Allianz Australia Insurance Limited v Tran

DETERMINATION OF REVIEW PANEL
CITATION:	Allianz Australia Insurance Limited v Tran [2025] NSWPICMP 418
CLAIMANT:	Thi Dan Tran
INSURER:	Allianz Insurance Australia Limited
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	Thomas Newlyn
MEDICAL ASSESSOR:	Christopher Rikard-Bell
DATE OF DECISION:	13 June 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); psychiatric assessment of Medical Assessor (MA) Barrett for whole person impairment assessment (WPI) of post-traumatic stress disorder (PTSD) and treatment and care for psychological consultations; claimant assessed by MA Barrett as having a persistent depressive disorder with anxious distress at 15% WPI and MA Home assessed claimant for physical injuries at 9% WPI; Held – claimant assessed as having an adjustment disorder with anxious and depressed mood; WPI assessed at 6%; the need for further psychological consultations was directly related to the accident but was not reasonable and necessary as it was not focused on pain management; MAC revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Determination 1. The Panel revokes the certificate of Medical Assessor Barrett dated 19 December 2023. 2. The Panel finds that as a result of the accident on 30 July 2020 the claimant suffered an adjustment disorder with depressed mood. 3. The Panel has assessed the claimant’s whole person impairment at 6%. 4. The request for eight further psychological consultations, dated 22 December 2021, relates directly to the injury sustained in the accident. 5. The request for eight further psychological consultations dated 22 December 2021, is not reasonable and necessary in the circumstances.

STATEMENT OF REASONS

INTRODUCTION

This is an application by the insurer for review of a certificate and reasons of Medical Assessor Barrett (the Medical Assessor) dated 19 December 2023.
The Medical Assessor found that the claimant had suffered a post depressive disorder with anxious distress and assessed the claimant's whole person impairment (WPI) at 16%.
The Medical Assessor also found that a request for eight further psychologist consultations on 22 December 2021 related to the injury caused by the accident.
The Medical Assessor also found that a request for eight further psychologist consultations on 22 December 2021 was reasonable and necessary in the circumstances.
There is a dispute between the claimant and the insurer about:
(a) the degree of permanent impairment under Schedule 2 , s 2(a) of the Motor Accident Injuries Act 2017 (the Act);
(b) whether any treatment and care relate to an injury caused by the accident under Schedule 2, s 2(b) of the Act, and
(c) whether any treatment and care provided is reasonable and necessary in the circumstances under Schedule 2, s 2(b) of the Act.
The following injuries were referred by the Personal Injury Commission (Commission) for assessment:
(a) psychological – post-traumatic stress disorder.
The following treatment and/or care disputes were referred by the Commission for
assessment:
(a)
whether the request for eight further psychologist consultations on

22 December 2021 relates to the injury caused by the motor accident, and
(b)
whether the request for eight further psychologist consultations on

22 December 2021 is reasonable and necessary in the circumstances.

The accident

The subject accident occurred on 30 July 2020. The claimant was driving alone, on her way home. The claimant says the car in front of her suddenly braked and stopped. She applied the brakes on her car and was able to stop in time. However, the car behind her was not able to stop in time and collided with the rear of her car.
The claimant reported to the Medical Assessor that she, “lost consciousness”. A passerby knocked on the window and then helped her out of the car. Police and ambulance were not called. She drove to a park nearby, calmed down, and then drove home. The airbags did not deploy. Her car was subsequently repaired but the claimant did not know the cost of the repairs.
According to comments made by the Medical Assessor, the airbags did not deploy and the claimant’s car was capable of being driven after the accident. Police and ambulance did not attend the accident.

Bundles of documents

The parties have each presented their respective bundles of documents upon which they rely. The Panel have read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel or a Panel Member has not read it, in much the same manner as parties not referring to or not specifically relying on a document in their own bundle and submissions.
The fact that evidence is not referred to in these reasons does not mean it has been overlooked and nor is it required that each piece of evidence be mentioned – see WAEE v Minister for Immigration and Citizenship (2003) 75 ALO 630 at [46].The Panel is not required to “analyse every piece of information from every opinion contained in a document with which he [it] was provided” – see Farr v Insurance Australia Limited t/as NRMA Insurance Ltd [2014] NSWSC 1435 at [46]. The Panel has come to its own conclusion and has taken its own history.

Insurer’s submissions

The insurer submits that the Medical Assessor has erred on the following grounds:
· Ground 1- Application of pain to determine psychiatric impairment rating scale (PIRS) categories.
The insurer referred to the Medical Assessor’s certificate where he recorded “as a result of pain she is avoidant of tasks that exacerbate her pain” and “she reports her restrictions predominantly relate to her physical restrictions”. The insurer relies on cls 6.214 and 6.215 of the Motor Accident Guidelines version 9.2 (the Guidelines), which state:
“6.214- Impairment due to physical injury is assessed using different criteria outlined in other parts of these Guidelines.
6.215
The PIRS must not be used to measure impairment due to somatoform disorders or pain.”
The insurer submits that notwithstanding these clauses, the Medical Assessor based the determination of the PIRS classes on aspects of the claimant’s pain-related restrictions. The insurer submits there was a lack of proper consideration of the pain and physical issues reported by the claimant.
The insurer submits that the Medical Assessor has erred in considering the impairments due to physical injury when determining the PIRS classes, pursuant to cls 6.214 and 6.215 of the Guidelines.

Ground 2 – PIRS: social and recreational activities

The insurer submits that the Medical Assessor erroneously found a moderate impairment, class 3, for Social and Recreational Activities in circumstances where the claimant no longer goes out for meals, no longer goes to the Buddhist temple, and in light of the marked reduction compared to her pre-accident pattern.
The insurer submits that there is no evidence the claimant is required to go out without a support person, as required by the Guidelines for a class 3 impairment. Further, the insurer says that the claimant self-reported that her restrictions predominantly related to her physical restrictions which the insurer says has not been taken into consideration for this class rating. The insurer submits that this is an error as the claimant only reduced contact with friends that was often limited to phone contact, per the various psychiatrist Allied Health Recovery Requests (AHRR). The insurer submits that at most, this should be a class 2 mild impairment.

