BNP v Transport Accident Commission of Victoria

DETERMINATION OF REVIEW PANEL
CITATION:	BNP v Transport Accident Commission of Victoria [2023] NSWPICMP 377
CLAIMANT:	BNP BNP
INSURER:	Transport Accident Commission
REVIEW Panel
MEMBER:	Belinda Cassidy
MEDICAL ASSESSOR:	John Baker
MEDICAL ASSESSOR:	Chris Rikard-Bell
DATE OF DECISION:	2 August 2023
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; medical assessment of whole person impairment (WPI) by Medical Assessor (MA) Jones and claimant’s review under section 7.26; claimant involved in intersection collision in May 2018; claimant’s infant grandson in child seat behind her; claimant sustained soft tissue injuries and chronic pain; claimant developed psychological symptoms; MA Parmegiani assessed WPI at 18% in October 2021; insurer obtained surveillance film and social media posts suggesting activity inconsistent with severity of claimant’s alleged injury; MA Jones determined WPI at 8% in April 2022; no issue that clamant had sustained an injury (diagnosed as post-traumatic stress disorder); claimant provided evidence that about half of the social media posts were “old” posts reposted and evidence from family and friends as to the impact of the accident on her functioning both physically and psychologically; issue of alleged pre-existing psychiatric condition addressed and evidence obtained that no previous psychological treatment had been provided; Held – Panel applied International Statistical Classification of Diseases and Related Health Problems (not Diagnostic and Statistical Manual of Mental Disorders) and reasons given; face to face medical examination occurred; claimant diagnosed with post-traumatic stress disorder; no previous psychiatric condition, no adjustment for treatment and WPI assessed at 13%.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 The Review Panel: 1. Revokes the certificate of Medical Assessor Jones dated 5 April 2022. 2. Certifies that the degree of BNP’s permanent impairment resulting from injuries caused by the motor accident on 15 May 2018 is greater than 10%.

STATEMENT OF REASONS

INTRODUCTION

BNP was involved in a motor accident on 15 May 2018.
The claimant says she was driving with her grandson in the back when another car coming from the opposite direction turned in front of her causing a head on collision. Both cars were written off.
BNP made a claim for statutory benefits against the Nominal Defendant because the third-party insurer of the car at fault was insured interstate (Victoria). The Nominal Defendant has paid statutory benefits to BNP as the relevant insurer however recently, iCare has commenced making those payments as it is now the relevant insurer within the meaning of the legislation.
BNP has also made a claim for damages against the interstate insurer.
A medical dispute about the degree of the claimant’s whole person impairment (WPI) has arisen in connection with that claim and BNP referred that dispute to the Personal Injury Commission (the Commission) for assessment.
On 22 October 2021, Medical Assessor Enrico Parmegiani determined that the degree of BNP’s WPI was greater than 10% (18%). The insurer sought a further assessment, which was allowed, and on 5 April 2022, Medical Assessor Jones determined the claimant’s WPI was not greater than 10% (8%).
The claimant then lodged an application with the Commission seeking a review of the Medical Assessor’s decision. On 26 October 2022, a delegate of the President determined there was reasonable cause to suspect a material error in the assessment and has allowed the Review and on 31 January 2023 the President convened this Panel to conduct the Review.

LEGISLATIVE FRAMEWORK

BNP’s claim and entitlements to compensation are governed by the provisions of the Motor Accident Injuries Act 2017 (the MAI Act).
Damages for non-economic loss are limited and restricted by the provisions in Part 4, Division 4.3 of the MAI Act. For example, non-economic loss damages are limited to a maximum amount in accordance with s 4.13[1] and entitlement to those damages is restricted by s 4.11 to persons who have a greater than 10% WPI as a result of the injuries sustained in the accident.
[1] The current maximum as of October 2022 is $605,000.
If there is a dispute about the degree of the claimant’s permanent impairment, damages for non-economic loss cannot be awarded and disputes must be referred to a Medical Assessor for determination.[2]
[2] See s 4.12 of the MAI Act.
Chapter 7, Division 7.5 of the MAI Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as Medical Assessor Parmegiani’s.[3] Section 7.24 permits further medical assessments such as Medical Assessor Jones’ but not “on more than one occasion” and the legislation also provides for the review of medical assessments by a Panel.[4]
[3] Section 7.20 of the MAI Act.
[4] Section 7.26 of the MAI Act.

