Asraf and Australia and New Zealand Banking Group Limited (Compensation) [2025] ARTA 1144 (30 May 2025)
Applicant/s: Nazmin Asraf
Respondent: Australia and New Zealand Banking Group Pty Ltd
Tribunal Number: 2023/0858
2023/2773
2023/4228
Tribunal:Senior Member S Webb
Place:Sydney
Date:30 May 2025
Decision:The Tribunal affirms the decisions under review.
Statement made on 30 May 2025 at 11:52am
Catchwords
WORKERS’ COMPENSATION – claims for compensation – liability accepted for psychological injury – claimed household and attendant care services – determination denying liability for medical treatment expenses and incapacity for work – claimed knee injuries – employment contribution – issues of credit – disputed facts – video recording and surveillance materials – unreliable evidence – weight of medical and expert opinions based on unreliable subjective account of symptoms and effects – probative value of relevant materials – causal thresholds not met on objective assessment – decisions affirmed
Legislation
Administrative Appeals Tribunal Act 1975 (Cth)
Administrative Review Tribunal Act 2024Safety, Rehabilitation and Compensation Act 1988 (Cth), ss 4, 5A, 5B, 14, 16, 19, 24, 27, 29
Cases
Australian Building and Construction Commissioner v Hall [2019] FCA 274
Comcare v Lees [1999] FCA 753
Fox v Percy [2003] HCA 22
Rush v Nationwide News Pty Ltd (No. 7) [2019] FCA 496
Société d’Avances Commerciales (Société Anonyme Egyptienne) v Merchants’ Marine Insurance Co (The “Palitana”) (1924) 20 Ll L Rep 140
Telstra Corporation Ltd v Hannaford [2006] FCAFC 87Woodhouse v Comcare [2021] FCAFC 95
Statement of Reasons
Nazmin Asraf claimed compensation for a psychological injury in her employment by the Australia and New Zealand Banking Group Pty Ltd (ANZ). Her claim was accepted and compensation was paid. Mrs Asraf subsequently claimed compensation for household and attendant care services, permanent impairment and a right knee injury. ANZ decided to refuse these claims and issued a determination of no present liability to pay compensation for medical treatment expenses and incapacity for work. Mrs Asraf lodged applications for review of these decisions by the Tribunal.
The applications were lodged under the Administrative Appeals Tribunal Act 1975 (AAT Act). The AAT Act was repealed and the Administrative Review Tribunal Act 2024 (ART Act) came into effect on 14 October 2024, establishing the Administrative Review Tribunal (Tribunal). Under the transitional provisions set out in Schedule 16 to the Administrative Review Tribunal (Consequential and Transitional Provisions No.1) Act 2024, the Tribunal has jurisdiction to conduct these reviews.
At the outset of the hearing, Mrs Asraf withdrew application 2024/0592 in respect of compensation for permanent impairment.
As will appear, to a very substantial degree this case turns on accounts Mrs Asraf has given of symptoms and effects she attributes to an incident in her employment, the accuracy and veracity of which are contested. Consequently, it is necessary to closely examine the factual background recorded in the contemporaneous medical records, even though this increases the length of these reasons.
Facts
On 14 January 2019, Mrs Asraf commenced ANZ employment.
In August 2021, she was employed as a banking consultant in the ANZ’s Blacktown branch. Public health restrictions were in place and ANZ instituted restrictive operating policies to limit spread of the Covid 19 virus. Only ANZ customers from the local government area were allowed into the branch.
On Monday, 30 August 2021, Mrs Asraf was involved in an incident with a customer who was refused access to the branch. A video recording of the incident has been provided to the Tribunal. She lodged an Incident Notification Form[1] which included the following information:
[1] Exhibit 1, AT4, 14.
Incident Type: Near miss/No Injury or Illness Brief Description of Incident: (COVID – LGA NON COMPLIANCE) WHEN CUSTOMER WAS ADVISE OF LGA RULES AND HE WAS FROM ANOTHER LGA AND WE WILL NOT BE ABLE TO ASSIST HIM AND HE NEEDS TO GO TO HIS NEAREST LAG BRANCH, HE WAS VERY AGGRESSIVE AND START SWEARING AND BANGING ON THE DOOR AND RESTRICTION TO CLOSE THE DOOR AND COMING TOWARDS MYSELF AND THREATENING ME. Immediate Actions Taken: ANOTHER STAFF MEMBER CAME FOR ASSISTANCE Suggested Preventative Actions: MANAGER ALSO CAME FOR AID AND TALK TO THE CUSTOMER.
After a short break, Mrs Asraf resumed her duties.
On Thursday 2 September 2021, Mrs Asraf attended the Lourdes Medical Centre and obtained a Covid 19 vaccination from a nurse, who noted Mrs Asraf was “Well today”.[2]
[2] Exhibit 3, 341.
Four days later, on Monday, 6 September 2021, Mrs Asraf returned to the Lourdes Medical Practice and consulted Dr Van Thien Nguyen, a general practitioner. Dr Nguyen noted:
55 yo lady presents with PTSD
Work for ANZ bank for 3 years.
Incident at Blacktown Branch happened on 30/08/2021
Abusive male customer – screaing, nearly hit her
She was trying to stop the customer getting into the bank,
He was from a different LGA,
Since has been feeling stress, disturbed sleep
Unable to concentrate
Not able to do housework
Went to work on Tues/Wed
Stay home on Thu/Fri
Traumatic
Been contact with HR
Reason for visit:
Post- traumatic Stress[3]
[3] Exhibit 3, 341.
As can be seen, the doctor noted Mrs Asraf presented ‘with PTSD’ and the reason for her visit was ‘Post-traumatic stress’. It is not clear if Dr Nguyen conducted a mental state examination in order to formulate a diagnosis of any mental ailment Mrs Asraf was experiencing. He did not note any such examination but recorded post-traumatic stress as the reason for the consultation. On his notes, it is likely ‘PTSD’ was a term Mrs Asraf used to describe her symptoms and the reason for her visit. The doctor was not called to give oral evidence so it was not possible to clarify this point with him.
In any event, Dr Nguyen issued a medical certificate in which he recorded the diagnosis of “Post-Traumatic Stress Disorder” and stated Mrs Asraf was unfit for work from 6 September 2021 to 20 September 2021.[4] In all likelihood, the account Mrs Asraf gave on 6 September 2021 informed Dr Nguyen’s reference to a diagnosis of post-traumatic stress disorder in the medical certificate he issued and the terms of his referral of Mrs Asraf to the Blacktown Psychology Centre for treatment, in which he referred to her being “abused from a male customer- who was verbally abusive and physically aggressive toward her”.[5]
[4] Exhibit 1, AT6, 17-18.
[5] Exhibit 1, AT5, 16.
On 7 September 2021, ANZ provided information to Mrs Asraf in respect of claiming compensation.[6]
[6] Ibid, AT7.
On 8 September 2021, Mrs Asraf lodged a claim for compensation.[7]
[7] Ibid, AT8.
In a subsequent consultation with Mrs Asraf on 15 September 2021, Dr Nguyen did not refer to post-traumatic stress disorder, but diagnosed ‘insomnia’ and noted Mrs Asraf was still suffering with stress from the incident and she had a problem sleeping. He prescribed a trial of melatonin.[8]
[8] Exhibit 3, 342.
Mrs Asraf consulted Dr Nguyen on 18 September 2021 and 21 September 2021, but the clinical notes of these consultations do not refer to any psychological symptoms or other alleged effects of the incident on 30 August 2021.
On 20 September 2021, in a telehealth consultation, Mrs Asraf consulted Dr Eric Lim, a general practitioner in the Workers Doctors practice (also known as Wyong Doctors) for the first time. It is not clear if Dr Lim conducted a mental state examination of Mrs Asraf and, if so, what the examination involved. It is likely Dr Lim relied on what he was told by Mrs Asraf. Dr Lim referred Mrs Asraf for psychological therapy and to Dr David Kumagaya, a psychiatrist. Dr Lim noted:
[Mrs Asraf] initially presented on Monday, 20 September 2021, following Psychological injury(ies), sustained on Monday, 30 August 2021.