Ground 3 – PIRS: social functioning

The insurer submits that the Medical Assessor erroneously found a moderate impairment, class 3, for social functioning in circumstances where the claimant had become more irritable, socially withdrawn, and her patterns of interpersonal interaction and socialising were not capable of forming new intimate relationships.
The insurer submits that there is no evidence of severely strained relationships evidenced by periods of separation or some other party looking after the claimant’s children, as required by the Guidelines for a class 3 impairment. The insurer submits that this is an error as the claimant only reduced contact with friends that was often limited to phone contact, per the various psychiatrist AHRR’s. The insurer submits that at most, this should be a class 2, mild impairment.

Ground 4 – PIRS: adaptation

The insurer submits that the Medical Assessor erroneously found a moderate impairment, class 3, for adaption in circumstances where the claimant allegedly would only be able to work less than half normal hours and in a less demanding role when the psychiatric symptoms only were considered. The insurer says that the Medical Assessor recorded “as a result of pain she is avoidant of tasks that exacerbate her pain” and “she reports her restrictions predominantly relate to her physical restrictions”. The insurer submits the claimant self-reported that her restrictions predominantly related to her physical restrictions, including specific physical working restrictions, which have not been taken into consideration for this class rating.
The insurer also submits that there is no evidence the claimant would be unable to work in the same position for less than 20 hours per week on only psychiatric restrictions, as required by the Guidelines for a class 3 impairment. The insurer says that there is also no evidence why her business closed close to two years after the subject accident, which may have been unrelated and suggests that possibility of COVID-19 related reasons, for example.

Ground 5 – Stability for assessment

The insurer says that the Medical Assessor considered the claimant stable for assessment of WPI. However, she certified the request for treatment for further psychiatric sessions was reasonable and necessary.
The insurer says that the Medical Assessor specifically noted that further treatment may result in some further reduction of symptoms and improvement in functioning. The insurer submits that the Medical Assessor has clearly erred as her findings have contradicted themselves in circumstances where treatment is necessary, but the claimant’s condition was also found to be stable.

Insurer’s submissions for WPI determination

The insurer submits the claimant failed to comply with cl 14 of Procedural Direction PIC6 which requires a claimant to provide evidence in support of the degree of impairment, asserted by the party.
The insurer submits that there is a lack of any medico-legal evidence, in line with the Guidelines, in support of the claimant’s application. The insurer says that there is no evidence of any impairment of any alleged physical or psychiatric injury that exceeds the threshold, or at all.
The insurer relies on the report of Dr Whetton, psychiatrist, dated 19 October 2021 who diagnosed the claimant with residual symptoms of anxiety from previous post-traumatic stress disorder, and said that maximum medical improvement has been reached.
The insurer said that Dr Whetton provided a WPI of 1% in relation to psychiatric injuries sustained in the motor vehicle accident.
The insurer submits there is no evidence to support the claimant’s sustained psychological injury as alleged, or that the impairment exceeds the threshold.
The insurer submits the claimant’s psychiatric injuries do not exceed 10% WPI.
The insurer relies on the opinion of Dr Whetton who stated, “Further psychological treatment is unlikely to be necessary or useful and it is recommended that this can be reduced and ceased.”

Reasonable and necessary

The insurer refers to the AHRR’s dated 18 September 2020, 15 January 2021, and
3 June 2021, and submits the claimant has received psychoeducation on trauma, eye movement desensitisation reprocessing, established calm place relaxation, implemented exposure therapy and cognitive restructuring.
The insurer submits the claimant has been provided sufficient education in independent management of psychological injury, especially in the current situation where maximum medical improvement has been reached.
The insurer submits the further psychologist consultations are not reasonable or necessary as the claimant has received treatment in the past and has reached maximal medical improvement as stated by Dr Whetton.

Claimant’s submissions

The claimant has addressed the various grounds of the insurer’s submissions.

Ground 1 - Application of pain to determine PIRS categories

The claimant submits the insurer has incorrectly interpreted the Medical Assessor’s medical assessment and certificate.
The claimant submits that the Medical Assessor’s comment that “As a result of pain she is avoidant of tasks that exacerbates her pain” was merely a record of the claimant’s complaint of the pain being experienced and the history of symptoms and treatment following the motor accident.
The claimant submits that the Medical Assessor had clearly identified that she was making a record of the “Physical symptoms” reported by the claimant.
In addition, the claimant says that at no time did the Medical Assessor rely on the claimant’s reported pain symptoms in making and determining her PIRS categories. The claimant submits that this has absolutely no relevance to the Medical Assessor’s psychological assessment as alleged by the insurer.
The claimant says that the insurer is incorrect in alleging that the Medical Assessor had erred on the grounds that she had based the determination of the PIRS classes on aspects of the claimant’s pain-related symptoms.

Ground 2 - PIRS: Social and recreational activities

The claimant refers to the insurer submission that the Medical Assessor has erroneously found a moderate impairment, class 3, for Social Recreational Activities in the circumstances.
The claimant notes that the insurer submits that it should be a mild impairment, class 2.
The claimant says that the insurer’s allegation has not identified that the medical assessment was incorrect. The claimant says that the insurer’s allegation merely states that its opinion on the class rating is different from the class rating of the Medical Assessor. The claimant submits that this is not a ground to establish any reasonable cause to suspect the medical assessment was incorrect in a material respect.
Furthermore, the claimant says that the Guidelines, Version 9.2, states:
“6.217 The scale must be used by a properly trained medical assessor. The psychiatrist's clinical judgment is the most important tool in the application of the scale. The impairment rating must be consistent with a recognised psychiatric diagnosis and based on the psychiatrist's clinical experience.
6.220 Impairment in each area of function is rated using class descriptors. Classes range from 1 to 5 according to severity. The standard form (Figure 6.2) must be used when scoring the PIRS.”
The classes in each area of function are described through the use of common examples. The claimant says that there are intended to be illustrative rather than literal criteria. The claimant says that the Medical Assessor should obtain a history of the injured person's pre- accident lifestyle, activities and habits, and then assess the extent to which these have changed as a result of the psychiatric injury. The Medical Assessor should take into account variations in lifestyle due to age, gender, cultural, economic, educational and other factors.
The claimant says that it is submitted the Medical Assessor has applied her clinical judgment in determining the scale rating, and the assessment cannot be considered incorrect in a material respect merely on the grounds the insurer disagrees with the scale rating.