Permanent impairment assessment

The MAI Act provides that permanent impairment is to be assessed in accordance with Chapter 6 of the Motor Accident Guidelines (the Guidelines)[5] which are largely based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides).
[5] Section 7.21. The current version of the Guidelines is Version 9.1 which is effective from 1 April 2023.
The Guidelines include a chapter entitled “Mental and behavioural disorders” and require the assessment to be undertaken in accordance with the psychiatric impairment rating scale (PIRS) and that the AMA4 Guides are to be used as “background or reference only”.[6]
[6] Clause 6.203 of the Guidelines.
The PIRS requires a psychiatric diagnosis to be undertaken first in accordance with the current edition of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Statistical Classification of Diseases and Related Health Problems (ICD)[7]. The current version of the DSM (released in 2013) is DSM5. The current version of the ICD is ICD11 which commenced on 1 January 2022 and is therefore the most current diagnostic system.
[7] Clause 6.213 of the Guidelines.
The PIRS provides[8] for the consideration of any psychiatric condition present before the accident in question:
“In order to measure impairment caused by a specific event, the medical assessor must, in the case of an injured person with a pre-existing psychiatric diagnosis or diagnosable condition, estimate the overall pre-existing impairment using precisely the method set out in this part of the Guidelines, and subtract this value from the current impairment rating.”
[8] Clause 6.218 of the Guidelines.
The PIRS provides in clause 6.219 for six areas of function:
1.219.1   self-care and personal hygiene;
1.219.2   social and recreational activities;
1.219.3   travel;
1.219.4   social functioning (relationships);
1.219.5   concentration persistence and pace, and
1.219.6   adaptation.
The PIRS then provides at clause 6.220 for five classes, where class one is assigned if there is no impairment and class five is applied where there is total impairment. There is a descriptor for each as a guide to Medical Assessors and other examiners which is “illustrative rather than literal” and which is based on:
“… a history of the injured person’s pre-accident lifestyle, activities and habits, and then [an assessment of] the extent to which these have changed as a result of the psychiatric injury.”
The impairment may be adjusted for treatment[9] such as medication taken or therapy provided to treat the psychiatric condition.
[9] See clauses 6.222 – 6.223 of the guidelines.
Once all six areas of function have been categorised into a particular class, the median class score is determined, the aggregate score is determined and the median and aggregate is converted to provide a specific WPI percentage using table 17.[10]
[10] See clauses 6.225 – 6.228.

ASSESSMENT UNDER REVIEW

Medical Assessor Jones examined the claimant on 22 February 2022 (by audio-visual means) and issued his certificate on 5 April 2022. He was asked to assess the claimant’s psychological injuries namely a post-traumatic stress disorder.
Medical Assessor Jones has a history of the claimant’s previous health, education and work, as well as her previous marriage. She divorced her first husband in 2000 and married Robert in 2005. The Medical Assessor has a record that, in 2015, “she had marital problems … her husband threw a water bottle in the kitchen and it hit her”. She denied any episodes of violence towards her saying she and her husband only had verbal arguments.
Medical Assessor Jones took a detailed history of the accident. The claimant was with her grandson Sebastian in the family car, driving towards an intersection with a green light when a truck turned directly in front of her and a collision occurred. The airbags in her vehicle did not deploy, but Sebastian started screaming and she became distressed.
Physically the claimant had injuries to her neck, shoulder and back, participates in continued hydrotherapy and physiotherapy and takes pain medication and an antidepressant Venlafaxine.
BNP reported seeing a psychiatrist in the past and she still sees a psychologist. Medical Assessor Jones documents BNP’s strong and intense reaction to the surveillance and social media material.
The claimant reported shock immediately after the accident and that it took her several months to return to driving. BNP said she cried a lot, was emotional, hard on herself and “pissed off”. She did not report recurring thoughts of the accident but had to think about it when events occurred such as the assessment.
The claimant reported her sleep was poor, her appetite was poor, and her memory and concentration were affected. She is frightened of having her grandson to stay as she does not trust herself driving.
Medical Assessor Jones refers to the general practitioner (GP) records and “a history of previous post-traumatic stress disorder, obsessive compulsive disorder (OCD), anxiety, domestic violence and subsequent difficulties associated with then” but found it difficult to ascertain the level of functioning to allow a pre-existing impairment to be identified and assessed.
Medical Assessor Jones diagnosed a chronic adjustment disorder with depressed mood or a chronic post-traumatic stress disorder in partial remission. He considered the precise “label” academic and semantic. He was satisfied she had sustained a psychiatric disorder caused by the accident.
He assessed the claimant’s class of impairment as follows:
(a)   self-care and personal hygiene                class 1           minor deficit
(b)   social and recreational activities              class 2           mild impairment
(c)   travel  class 2           mild impairment
(d)   social functioning  class 2           mild impairment
(e)   concentration, persistence and pace        class 2           mild impairment
(f)    adaptation  class 4           severe impairment
The median value of the above was 2, the aggregate score was 13 which translated to a WPI of 7%. The Medical Assessor allowed 1% for the effects of treatment.

