Allianz Australia Insurance Limited v Moore
[2025] NSWPICMP 557
•30 July 2025
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Allianz Australia Insurance Limited v Moore [2025] NSWPICMP 557 |
| CLAIMANT: | Kristy Moore |
| INSURER: | Allianz Australia Insurance Ltd |
| REVIEW PANEL | |
| PRINCIPAL MEMBER: | John Harris |
| MEDICAL ASSESSOR: | John Baker |
| MEDICAL ASSESSOR: | Christopher Rikard-Bell |
| DATE OF DECISION: | 30 July 2025 |
| CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); motor accident; assessment of whole person impairment (WPI) for psychiatric impairment; claimant front seat passenger; no relevant principles in assessment of psychological impairment; Held – claimant’s degree of permanent impairment assessed at not greater than 10%; MAC revoked. |
| DETERMINATIONS MADE: | Medical Assessment – Permanent Impairment WHETHER THE DEGREE OF PERMANENT IMPAIRMENT OF THE INJURED PERSON AS A RESULT OF THE INJURY CAUSED BY THE MOTOR ACCIDENT IS GREATER THAN 10% THE ASSESSMENT MADE BY THE REVIEW PANEL UNDER S 7.23(1) OF THE MOTOR ACCIDENT INJURIES ACT 2017 IS AS FOLLOWS: 1. The Panel revokes the Medical Assessment Certificate of Medical Assessor Canaris dated · Post-traumatic Stress Disorder. |
REASONS
BACKGROUND
On 5 October 2020 Ms Kristy Moore (the claimant) was injured in a motor accident. The claimant was a front seat passenger in a vehicle which was T-boned by the insured causing the claimant’s vehicle to collide with a power pole.[1]
[1] Claimant’s bundle, p 57.
Allianz Australia Insurance Ltd (the insurer) insured the owner and/or driver of the motor vehicle for liability to pay to Ms Moore any damages and/or statutory benefits under the Motor Accident Injuries Act 2017 (the MAI Act).
The issue in this medical dispute are whether the “degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%”. This constitutes a medical dispute within the meaning of the MAI Act.[2]
[2] See Division 7.5 and Schedule 2, cl 2 of the MAI Act.
Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be made in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines are issued pursuant to s 10.2 of the MAI Act. The Guidelines adopt the fourth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA4). Where there is any difference between AMA4 and the Guidelines, the Guidelines are definitive.[3]
[3] Clause 6.2 of the Guidelines.
Pursuant to Schedule 2, cl 2 of the MAI Act, disputes about whether the extent of impairment is a medical assessment matter. 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[4] and, pursuant to s 7.26 of the MAI Act, on review by a review panel.
[4] Section 7.20 of the MAI Act.
This is a review of a medical assessment pursuant to s 7.26 of the MAI Act. The medical assessment the subject of this review was conducted by Medical Assessor Canaris and dated 3 July 2024 (the medical assessment certificate).[5]
THE REVIEW
[5] Insurer’s bundle, p 506.
The application for referral of a medical assessment to a Review Panel (the Panel) was made by the insurer within 28 days after the parties were issued with the original certificate for which the review is sought.[6]
[6] Section 7.26(10) of the MAI Act.
The President referred the medical assessment to the Panel as they were satisfied that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application.[7]
[7] Section 7.26(5) of the MAI Act.
Pursuant to s 7.26(5A) of the MAI Act and Schedule 1, cl 14F(2) of the Personal Injury Commission Act 2020 (the PIC Act), the Panel consists of two Medical Assessors and a Member of 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 the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Merit Reviewer or a Medical Assessor.[8]
[8] Section 41(2) of the PIC Act.
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 proceedings solely based on the written application.[9]
[9] Rule 128 of the PIC Rules.
The review is by way of new assessment of all matters with which the medical assessment is concerned.[10]
[10] Section 7.26(6) of the MAI Act.
The parties filed bundles of documents for the Panel’s consideration.
STATUTORY PROVISIONS
The provisions of the Civil Liability Act 2002 (the CL Act) apply to the MAI Act in determining issues of causation. Particularly ss 5D and 5E of the CL Act.[11] In Raina v CIC Allianz Insurance Ltd[12] Campbell J stated:
“One may accept that a review panel is engaged in a process of dispute resolution by expert assessment of medical issues arising under the Act. However, the questions arise in a legal context and it is incumbent upon the panel, medical practitioners they may be, to correctly apply the law including the law of causation in the exercise of their powers. This includes the provisions of Division 3 of Part 1A of the Civil Liability Act 2002 (NSW), ss5D and 5E: see s 3B(2)(a) of that Act. Although it may be expected that questions about the appropriate scope of liability will arise but rarely.”
[11] See s 3B(2) of the CL Act.
[12] [2021] NSWSC 13 (Raina) at [65].
Further, cls 6.5 to 6.7 of the Guidelines refer to causation of both injury and whether the degree of permanent impairment is caused by injury.