Ground 3 - PIRS: Social Functioning

The claimant referred to the submission of the insurer that the Medical Assessor had erroneously found a moderate impairment, class 3, for social functioning in the circumstances. The insurer submitted that it should be a mild impairment, class 2. The claimant noted that the allegation merely stated that the insurer’s opinion on the class rating was different from the class rating of the Medical Assessor and that these are not grounds to establish any reasonable cause to suspect the medical assessment was incorrect in a material respect.

Ground 4 - PIRS: Adaptation

The claimant referred to the submission of the insurer when it said that the Medical Assessor had erroneously found a moderate impairment, class 3, for Adaptation, in the circumstances. The claimant says that the insurer has made allegations with respect to the claimant’s inability to work with no substantial evidence.
The claimant submits that it is also clear that the Medical Assessor has clearly expressed her reasonings when determining the claimant’s class rating which has a clear separation from physical restrictions.
The claimant says that the insurer’s allegation merely states that its opinion of the class rating is different from the class rating of the Medical Assessor and that these are not grounds to establish any reasonable cause to suspect the medical assessment was incorrect in a material respect.

Ground 5 – stability for assessment

The claimant says that the insurer’s last ground for review submitted that the Medical Assessor had erred as the findings contradicted themselves in circumstances where treatment was necessary, but the claimant was alleged to be stable.
The claimant submits this ground is not sensible. The claimant says that the Guidelines state:
“6.19 Before an evaluation of permanent impairment is undertaken, it must be shown that the impairment has been present for a period of time, and is static, well stabilised and unlikely to change substantially regardless of treatment. The AMA4 Guides (page 315) state that permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment. A permanent impairment is considered to be unlikely to change substantially (i.e. by more than 3% whole person impairment in the next year with or without medical treatment. If an impairment is not permanent, it is inappropriate to characterise it as such and evaluate it according to these Guidelines.”
The claimant submits that it is clear that a medical assessment may find a claimant stable, and in need of further treatment. The claimant submits there is absolutely no contradiction as alleged by the insurer.

Medical evidence

The insurer has relied on a report Dr Peter Whetton, psychiatrist, dated 19 October 2021. The claimant reported worsening pain, nightmares, and sleep disturbance. She said that she required assistance due to physical restrictions. Shoulder pain continued to impact her sleep. At the time of his assessment, the claimant was using 10 mg of amitriptyline, 300 mg Neurontin and pro re nata (prn- as needed) paracetamol or Panadeine. She was experiencing ongoing lack of sleep, which was reported to be impacting her mood resulting in agitation, anger, frustration and irritability. She said that she was driving but did so more carefully and with less confidence.
Dr Whetton concluded that “Her complaints stem mostly from her lack of sleep”. He noted that she experienced nightmares and intrusive thoughts about the accident for the first six months and was unable to drive. Thereafter she needed to drive and was gradually able to increase her driving ability. Dr Whetton considered that the claimant had post-traumatic stress disorder and over time and with treatment, she had some residual anxiety symptoms but no longer fulfilled criteria for the diagnosis of post-traumatic stress disorder.
Dr Whetton assessed the claimant as having a class 1 impairment in self-care, a class 1 impairment in social and recreational activities, stating she maintained good relationship with her children and family, a class 2 impairment in travel, stating she drove cautiously and with less confidence, a class 1 impairment in social functioning, a class 2 impairment in concentration, persistent in pace, with reduced focus and less accuracy dealing with money in the business. Finally, he assessed a class 1 impairment in employability, when he assessed her difficulties attending and performing work as relating to her physical restrictions rather than psychiatric symptoms.