…
History of injury:
Psychological injury from the workplace. She was verbally abused by a customer at work.
On 30/08/2021, she advised a customer that she was unable to assist him as he lived outside the local government area. She reports that he became aggressive and was shouting at her and trying to hit her. She continued working that day. Her last day of work was 02/09/2021 as she was no longer able to cope psychologically.
She has disturbed sleep due to anxiety and nightmares. She dreams about the customer yelling at her and trying to hit her.
She has gained weight and has been eating more food. She does not have the motivation to exercise.
Symptomatology:
Depressed, stressed, trouble sleeping, trouble concentrating, anxious, nightmares, flashbacks, fatigued, low motivation, palpitations, low motivation, low energy.
Examination:
Current weight: 73kgs
R) handed
Poor concentration
Non-smoker
Does not drink.
Stays at home.
Lives with her family.
Showering everyday.
Impact on patient’s activities of daily living (ADLs)
Self care. Showering everyday.
Domestic duties. Low motivation.[9]
[9] Ibid, 196-198; Exhibit 1, AT10, 36-37.
On 27 September 2021, Carl Nielsen, a psychologist, examined Mrs Asraf in a telehealth consultation. Mr Nielsen’s notes confirm he relied on what he was told by Mrs Asraf. Mr Nielsen reported to Dr Lim:
Psychological History
Dates, timeline of stressors:
Mrs Asraf reflected that she commenced working with ANZ as a banking consultant in 2018 on a part time basis four (4) days per week, seven (7) hours per day. Mrs Asraf explained that on 30th Ausgust 2021 she was at her branch in Blacktown when a customer requested service. There were current covid restrictions in place and the customer was informed by Mrs Asraf that she was unable to serve him as he was not from the same Local Government Area. The client became irate and leant towards Mrs Asraf in attempt to punch her in the face. He continued to scream and push against the entrance door preventing Mrs Asraf to close it. Mrs Asraf noted that there was no security guard on duty on that particular day and that she was experiencing extreme fear. She noted that a colleague came over to assist her with closing the door so that the abusive client could not enter. Mrs Asraf explained that she continued working for the rest of the day. Mrs Asraf explained that she filled out an incident report and called her manager on 30th August 2021. Mrs Asraf noted that approximately three (3) days later she was unable to attend work due to the experience of nightmares and flashbacks regarding the incident as well as sleep disturbance. Mrs Asraf explained that her last day of work was 1st September 2021.
Dates, Onset of Psych Issues:
Mrs Asraf noted a deterioration in her mental state characterised by intrusive and unwanted memories as well as flashbacks to the perpetrator lunging towards her face and attempting to hit her. Mrs Asraf noted anxious and depressive cognitions, rumination and irritability regarding the possibility she may have been stabbed as well as the unanswered question regarding why there was no security guard at her place of work. Mrs Asraf noted avoidance of social interactions and being unable to communicate with her children as well as hypervigilance and nausea. Mrs Asraf noted anergia from sleep disturbance and hypervigilance
…
Mrs Asraf in unfit for any work duties
Diagnosis
Post Traumatic Stress Disorder
Symptoms
Current Signs and symptoms:
Intrusive and unwanted memories as well as flashbacks to the perpetrator lunging towards her face and attempting to hit her. Mrs Asraf noted anxious and depressive cognitions, rumination and irritability regarding the possibility she may have been stabbed as well as the unanswered question regarding why there was no security guard at her place of work. Mrs Asraf noted avoidance of social interactions and being unable to communicate with her children as well as hypervigilance and nausea. Mrs Asraf noted anergia from sleep disturbance and hypervigilance
Return to work barriers
Issues affecting return to work:
Mrs Asraf has lost confidence in her abilities to perform work duties. She has lost trust in her work environment to ensure her safety. Mrs Asraf noted suffering with anergia secondary to hypervigilance and sleep disturbance[10]
[10] Ibid, 199.
As can be seen, Mr Nielsen relied heavily on what he was told by Mrs Asraf.
Later on 27 September 2021, Mrs Asraf consulted Dr Lim by video. The doctor noted:
Acute stress disorder
DOI: 30/08/2021
Ongoing issues
Low mood
Stressed
Overthinking spend most of time
Angry towards company due to lack of support
Trouble sleep
fatigue[11]
[11] Ibid, 200.
On 5 October 2021, by teleconference, Mrs Asraf consulted Dr Ben Dickson, a general practitioner at the Workers Doctors practice. It is probable the doctor relied on what he was told by Mrs Asraf. So much is confirmed by his clinical notes:
Injury: acute stress disorder
Working as consultant at ANZ bank
During covid lockdown advised a customer that could not serve him due to being from another LGA. They became highly agitated, verbally abused her, leaned in towards her and [Mrs Asraf] believed he intended to punch her in the face, he pressed against the entrance door preventing her from closing it. There was no security guard that day for assistance.
She continued working the rest of the day but was unable to continue working beyond 1/9 due to emergence of flashback with anxiety and mood symptoms, nightmares and disturbed sleep
Continues to suffer flashbacks to the event at ANZ
Sleep disturbed
Anxious, agitated during review
Distressed
Hypervigilant
Depressed mood
Has been experiencing these symptoms for just on 1 month
Lady of stated years, appears of Indian ancestry, psychomotor agitation on review, engaged with review
Speech normorpoductive
Mood described in anxous terms
Affect congruend
Nil FTD
Thouhgts characterised by constant fear following the event and post-trauma symptoms, nil pyschotic or acute risks, nil
perceptual Cog grossly intact
l&J appear reasonable
Anxiety has worsened in the past week as has been referred for an IME which is taking place today at 430pm
Has also been referred for a rehabilitation provider?! who has been harassing her about engaging despite her symptoms and severity
Discussed management of Acute Stress Disorder/ PTSD encouraged re: psych thearpy
psychiatrist review coming up in 4 weeks[12]
[12] Ibid, 201.
Later on 5 October 2021, Mrs Asraf was examined in a telehealth assessment by Dr Graham Vickery, a psychiatrist. Dr Vickery produced a report for ANZ in which he set out matters related by Mrs Asraf, including:
Mrs Asraf is employed as a Banking Consultant with ANZ and reported “on 30 August 2021 there was a client from a different local government area when we checked his driver’s licence and when I told him I couldn’t serve him he started screaming abuse straight in my face and then he launched himself at me and I thought he was going to punch me in the face and I was trying to close the door but he was too strong.”
The Supervisor had then come out with hearing the commotion and went to talk to the client and “I said to him he should have called the Police but he said not to worry about it and that I didn’t need to fill out the incident form and I said he should have a Security Guard as there had been a lot of abuse which he had organised for the following day.”
Mrs Asraf had continued working following the incident however “I was upset and nauseated and I felt embarrassed and the Supervisor didn’t ask me how I was and I felt let down and not supported and it should not have happened to me as there should have been a Guard as my workplace was not a safe place”.
Mrs Asraf had not slept that night and has spoken with EAP and then consulted her General Practitioner and she was placed on WorkCover leave.
Mrs Asraf reported “I see the man in my face all the time now because of his abuse and how aggressive he was and I am dreaming about it and I am sweating and I have palpitations and I wake up every hour and I’m not sleeping.”
… “my family are upset with me because I am so irritable and I am having outbursts at my family and I don’t care about things like I did before and I don’t have interest in doing things and I am a different person now and I feel my life has been ruined.”
…
There is fear of being followed by the client and “he could even know where I live and when it happened he told me to call the Police as he didn’t care and he said I didn’t know what he could do and that he needed the money and I had to give it to him and I felt very threatened.”
Mrs Asraf is not driving as “I feel very unsafe as I think he might be following me and I can’t go anywhere by myself and it’s like I don’t have any freedom now and I can’t even go to see my four grandchildren now.”[13]
[13] Exhibit 1, T4, 34-35.