Clause 6.7 of the Guidelines provides:
“There is no simple common test of causation that is applicable in all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.”
ASSESSMENT UNDER REVIEW
The Medical Assessor found that the motor accident caused an aggravation of a pre-existing depressive condition which probably re-emerged following the motor accident.
The Medical Assessor assessed permanent impairment for the psychological injury at 15% finding class 3 for self-care and personal hygiene, social and recreational activities, concentration persistence and pace and adaptation. In respect of the pre-existing condition based on the account of the functioning described by the claimant before the accident, this was assessed at 0% pre-existing impairment with an allowance of 2% made for the treatment effects based on medication.
MATERIAL BEFORE THE PANEL
Pre-existing conditions
The mental health plan created by the General Practitioner (GP) dated 27 October 2017 noted depression and anxiety.[13]
[13] Claimant’s bundle, p 199.
In October 2017 the claimant was prescribed Citalopram and Sertraline which are both anti-depressant medication. The medication was changed to Effexor 75 mg in January 2018.[14]
[14] Insurer’s bundle, p 280.
Ms Baumann, psychologist, provided a report dated 27 October 2017 in relation to the claimant’s treatment for depression and anxiety.[15] The psychologist administered the DASS testing noting scores in the severe or extremely severe range. The claimant reported a cessation of her relationship with her fiancé and moving out of shared rental accommodation and the avoidance of mutual friends which was having a negative impact on her well-being.
[15] Insurer’s bundle, p 61.
In March 2018 Ms Baumann noted improved functioning as the claimant had been involved in a considerable number of large group interactions. The psychologist recommended a continuation of therapeutic counselling.[16]
[16] Insurer’s bundle, p 63.
In April 2018 the GP increased the dosage of Efexor from 75 mg to 150 mg per day[17] and thereafter regularly prescribed that dosage.[18]
[17] Insurer’s bundle, p 267.
[18] Insurer’s bundle, p 280.
In December 2018 Ms Baumann noted ongoing severe range scores on DASS testing. The claimant was dissatisfied with her current employment and considered returning to drafting and wished to continue psychological counselling.[19]
[19] Insurer’s bundle, p 64.
In July 2019 Ms Baumann noted the claimant had started a new job and was enjoying the new workplace culture. The employment change meant that the claimant was not in the same places as her ex-partner. The claimant stated that she was now moving forward making new friends and workplace connections. DASS testing showed a significant improvement although the claimant reported severe anxiety.[20]
[20] Insurer’s bundle, p 65.
On 11 June 2020 the GP provided the claimant with a prescription with five repeats for Effexor (venlafaxine) 150 mg.[21]
[21] Claimant’s bundle, p 160.
Medical records post-accident
The ambulance report noted a high speed two car accident with the claimant trapped in the vehicle, amnesic to events and reporting pain to the cervical spine and left hip.[22]
[22] Claimant’s bundle, p 95.
The hospital emergency discharge record noted a high-speed motor accident with airbags deployed and complaints of pain in the cervical spine and left hip with the claimant amnesic to events.[23] The CT scans of the brain and cervical spine were normal.[24]
[23] Claimant’s bundle, p 100.
[24] Claimant’s bundle, pp 171 - 173.
The claimant attended her GP on 8 October 2020 referring to the motor accident with ongoing hip pain and walking on crutches.[25] The claimant regularly attended her GP for ongoing symptoms caused by the motor accident over the following months. The GP referred the claimant for physiotherapy.
[25] Claimant’s bundle, p 159.
The MRI scan of the left hip dated 19 April 2021 showed a small partial-thickness tear at the anterior superior chondrolabral junction.[26]
[26] Insurer’s bundle, p 210.
On 29 April 2021 Dr Bhimani, orthopaedic surgeon, noted the claimant reported significant left hip pain and referred the claimant to Dr Leong for an opinion on whether a hip arthroscopy would be beneficial.[27]
[27] Claimant’s bundle, p 141.
The CT scan of the lumbar and thoracic spine dated 31 May 2021 was normal.[28]
[28] Insurer’s bundle, p 208.
On 25 June 2021 the GP noted the claimant was coping well with work and had only missed two days in the month. It was noted the claimant was seeing a psychologist fortnightly and her “mental health is going well”.[29] On 14 July 2021 the GP noted that “mood and pain had improved since doing hydrotherapy” although the claimant was unable to do more hours of work due to pain and fatigue and time required for appointments.
[29] Insurer’s bundle, p 108.
In August 2021 the GP noted that the claimant had burning right (sic) hip pain, was using a stick to ambulate and was unable to sleep due to pain.[30] Dr Leong, orthopaedic surgeon, then recommended that the claimant undergo a left hip arthroscopy and labral repair.[31]
[30] Insurer’s bundle, p 112.
[31] Claimant’s bundle, p 149.