ISSUES FOR DETERMINATION

Claimant’s submissions

The claimant lodged submissions[11] dated 6 April 2022 in support of the review alleging errors in the assessment of the following areas of function:
(a)   self-care and personal hygiene - the Medical Assessor had assessed this as class 1 however the claimant says it should have been assessed as class 3 because the claimant’s husband helps with her hair, and she goes weekly to the hairdresser. She does not want her hair cut and does not shower. The claimant has a poor appetite, does not eat regularly and does not cook often.
(b)   social and recreational activities were assessed as class 2 but should be class 3 because the claimant’s psychiatric injury limits her ability to go out and spend time with her grandchildren, and
(c)   concentration persistence and pace which was assessed as class 2 but should be assessed as class 3. The alleged error was stated as assessing the claimant’s physical capacity to do things and not focussing on her psychiatric impairments.
[11] Page 1 of the claimant’s bundle.
The claimant also alleges errors in the test for stabilisation and an error in the dosage of venlafaxine.

Insurer’s submissions

The insurer outlines in its submissions the assessments undertaken in respect of WPI and summarised the surveillance material including the review of the claimant’s social media posts. The insurer addresses the claimant’s submissions by pointing to the social media and surveillance evidence.
The insurer suggests the error in respect of medication is not material and that there is no error in the determination of stabilisation.

Procedural matters

The Panel issued directions to the parties on 1 February 2023 for the production of documents and both parties produced documents, 100 pages from the claimant and 1,700 pages from the insurer.
The Panel met on 29 May 2023 and reported to the parties on 5 June 2023 as follows:
(a)   while the claimant challenged only three of the six areas of function, the Panel will be assessing all six;
(b)   the claimant had challenged the assessment of stabilisation and the Panel asked for confirmation of the claimant’s current views about whether her injuries has stabilised, and
(c)   the claimant had challenged the findings about medication and was asked to bring details of her medication to the re-examination.
Due to issues with the bundles, the Panel directed the parties to provide a joint bundle.
The Panel noted mental health plans and referrals in 2015 and 2017 and asked the claimant for any relevant records. The Panel also noted no medico-legal reports had been provided by the insurer in this matter (for psychological or psychiatric injuries).
The Panel noted while it had the surveillance and social media reports, it did not have the film but was not of the view it was necessary for the Panel to view it.
The parties were advised about the re-examination and were invited to provide final submissions addressing any of the matters raised in the report.
The claimant provided final submissions dated 23 June 2023:
(a)   she provided at [1] a comparison table of the assessments and advised at [2] there was no issue about stabilisation, she accepts her injuries have stabilised;
(b)   she has provided copies of her medications and will take them to the re-examination;
(c)   the claimant has not been to the Delta Clinic or had counselling pursuant to any care plan before the accident [4] and [5];
(d)   the GP records were provided, and the social media and surveillance film has been addressed [6] and [7], and
(e)   the claimant said she had never taken any anti-depressant medication and did not have a pre-existing psychological condition.
The Panel has not been advised of any response received at the Commission from the insurer.