Dr Vickery reported his mental state examination findings, including:
Mrs Asraf’s affect range was labile while her behaviour and mood were often distressed. Her history and presentation were consistent. She was able to relate a coherent and chronological history.
Mrs Asraf was frustrated, apprehensive and fearful. There was no clinically significant anxiety, melancholic depression, paranoid delusional ideation or formal thought disorder. There was no apparent cognitive impairment.[14]
[14] Ibid, 35.
Despite his mental state examination findings, relying on what he was told by Mrs Asraf, Dr Vickery reported a diagnosis of Post-Traumatic Stress Disorder and his opinion:
Mrs Asraf continues to suffer from the effects of the psychological condition on the basis of the history provided.
…
I would anticipate that this condition will resolve within six months or so.[15]
[15] Ibid, 39.
On 7 October 2021, 22 October 2021 and 1 November 2021, Mrs Asraf consulted, Stephanie Falero, a psychologist by telehealth. On each occasion, the psychologist recorded Mrs Asraf’s “Symptoms – patient experience” and her “Examination/Mental State – presentation”.[16] On 7 October 2021, Ms Falero noted:
[16] Exhibit 3, 202-208; Exhibit 1, AT20.
Symptoms - patient experience
-Work: ANZ Banking Consultant (Blacktown). 30/08/21: Customer at work requested service but could not provide this due to Covid restrictions.
Customer lunged towards her and tried to hit her.
Filled out incident form and finished her shift. Worked until 01/09/2021.
-Feels unsupported by her employer.
Since the workplace incident has experienced the following symptoms;
-Low mood, sleep disturbance, avoidance, hypervigilance, feelings of shame, irritability, nightmares, appetite disturbance, somatic symptoms.
-Amotivation, anhedonia, flashbacks, intrusive memories, anergia, impairment in concentration and memory, exaggerated startle response.
-Has gained 4kg due to increased appetite and withdrawal from recreation and exercise.
-Reported taking panadol regular for headaches/other body aches - somatic symptoms?[17]
[17] Ibid, 202.
On 18 October 2021, Mrs Asraf consulted Dr Dickson by telehealth. The reason for contact was noted to be “Work cover”. Dr Dickson noted:
Injury: Acute Stress Disorder/PTSD
Persistent symtpoms 'highly stressed out'
Is being harassed by rehab provider, frequent calls and emails Despite certified as unfit
Worsening symmptoms of intursion, anxiety, disturbed sleep, low mood[18]
[18] Ibid, 203, 206-207.
On 22 October 2021, Ms Falero noted:
Symptoms - patient experience
-Anxious mood, panic attacks, frustration, sleep disturbance (1 hour), headaches, muscle tension, avoidance.
-Hypervigilance, impairment in memory and concentration, hypervigilance, flashbacks, intrusive memories.
-Reported being harrassed by rehab provider via frequent calls/emails. NTD advised that they were awaiting psychiatric r/v.
Examination/Mental State - presentation Low mood, dysphoric affect, normal speech.
ADL's/Psycho Social/RTW - impact on function
-Strain in relationship with family due to irritability.
-Delayed with ADL's.[19]
[19] Ibid, 203.
On 1 November 2021, Mrs Asraf consulted Ms Falero and (separately) Dr Dickson by telehealth. Ms Falero noted:
Symptoms - patient experience
-Receiving calls from her manager every week updating her about what is happening at work. Case manager also calling her for updates. Finds this overwhelming and distressing.
-Muscle tension, irritability, flashbacks, intrusive memories, sleep disturbance, rumination, anxious and depressive cognitions.
-lrritational guilt.
-Taking panadol osteo every 4 hours due to body aches/muscle tension.
Examination/Mental State - presentation Low mood, dysphoric affect, normal speech.
ADL's/Psycho Social/RTW - impact on function
-Strain with family members due to irritability.
-Socially and recreationally withdrawn.[20]
[20] Ibid, 204.
Dr Dickson noted the reason for contact was “Work cover” and:
Persistent symptoms 'really stressed'
ASking re: remedial massage, has already discussed with case manager and asking for a referral. Dicsussed - not a referral service but if case manager indicating support it may be of help in reducing tension headache associated with stress. ADded to management plan on COC
Asking about IME report - case manager had emailed. Discussed findings. Requesting copy. Reminded will meet psychiatrist for treatment this week
Rehab group have not been harassing any further[21]
[21] Ibid, 204-205.
On 2 November 2021, ANZ issued a determination in which it accepted liability for Mrs Asraf’s claimed PTSD injury under s 14 of the Safety, Rehabilitation and Compensation Act 1988 (SRC Act) and determined ANZ is liable to pay compensation under s 16 and s 19 of the SRC Act. The date of the injury was determined to be 30 August 2021.[22]
[22] Exhibit 1, T5, 44.
On 4 November 2021, Mrs Asraf was examined by Dr Kumagaya. The doctor reported to Dr Lim:
… [Mrs Asraf] described how, on 30 August 2021, she had advised a customer that she was unable to serve him due to COVID-19 restrictions. [Mrs] Asraf reported how this customer became upset and agitated, and attempted to punch her. She stated that he subsequently began screaming and pushing against the entrance door to the branch, preventing [Mrs] Asraf from closing it. Given her emergent psychiatric symptoms, she was unable to work from 1 September 2021 onwards.
[Mrs] Asraf reported the onset of posttraumatic stress disorder symptoms subsequent to her workplace incident…
…
Upon mental state examination… There was no psychomotor disturbance, nor any abnormal movements. [Mrs] Asraf’s mood was described in dysphoric and anxious terms. Her affect was dysphoric and restricted in range/mobility/intensity; reactivity was retained, although attenuated. Her speech was assessed to be normal in all domains. There was no formal thought disorder. Her thought content reflected a preoccupation regarding workplace stressors, and depressive and anxious cognitions. She did not identify any acute risks to herself or others. Her cognition was grossly intact, and her insight and judgement were reasonable.
Diagnosis
Posttraumatic stress disorder.[23]
[23] Exhibit 1, AT27.
Dr Kumagaya also provided a report to ANZ in which he reiterated his diagnosis and discussed Mrs Asraf’s functional restrictions and symptoms in the following terms:
Her functional restrictions include those relevant to her capacity towards self-care, personal hygiene, travel, social functioning, engagement in social and recreational activities, concentration, persistence and pace, and employability.
[Mrs] Asraf’s ongoing symptoms include intrusive and distressing memories and dreams of the workplace incident, psychological distress at exposure to external cues that resembled the incident, avoidance of external reminders of the incident, negative emotional state, difficulty experiencing positive emotions, markedly diminished interest in participation in significant activities e.g. leaving the home, socialising, spending time with her family, hypervigilance, exaggerated startle response, consistent middle insomnia, and concentration difficulties.
…
… [Mrs] Asraf is not psychologically fit to complete the initial rehabilitation assessment. The primary barrier towards engagement in the initial rehabilitation assessment is the nature and severity of [Mrs] Asraf’s psychological injury…[24]
The basis on which Dr Kumagaya assessed Mrs Asraf’s functional restrictions is not clear. It is probable he relied on what he was told by Mrs Asraf.
[24] Ibid, AT31, 118-119.
On 11 November 2021, Mrs Asraf consulted Ms Falero by telehealth. Ms Falero noted Mrs Asraf’s symptoms included “panic attacks” and in her mental state examination that Mrs Asraf had “[n]ot engaged recreationally or socially – not walking”.[25]
[25] Ibid, 205-206.
On 15 November 2021 and 29 November 2021, Mrs Asraf consulted Dr Dickson by telehealth. The reason for each visit is recorded as “Work cover”. On 15 November 2021, Dr Dickson noted:
Persistent symtpoms
Avoidant of leaving home
'paranoia'
Anxious
Low mood
Continues to be harassed by rehab provider
Conts to benefit from psych therapy
Has had psychiatric review, discussed continuing psych with consideration of pharmacotherapy at next appt[26]
[26] Ibid, 206.