In January 2022 the GP noted that the claimant’s grandmother had passed away recently from pneumonia which was unexpected, and the claimant was seeing a psychologist that day.[32]
[32] Insurer’s bundle, p 124.
On 13 January 2022 Ms Vracar noted that the applicant reported insomnia from nightmares and flashbacks, fatigue and chronic pain from the left hip injury described as between seven on better days and 10 out of 10 on the bad days.[33]
[33] Claimant’s bundle, p 131.
On 9 March 2022 the claimant underwent left surgery when the acetabular labral was repaired.[34]
[34] Claimant’s bundle, p 220.
In mid-2022 the GP noted a flareup of endometriosis.
On 3 September 2022 the GP noted the claimant was feeling better and wanted to reduce the dose of Effexor reporting that she is “getting better with her depression and would like to wean herself off it”.[35]
[35] Insurer’s bundle, p 130.
On 29 October 2022 the GP noted that the claimant had been “feeling better lately for the last seven months”. The claimant had been tapering the medication for the last two months which was then halved to 37.5 mg every second day.[36]
[36] Insurer’s bundle, p 140.
On 23 November 2022 the GP noted the claimant was feeling better, had no self-harm thoughts and was continuing to taper her dosage of Effexor.[37]
[37] Insurer’s bundle, p 134.
Ms Baumann, psychologist provided a report dated 4 March 2023.[38] The psychologist requested the employer to then consider reducing the claimant’s work hours. It was noted that part of the claimant’s self-care included psychological counselling, getting into nature by camping and engaging in artistic pursuits.
[38] Claimant’s bundle, p 92.
In mid-2023, Dr Malouf, surgeon, noted recent deterioration in gastrointestinal symptoms and recommended further scans.[39] This consultation followed recent robotic lap endometriosis removal.[40]
[39] Insurer’s bundle, p 85.
[40] Insurer’s bundle, p 150.
Qualified opinions
Dr Nagesh, psychiatrist, was qualified by the claimant and provided a report dated 1 May 2023.[41] The doctor noted that the claimant was currently unemployed having been off work since March 2023.
[41] Claimant’s bundle, p 85.
Dr Nagesh noted that the claimant was previously diagnosed with depression and was prescribed antidepressant medication which she continued to take up till motor accident. At the time of the accident the claimant was working full-time and was fully functional.
Dr Nagesh noted post-accident symptoms including the development of nightmares, flashbacks, anxiety, hypervigilance, mood swings and irritability, anxiousness, hypervigilance, social withdrawal and lack of energy and motivation. The medication was changed from venlafaxine to sertraline because of the above symptoms.
Mental state examination showed that the claimant appeared of stated age, was casually dressed with reasonable self-care, was highly anxious, cooperative and made intermittent eye contact. There was no formal thought disorder, no delusions of obsessions and no suicidal ideation.
Dr Nagesh diagnosed post-traumatic stress disorder and persistent depressive disorder with a guarded prognosis caused by the motor accident. The doctor opined that the psychological conditions were quite severe and debilitating and prevented the claimant from maintaining employment.
Dr Nagesh assessed the claimant is having a class 3 (moderate) impairment for self-care and personal hygiene, social and recreational activities, concentration persistence and pace and was totally impaired (class 5) for adaptation.
Dr Potter, psychiatrist, was qualified by the insurer and provided a report dated 21 May 2024.[42] Dr Potter noted post-accident employment as a digital sales agent selling health insurance on a part-time basis and then working with the Australian Taxation Office (ATO) working approximately 10 hours a week.
[42] Insurer’s bundle, p 21.
The doctor noted that the claimant moved back into her mother’s home after the accident and the mother attended to the domestic duties. The claimant drover her vehicle although felt anxious and more cautious.
The claimant reported having no interest or hobbies and no social activities. The only family relationship was with her mother. The claimant’s job with the ATO involved processing.
Dr Potter opined that the claimant presentation was consistent with a flat/depressed emotional state or a lower end of cognitive functioning. The doctor opined there was a poverty of history and some unreliability which made a diagnosis difficult.
Dr Potter opined that the claimant presented with anxiety and depression which is limiting her life and functioning significantly. He opined that the claimant suffered an adjustment disorder with mixed anxiety depression which was facilitated by a background of emotional fragility.
Dr Potter assessed the claimant as 6% whole person impairment with class 2 assessments across a broad range of PIRS categories and an assessment of class 3 for adaptation.
Dr Ho, orthopaedic surgeon, was qualified by the insurer and provided a report dated
12 October 2022.[43] The doctor noted that the claimant was six months post hip arthroscopy with significant improvement involving less pain and more function.[43] Insurer’s bundle, p 35.
Dr Ho opined that the motor accident caused injury to the left hip and some muscle strain to the neck and low back. The doctor noted there was ongoing mild discomfort in the left hip and end-range discomfort and stiffness and some degree of low back pain without significant functional problems.