Dr Whetton assessed WPI at 1%.
Contained within the bundles of documents are various Certificates of Capacity/Certificate of Fitness completed by Dr Duong, the treating GP. Reading this documentation shows that until September 2020, physical injuries mainly were recorded, with the accident having occurred on 30 July 2020.
Clinical notes of the claimants treating general practitioner (GP), Dr Duong, from 1 April 2011 to 8 October 2020, showed that no pre-accident psychiatric history was recorded.
An entry of 31 July 2020 noted, “She felt dizzy and in shock, sat in the car to settle her down. Today she came for assessment as she experiences pain at her shoulders and left elbow, right hand, middle finger numbness, neck pain and back pain.. For stress, anxiety she needs counselling with psychologist”.
An entry of 12 August 2020, recorded “driving only when necessary to see GP, disturbance in sleep, stress situation, fear when driving mood changes, need further psychologist counselling”.
There is an entry of 9 September 2020 that the claimant “had to see psychologist Mina Candalepas for counselling of her anxiety, posttraumatic stress and fear with driving”.
An undated letter from Mr Li, psychologist, received on 19 September 2020 reports the claimant complaining of intrusive distressing dreams, flashbacks about the accident, intense distress, avoidance of driving, avoidance of Parramatta Road, feelings of fear, hypervigilance, startled response, avoiding talking, thinking about the accident, depressed mood irritable mood, sleep disturbance and negative affect. He diagnosed post-traumatic stress disorder.
There is a rehabilitation plan of 30 October 2020 where the psychological symptoms were recorded as “feeling depressed, feeling lots of stressors, not sleeping well. Reported average four to five hours of sleep per night, avoids long distance driving, feeling frustrated and angry”.
In a Certificate of Capacity/Certificate of Fitness dated 12 August 2020 the management plan included “Psychol counselling for PTSD”.
An AHRR number 1, by Mr Li, dated 18 September 2020, gave a diagnosis of “PTSD”. The claimant was reported as having distressing dreams once a week and flashbacks twice a week. She had limited her driving to 15 minutes and was driving less frequently. She had reduced contact with friends.
There is a second AHRR, dated 15 January 2021. There was no change in her capacity compared to that at the initial assessment.
There is a letter from Mr Li undated, recording how Ms Tran fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria with criteria A being “direct exposure – Ms Tran was involved in a car accident”.
AHRR no. 3 dated, 3 June 2021 reported that the then current signs and symptoms were unchanged from the previous two AHRR’s. There had been an improvement to driving 20 minutes at a time compared to 15 minutes at an earlier assessment but no other improvements in functional capacity.
Within the physiotherapy records, there is a letter dated 12 August 2020 which described the claimant as feeling “really shaky” for about 10 minutes after the accident but then her symptoms settled and she was able to drive home, “She reported increased anxiousness/stress following accident and feels very scary to drive especially for long distance”. The claimant was reported as working in her own bakery, 10 to 12 hours a day seven days a week. Following the accident she was noted to be working normal hours but light duties.
Photographs of the claimant’s car were referred to by the Medical Assessor within her certificate but no photographs were contained in the bundles of documents from either party. The Panel has not seen any photographs.
Regarding the claimant’s physical injuries there is a report of Dr Gothelf, orthopaedic surgeon, dated 30 November 2021. The claimant reported that after the accident she had ongoing pain. She was unable to work her pre-accident hours due to pain but felt at that stage she was slowly improving. Dr Gothelf considered that the claimant had suffered cervical neck strain, whiplash and whiplash associated disorder, lumbar spine soft tissue strain and exacerbation of underlying pre-existing degenerative lumbar spine, right shoulder soft tissue injury and left shoulder soft tissue injury as a result of the accident. Dr Gothelf assessed the claimant as having a 21% WPI as a result of the physical injuries.
The records include a letter from Professor Aggarwal, neurologist, 2 August 2021. The claimant was reported as complaining of chronic neck pain since 2016. Notwithstanding this, the claimant was noted to have been able to work full-time but after the motor accident she had reduced to two to three hours, three days a week. Professor Aggarwal considered the claimant presented with chronic generalised musculoskeletal pain syndrome with a neuropathic component and associated sleep disturbance. Professor Aggarwal recommended amitriptyline 10 mg at night, increasing to 20 mg. He was going to request funding for cervicothoracic and lumbar paravertebral blocks, and upper limb nerve conduction studies.
There is a further letter from Professor Aggarwal, dated 13 September 2021. The claimant was reported as having had no improvement in pain since commencing amitriptyline up to 20 mg and was still complaining of pain in her cervical, thoracic and lumbar regions. She was sleeping poorly. Professor Aggarwal recommended adding gabapentin up to 600 mg three times a day and continuing amitriptyline 20 mg.
Regarding the claimant’s physical disabilities, she was assessed for physical WPI by Medical Assessor Home who provided a certificate dated 3 November 2023. Medical Assessor Home concluded that as a result of the accident the claimant suffered soft tissue injury to her cervical spine, thoracolumbar strain injury, musculoligamentous strain to the left elbow, and soft tissue injury with bursitis in the left and right shoulders.
Medical Assessor Home assessed the claimant as having a 9% WPI as a result of the injuries and considered that further treatment, consisting of an upper limb nerve conduction study, cervical and thoracic paravertebral blocks, as well as consultation with Professor Aggarwal, were related to the accident and also reasonable and necessary. Medical Assessor Home also considered that eight sessions of physiotherapy were related to the accident but not reasonable and necessary.
Medical Assessor Barrett concluded that the claimant appeared to have developed an admixture of some anxiety symptoms, fears and phobia of driving, and re-experiencing symptoms with some nightmares and flashbacks, combined with pain-related insomnia, and mood symptoms. She said that this was most consistent with a diagnosis of adjustment disorder with mixed anxiety and depressed mood.
The Medical Assessor said that the symptoms had persisted and had worsened, such that at times she would have fulfilled the criteria for major depressive disorder, noting negative thoughts, worrying which would impacted her sleep, loss of appetite, poor energy, poor concentration, anhedonia and some suicidal ideation in the past.
The Medical Assessor said that considering the claimant’s symptoms had persisted since mid-2020, over three years to the date of her certificate of 19 December 2023, the claimant would now meet the superseding DSM-5 diagnosis of persistent depressive disorder with anxious distress.
Regarding causation, the Medical Assessor said that the claimant’s condition was caused by the subject accident. There was no known past psychiatric history. The subject accident would not have fulfilled DSM-5 criteria A, as a life- threatening stressor, but nevertheless would have been frightening and she responded with some anxiety. It was noted that the experience of pain from physical injuries, which Medical Assessor Home considered were caused by the subject accident, has caused pain-related restrictions impacting her ability to fulfil her role, her work and non-work roles and which have resulted in pain-related insomnia which have impacted the claimant’s mood and anxiety. In this context the Medical Assessor said that the claimant had developed an adjustment disorder.
The Medical Assessor provided the following PIRS assessment;

Psychiatric diagnoses	1.Persistent Depressive Disorder with anxious distress	2.
Psychiatric diagnoses	3.	4.
Psychiatric treatment description	Previous treatment trial of low dose amitriptyline, 20 mg, for pain, previous psychological treatment, last in 2021