In his clinical notes of the 29 November 2021 consultation, Dr Dickson recorded that Mrs Asraf was “Feeling ‘very agitated’” and she was “avoidant of leaving home without a support person”. He noted:
Has had psychiatrist review, declined psychotropic medication at that time but now thinking would like to trial medication due to symptom burden
Psychoeducation re SSRIs, role in PTSD and management of anxiety/agitation
Discussed fluoxetine, potential side effects, happy to triel
Also disclosed has been taking Nurofen plus (codeine) twice a day for past 3+ months for back pain since the injury.
Recommended ceasing opioids in favour of simple analgesia, suggested d/w local GP[27]
[27] Ibid, 207.
On 7 December 2021, Mrs Asraf consulted Dr Shervin Prasad, a general practitioner. The records of this consultation do not refer to any psychological ailment or related symptoms. The doctor noted the following reasons for the consultation:
Drivers Licence medical
Disabled parking permit
BP Check
Prescription renewal
Atypical chest pain[28]
[28] Ibid, 317.
On 9 December 2021, Mrs Asraf consulted Ms Falero by telehealth. Ms Falero noted:
Symptoms - patient experience
-Flashbacks, intrusive memories, hyperarousal, anxious and depressive cognitions, nightmares, hypervigilance.
-Low mood, anxious and depressive cognitions, rumination, sleep disturbance.
-Ongoing contact from employer every 2 weeks, feels uncomfortable and pressured to share information about how she feels and her treatment.
To discuss adding no contact to COC with NTD due to distress caused.
-Commenced fluoxetine 10mg on 03/12, experiencing nausea and dizzyness. Taking nexium for GI symptoms.
-Taking panadol only now after discussing with NTD, no nurofen.
Examination/Mental State - presentation Low mood, dysphoric affect, normal speech.
ADL's/Psycho Social/RTW - impact on function
-Strain in relationship with her family.
Her family is worried about her and have noticed how 'different I am'.[29]
[29] Ibid, 207-208.
On 13 December 2021, Dr Dickson noted the reason for Mrs Asraf’s visit was “Work cover” and:
Nil shift in symptoms
Has commenced fluoxetine 10mg
Noting some nausea over the past week
Discussed - will usually settle in couple of weeks
Discussed continuing at 10mg/until nausea settles
Conts to benefit from psych therapy[30]
[30] Ibid, 208.
On 23 December 2021, Ms Falero noted:
Symptoms - patient experience
-Reported mood as fluctuant.
-Sleep disturbance, anxious and depressive ruminations, anergia, intrusive memories, flashbacks, hyperarousal.
-Impairment in memory and concentration, amotivation.
Examination/Mental State - presentation Low mood, dysphoric affect, normal speech.
ADL's/Psycho Social/RTW - impact on function
-Trying to do more domestic duties.
-Went grocery shopping - avoids peak hours.
-Having Christmas at her home with her family.[31]
[31] Ibid, 209.
On 10 January 2022, Mrs Asraf consulted Dr Dickson by telehealth. The reason for the consultation was recorded as “Work cover” and the doctor noted:
'not very good'
Self-isolative
'not doing anything much'
Low motiavtion, high anxiety
Symptoms of intrusion
nausea settled
Discussed increasing to 20mg fluoxetine
Conts to engage in psych therapy[32]
[32] Ibid, 209.
On 20 January 2022, Dr Kumagaya reviewed Mrs Asraf and reported:
[Mrs] Asraf reported an improvement in her mental state from the point of her previous review with the undersigned. In the intervening period between appointments, she had been commenced on fluoxetine by her general practitioner, the dosage had been increased to 20mg PO Mane approximately 10 days ago.
[Mrs] Asraf reported ongoing problems with posttraumatic stress disorder symptoms. She continued to experience challenges with flashbacks, nightmares, psychological distress at exposure to external cues that resembled the workplace incident, avoidance symptoms, low mood, difficulty experiencing positive emotions, diminished interest and participation in significant activities, hypervigilance, exaggerated startle response, consistent middle insomnia and concentration difficulties…
[Mrs] Asraf denied any side effects to her fluoxetine medication. Given that the dosage had only been increased recently, she agreed to maintaining the dosage as per current.
Examination
…[Mrs] Asraf was calm, settled and engaging. Her eye contact was noted to be adequate. There was no psychomotor disturbance, nor any abnormal movements. [Mrs] Asraf’s mood was described in ongoing dysphoric and anxious terms, although there was an improvement noted from previously. Her affect was euthymic, with slight emerging reactivity. Her speech was assessed to be normal in all domains. There was no formal thought disorder. Her thought content reflected ongoing trauma-related cognitions. Future orientation was preserved…[33]
[33] Exhibit 1, AT34, 127-128.
On 24 January 2022, Dr Dickson noted:
Persistent symtpoms
Also feeling ill today
Tolerating fluoxetine 20mg
Not noting much of an effect,, discussed length of trial
Conts to benefit from psych therapy
Ongoing psychiatric review, potnetial for further titration of fluoxetine[34]
[34] Exhibit 3, 209.
On 4 February 2022, Ms Asraf consulted Ms Falero by telehealth. Ms Falero noted:
Symptoms - patient experience
-Commenced fluoxetine 20mg almost 4 weeks ago.
Has not noticed any change yet.
-Low mood, sleep disturbance, anergia, irritability, amotivation, flashbacks, feelings of helplessness.
-Hypervigilance, intrusive memories, avoidance.
Examination/Mental State - presentation Low mood, dysphoric affect, normal speech.
ADL's/Psycho Social/RTW - impact on function
-Visted grandchildren. Derived enjoyment from this.
-Visits shopping centre with her husband. Never alone.
-Difficulty activating.[35]
[35] Ibid, 211.
On 18 February 2022, Ms Falero reported:
[Mrs] Asraf’s symptoms include low mood, intrusive memories, anergia, flashbacks, sleep disturbance, impairment in memory and concentration, hyperarousal, hypervigilance, avoidance, irritability, nightmares, anxious and depressive ruminations.
…
The current interventions being implemented are trauma focused cognitive behavioural therapy, motivational interviewing, psychoeducation, and arousal reduction strategies. The PCL-5 is being used to measure progress.
…
[Mrs Asraf] is currently unfit and has experienced an exacerbation in her symptoms due to persistent harassment from rehabilitation providers.[36]
[36] Ibid, AT37, 135; Exhibit 3, 212-213.
On 28 February 2022, Dr Dickson noted:
Feels is 'slowly getting there'
but continues to complain of hyperarousal, anxiety++, feels unable to do anything, avoidant of going out
Supportive husband, relying on him for household duties and as a support person if anything needs to be done (outside of home)
Wondering if fluoxeitne should be increased. Discussed awaiting psychiatric review Conts to benefi tform psych therapy[37]
[37] Exhibit 3, 213.
On 4 March 2022, Mrs Asraf consulted Ms Falero by telehealth. Ms Falero noted:
Examination/Mental State - presentation Low mood, congruent affect, paced speech.
AOL's/Psycho Social/RTW - impact on function
-Husband completes majority of domestic tasks, she does simple duties.
-Socially and recreationally withdrawn.
-Has left the home a couple of times with her husband.
In a further consultation by telehealth on 18 March 2022, Ms Falero noted:
Symptoms - patient experience
-Intrusive memories, flashbacks, low mood, rumination, hyperarousal, anxious and depressive cognitions.
-Avoidance, sleep disturbance, impaired memory and concentration.
-Ongoing checking behaviours even after making a mental note that she had checked the doors/windows the first time.
Examination/Mental State - presentation
Low mood, congruent affect, paced speech.
AOL's/Psycho Social/RTW - impact on function
-Warning children to be safe when they leave the home.
-At the shops becomes hypervigilant, buys what she needs[38]
[38] Ibid, 214.
On 18 March 2022, Dr Kumagaya reviewed Mrs Asraf and reported “little change in her mental state from previously”. The doctor increased the dose of Mrs Asraf’s fluoxetine prescription to 40mg PO Mane.[39]
[39] Exhibit 1, AT41.