Dr Ho noted that the claimant was off work for six months and then returned on part-time light duties. In the last two months the claimant had returned to full-time duties. The doctor assessed whole person impairment of the hip at 2% and opined that this may improve after a further period of exercise physiology.
Dr John Bentivoglio, orthopaedic surgeon, was qualified by the insurer and provided a report dated 12 March 2024.[44] The doctor diagnosed soft tissue injuries to the left shoulder and neck as well as a labral tear to the left hip.
[44] Insurer’s bundle, p 42.
Dr James Bodel, orthopaedic surgeon, was qualified by the claimant and provided a report dated 29 November 2022.[45] Dr Bodel assessed rateable impairments of the cervical spine (5%), lumbar spine (5%) and the left shoulder (6%) totalling 15% whole person impairment. The doctor noted some discomfort on external rotation of the left hip with no assessable impairment.
[45] Claimant’s bundle, p 78.
Claimant’s statement
The claimant provided a statement dated 21 June 2024.[46] The claimant was seeing a psychologist once every month to two months before the accident but was working full-time and functioning well, able to drive and travel without restriction, was sociable and independent in her self-care.
[46] Claimant’s bundle, p 14.
The claimant asserted that since the motor accident she required psychological treatment more frequently and relies on her mother to do the cooking, cleaning and shopping. She requires prompting with showering and her mother’s assistance.
The claimant stated she has become a social recluse and can only drive and travel in local and familiar places. Due to the psychological symptoms the claimant’s concentration and attention is extremely poor, and she cannot concentrate long enough to read newspaper articles.
The claimant commenced work with the Australian Taxation Office as a service delivery officer working 10 hours per week and stated she has does not have the capacity to work any more hours. The duties include liaising with customers and assisting them in providing them with advice regarding superannuation.
The claimant stated that she has ongoing left hip and lower back pain and walked around the office every hour to ease the pain.
The claimant stated she remained depressed and continued to have mood swings, was irritable and suffered panic attacks, anxiety, excessive worry, nightmares and flashbacks. She remained hypervigilant when in the car and lacked energy and motivation. She said she spent most of her time at home and did not go out.
SUBMISSIONS
Claimant’s submissions dated 15 December 2023[47]
[47] Claimant’s bundle, p 7.
These submissions supported the application that the claimant’s whole person impairment as a consequence of the injury sustained in the motor accident exceeded 10%.
The claimant referred to the various physical’s injuries caused by the motor accident noting that the claimant experienced nightmares and flashbacks of the accident approximately one month later.
The claimant referred to the history and pre-existing psychological symptoms following the dissolution of our engagement in 2017 and consultations with Ms Baumann, psychologist. It was submitted that her symptoms resolved however she remained on Venlafaxine.
The claimant noted that she returned to work on four days per week in March 2022 but struggled with the increased hours due to both physical and psychological injuries and reduced these to three days a week. In May 2023 the claimant took a casual position with the Australian Taxation Office working up to 15 hours per week.
The claimant relied on the report of Dr Nagesh who assessed whole person impairment of 20%. She also relied on the opinion of Dr Ho who assessed the physical injuries at 15% whole person impairment.
Claimant’s submissions dated 19 August 2024[48]
[48] Claimant’s bundle, p 4.
These submissions opposed leave to review the medical assessment submitting that the application was an attempt to conduct a merits appeal rather than a medical review of the medical assessment.
Insurer’s submissions dated 17 January 2024[49]
[49] Insurer’s bundle, p 8.
These submissions responded to the claimant’s claim for assessment of whole person impairment for injuries to the cervical spine, lumbar spine, left shoulder, left hip and psychiatric condition.
The insurer noted that the claimant had been treated by Ms Baumann for depression and anxiety in October 2017 and March 2018. In October 2017 the claimant reported that her relationship ended, she had moved out of shed accommodation and was avoiding mutual friends.
In July 2019 Ms Baumann noted that the claimant had commenced a new job and was enjoying the new work culture which meant that she no longer worked with her ex-partner.
In January 2020 the claimant attended upon the Corrimal Healthcare Centre advising that the reduction in Efexor had not helped and would like to go back to the stronger dose (150 mg).
The insurer also noted the records from Dapto Medical and Dental Centre which showed a history of symptomatic endometriosis requiring surgery.
The insurer referred to records from East Corrimal Medical Centre which noted the claimant’s history of pre-accident depression and need for antidepressant medication
The insurer referred to the clinical note dated 27 May 2021 which noted the claimant was coping well with her work activities and that her mood was okay. On 14 July 2021 the claimant reported that her mood had improved since commencing hydrotherapy. On 29 October 2022 claimant reported she continue with antidepressant medication was feeling better over the last seven months. On 23 November 2022 she indicated she believed her symptoms were well-controlled.
The insurer noted the pre-accident antidepressant medication with ongoing complaints of left hip symptoms and had undergone a left hip level repair. In August 2022 the claimant was six months post-surgery and was moving towards pre-injury duties.