Category	Class	Reason for Decision
1. Self Care and	2	The predominant restrictions here relate to
Personal Hygiene	physical restrictions and pain which cannot be
rated here under Guidelines 1.214 and 1.215.
However there is some reduction in the
frequency of showering, now four or five times
a week compared to daily, and she does not
take care with her appearance, no longer
wearing any makeup. This is consistent with a
mild impairment.
2. Social and Recreational Activities	3	Apart from going to the supermarket and some exercise at home, she no longer goes out for meals. She does not go to the Buddhist temple. She does not go out for meals or otherwise socially. Compared to her pre-accident pattern of socialising there is a marked reduction and she now rarely socialises. This is consistent with a moderate impairment.
3. Travel	2	She drives only short distances. This is consistent with a mild impairment.
4. Social Functioning	3	She described herself as irritable with her children and there had been substantial strain in her relationship with her adult daughter, such that she says her daughter has indicated that she wants to move out. She has forgotten to collect her son from the school and had to set an alarm to do so. She stated she is no longer talking with her sister. Noting her irritability and social withdrawal has resulted in loss of her relationship with her sister, and threats of separation from her adult daughter, and as her current patterns of interpersonal interaction and socialising would not facilitate the formation of any new intimate relationship, on balance this is consistent with a class 3 impairment.
5. Concentration, Persistence and Pace	2	She reports reduced capacity to focus and loss of interest. Subjectively at assessment she needed prompting with questions and some encouragement to continue to participate in the assessment. This is consistent with a mild impairment.
6. Adaptation	3	Although the predominant cause of her inability to work in a bakery were physical restrictions, which are excluded from rating here under guideline 1.214 and 1.215, noting her mood symptoms of irritability and withdrawal and her restrictions to travel only locally, in my view she would be able to work less than half normal hours and in a less demanding role when the psychiatric symptoms only are considered.
List classes in ascending order: 2, 2, 2, 3, 3, 3
Median Class Value: 2.5 equals 3
Aggregate Score: 15
% Whole Person Impairment: 15%

Regarding effects of treatment, the Medical Assessor said that although the claimant reported some reduction in nightmares and improved confidence with psychological treatment, the (AHRR) described minimal change in her symptomatology other than some slight improvement in driving capacity. The Medical Assessor said that therefore, at most there is a 1% treatment effect.
The final WPI was calculated as 15% + 1% = 16%.
Regarding the issue of whether treatment and care was reasonable and necessary, the Medical Assessor said that as it appeared that some of the treatment noted in the AHRR of 3 June 2021 did involve some cognitive behavioural techniques, worry management strategies, sleep hygiene, cognitive restructuring and relaxation, then she considered this treatment was reasonable and necessary.
The Medical Assessor concluded that the request for eight further psychologist consultations on 22 December 2021 was reasonable and necessary in the circumstances and related to the injuries caused by the accident.