On 28 March 2022, Dr Dickson reported:
Ongoing distress over symptoms of intrusion
Additional stressor of IME tomorrow anxious
Tolerating increase in fluoxetine, sleep has improved a little since the increase Supportive husband, conts to assist/perform household tasks
COnts to engage in psych therapy[40]
[40] Exhibit 3, 215.
On 7 April 2022, Dr Vickery produced a report for ANZ following a telehealth consultation with Mrs Asraf, in which he reported the following symptoms:
Mrs Asraf reported “I have the nightmares of his face so close to mine and of him being outside of the house and wanting to harm me.”
There is a disrupted sleep with initial insomnia for several hours or more and “I look in the security camera for up to an hour and my family are saying that I shouldn’t be doing that and that I am being stupid.”
Mrs Asraf is sleeping from 3am or 4am to 6am and then at 9am “I don’t have energy to do anything and I have a sleep for an hour and when I wake up I have pain from the tension in my body and particularly in my head, my neck and the base of my head and all over and I have to take Panadol so I can do things and I take it again later in the day.”
Mrs Asraf repeatedly checks the windows and doors are locked and when there is a noise “it can be every couple of hours.”
There is reduced hygiene and grooming as “I’m not motivated to do those things.”
There is avoidance of going out to socialise and I just stay at home and I’m watching the television and I’ve put on eight kilograms as I’m not doing anything and my blood sugar for my diabetes is up and so is my blood pressure.”
Mrs Asraf has not left the house without her husband and “I can feel he is watching me and I can’t go where there are too many people as I get so distressed and I have to go to sit in the car and I cry.”
There is a particular intolerance to the noise of a door closing as “I get a flashback of the banging of the door with the man.”
There is avoidance of socialising and “I can’t talk about what happened to my friends and now I am not in contact with them as they don’t understand why I am like this and I become too embarrassed.”
There is a lowered frustration tolerance with her husband and her children. There is tension in the marital relationship and “it is making me sad and I cry.” There is also tension with the children as “I am too worried for them to be safe and it causes arguments.”[41]
[41] Ibid AT45, 162.
It was Dr Vickery’s opinion Mrs Asraf’s psychological condition “had deteriorated”.[42]
[42] Ibid, 168.
Later on 7 April 2022, Mrs Asraf consulted Ms Falero by telehealth. Ms Falero noted:
Symptoms - patient experience
-Had IME, this caused a lot of anxiety.
-Low mood, anxious and depressive cognitions, intrusive memories, headaches, flashbacks, hyperarousal, avoidance.
-Anergia, anhedonia.
-Reported anxiety about the safety of her family - tells family to be careful when they leave the home.
-Reported an improvement in sleep disturbance; noted reduction in checking behaviours. Checking locks 3 times a night.
-Thyroid levels are high and has gained weight recently.
Examination/Mental State - presentation Low mood, congruent affect, paced speech.
ADL's/Psycho Social/RTW - impact on function
-Socially withdrawn
-Recreationally withdrawn.
-Delayed with domestic duties - able to clean once/week if she 'pushes' herself.[43]
[43] Exhibit 3, 216.
In a further telehealth consultation with Mrs Asraf on 22 April 2022, Ms Falero noted:
Symptoms - patient experience
-Sleep and energy levels improved slightly since increase in fluoxetine.
-Impaired memory and concentration, nightmares, low mood, irritability, amotivation, anergia, avoidance.
-Hyperarousal.
-Triggered by loud noises, storms, the news, arguments.
Examination/Mental State - presentation
Low mood, congruent affect, normal speech.
AOL's/Psycho Social/RTW - impact on function
-Gradually trying to complete domestic tasks.
-Socially withdrawn.
-Some disagreements with her family. Calls her family when they leave the house to check on them.[44]
[44] Ibid, 216-217.
Mrs Asraf consulted Dr Dickson on 3 May 2022 and 5 May 2022 by telehealth. On each occasion the reason was recorded to be “WorkCover”. On 3 May 2022, the doctor noted:
Ongonig post-trauma symptoms
Sleep has improved with increased fluoxetine still broken but far less so than previously remains anxious, low in mood, flashbacks, 'on edge'
fixated on receiving copy of report that was sent to the practice
?if is encrypted and therefore unable to accesss or view
?content
conts to engage in psych therapy[45]
[45] Ibid, 217.
On 5 May 2022, he noted:
Patient requested early appointment regrading copy of Dr Vickery's report
Decrypted copy now available
Discussed
regards as unfit, unsuitable for vocational assessment, requires intensive treatment and guarded re: prognosis
Sent to patient via email[46]
[46] Ibid, 218.
On 12 May 2022, in a telehealth consultation with Mrs Asraf, Ms Falero noted:
Symptoms - patient experience
-Reported isolating and noted worsening of mental state in past 2 weeks.
Felt overwhelmed due to increased arguments with her family and Dr Vickery' report.
-Today is visiting her GP due to chest pain she has been experiencing for 1 week.
-Low mood, anxious and depressive ruminations, avoidance, irritability, hyperarousal, intrusive memories.
-Impaired concentration, amotivation, anergia.
Examination/Mental State - presentation Low mood, congruent affect, paced speech.
ADL's/Psycho Social/RTW - impact on function
-Reported disagreements with her son due to asking him to come home.
Also asks him to turn down the volume of his devices as she find loud noises anxiety provoking.
-Socially and recreationally withdrawn.
-Difficulty applying coping strategies.[47]
[47] Ibid.
Clinical notes of Mrs Asraf’s telehealth consultations with Dr Dickson on 31 May 2022 and Ms Falero on 8 June 2022 refer to persistent symptoms. Dr Dickson noted a “flare up of anxiety for couple of weeks, progressed to panic and chest pains”.[48] Ms Falero noted Mrs Asraf “[c]annot be alone in the house or outside the home” and noted she “Discussed insurer questions and sent through response”.[49]
[48] Ibid, 217.
[49] Ibid, 219-220.
In a further telehealth consultation with Mrs Asraf on 22 June 2022, Ms Falero noted:
Symptoms - patient experience
-Low mood, anxious and depressive ruminations, hyperarousal, impaired memory and concentration.
-Hypervigilance, avoidance, amotivation, intrusive memories, sleep disturbance, somatic symptoms.
Examination/Mental State - presentation Low mood, congruent affect, paced speech
ADL's/Psycho Social/RTW - impact on function
-Socially isolated.
-Relies on husband for domestic duties.
-Attempted to go out for dinner with her daughter, saw a coworker and did not want to be seen.
Experienced anxiety and could not stay to eat, left the restaurant.[50]
[50] Ibid, 220.
On 23 June 2022, Ms Falero reported:
…
Mrs Asraf has noted a stabilisation of her condition and she is now able to leave her home accompanied by a support person
…
Mrs Asraf is able to engage in some self directed CBT for arousal reduction. Mrs Asraf has engaged support people around her in order to assist her with activities of daily living
…[51]
[51] Ibid, 221.
On 5 July 2022, ANZ sent an email to Mrs Asraf setting out the following questions in respect of household services assistance raised by her treating psychologist:
1. Which household service(s) are you requesting?
2. How often do you feel the service is required?...
3. Anticipated hourly cost of each service?
4. Who carried out the service(s) prior to the onset of your compensable condition? (e.g. You or another person)
5. Further to your response to question 4, please indicate why you, or the person nominated above cannot continue to provide the household service(s).
6. Are there any other members of your household who could be reasonably expected to undertake the household service(s)? If yes, provide details?
7. Please list the members of your household, in doing so please provide the following information:
(a) name
(b) age
(c) occupation
(d) relationship to you
(e) able to assist (hrs/wk)(f) any further comments[52][52] Exhibit 1, T7
Mrs Asraf replied on 7 July 2022 and provided the following information:
1. cooking, cleaning, lawn mowing and gardening.
2. weekly except lawn mowing and gardening fortnightly.
3. Not known yet.
4. Myself
5. I am suffering PTSD and also refer to my Doctor’s report.
6. No.[53]
[53] Ibid, T8, 62.