The insurer referred to the opinion of Dr Nagesh, psychiatrist, who was qualified by the claimant. Dr Nagesh noted a pre-existing psychiatric condition and diagnosed a post-traumatic stress disorder and persistent depressive disorder. The insurer submitted that the assessment of whole person impairment made by Dr Nagesh was “exaggerated and inconsistent with the objective evidence of function and impairment”. It otherwise submitted that the assessment was inconsistent with the fact that the claimant was on antidepressant medication at the time of the subject accident and in the 12 months prior to the accident and requested an increasing dosage to control symptoms.
The insurer submitted that the conclusion by Dr Nagesh that the claimant had not achieved any significant recovery following the accident was inconsistent with the records identifying a good response to medication and stabilisation of her symptoms.
Insurer’s submissions dated 7 June 2024[50]
[50] Insurer’s bundle, p 16.
These submissions related to the application to rely on the report of Dr Potter, psychiatrist dated 21 May 2024. The insurer referred to the various histories obtained by Dr Potter.
The insurer also referred to records produced by East Corrimal Medical Centre noting:
· 15 February 2023 – Sertraline was working better and anxiety symptoms were well-controlled;
· 17 April 2023 - symptoms of depression were reportedly well-controlled;
· various treatments for pain and surgical procedure in 2023;
· the claimant had been on antidepressant medications from at least 2015, and
· prior to the motor accident the claimant had been prescribed medication for gastroenterological conditions and insomnia.
Insurer’s submissions dated 1 August 2024[51]
[51] Insurer’s bundle, p 5.
These submissions sought leave to review the medical assessment.
The insurer referred to clause 6.213 and 6.214 of the Guidelines which provide that the assessment of the impairment under the PIRS scales must be attributable to a psychiatric diagnosis and not to physical injury.
The insurer submitted that a class 3 assessment for self-care and personal hygiene was inconsistent with the history provided by the claimant that she had returned to employment after the accident, at times on a full-time basis. It also submitted that Dr Potter, who assessed the claimant in May 2024, assessed a class 1 impairment.
The insurer submitted that the assessment of the pre-existing psychological condition was not undertaken in accordance with clause 6.218 of the Guidelines as there was only an estimate of the level of pre-accident impairment.
RE-EXAMINATION
Ms Moore was examined by both Medical Assessors on 23 July 2025. The examination report is as follows:
“The claimant attended the re-examination on 23 July 2025. The examination was conducted via MS Teams.
HISTORY
Psychosocial History
Ms Kristy Moore is a 32-year-old woman and resides with her mother, aged 56, who works full-time in aged care. Ms Moore is currently working 8 hours per week for the Australian Taxation Office in superannuation enquiries in a call centre. She ceased work at Medibank in March 2023 and commenced at the ATO in May 2023, 15 hours per week, which was reduced to 10 hours per week until early 2025, then reduced further to 8 hours per week. Ms Moore is the only child of her parents who separated when she was 4 years old. There was very little contact with her father, and she last had contact with him when she was 17 years old. Ms Moore was raised by her mother and grandparents, with whom there was a close, loving relationship and she felt secure and supported. She said, “I felt loved” and said she grew up in Russell Vale. Ms Moore did well in primary school; however, due to her age, she repeated Year 3. She continued to progress well throughout the remainder of primary school, and she excelled at sport. In high school, she attended Kiera High School from Year 7 to 10, then Year 11 and 12 at Wollongong High School. Ms Moore achieved well in the HSC, then studied architecture and interior design at TAFE for two years. She worked at a call centre as a manager at an electrical and gas company for five years, then changed to Medibank, where she worked for four years before the motor vehicle accident.
Pre-Accident Functioning
Before the accident, Ms Moore was able to care for herself well. She took pride in her appearance, fitness and health. She was self-sufficient, even though she had moved back to live with her mother; however, this was during the COVID pandemic. There was a close relationship between her mother and her mother’s friends. She attempted to date, but was unable to establish an ongoing relationship and did not form any new relationships. She was able to concentrate well and was efficient with problem solving. She was socialising well and attending the gym, where and claims she was able to bench press 110 kg. Ms Moore was working 8 ½ hours per day in a high-profile managerial position and she could travel without restrictions.
Past Medical History
There has been treatment for endometriosis, including four laparoscopic procedures. The most recent procedure was in 2025 and hopefully a success. There has been treatment with Amitriptyline for endometriosis, which was not successful, and the medication was ceased in 2015. There has been treatment with venlafaxine for depression when there was a relationship breakdown and she required counselling. Treatment with venlafaxine 150 mg continued until 2023, when it was changed to Sertraline 50 mg, which is continuing. There are no other serious illnesses, injuries or conditions. There is no family history of psychiatric illnesses and no drug or alcohol history.