Medical examination

The claimant was examined by Medical Assessor Newlyn and Medical Assessor Rikard-Bell on 2 May 2025. Their report follows:
Background
Summary of additional documents considered
All Review Panel members confirmed that they had received and considered the following documents:
1.   Clinical Notes of Dr Chi Lang Duong dated 17 June 2024.
2.   Mr Hansen Li Clinical Notes.
Clinical Notes of Dr Chi Lang Duong dated 17 June 2024 were orthopaedic and neurosurgical consultations that focused on the claimant’s physical symptoms.
Mr Hansen Li clinical notes consisted of psychological Allied Health Recovery Requests (AHRR), The latest AHRR was dated 18 September 2020. Rehabilitation services reports focused on physical symptoms.
Re-Examination
The claimant was 53 years 11 months at the time of the appointment. She was examined using Teams videoconferencing at her home in Kingsgrove. She was unaccompanied. Her daughter and son were not at home.
The interpreter engaged by PIC, Ms Phong (Irene) Bui, was present for the duration of the assessment. Ms Bui's audio stream was sometimes inaudible and she needed to repeat answers and questions. Occasionally, Ms Bui did not hear the assessor's questions that were then repeated.
The assessment began at 9 a.m. and finished at 11:40 a.m.
Assessor Rickard-Bell left the interview at 10:50 a.m. The assessors met in a conference telephone call at 3:40 p.m. to discuss the assessment.
History
Medical History
The claimant was 167 cm.
She weighed 60 kg.
When asked about musculoskeletal problems, the claimant initially stated that there were no issues. When questioned specifically about the neck pain recorded by her GP, she reported having experienced a sore neck sometime before the 30 July 2020 motor vehicle accident (MVA) but said the pain had fully resolved and she could work seven days a week.
Operations: None recalled.
Allergies: No known allergies to medications.
Education History
The claimant completed high school in Vietnam.
After high school she studied with a seamstress in the city.
Employment History
After high school, the claimant worked as a seamstress from her parents’ home. She emigrated to Australia in 1998 to learn English. She knew an acquaintance of her sister who lived in Australia.
She started work in 2000 at a tailor shop, then worked as a seamstress in a factory. She then worked in a poultry factory, where she stayed for 10 years.
In 2008 or 2009, she started her own bakery business in Neutral Bay. She had three employees.
After the MVA, because of pain, she worked only a few days a week and took customer orders. The store remained open during COVID but even though the business was still running, she could only be there a few days a week. Because of her inconsistent presence, the business lost customers and had to close.
Economic status
The claimant has received the Disability Support Pension (DSP) from September 2023 because of persistent pain,
Family History
The claimant was born in Hanoi. Both her parents are dead. Her mother died 3 years ago. The claimant returned to Vietnam for the funeral. Her children did not go. She has two older brothers and two older sisters. Her brothers and a sister live in Vietnam. She rarely contacted her brothers and sister in Vietnam before the accident. She visited her sister in Sydney before the MVA. Since the MVA her sister occasionally visits the claimant.
Developmental History
Early development was not recalled or relevant to the present problem.
No childhood sexual or physical trauma reported.
Relationship history
Marital status: Divorced
Marriage history: The claimant married a Vietnamese Australian in 2000. They separated in 2006 and then divorced. Their daughter has lived with her mother since the separation.
A few years after the separation, she started a relationship that lasted two or three years. It ended because she “didn’t feel comfortable in the relationship.” Her son is from that relationship.
She reports maintaining friendly relationships with her former partners, who financially supported their children.
Chemical Dependency History
No use of alcohol, recreational drugs or cigarettes reported. The claimant does not vape.
Forensic History
The claimant reports anger management problems at present.
The claimant does not have a history of legal problems.
The claimant does not have a gambling problem.
The claimant said she had not made any compensation claims before the MVA.
Psychiatric History Before the Motor Vehicle Accident
The claimant denied a mental health problem before the MVA.
Pre-Accident Functioning
The claimant reported she showered before and after work and cooked for her family.
Friends visited the claimant at her shop after trading ended and they would then socialise. She and her children would go to the movies or attend birthday parties on special occasions. She would occasionally go on holiday for up to two weeks. She returned to Vietnam to visit while her mother was still alive.
She had a good relationship with her children, ex-partners and friends
She drove to work every day. She travelled to Vietnam.
She had no problems with focus. She was too busy to read.
She kept her bakery open 7 days a week and worked every day.
History of the Motor Vehicle Accident
The claimant said, "I was on my way home from work. I had just passed Darling Harbour. The car in front braked suddenly and the car behind me hit that car. Then, another car hit them and the car behind struck my vehicle. I fainted but I don’t know for how long.
I woke up in a panic and saw that the back of my car was destroyed. I was scared and overwhelmed. I sat down for a while, then drove to a park near Broadway where I calmed. I drove home. I had trouble sleeping that night because I kept dreaming about the accident. The next morning, I had pain in my neck and shoulders. I visited my doctor that day. My doctor asked me about the pain and I described it. He sent me for an ultrasound and to see a specialist. I can only say that I felt the pain strongly. I remember it being focused on three vertebrae and my lower back.
I had physiotherapy and they gave me a heat pad to use in the microwave. I also received an injection in my shoulder from a specialist but it didn’t help. The last physiotherapy I had was years ago. The pain eventually returned and I got tired of going. The pain still varies and gets worse in cold weather. It feels the same as it did before. I may now have a few physiotherapy sessions under Medicare. Physiotherapy only helps if I go continuously.
I have to take Panadol or get stronger painkillers from my doctor. He prescribes me Mobic. I still use it and even took it last night. The pain affects my sleep a lot.
Because of the pain, I can’t change positions easily, so I end up lying flat. My maximum sleep is four to five hours and then I wake up and try to go back to sleep. Sometimes, I still have dreams about the accident and they wake me. I can't sleep during the day either. I feel tired but still can’t sleep."
History of Symptoms Following the Motor Vehicle Accident
The claimant said, “I fainted. I think I was driving around 70 km/h and panicked when I braked. I’m not sure why I fainted. I woke up to someone knocking on my window. I woke up scared and my heart was beating fast. I was so frightened that driving the car to the park near Broadway was hard. My legs and arms were trembling.
At first, I couldn’t call my friends. I called my daughter and then I drove home. I was scared.
I couldn’t drive for a long time. Later, the insurance company sent me to see a psychologist, who advised me to try driving again. I started by driving to the station and taking the train to work.
My injury affected my emotions. Now, I can't work because of the pain, and I also can’t do housework. It has been a long time since I’ve gone out to see anyone—maybe a few years. When you’re in pain and exhausted, you don’t have the spirit to do anything.
Now, I only drive my son to and from school. I go grocery shopping and cook a few times a week. We rarely go out, usually only when my children insist—maybe once or twice a year. I go out with them for their birthdays. (The claimant was tearful as she talked of driving her son.) I want to go out for my own birthday. I go out with them because I want them to be happy. But inside, I don’t feel happy. Because of the pain, I’m often grumpy and unhappy. I see that this hurts my children.
I’m unhappy that I can’t work and don’t have much money. I’m angry because of the pain. When my children make mistakes, I speak my mind and it can be hurtful.
(Asked about thoughts of self-harm, she became tearful ) Yes, I have thought about dying. But when I thought of my children, I couldn’t do it. I couldn’t go through with it. I thought I needed to be healthy to support my children.
I wish I could think more positively but I keep thinking I’m sick and in pain. I think negatively.
I wish I could be healthy again and care for my children. I can’t think about anything else but my children. My children are my motivation."
History of Treatment Following the Motor Vehicle Accident
The claimant said, “I did not take any other medicine besides painkillers. I bought medicine from the chemist to help me sleep. I didn’t want to rely on medication for sleep. I didn’t ask for any medicine for depression.”
She was prescribed Mobic (the non-steroidal anti-inflammatory medication meloxicam) and also used paracetamol (an analgesic).
She did not consult a psychiatrist.
The claimant said, “I saw a psychologist [Mr Hansen Li]. The insurer sent me there. When I met with him, I did feel a bit better. But when I’m in pain, I think negative thoughts.”
She consulted a pain specialist but reported that her condition did not improve. She was prescribed medicines, but she stated that they did not help. She could not recall their names. The Joint Bundle lists Neurontin [the pain-modulating anticonvulsant medicine gabapentin] and amitriptyline [a tricyclic antidepressant medicine prescribed in low doses for pain management].
One specialist believed surgery might help but advised that she was too young for surgery. The claimant said she was also afraid of having surgery.
Physiotherapy and exercise programs were prescribed.
Details of Any Relevant Injuries or Conditions Sustained Since the 30 July 2020 Motor Vehicle Accident
There have been no relevant injuries or conditions sustained since the MVA.
Current and Proposed Treatment
The claimant uses Mobic and paracetamol for pain control.
She receives general practitioner care.
The claimant does not receive psychiatric or psychological care. The claimant said, “I feel my mood will be better when my pain is better.”
There are no physiotherapy or exercise programs in progress.
The claimant did not expect a change in her current treatment.
Mental State Examination
Appearance: Her appearance was consistent with her age. She wore glasses.
Grooming: She was neatly groomed. Her hair was brushed and short. She did not wear makeup. She had neatly applied nail polish.
She wore a long-sleeve fleece top and slacks.
Activity: She sat for ninety minutes without moving but after that, she appeared uncomfortable in her chair. At 11:15 a.m., she complained of increasing pain due to the length of time she had to remain seated while answering questions.
No psychomotor retardation or agitation was observed.
Movements: No tics or vocalisations were reported.
Aggression: No hostile acts towards peers or property were reported.
Impulse Control: Impulse control was average. She was not accident-prone.
Interaction: She was cooperative throughout the interview.
Facial Expression: Her facial expression was appropriate to the verbal content. At times, she appeared anxious.
Eye Contact: Eye contact was good.
Language: She spoke at an appropriate rate and average volume, providing goal-directed responses. Her answers were lengthy and conveyed relevant information clearly.
Affect: She appeared anxious, which was consistent with the content of her thoughts. Affective reactions were appropriately modulated. No evidence of cyclic mood changes. Suicidal ideation was absent.
Phobias: None reported.
Obsessions: None observed or reported.
Dissociative Features: No dissociative behaviours were observed or reported.
Preoccupations: None reported. No recurrent self-injurious behaviour patterns were identified.
Perceptions: No perceptual anomalies were reported.
Hallucinations: None reported.
Delusions: None reported.
Sensorium: Clear.
Memory: No short-term or long-term memory deficits were noted. While she did not recall the names of specific medications or some dates, she could clearly describe other past events that did not need precise dating.
Concentration: Not impaired during this clinical assessment. She attended to the task at hand without difficulty. Her comprehension of posed questions was intact.
Abstraction: Abstraction was not formally assessed. Her first language is not English.
Attitude: She expressed feelings of worthlessness and loss of function, saying: "Before, I could work and now I can’t. I don’t enjoy anything and feel like I’m a worthless person. I can only try to be with my children. I have to be here for them—they rely on me."
Current Functioning
The claimant lives with her son and daughter in a house she owns in Kingsgrove.
She has no pets.
Daily routine:
She wakes up around 4 or 5 a.m., walks in the yard, has a light breakfast, usually cereal from Woolworths and then wakes her children. Her children help themselves in the morning.
In the morning, she watches television for 10–15 minutes but then stops out of boredom. She then goes into the garden to sit. When it rains, she sits under cover outside. When she has lunch, it is often noodles or leftovers and sometimes she skips lunch.
To pass the time, she draws or crochets. She makes simple squares. She explained that she did not have time for these activities before the accident and only started them afterwards. She also colours in picture books. Reading is difficult and she struggles to remember what she reads.
She may watch television depending on her mood but often finds it difficult to concentrate and described doing "a little of this and that." She finds it hard to focus due to boredom and pain, which also makes it difficult to sit still. She reported pain at 11:04 a.m at the time of the conference, having commenced at 9.00am, from sitting for a long time.
She usually has dinner with her children. If she had a late lunch, she may not eat dinner. After dinner, usually around 8 p.m., she lies down to make her back more comfortable. She checks her son’s homework and advises him to go to bed. Her daughter typically goes to bed later.
From around 10 p.m., she tries to fall asleep, but it usually takes an hour or more before she can fall asleep.
Her son studies Vietnamese online on Saturdays. On Sunday afternoons, he attends tutoring and his father drives him there. Her son never stays with his father. The claimant stated that she has a normal relationship with her ex-partners.
Her daughter occasionally goes out with friends.
Self-Care and Grooming:
Before the accident, the claimant bathed before and after work. Currently, she bathes three times a week when it is hot and twice a week when it is cold.
She has short hair. Roughly three to four weeks ago, she had it cut short, saying that it had been long and difficult to maintain. She had long hair for two to three years and her daughter trimmed it when it was long.
She does not wear makeup anymore. She used to before the accident, but she no longer does, saying, “There is no reason, as I stay at home. I’m not motivated.”
She cooks two to three times a week. Her children often purchase takeaway meals.
Domestic Functioning:
The claimant does not complete many household chores. She may wipe the table and put dishes into the sink but her daughter does most of the cleaning.
Mood and Emotional State:
She reported no significant change in her mood throughout the day.
She is no longer actively involved in any social network. Previous relationships have ended. Initially, friends may have sent her messages but contact diminished and she eventually stopped responding. She stated, “Now, I don’t really have friends.”
Her intrafamilial relationships are restricted. She said her sister may visit but the relationship is poor.
Mobility and Travel:
There are no formal psychiatric restrictions on travel. However, the claimant reported fear when driving, particularly due to pain when turning her head. For safety reasons, she rarely drives.
Following the MVA, she travelled to her work by train and the M30 bus from Sydenham to Neutral Bay. She reported still feeling scared even when someone else drives her to appointments. However, she noted that being on a plane felt different—“like a house”—and she was not as frightened.
Cognitive and Functional Capacity:
Since the MVA, the claimant has lost interest in pastimes and does not go to recreational venues.
She reported difficulty concentrating on tasks compared to before the MVA. She cannot focus on reading but may spend up to 10 minutes trying. She stated that she does not enjoy reading and becomes bored easily. She may do a little crocheting for up to 10 minutes. She rarely completes tasks and is easily distracted. Her work pace has slowed.
She could not work seven days a week after the MVA because of her pain. She returned to work part-time and only took orders and supervised her employees. Eventually, the business was unprofitable and she closed it in early 2022.
Spiritual Practice:
She identifies as Buddhist. She used to attend the temple occasionally before the MVA but has not done so since.
Comment on consistency
There was consistency between the history of current psychiatric symptoms, presentation at the assessment interview and findings on examination.
Review Panel Deliberations
Stabilisation:
The Review Panel considered that the claimant’s injury is permanent because of the time since the MVA and the stability of symptoms. The impairment is unlikely to change substantially or by more than 3% in the next year with or without mental health treatment.
DSM 5-TR Psychiatric Diagnosis and reasons
F43.20 Adjustment Disorder with Anxious and Depressed Mood, Persistent
Adjustment Disorder – Diagnostic Criteria
A. Developing emotional or behavioural symptoms in response to an identifiable stressor (in this case, the MVA with resulting persistent pain) occurring within three months of the onset of the stressor.
B. These symptoms or behaviours are clinically significant, as shown by one or both of the following:
·    Marked distress that is out of proportion to the severity or intensity of the stressor, considering the external context and cultural factors that may influence symptom severity and presentation.
·    Significant impairment in social, occupational, or other important areas of functioning.
C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a pre-existing mental disorder.
D. The symptoms do not represent normal bereavement.
E. Once the stressor or its effects have ended, the symptoms do not persist for more than another six months.
Persistent Specifier:
The Persistent specifier applies when the length of the disturbance exceeds six months in response to either a chronic stressor (persistent pain) or a stressor with enduring consequences.
Comment:
Given the claimant’s description of pain as persistent and severe, she continues to meet the diagnostic criteria for Adjustment Disorder with Anxious and Depressed Mood. She reports sadness that varies with the pain and anxiety about the future. She does not meet the criteria for Persistent Depressive Disorder, as her mood is reportedly better on some days, particularly when the pain is less severe, and she said would no longer be sad and anxious if she were not in pain.
The claimant’s experience of the MVA does not meet the diagnostic criteria for Posttraumatic Stress Disorder, as it does not satisfy Criterion A. Specifically, she was not involved in an accident that involved actual or threatened death or serious injury.
Causation and reasons
The claimant had no history of mental health disorders before the 30 July 2020 MVA. She responded to the accident with anxiety symptoms and nightmares within the first twenty-four hours. Her persistent pain that did not respond to treatment led to the development of an Adjustment Disorder with Anxious and Depressed Mood, which has continued and has not responded to psychological counselling treatment.
On 2 May 2025, she reported symptoms consistent with the diagnostic criteria for Adjustment Disorder with Anxious and Depressed Mood.
Current permanent impairment
Under the Guidelines, the Psychiatric Impairment Rating Scale does not assess impairment from somatoform disorders or pain.
The degree of whole person permanent impairment of the injuries caused by the accident was calculated as follows: -