On 11 July 2022, ANZ asked Mrs Asraf to respond to question 7 and to provide information about members of her household.[54] On 12 July 2022, Mrs Asraf provided the following further information:
Hi answers for question 7:
a: Asraf Mohammed
b: 65
c: Plumber
d: Husband
e: Nil
d: my family has own commitment and cannot assist me[55]
[54] Ibid, T9.
[55] Ibid, T10, 68.
On 15 July 2022, Mrs Asraf consulted Ms Falero by telehealth. Ms Falero noted:
Symptoms - patient experience
-Low mood, hyperarousal, avoidance, anxious and depressive cognitions, anger, impaired memory and concentration.
-Intrusive memories, amotivation, anergia, sleep disturbance.
-Insurer stressors - wages reduced.
Examination/Mental State - presentation Low mood, congruent affect, paced speech.
ADL's/Psycho Social/RTW - impact on function
-Socially withdrawn.
-Difficulty sitting in the backyard.
-Relies on family for ADL's.[56]
[56] Exhibit 3, 223.
On 29 July 2022, Mr Nielsen conducted a telehealth consultation with Mrs Asraf and noted:
"everything the same"
"my husband supports me"
Psych Treatment Benefits
condition stabilised
Past psychological history - aggravating factors
denied
Diagnosis - relation to the injury PTSD
Symptoms - patient experience
Low mood, low motivation, anxisou distress, hyperviginace
Examination/Mental State - presentation/self care mood: low
affect: flat
insight and judgmeent: reasonable
ADL's/Psycho Social - function/relationships
require support in social situtaions, has supportive family and is accompanied by support person when socailising, uses cleaner to perform domestic duites, showers on alternate days
RTW barriers
Loss of tyrust in the working environment, poor memory, fatigue, loss of confidnce in her ablities to perform work duites[57]
[57] Ibid, 224-225.
On 5 August 2022, Mrs Asraf consulted Mr Nielsen by telehealth. Mr Nielsen noted:
"i have been the same as last consult"
"im coping with family support"
Psych Treatment Benefits
condition stabilising
Past psychological history - aggravating factors
denied
Diagnosis - relation to the injury
Post Traumatic Stress
Symptoms - patient experience
low mood, avoidance, sleep disturbance
Examination/Mental State - presentation/self care
ADL's/Psycho Social - function/relationships
able to sit outside afgter being promted by family for 15 mnutes and with them, unable to drive on her own, unable to concentrate on doing any paperwoirk activities, does not go out and exercise[58]
[58] Ibid, 225-226.
In a telehealth consultation with Mrs Asraf on 12 August 2022, Ms Falero noted:
ADL's/Psycho Social - function/relationships
-Tolerates sitting out the front and back of the house with a support person.
-Pays for s cleaner to come twice a week, has gardening assistance. Completes simple tasks.
-Showers every second day.
-Socially withdrawn apart from seeing my family. Visit daughter once/fortnight.
-Recreationally withdrawn - watches TV, walking around home and listens to music.[59]
[59] Ibid, 226-227.
On 23 August 2022, Mrs Asraf consulted Dr Dickson by telehealth. The doctor noted:
persistent trauma and mood symptoms
doesn't leave home without family due to fear and anxiety feels well supported by them
has domestic assistance which she has been paying for
wants to explore putting this on her claim with her case manager
reports the insurer sent a questionaire in this regard and reception confirmed it is here
?can not locate
discuss - ?usually requires an assessment with OT
conts to engage in psych therapy adherent to medication[60]
[60] Ibid, 227.
On 26 August 2022, in a telehealth consultation with Mrs Asraf, Ms Falero noted:
Symptoms - patient experience
-Low mood, avoidance, intrusive memories, poor concentration, sleep disturbance, hyperarousal.
-Low motivation, anergia, anhedonia, anger.
-Reported that writing is 'uncomfortable' for her and leads to frustration.
Examination/Mental State - presentation/self care
Low mood, flat affect, paced speech.
AOL's/Psycho Social - function/relationships
-Tolerates sitting out the front and back of the house with a support person.
-Has not been practising further exposure or finalising fear hierarchy.
-Family has to sit outside the door of the bathroom whilst she is in shower, rushes out after 5 minutes.
Has almost fallen several times.[61]
[61] Ibid, 228.
On 5 September 2022, Mrs Asraf consulted Dr Prasad, who conducted a review of her medications.[62] The doctor’s records of this review do not refer to Mrs Asraf taking fluoxetine as prescribed by Dr Dickson and Dr Kumagaya.
[62] Ibid, 319-320.
In a further telehealth consultation with Mrs Asraf on 9 September 2022, Ms Falero noted:
Symptoms - patient experience
-Reported nil change in symptoms or functioning.
-Difficulty completing fear hierarchy; did not ask family to help with creating notes on phone/using voice-to-text app.
Difficulty creating in session due to poor concentration.
-Low mood, irritability, intrusive memories, avoidance, anhedonia, anergia, sleep disturbance, low motivation, hyperarousal.
Examination/Mental State - presentation/self care
Low mood, flat affect, paced speech.
Nil acute risks.
ADL's/Psycho Social - function/relationships
-Socially and recreationally withdrawn.
-Continues to sit out the front and back of the house but has been unable to progress with other exposure based tasks.
-Delayed with personal care and relies on family/assistance for domestic duties.[63]
[63] Ibid, 228-229.
On 13 September 2022, Mrs Asraf consulted Kathy Mill, a psychologist at Workers Doctors. Ms Mill noted:
Diagnosis - relation to the injury
PTSD
Symptoms - patient experience
Managing with the support of her husband and children
Sleeping - wakes every 3-4 hours - medication is helping - nightmares 2x per night - guy at
work-banging, following me - sometimes exactly the same - sometimes somebody else following her and attacking her - wakes up and cries - husband supports her - heart beats fast - also during the day when trying to get to sleep
Tries to avoid reminders of the experience
Goes to bed 9-10.30pm - sometimes has trouble getting to sleep 2-3x per week difficult to sleep Showers - quickly with someone staying outside every 2nd day
Severe headache - every 4 hours takes panadol
Pain in chest due to stress - takes maxium
Breathing stops when sleeping - panic
Diabetic - has worsened - taking increased medication From Fiji
Doesn't go for a walk - just on balcony or in the backyard Watches TV - engages with family
Tidies up
Husband has reduced his working hours since she has been injured Husband sometimes cooks
Helps with cooking
Unmotivated - stays in her room Cleaner helps with laundry Husband does the shopping
Examination/Mental State - presentation/self care Depressed
Unmotivated
Always checks on family
ADL's/Psycho Social - function/relationships RTW barriers
Can't drive
Treatment/Review - rationale
Has a cook, cleaner twice per week - gardener - once per fortnight
Controlled breathing
Shower
Goal - have a shower every day Relaxation (white) music
Goal - go for a walk once per week[64]
[64] Ibid, 229-230.
On 15 September 2022, Mrs Asraf consulted Dr Dickson by telehealth. Dr Dickson noted:
Requested earlier review due to request for evidence from ANZ as to why domestic services are required
requests evidence for PTSD causing inability to cook, clean or mow lawns
discussed limitations in providing evidence based on phone consult
disucssed need for specialist endorsement, suggest requesting statement from Dr Kumagaya at next review (next week) regarding need for these services due to psychaitric condition, will help in providing evidence as reasonable/necessary
patient understanding
discussed cotinuing current medication and psych therapy[65]
[65] Ibid, 231.
On 16 September 2022, Mrs Asraf consulted Mr Nielsen by telehealth. Mr Nielsen noted:
Psych Treatment Benefits
i feel like i haev stablised
Past psychological history - aggravating factors
denied
Diagnosis - relation to the injury
PTSD
Symptoms - patient experience
low mood, anxiuos distress, flashbacks to incidnet
Examination/Mental State - presentation/self care
mood: low
affect: flat
insight and judgement: reasonable
ADL's/Psycho Social - function/relationships
able to go out wth a support person, unabel to drive on her own, unabel to go out unaccompaniesd, requires support person for showering and cleaning, psends mos t of her day in her room, unbael to garden unaccompanied
RTW barriers
anxiosu distress, avoidance, low motivatin[66]
[66] Ibid, 232-233.