Past Psychiatric History
There was a depressive condition in 2017 when the relationship with her fiancée broke down and there was treatment with Deborah Bauman, as well as antidepressant medication. Due to the condition, Ms Moore moved from independent living to her mother’s residence and there was further treatment with counselling and antidepressant medication, following which her condition improved; however, the COVID pandemic coincided at the time, therefore she remained at her mother’s home.
Past Forensic History
There is no history of motor vehicle accidents, Workers’ Compensation claims, insurance claims or legal issues.
History of the Accident
On 5 October 2020, Ms Moore was involved in a motor vehicle accident as a passenger with her mother, who was the driver, when another vehicle collided with the driver’s side of the car. Ms Moore was knocked unconscious, briefly waking up when the car was being cut open, then fell unconscious again and woke up in the hospital. Ms Moore remained in the hospital overnight. It was discovered later that she had a tear of the left labrum, which required surgery in 2022 and a pin was inserted. Ms Moore stated her hip is still problematic and there is pain in the hip rated at 4-8/10 depending on how long she is sitting, standing or walking.
History of symptoms and treatment after the accident
Following the accident, Ms Moore received psychological treatment with Deborah Beauman for a year, then took a break for two years then returned for further treatment in May 2025. The treatment has been helpful, however has not been sufficient. After the accident, Ms Moore was unable to work for a month, then returned to part-time, 4 hours per day, 5 days per week. There was surgery in 2022, and she was away from work for three months and in late 2022, she returned part-time. In March 2023, she ceased work with her previous employer then commenced in her current role in May 2023, 15 hours per week, reducing to 10 hours per week in 2024 and further reduced to 8 hours per week in 2025.
Current Routine
Ms Moore will go to bed at 9:30 or 10 pm and wakes up early on workdays; otherwise, she sleeps in and then will get up and usually stay home. On workdays, Ms Moore arrives at work an hour early, which is a 15-minute journey, and she will drive. She explained there are four floors at work, and she will take calls regarding superannuation and individual personal circumstances regarding accounts, or whether superannuation has been paid correctly. She was required to undergo three weeks of training and upskilling to be able to manage questions regarding superannuation. On returning home, Ms Moore’s mother will cook, and she may assist with tidying up. She will watch television with her mother; however, Ms Moore has difficulty concentrating, or they will look on Netflix to see what movies are of interest.
Current Symptoms
Ms Moore’s sleep is interrupted and there are nightmares about feeling trapped in a vehicle or the perception that everything is blank. There are nightmares about being hit by a truck, a falling feeling or an impact feeling. The nightmares can occur twice per week or worse, up to five times per week. Her appetite and weight are normal. Ms Moore’s mood is low and she feels anxious. She stated she previously liked to read; however, she has found it difficult to read over the past number of years and she has not read a full novel since the motor vehicle accident. Currently, Ms Moore stated she is able to read for up to 30-40 minutes in one session. On weekends, she stays home and potters in the backyard. She will shop online and does not go out apart from when going to work. Only rarely will she go out on a social visit. Ms Moore stated she wished she were no longer anxious and that she was able to manage better. There are still palpitations and a feeling of breathlessness if forced to go out and she avoids leaving the house where possible, although she can travel to work. She is fearful for her safety and there are vivid intrusive memories and dreams about the motor vehicle accident.
Work History
After TAFE, Ms Moore worked at a call centre as a manager at an electrical and gas company for five years, then changed to Medibank, where she worked for four years before the motor vehicle accident.
Mental State Examination
Ms Moore presented as a woman of stated age who was pleasant and cooperative with neatly parted hair tied behind her head. She was neatly dressed, wearing a turtleneck jumper over a white t-shirt and she wore Apple AirPods. Her demeanour was sad and mournful. At times, she became irritated, while at other times she was able to smile. She engaged well with the interview process and was able to provide a clear, coherent history. Her speech was normal in tone and volume. There was no abnormality of perception. Ms Moore’s affect was anxious and depressed with some reactivity. Her cognitive function appeared normal and her thoughts were logical. There was no evidence of any psychotic delusions or thoughts, and her insight and judgement appeared within normal limits. There was no suggestion of exaggerating symptoms or embellishment. Ms Moore wishes she were able to work full-time, return to independent living and be able to manage her life.
Current Functioning
Ms Moore is able to dress, feed and manage herself adequately. She was residing with her mother before the accident then returned to live with her mother after the accident. She was living independently; however, the relationship with her fiancée broke down and for that reason, she was residing with her mother. Even though she made a full recovery from the relationship breakdown and brief depression, Ms Moore remained at her mother’s home. After the accident, her mother has provided some assistance and will prompt her to shower. She will shower daily, and her mother will cook meals. If Ms Moore were residing alone, she would be able to manage adequately; however, she finds it reassuring with her mother’s assistance. Therefore, there is mild impairment of self-care and personal hygiene.