Psychiatric diagnoses	Adjustment disorder with depressed mood
Psychiatric treatment Description	Psychological counselling has ceased
Category	Class	Reason for decision
Self-care and personal hygiene	2	Mild impairment. The claimant can prepare meals for herself and her two children. She has reduced her frequency of showering from twice daily (pre-accident) to three times a week in warmer weather and twice a week in colder weather.
Social and recreational activities	2	Mild impairment. Pain-related symptoms and decreased motivation have led her to only go out with her children for birthday meals. She travelled to Vietnam to attend her mother’s funeral. Before the MVA, she met with friends at her shop and socialised after work. She has since stopped socialising with these friends.
Travel	2	Mild impairment. She can drive unaccompanied to grocery shop, travel by train alone and has flown to Vietnam for her mother’s funeral. Her anxiety while driving has resulted in her restricting her driving to her local area. She travelled to work after the MVA by bus and train but now has no need to travel.
Social functioning	2	Mild impairment. She has become more irritable with her children but there has been no breakdown in the relationship with them and no domestic violence. Her contact with friends has ceased and contact with her siblings is rare.
Concentration, persistence and pace	2	Mild impairment. Although she has taken up crocheting since the accident, she reports only being able to continue for 10–15 minutes at a time. She is similarly unable to read or watch television for more than 10–15 minutes due to reported poor concentration. However, during a two-hour and forty-minute assessment interview, she kept attention and provided well-organised, detailed responses. She admitted not persisting with tasks and described her pace of work as slow.
Adaptation	2	Mild impairment. After the MVA, she continued working in her bakery business in a limited role, primarily as a supervisor and order taker. She stopped working full-time because of pain that limited her ability to work seven days a week. Due to inadequate supervision, the business lost customers and eventually closed due to financial losses. She currently cooks three to four days a week, shops independently and drives her son to and from school. She does not clean the house and relies on her daughter for that.