REVIEW OF THE EVIDENCE

The Panel determined at the preliminary conference to admit into evidence the updated report of Dr Mason and the statement from the claimant addressing the surveillance and social media posts.
The Panel has considered the evidence but will not summarise all of it. As Basten J in Rahman v Insurance Australia Ltd t/as NRMA Insurance [2022] NSWSC 1079 said at [63]:
“The application of [a medical assessor’s] expertise permits (and indeed requires) the assessor to be discriminating as to that material which he or she considers significant and that which may be disregarded or given little weight. There is no requirement to identify material falling into the latter category, nor to justify its exclusion from consideration.”

Claim form and claim documents

The claimant’s application for personal injury benefits was signed and dated 25 August 2018. The claimant describes her injuries as follows:
“Whiplash, lower back, shoulder, neck, bruising to my right thigh area and right hand area. Trauma to my abdomen and have been teary and depressed since.”
BNP said she was not taken to hospital but that she had gone to her local doctor and was seeing a physiotherapist and psychologist.
In answer to the question about previous illnesses, injuries and conditions, the claimant said:
“Left shoulder thickening of the bursa but no other. Since incident my lower back, stomach, headaches and increased anxiety. Lack of sleep and focus. Crying continuously.”
The claimant said she had not returned to work and that before the accident she was a full-time, self-employed colour consultant with Advance Painting Solutions.
Dr Basiri of Kenthurst Medical Centre wrote the first certificate of capacity dated

25 May 2018. The doctor referred to injuries and symptoms as follows:
“Anxiety, panic attacks, phobia to drive, CBT [cognitive behavioural therapy], relaxation therapy, pain management, low back pain, neck pain, shoulder pain.”
Dr Basiri imposed certain work restrictions and advised treatment by a psychologist, physiotherapist and pain killers were required.

Statements, surveillance and social media

The surveillance footage was taken on Monday 25, 26 and 30 October, 7 and

10 November 2021. The claimant was seen in the local area driving and grocery shopping on her own. She was also seen being driven by her husband.
Social medica posts from Instagram in relation to an account held by the claimant in her maiden name were also provided. The accident occurred on 16 May 2018 and the posts suggested that after the accident the claimant had participated in activities inconsistent with her reports of injury and impairment. The individual activities and events will be addressed later in these reasons.
The claimant has provided four statements.[12]
[12] Commencing at page 132 of the claimant’s bundle.
In the first (9 October 2020) she details her previous work history, her marriage to Robert and her involvement in his business. She also sets out her pre-accident medical history and concedes she had a left shoulder problem but that at the time of the accident she was well.
The claimant said she was driving at 50 – 60 kmph. She describes the accident as a “head on collision”.
The Panel notes that the photographs provided by the claimant suggest, and the police report[13] provided by the insurer confirms, the collision was not a “head-on” collision in the usual sense. While the accident occurred at an intersection it would appear the insured vehicle turned right in front of the claimant’s car and the claimant’s car hit the front passenger side (or corner) of the insured vehicle in a T-bone type collision. The photographs are not entirely clear but do not appear to show airbags having been deployed in either vehicle.
[13] Page 154 of the insurer’s bundle.
The claimant gives a history of the development of her physical symptoms and her psychological symptoms.
BNP also sets out in great detail her daily routine, her difficulties driving and the impact of the accident on her work and relationship with her grandson.
In her second statement, dated 8 March 2021 the claimant addresses some of the insurer’s submissions in particular her pre-accident psychiatric condition and the two instances involving the claimant’s current husband. She also explains why she stopped seeing Dr Nguyen (who moved away) and her reluctance to take medication (her preference for natural remedies).
Her third statement addresses the social media material. The table below includes on the left the event or activity highlighted by the insurer and the claimant’s response to it.

Event or activity

Claimant’s response

The claimant attended a wedding on 20 May 2018.

The photo depicts a handbag on a table at a wedding. The wedding occurred on 16 July 2017 not 20 May 2018.

The claimant attended a kitchen tea on 28 May 2018.

The claimant attended the kitchen tea which was at her sister’s house, and it was for her niece. She left early and was collected by her husband due to her pain.

The claimant participated in a dress up event on 31 May 2018.

The photo was taken in 2015 and reposted as a thank you to a friend who visited her after the accident.

The claimant travelled to Mykonos in August 2018.

The trip was booked before the accident.