In terms of social functioning, Ms Moore is close to her mother and the relationship is solid. There is a good relationship with her mother’s friends, although there has been no attempt at dating or with other new relationships or friendships since the motor vehicle accident, as her anxiety levels are too high. Due to the fact that there has been inability to reinitiate or attempt new relationships or friendships, there is mild impairment of social functioning; nevertheless, the relationship with her mother is good.
In terms of concentration, Ms Moore can focus and read for up to 30-40 minutes. She is able to manage complex tasks, such as with her job answering questions about superannuation.
She is able to concentrate consistently for up to 5 hours at work, suggesting the ability to manage complicated tasks, even though she becomes tired. Therefore, there is mild impairment of concentration, persistence and pace.
In terms of social and recreational activities, Ms Moore is anxious and does not like to leave the house. She has lost friendships, and she no longer attends the gym or functions. She rarely visits friends, and the last occasion was in December 2024. Therefore, there is moderate impairment of social recreational activities.
In terms of adaptation, Ms Moore has gradually reduced her work hours from 15 hours to 10 hours and currently works 8 hours per week in a less complicated role than previously. Therefore, there is severe impairment of adaptation.
In terms of travel, Ms Moore is able to travel in a car; however, she becomes quite anxious. She prefers to travel in the local area and prefers to be the driver of the vehicle. Therefore, there is mild impairment of travel.
DETERMINATIONS
Diagnosis and Reasons
Ms Kristy Moore is a 32-year-old woman who is an only child. She has always been close to her mother and maternal grandparents, and she functioned well without school. After school, Ms Moore obtained high responsibility roles as a call centre manager at Medibank Private. Ms Moore was previously in a relationship and resided independently; however, the relationship broke down and she moved to live with her mother before the motor vehicle accident. Before the motor vehicle accident, Ms Moore was functioning well and progressing normally.
On 5 October 2020, Ms Moore was involved in a motor vehicle accident, which was frightening and a near-death experience. There was a previous episode of depression in 2017 following the breakdown of the relationship with her fiancée and there was treatment received with antidepressant medication and psychological counselling. Eventually, she recovered and the depression resolved; therefore, she was well before the motor vehicle accident. In summary, the Panel formed the view that Ms Moore developed posttraumatic stress disorder (309.81, F43.10). The criteria according to DSM-5-TR are outlined below:
A. Exposure to actual or threatened death, serious injury or sexual violence in the following way:
· Directly experiencing the traumatic event(s) which was a near-death experience
B. Intrusive recollections and re-experiencing phenomena with nightmares and flashbacks about the accident
C. Avoidance behaviours avoiding travelling as a passenger in a car, avoiding perceived dangerous situations, avoiding talking about the accident and avoiding topics about motor vehicle accidents
D. Negative cognitions with negative emotional state, inability to experience positive emotions and diminished interest in previous activities
E. Marked alterations in arousal with hypervigilance, anxiety, poor concentration and irritability
F. Duration of more than one month and in excess of 4 years
G. Significant impairment of functioning in social, occupational and other important areas of functioning
H. Not due to substance use or other medical condition
FINDINGS
The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[52]
[52] Section 7.26(6) of the MAI Act.
The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[53] and Insurance Australia Ltd v Marsh.[54]
[53] [2021] NSWCA 287 at [40], [41] and [45].
[54] [2022] NSWCA 31 at [11], [21] and [64].
The Panel adopts the extensive reasons provided by the Medical Assessors. We confirm that the impairment is based on the evaluation at the time of the medical assessment (cl 6.21 of the Guidelines) and we have relied on the combined clinical expertise of the Medical Assessors when examining the claimant.
Our assessment differs from that provided by the original Medical Assessor and Dr Nagesh. The differences are explained by the significant time difference between these assessments and that undertaken by the Panel and the claimant’s improved condition in some areas of functioning as explained in these reasons.’
We accept that, pursuant to clause 6.213 and 6.214 of the Guidelines, the assessment of the impairment under the PIRS scales must be attributable to a psychiatric diagnosis and not to physical injury. We have not included impairment of function related to the claimant’s ongoing pain.
The psychological condition is causally related to the motor vehicle accident given the history as provided by the claimant, the nature and onset of symptomatology following the motor accident.
Clauses 6.222 to 6.224 of the Guidelines relates to an adjustment for the effects of treatment. We are satisfied that there is clinical evidence that the medication has been effective in that the symptoms and/or that functioning has improved. Pursuant to cl 6.223 we allow 1% representing a mild treatment effect from the current medication.
We are satisfied, particularly based on the clinical expertise of the Medical Assessors, that the impairment is permanent within the meaning of cls 6.19 and 6.20 of the Guidelines because the condition is well stabilised, and the claimant does not require a change in medication in the foreseeable future.
The psychological condition has stabilised and is unlikely to change by more than 3% within the next 12 months with or without treatment.