On 23 September 2022, Dr Kumagaya examined Mrs Asraf and reported:
[Mrs] Asraf continued to report posttraumatic stress disorder symptoms, which had improved slightly from the point of her previous review…
[Mrs] Asraf reflected on the psychosocial impacts of her posttramatic stress disorder. She was particularly troubled by her attenuated capacity towards self-care and attendance to her household. Given such challenges, [Mrs] Asraf stated that she had hired domestic assistance to assist with meal preparation, garden maintenance and cleaning.
[Mrs] Asraf had tolerated the increase in her fluoxetine dosage to 40mg PO Mane. Given her good response and tolerability of this medication, Ms Asraf requested a further increase to 60mg PO Mane.[67]
[67] Exhibit 1, AT54, 196.
On 30 September 2022, Mrs Asraf consulted Ms Mill by telehealth. Ms Mill noted:
Symptoms – patient experience
Sitting outside with grandson - more engaged with what is going on Sleeps during the day - 1-2x per day
Still having nightmares
Stays in room in morning - tidies up a little bit Goes for a walk during the day
Spends time with grandson Watches TV
Goes shopping
Travels to see daughter (once per week) and mum (visits her once per month) Examination/Mental State - presentation/self care
3 children - 1 son and 2 duaghters - 1 son and daughter live with her
Social avoidance - friends call and doesn't answer - wants to avoid others at the moment AOL's/Psycho Social - function/relationships RTW barriers
Treatment/Review - rationale
Now taking 3 tablets instead of 2 for a week - sleeping has improved Been for a walk once or twice per week
Goal - go for a walk 3x per week
Has been having a shower every 2nd day Goal - will have a shower every day Sleep hygiene
Controlled breathing - helpful
Goal - stop checking on son (35) and daughter (23)
Goal - stop OCD behaviour - stop asking repetitive questions of son and daughter[68]
[68] Ibid, 233-234.
On 13 October 2022, Mrs Asraf consulted Dr Lim by telehealth. Dr Lim noted:
symptoms exacerbated by recent IME referral
more agitated
has d/w psychiatrist at last review the extent to which capacity for self-care and household duties have been impacted
has led to hiring domestic assistance 2 x 4h per week for about the past 12 months discussed
conts to engage inpsych therapy tolerating fluoxetine at 60mg[69]
[69] Ibid, 235.
On 13 October 2022, Dr Dickson provided information in response to questions from ANZ in respect of Mrs Asraf’s need for household services. The doctor reported that Mrs Asraf’s psychological symptoms “have led to reduced capacity for self-care and household tasks” and “She reports having hired some domestic assistance for meal preparation, cleaning and gardening maintenance for a total of 8 hours per week (4 hours twice a week) for about the last 12 months”.[70] It is probable the doctor relied on what he was told by Mrs Asraf when making this assessment.
[70] Exhibit 1, T13, 79.
On 28 October 2022, Mrs Asraf consulted Ms Mill by telehealth. Ms Mill noted:
Symptoms - patient experience
Sleeping - waking every 3-4 hours - nightmares - every night - multiple times per night - shadows
- try to choke her - spit on her - attacking her daughter - scary and hear noise - bang (slamming) of door - someone trying to get inside the house - changed from workplace injury to anything
Sleeping during day - always in her bed
Bad headache due to not sleeping - swollen eyes
Friends call and doesn't answer
Would like to visit mum more often
Examination/Mental State - presentation/self care
AOL's/Psycho Social - function/relationships RTW barriers
Treatment/Review - rationale
Been going for a walk with husband and grandchildren once per week
Goal - Goal - go for a walk 2x per week
Still asking son and daughter repetitive questions
Goal - stop OCD behaviour - stop asking repetitive questions of son and daughter Still checking on son and daughter
Goal - stop checking on son (35) and daughter (23) Been having a shower every 2nd day
Goal - will have a shower every day Goal - visit mother once per fortnight[71]
[71] Exhibit 3, 236.
On 31 October 2022, ANZ issued a determination to refuse Mrs Asraf’s claim for household services assistance in the form of cooking, cleaning, lawn mowing and gardening services.[72] Mrs Asraf requested reconsideration of this determination and stated:
I would like a review of this decision because my husband is no longer supporting me with any house hold task and running and maintenance of my house. [Mr Asraf] is a Plumber and because of Pandemic he was home and he did not have enough Jobs.
Now he is very busy with his work and unable to care for me or my property maintenance. I live in my own property and it is in my name only. I am struggling to meet Household services and I need assistance urgently.[73]
On 6 December 2022, ANZ issued a reconsideration decision to affirm its 31 October 2022 determination.[74] On 13 February 2023, Mrs Asraf lodged an application for review of this decision by the Tribunal (application 2023/0858).[75]
[72] Exhibit 1, T15.
[73] Ibid, T18.
[74] Ibid, T21.
[75] Ibid, T2.
On 10 November 2022, Mrs Asraf consulted Dr Dickson by telehealth. The doctor noted:
deteriorated since last review
husband less available as has returned to working in office with end of covid measurees stuggling with ADLs
recent IME, exacerbated symptoms
refered to IME from Melbourne who said was unaware of her history, additionally he had attempted to record the session without asking permission first
increased anxiety poor sleep
adherent to medciation
conts to engage in psych therapy[76]
[76] Exhibit 3, 237.
On 18 November 2022, Mrs Asraf consulted Ms Mills by telehealth. Ms Mills noted:
Symptoms – patient experience
Makes sure someone is home so she can have a shower
Examination/Mental State - presentation/self care
Sad Frustrated Angry Depressed
Unmotivated to do housework, eating
ADL's/Psycho Social - function/relationships RTW barriers
Treatment/Review - rationale
IME assessment - different doctor to what she is used to - recorded - questioned - turned it off - told would have all the reports - did not have the reports - told insurer - said errors, made a mistake couldn't find the report - Zoom interview with doctor from Melbourne - bad reviews - had to go through the trauma in the meeting because doctor did not have the reports - angry, agitated, upset crying - said can't think about returning to work at the moment - doesn't know how long it will be before she starts work
Has been having a shower every day
Goal - will have a shower every day
Used to have a domestic assistant - husband Mohammed - plumber - used to help during the pandemic - used to pay herself but stuggling financially as pay has decreased - will review 11 December
Has been visiting her mother once per fortnight for half an hour
Goal - visit mother once per fortnight for an hour
Still checking on son and daughter
Goal - stop checking on son (35) and daughter (23)
Still engaging in OCD behaviour - asking repetitive questions of son and daughter
Goal - stop OCD behaviour - stop asking repetitive questions of son and daughter
Going for a walk once per week
Goal - go for a walk with her husband and grandchildren 2x per week[77]
[77] Ibid, 238.
On 24 November 2022, Mrs Asraf consulted Dr Prasad, who conducted a review of her medications.[78] Dr Prasad’s notes do not refer to Mrs Asraf taking fluoxetine as prescribed by Dr Dickson and Dr Kumagaya.
[78] Ibid, 320.
On 2 December 2022, Mrs Asraf consulted Dr Kumagaya. The doctor reported to Dr Lim:
[Mrs] Asraf reported an initial improvement in her mental state since increasing her fluoxetine dosage. She had noted an improvement in her arousal symptoms, as well as her mood. [Mrs] Asraf reported, however, that her symptoms were exacerbated by a recent IME during which she found the process and the avenues of questioning rather distressing.
[Mrs] Asraf reported no side effects to her fluoxetine, and requested a further increase in the dosage. Following a discussion of the rationale, risks, benefits, and alternatives, [Mrs] Asraf agreed towards an increase in her fluoxetine to 80mg Mane.