The claimant travelled to Las Vegas in advance of a friend’s wedding in September 2018 and attended a night club.

The trip was booked before the accident, and she spent most of the week in her hotel room. She was in constant pain and could not keep up with the girls.

The claimant attended an event on 11 October 2018 with her hair professionally styled.

The claimant does not recall this.

The claimant hosted and attended a school reunion in October 2018.

The event had been planned for months before it occurred. It was held at her home, and everyone brought food and helped and clean up afterwards. She has declined to attend other events since then.

The claimant went on a boat trip at Barangaroo in October 2018

This was another hens event which she attended with her daughters.

The claimant was dancing on 22 December 2018.

The video is old and was reposted to thank someone.

The claimant attended a rooftop bar in Barangaroo in March 2019.

Not clearly addressed.

The claimant visited a venue in Caulfield North (Victoria) September 2019 and St Kilda in March 2019

The claimant does not know what this is and has not visited Melbourne in over 10 years.

The claimant ate fairy floss on 1 June 2019.

The claimant confirms attending the black-tie charity event with friends and her husband.

The claimant attended a fiftieth birthday costume party on 8 June 2019.

Her husband drove her to this.

The claimant attended a wedding 20 September 2019.

Not addressed.

The claimant travelled to Croatia in January and February 2020

Not addressed.

Lockdown posts March 2020, April 2020.

This was an old video reposted.

The claimant went out with friends December 2020

The photo posted was from 2015. It was reposted to say thank you.

The claimant was photographed with a child in January 2021.

The photo is an old photo posted for self-esteem purposes.

The claimant commented “dressed up nowhere to go” 26 June 2021.

This is an old photo touched up with the use of an app.

The claimant attended a family dinner out in June 2021.

Not addressed.

The claimant commented on having had her hair done.

The claimant accepts during lockdown she purchased a home hair dye kit to support her local hairdresser. She says she cannot physically do her own hair but does not want to cut it.

The claimant provides some commentary on social media generally and how it records the dates of posts but that the posts may not be of things that have occurred on that day.
Her final statement dated 16 June 2023 further explains how she came to be hit by a water bottle thrown by her husband. She was walking into a room at same time as he was throwing the bottle. The bottle was not thrown at her. She explains it was an accident and has never seen a psychologist or psychiatrist before the accident.

Other lay evidence

Ms Pope a real estate agent provided a letter dated 25 August 2020 concerning a business relationship with the claimant and stating that since the car accident “BNP has been unable to operate in her previous capacity”.
Ms Hardy, a close friend of the claimant provided a letter dated 13 January 2021. She has been a friend for 29 years and says that “since the car accident … BNP has become withdrawn, depressed and extremely anxious.” She says that the claimant’s ability to work has been affected and as a result of the claimant’s anxiety BNP has “lost her independence and confidence to driver herself in traffic situations.”
Ms Kemplen has also provided a statement dated 29 January 2021. She was a customer of the claimant’s husband’s business. He did the painting, and the claimant was the colour consultant and “performed a PR role”. She has remained friends with the claimant. She says that since the accident the claimant is “a bit neurotic”, stressed, crying, she does not go walking and has limited confidence in driving. Ms Kemplen also says that the claimant’s relationship with her husband has suffered.
Mr Glenn Mavin has provided a “reference” to Paul for the claimant which is undated. He says he has known the claimant for 17 years in a professional capacity as a site supervisor for a home building company. Since the accident, BNP has suffered from “ongoing pain and anxiety” and her husband has had to take time out of his work to take her to medical appointments. She is “too anxious to drive any further than a short trip”.
BOV has provided a statement in support of his wife’s case dated

23 April 2021. He confirms that before the accident BNP was a colour consultant, provided customer service, did office work and had a management role in the business.
The business has suffered because she cannot give 100% to the role and lacks confidence and cannot drive “at most she will do a few invoices a week for me and pay bills at the post office”. He says his wife is “always anxious, irritable, in constant daily pain and this has impacted both her ability to return to work and our relationship”.
The claimant’s friendship group has shrunk as her friends have not understood her, members of the family have stepped in to help. The claimant’s inability to drive is a problem and she has “jumped out the car” if it is too close to other cars.
The claimant’s personality has changed to being “sad, withdrawn, depressed [with] mood swings, and she cries almost daily”. He says his wife has lost self-confidence, her self-esteem is poor and “she suffers PTSD and panic attacks.”
The claimant’s daughter BLZ has provided a statement dated 26 April 2021 saying her mother has not been the same since the accident. She does not drive, and BOV has to drive her, or BLZ has to go and get her mother, and BNP panics every time she gets in the car.
BLZ says that a few of the claimant’s friends have isolated her mother and she is worried about her mother’s mental state.

