this has caused distress;
(c) significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day – [CZZ] described both a loss of appetite and a significant reduction in his weight;
(d) insomnia or hypersomnia nearly every day – [CZZ] said he had difficulty sleeping;
(e) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) – not applicable to [CZZ];
(f) fatigue or loss of energy nearly every day – [CZZ] reported these symptoms;
(g) feelings of worthlessness or excessive or inappropriate guilt nearly every day – [CZZ] reported feeling worthless and helpless particularly in the context of the loss of his relationship;
(h) diminished ability to think or concentrate, or indecisiveness, nearly every day (not applicable in this case), and
(i) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide (not applicable [CZZ] gave no history of suicidal thoughts).
Criterion B for this disorder requires the symptoms to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The claimant was particularly distressed in relation to the loss of his relationship, and he has had impairment in his work and social areas of functioning as a result of his feelings of depression.
The DSM-5-TR also provides in Criterion C that the episode must not be attributable to the physiological effects of a substance or to another medical condition and (Criterion D) must not be better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. Criterion E provides there must not have been a manic episode or a hypomanic episode.
It is the clinical judgment of the Medical Assessors that the claimant’s feelings of depression secondary to physical injury are not better explained by any other substance or condition or that he has any other disorder or episode.
DSM-5-TR Alcohol Use Disorder
The Panel is satisfied that [CZZ] satisfies the criteria for an alcohol use disorder. There is only one Criterion, Criterion A which requires there to be a “problematic pattern of alcohol use”, manifesting in two or more of the following within a 12-month period:
(a) consumes more alcohol or spends more time drinking than intended (not applicable);
(b) wants to limit or halt alcohol use, but has not succeeded – [CZZ] gave us a history of drinking to excess and wanting to stop but being unable to do so in recent times;
(c) spends a significant amount of time obtaining alcohol, drinking alcohol, and recovering from alcohol consumption (not applicable);
(d) craves alcohol (not applicable);
(e) has suffered consequences at home, school, or work due to recurring alcohol use – [CZZ] has lost a relationship in part because of his alcohol use;
(f) has suffered relationship problems due to recurring alcohol use – as above
[CZZ] and his partner are no longer together which he attributes to his alcohol consumption;(g) has given up or cut back on enjoyable activities due to recurring alcohol use (not applicable);
(h) continues to use alcohol in situations when it’s physically dangerous (not applicable, [CZZ] says he never drank before work in the mines and never drove after drinking);
(i) continues to use alcohol despite knowing it is causing them physical or psychological harm. [CZZ] confirmed he was told about his abnormal liver function tests (in April 2017) but continued to drink despite this. He knows now that alcohol is bad for him but says he is unable to stop;
(j) has become increasingly tolerant of alcohol, meaning they are less sensitive to the effects of drinking and need to drink more to become intoxicated – [CZZ] reports that he was drinking a case of beers every two days but that he now could finish the case earlier than two days, and
(k) suffers withdrawal symptoms within a few hours or days after they stop drinking (not applicable to [CZZ]).
As [CZZ] had an alcohol use disorder before the accident, the Medical Assessors are of the view that the appropriate diagnosis is that of an exacerbation of a pre-existing alcohol use disorder.
Other diagnoses
It is the clinical judgment of the Medical Assessors that [CZZ] had a pre-existing anxiety disorder. However, on his presentation at the re-examination he did not exhibit any significant anxiety symptoms.
It is the clinical judgment of the Medical Assessors that [CZZ] does not have a post-traumatic stress disorder primarily because the accident does not appear to satisfy the severity criteria (Criterion A). While the impact is said to have occurred at 60 kmph and the claimant saw the approach of the truck in his rear-view mirror, the claimant was able to drive away from the scene and sustained soft tissue injuries only.
CONCLUSION
The Medical Assessors have, in their clinical judgment diagnosed the claimant with a major depressive disorder and an exacerbation of a pre-existing alcohol use disorder. It is the Panel’s view that at the current time, neither of these disorders are in remission.
Both a major depressive disorder and an alcohol use disorder are psychiatric disorders recognised as such by the DSM-5-TR. Neither of those disorders is a threshold injury disorder as set out in the Regulation. In accordance with the Todev and Hoblos decisions (see paragraph 17 above) and aggravation or exacerbation of a pre-existing non-threshold injury is also a threshold injury.
It is therefore the Panel’s decision that the claimant has a psychiatric injury that is not a threshold injury.
While the Panel has come to a similar decision to Medical Assessor Hong’s, that is that the claimant has a non-threshold injury, the diagnosis is different and for that reason the certificate of Medical Assessor Hong should be revoked and a fresh certificate issued.
Due to the sensitive nature of some of the claimant’s history, the Panel directs that this decision be de-identified in accordance with Rule 132(1) of the Personal Injury Commission Rules 2021.
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