…
Upon mental state examination, [Mrs] Asraf presented as calm, settled, and engaging. There was no psychomotor disturbance. [Mrs] Asraf’s mood was described in stable dysphoric and anxious terms. There was no formal thought disorder. Her thought content reflected persistent trauma-related cognitions. Future orientation was preserved. She did not identify any acute risks to herself or others. Her cognition was grossly intact, and her insight and judgement were reasonable.[79]
[79] Exhibit 1, AT65, 263.
On 8 December 2022, Mrs Asraf consulted Dr Dickson by telehealth. The doctor noted:
enduring trauma symptoms presents as highly fatigued anxiety
low mood and irritabiltiy
mood symptoms exacerbated by insurer
harassing her to have the case manager call in to her medical appointmetns discussed
case manager has requested a case conference from the practice to discuss an IME report (I note no copy of this in the file)
[Mrs Asraf] does not consent to this and advises she has asked her case manager to send the report and any questions in writing
is tolerating increased fluoxetine cants to benefit from psych therapy[80]
[80] Exhibit 3, 239.
On 16 December 2022, Mrs Asraf consulted Ms Mill, who noted:
Symptoms - patient experience Examination/Mental State - presentation/self care Scared to go outside by herself
AOL's/Psycho Social - function/relationships RTW barriers
Treatment/Review - rationale
Domestic assistance has been declined due to having 3 adult children living nearby - wants to challenge decision
Hasn't been for a walk with husband and grandchildren
Goal - go for a walk with her husband and grandchildren 1x per week Still asking repetitive questions of son and daughter
Goal - stop OCD behaviour - stop asking repetitive questions of son and daughter Still checking on son and daughter
Goal - stop checking on son (35) and daughter (23) Visiting her mother once per month
Goal - visit mother once per fortnight for an hour Having a shower every 2nd day
Goal - will have a shower every day[81]
Ms Mill provided an Allied Health Recovery Request for further psychological treatment of Mrs Asraf’s psychological condition.[82]
[81] Ibid, 240.
[82] Exhibit 1, BT69.
On 19 January 2023, Mrs Asraf consulted Ms Mill, who noted:
Symptoms - patient experience
Examination/Mental State - presentation/self care
Was going well with her goals until the rehab guy called her on 3/4/5 January and she went backwards
ADL's/Psycho Social - function/relationships RTW barriers
Doctors and solicitors have stated not fit for work
Treatment/Review - rationale
Dr Mendelhsen's report saying family members can help her - not the case
Jade - caseworker
Been showering every day
Goal - will have a shower every day
Has been visiting mother once per fortnight fof an hour
Goal - visit mother once per fortnight for an hour
Still checking on son and daughter
Goal - stop checking on son (35) and daughter (23)
Still engaging in OCD behaviour - asking repetitive questions of son and daughter
Goal - stop OCD behaviour - stop asking repetitive questions of son and daughter
Been going for a walk with her husband and grandchildren once per fortnight
Goal - go for a walk with her husband and grandchildren 1x per week
Has to go to the tribunal to tell them that her children are not helping her and to challenge decline of domestic assistance - Comm Care is different legislation - other doctors have indicated domestic assistance required[83]
[83] Exhibit 3, 241.
The relevant evidence does not establish Mrs Asraf sustained a right knee ‘injury’ on 16 December 2022 or on 21 January 2023 for which ANZ is liable to pay compensation. It is not presently established by relevant probative material, and I am not satisfied, that the medial meniscus tear in Mrs Asraf’s right knee arose out of her ANZ employment.
In all likelihood, Mrs Asraf experienced stress as a result of the incident on 30 August 2021 which resolved soon after 15 September 2021. The question whether this amounts to an ‘ailment’ and an ‘injury’ is vexed. Certainly, Dr Nguyen accepted Mrs Asraf’s account at the time and he certified she was unfit for work. Doing the best with the contemporaneous materials, it possible, even likely, Dr Nguyen responded to Mrs Asraf’s description of her symptoms as ‘PTSD’ without undertaking a thorough mental state examination. If that is correct, there is a serious question about the veracity of the symptoms Mrs Asraf alleged at the time.
Therein lies a substantial difficulty in this unfortunate case. On the one hand, if one accepts Mrs Asraf’s accounts and the related medical and therapeutic records, assessments and opinions, her case would very likely succeed. In all likelihood, ANZ accepted the veracity of her account of alleged injury when determining her claim for compensation. On the other hand, if one does not accept her evidence and the accounts she has given are reliable, her case is fatally undermined. This is because, at least in part, in cases of this kind involving compensation claims in respect of reactive psychiatric disorders, such as post-traumatic stress disorder, a great deal of reliance is placed by doctors and decision makers on the person’s account of alleged symptoms and adverse effects as a result of an incident in their employment. Commonly in such cases, it is the person’s account of alleged perceptions and psychological symptoms which affect their ability to function in daily life that inform diagnosis and treatment.
In many cases, these are not matters which are readily amenable to objective testing. They are substantially informed by subjective self-reporting. It is for this reason a thorough mental state examination by a suitably qualified person, applying standard diagnostic criteria and impartial clinical judgment is required. This provides a framework for the assessment and categorisation of an alleged psychiatric ailment and contributory factors based on the person’s description of their perceptions, experiences and symptoms. As Dr Canaris pointed out, it is not for a psychiatrist to test the veracity of the person’s account of their perceptions and experience, which is within the purview of courts and tribunals. Nevertheless, as Associate Professor Mendelson explained, exercise of clinical judgment in the context of compensation claims extends to considerations of malingering, which requires more than simple acceptance.
It is not possible to know with certainty what is in the mind of a claimant such as Mrs Asraf. It is entirely possible she believes what she has alleged is true and that the accounts she has given doctors and therapists (and this Tribunal) are accurate. It is possible, as Associate Professor Mendelson observed, that she is catastrophising and pathologising a normal stress response to a stressful incident. It is also possible, as ANZ asserts, she has not been entirely truthful and she has fabricated or exaggerated claims in order to obtain compensation.
In these reviews, determination of Mrs Asraf’s case turns on objective assessment of the extensive evidence, in which her evidence, her claims and accounts, are considered against other materials, and careful assessment of the weight to be given to witness evidence, including expert opinion evidence, and to contemporaneous medical records and surveillance materials. This has not resulted in a positive finding.
In the result, I have found the threshold of satisfaction is not surpassed and Mrs Asraf’s claims are not made out. From this it follows the decisions under review are affirmed.
Dates of hearing: 24, 25, 26, 27 February 2025, and 10 April 2025
Counsel for the Applicant:
Applicant’s Representative:
Mr Rob O’Neill
McDonnell Schroder Solicitors
Counsel for the Respondent:
Solicitors for the Respondent:
Ms Sarah Wright
HWL Ebsworth Lawyers
- AGLC
- Asraf and Australia and New Zealand Banking Group Limited (Compensation) [2025] ARTA 1144
- Case
- [2025] ARTA 1144
- Decision Date
CaseChat Overview and Summary
The central issue before the court was whether ANZ was liable for the compensation claims made by Mrs Asraf. The primary issue was the credibility of Mrs Asraf's evidence about her symptoms and the effects of the incident. The court also had to consider the probative value of the video recording and other materials and the weight to be given to the medical and expert opinions. The court had to determine whether the causal thresholds for compensation were met on an objective assessment.
The court examined the contemporaneous medical records and the video recording of the incident. The court found that the medical records were inconsistent with Mrs Asraf's account of her symptoms and effects. The court found that the video recording and other materials did not support Mrs Asraf's account of the incident. The court found that the medical and expert opinions were based on Mrs Asraf's subjective account of her symptoms and effects and were unreliable. The court found that the causal thresholds for compensation were not met on an objective assessment. The appeal was dismissed.
The final orders of the court were that the appeal be dismissed, that the decision of the primary decision maker be affirmed, and that each party bear their own costs of the appeal.
Orders
Orders of the court
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Background
Background to the litigation
Evidence
Evidence Before The Court
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Decision
Reasons for decision
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Ratio Decidendi
Legal Principle Established
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