Treating medical records and reports

Ms Melissa Hill psychologist wrote to Dr Basiri on 28 October 2018.[14] The claimant had attended three sessions, as at 22 June 2018. The claimant reported she was making progress and had recommenced driving in her local area. Further sessions were suggested, “though she has not been seen since this time”. Ms Hill says she maintained contact with BNP and the claimant reported further progress and the referral was closed.
[14] Page 486 of the claimant’s bundle.
Psychological treatment re-commenced with Mr Georginis of Starlight Psychology.[15] The claimant first attended on 11 July 2019 “emotionally distraught with a flat mood and affect”. She reported requiring people to drive her to her appointments because she was “too traumatised to drive again”. She said she had six psychology sessions before this.
[15] Page 496 of the claimant’s bundle.
The claimant reported poor sleep and was upset at having to take medication.
The accident was said to be “all consuming” and she was experiencing flashbacks and her daily functioning was seriously affected.
On the next occasion (1 August 2019) the depression anxiety stress scale revealed she was extremely depressed, extremely anxious and extremely stressed. CBT was explained, psychological education was given and mindfulness and psychotherapy was explained.
On 9 September 2019 the claimant reported obsessive compulsive-like symptoms and panic attacks.
Further sessions occurred and on 7 November 2019 the claimant reported, “she is feeling very anxious about being in a car and finds it difficult to contemplate driving a car”.
After further monthly sessions, on 5 March 2020 the depression anxiety stress scale was re-administered with the claimant scoring moderate for depression, and severe for anxiety and stress. In April 2020, the claimant reported she was relapsing because of COVID-19. At this time the claimant began expressing concerns about her dealings with the insurer. On 9 July 2020 while she was becoming more comfortable in a vehicle, she was hypervigilant and emotion in everyday situations.
On 19 October 2020, she was anxious about the sessions ending. She reported being able to drive herself to medical appointments and the local shops, but she remained anxious and depressed. On 19 November 2020, the claimant had participated in a case conference to address physiotherapy, hydrotherapy, ongoing psychology and so on.
Further attendances occurred in 2021 with the claimant frustrated with the insurer and her case and changes in case managers and having to relive the trauma when talking about it with examiners and assessors.
On 29 June 2021, the claimant’s depression anxiety stress scale was moderate for depression and severe for anxiety and stress.
On 23 August 2021 a settlement conference had occurred, but the claimant was distraught the claim did not settle.
In a session on 29 November 2021 the claimant was “highly distressed … and crying regularly”. This and the 9 December 2021 session appeared to be related to the insurer’s service of the surveillance footage and social media posts and she said, “she felt violated”. On 11 February 2022 she expressed a fear of going out concerned for her own safety and expressed “a desire to cut herself”.
Throughout 2022 there are consultations where reports of her case are given and a continuation of her symptoms of pain and anxiety and depression. On 3 November 2022 she reported, “very strong sense of injustice in how she believes she has been treated by her insurer”. She felt the surveillance has caused a decline due to the invasion of her privacy. Similar thoughts were expressed on 16 January 2023 although the claimant reported she was driving and employing the strategies she had been taught.
Mr Georginis wrote to Dr Basiri on 14 February 2022 urging all involved in BNP’s case to attempt to resolve it and he wrote about the effect of the surveillance on her mental health.
There is a letter from Delta Care advising they have no records of treating the claimant.
There is a letter from iCare’s “CTP care” approving six consultations of psychology from 15 May to 30 July 2023.
The claimant relies on reports from Dr Nguyen, psychiatrist.[16] It appears the claimant attended nine times from 28 January 2019 to 29 October 2019 before Dr Nguyen left the practice. In the first report Dr Nguyen diagnosed a post-traumatic disorder with panic disorder and agoraphobia secondary to the accident. Dr Nguyen notes the claimant was not keen on medication as “antidepressants in the past have caused her side effects”.
[16] Records commence at page 216 of AD1.
In the last report dated 29 October 2019, Dr Nguyen says the claimant was improving. She was benefitting from the pain management therapy. BNP was anxious but not depressed.
Dr Standen of Sydney Pain Specialists became involved with the claimant’s treatment for her physical injuries. On 13 May 2019 she recorded her impressions of the claimant as follows, “anxious demeanour, elements of post-traumatic stress disorder with probably underlying mood disorder”.
Dr Standen reported improvement in the reports before the claimant ceased treatment with Dr Nguyen. On 15 April 2020 Dr Standen reports “her mood has plummeted with the requirement for social isolating”. She said she was unable to visit her daughter because of social isolation. The claimant was not taking her medication regularly and she was having symptoms consistent with panic attacks.