* %WPI = percentage whole person impairment

List classes in ascending order						Median Class Value
2	2	2	2	2	2	2
Aggregate score						Total	%WPI
+	+	+	+	+	=	12	6%

Current % whole person impairment 6%
Apportionment
There is no pre-existing or subsequent impairment because she did not have a mental health disorder before the 30 July 2020 MVA and the closure of her business did not result in a change in her Adjustment Disorder symptoms.
Adjustment for the effects of treatment

No adjustment is needed, as the psychological counselling provided has demonstrated no measurable treatment effect. The claimant said that her depressed mood was because of her pain and that counselling only helped during the session.

The degree of whole person impairment of the claimant because of the injuries caused by the Motor Vehicle Accident
The total percentage whole person permanent impairment for assessed psychiatric injuries caused by the MVA is 6%. Therefore, permanent impairment is not greater than 10%.
Determination regarding Treatment and Care
Treatment and Care – causation
The request for eight further psychological consultations, dated 22 December 2021, relates directly to the injury sustained in the MVA.
There was no pre-existing mental health condition. The MVA caused the psychiatric condition present at the time of the AHRR, requesting further counselling consultations.
Therefore, the resulting treatment and care relate to the injuries caused by the MVA:
· Request for eight further psychological consultations on 22 December 2021.
Treatment and Care – reasonable and necessary
Specific psychological treatments have proven results for both Adjustment Disorders and Persistent Pain. In 2021, the claimant was treated with trauma-focused therapy. However, this treatment was not directed towards managing an Adjustment Disorder or Persistent Pain. There was no change in the claimant’s capacity during this period, except for a minor increase in driving tolerance, from 15 to 20 minutes.
The psychological intervention was not tailored to aid with her adjustment to chronic pain and the claimant did not find it helpful. Similarly, she did not experience improvement following referral to a pain doctor. As the psychological treatment was not focused on pain management, the request for more sessions is not considered reasonable or necessary.
Therefore, the following treatment and care is not reasonable and necessary in the circumstances:
· Request for eight further psychological consultations on 22 December 2021

The Panel adopts the report and findings of Medical Assessor Newlyn and Medical Assessor Rikard-Bell.

Causation

This has been dealt with in the report of the Medical Assessors, which the Panel has adopted.
The Panel is satisfied that the claimant developed emotional and behavioural symptoms in response to an identifiable stressor, being the subject collision with resulting persistent pain and which occurred within three months of the onset of the stressor.

Conclusion

The Panel finds that as a result of the accident on 30 July 2020 the claimant suffered an adjustment disorder with depressed mood.
The Panel has assessed the claimant’s WPI at 6%.

Determination

The Panel revokes the certificate of Medical Assessor Barrett dated 19 December 2023.
The Panel finds that as a result of the accident on 30 July 2020 the claimant suffered an adjustment disorder with depressed mood.
The Panel has assessed the claimant’s WPI at 6%.
The request for eight further psychological consultations, dated 22 December 2021, relates directly to the injury sustained in the accident.
The request for eight further psychological consultations dated 22 December 2021, is not reasonable and necessary in the circumstances.

ut108comeDocumentSignee

[2025] NSWPICMP 418

13 June 2025