The determination as to permanent impairment is made in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Fourth Edition) and Part 6 of the Guidelines.
| Psychiatric diagnoses | 1. Post-traumatic Stress Disorder | 2. pre-existing major depressive disorder, resolved |
| Psychiatric treatment description | Psychological counselling, medication | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene 2. Table 6.11 | 2 | Ms Moore is able to dress, feed and manage herself adequately. She was residing with her mother before the accident then returned to live with her mother after the accident. She was living independently; however, the relationship with her fiancée broke down and for that reason, she was residing with her mother. Even though she made a full recovery from the relationship breakdown and brief depression, Ms Moore remained at her mother’s home. After the accident, her mother has provided some assistance and will prompt her to shower. She will shower daily, and her mother will cook meals. If Ms Moore were residing alone, she would be able to manage adequately; however, she finds it reassuring with her mother’s assistance. Therefore, there is mild impairment of self-care and personal hygiene. |
| 3. Social and Recreational Activities 4. Table 6.12 | 3 | In terms of social and recreational activities, Ms Moore is anxious and does not like to leave the house. She has lost friendships, and she no longer attends the gym or functions. She rarely visits friends, and the last occasion was in December 2024. Therefore, there is moderate impairment of social recreational activities. |
| 3. Travel Ta Table 6.13 | 2 | In terms of travel, Ms Moore is able to travel in a car; however, she becomes quite anxious. She prefers to travel in the local area and prefers to be the driver of the vehicle. Therefore, there is mild impairment of travel. |
| 5. Social Functioning 6. Table 6.14 | 2 | In terms of social functioning, Ms Moore is close to her mother and the relationship is solid. There is a good relationship with her mother’s friends, although there has been no attempt at dating or with other new relationships or friendships since the motor vehicle accident, as her anxiety levels are too high. Due to the fact that there has been inability to reinitiate or attempt new relationships or friendships, there is mild impairment of social functioning; nevertheless, the relationship with her mother is good. |
| 5. Concentration, Persistence and Pace Table 6.15 | 2 | In terms of concentration, Ms Moore can focus and read for up to 30-40 minutes. She is able to manage complex tasks, such as with her job answering questions about superannuation. She is able to concentrate consistently for up to 5 hours at work, suggesting the ability to manage complicated tasks, even though she becomes tired. Therefore, there is mild impairment of concentration, persistence and pace. |
| Adaptation | 4 | In terms of adaptation, Ms Moore has gradually reduced her work hours from 15 hours to 10 hours and currently works 8 hours per week in a less complicated role than previously. Therefore, there is severe impairment of adaptation. |
| List classes in ascending order: 2,2,2,2,3,4 | ||
| Median Class Value: 2 | ||
| Aggregate Score: 15 | ||
| % Whole Person Impairment: 9% including 1% treatment effect | ||
*%WPI = Percentage Whole Person Impairment
Psychiatric Impairment Rating Scale – Pre-existing/subsequent impairment
| Psychiatric diagnoses | Major Depression | |
| Psychiatric treatment description | Psychological counselling Antidepressant medication | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 1 | Ms Moore was able to care for herself well. She took pride in her appearance, fitness and health. She was self-sufficient, even though she had moved back to live with her mother. Therefore, there was no impairment of self-care and personal hygiene. |
| 2. Social and Recreational Activities | 1 | In terms of social and recreational activities, Ms Moore was socialising well and attending the gym. Therefore, there was no impairment of social and recreational activities. |
| 3. Travel | 1 | In terms of travel, Ms Moore could travel and drive without restrictions and there was no impairment of travel. |
| 4. Social Functioning | 2 | In terms of social functioning, there was a close relationship with her mother and her mother’s friends; however, Ms Moore had not resumed dating or formed any new relationships. Therefore, there was mild impairment of social functioning. |
| 5. Concentration, Persistence and Pace | 1 | In terms of concentration, Ms Moore was able to concentrate well and was efficient with problem solving. Therefore, there was no impairment of concentration, persistence and pace. |
| 6. Adaptation | 1 | In terms of adaptation, Ms Moore was working 8 ½ hours per day in a high profile managerial position. Therefore, there was no impairment of adaptation. |
| List classes in ascending order: 1,1,1,1,1,2 | ||
| Median Class Value: 1 | ||
| Aggregate Score: 7 | ||
| Pre-existing % Whole Person Impairment: 2% (treatment effect) | ||
*%WPI = Percentage Whole Person Impairment
Apportionment – pre-existing/subsequent impairment
The claimant was on a high dosage of venlafaxine pre-accident which resulted in substantial improvement in symptoms. We allow 2% for the effects of treatment from medication. Accordingly, there is 2% assessment for the pre-existing psychological condition.
There is no relevant subsequent incident giving rise to any assessable impairment.
Permanent Impairment
The degree of permanent impairment caused by the motor accident is 7% (9% – 2%).
CONCLUSION
The medical assessment certificate for permanent impairment is revoked. A new medical assessment certificate is attached at the commencement of these Reasons.
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