Medico-legal reports

Dr Mason, psychiatrist has provided a report to the claimant’s solicitor’s dated

15 June 2023 following his examination of the claimant a few days earlier.
Dr Mason takes a history of the accident consistent with the other records and states that the at fault vehicle had a large bull bar affixed to it. She says her car got stuck on this bull bar and was pushed across the road. He also notes that the claimant’s three-year old grandson was in the back and was screaming and she thought he was going to die.
She reports feeling of shock and anxiety at the scene and said that pain developed in her neck, left shoulder, lower back, left thigh and both hands later in the day and that she developed nausea and vomited. She saw her GP and was given Voltaren gel. She was referred to a physiotherapist but could not get in so had a massage and has been having massages and using heat pads and creams.
BNP then had investigations in relation to her spine, a steroid injection into her shoulder and she has seen a pain specialist.
The claimant recounted panic attacks and an inability to drive. She was fearful and hypervigilant as a passenger. She reported disturbed sleep, flashbacks, smells the road and sees the other woman in the car. She can now drive to the local shops and to her physiotherapist but cannot got to her psychiatrist or pain specialist and her husband has to drive her.
She expressed fear, says she was depressed and was distressed about the pain.
The claimant saw Dr Nguyen every four then every six weeks until Dr Nguyen left the practice in October 2019. She has not engaged a new psychiatrist but has continued on medication and she sees a pain specialist.
The claimant said she was depressed after her mother died but was not prescribed medication. Otherwise, her general health was good.
Dr Mason considered the claimant’s presentation was consistent but that there was a high level of pain behaviour.
Dr Mason diagnosed post-traumatic stress disorder and an adjustment disorder with mixed anxiety and depressed mood and was developing an opioid use disorder. He also considered she had a somatic symptom disorder (although indicates this is not assessable under the guidelines).
He assessed WPI at 15% and made no allowance for the effect of treatment.
Dr Mason saw the claimant again on 9 and 15 March 2023 and has provided a report for the claimant’s solicitors dated 24 March 2023.[17]
[17] Document AD9 in the Commission’s file.
Dr Mason has a history of the claimant working two hours a week for her husband sending out invoices.
The claimant confirmed the history of the accident and her treatment to date as reported in the previous report.
BNP says:
(a)   she was anxious with sweaty palms, dry mouth and fatigue;
(b)   she has impaired concentration;
(c)   she is overwhelmed by anxiety and undertakes breathing exercises;
(d)   the pins and needles she has in her hands worsen with anxiety;
(e)   she has panic attacks, about twice a week, as a passenger with her husband driving;
(f)    she is depressed and cries a lot;
(g)   her life has deteriorated and she is no longer independent;
(h)   she has had thoughts of suicide but will not act on them because of her faith. She does not go to mass but watches the services on line;
(i)    she struggles to motivate herself to attend family functions, and
(j)    she is erratic in mood.
Dr Mason questioned the claimant’s pre-accident history including the mental health plan from December 2015 however the claimant could not recall any difficulties.
Dr Mason questioned the claimant about the social media posts and the claimant’s responses advised that seven of the posts were accurate and eight were not. He also reviewed the surveillance footage and had the statement from the claimant responding to the footage.
On examination, Dr Mason noted the claimant was a difficult historian and that she was very angry with the insurer.
He restated his diagnosis that the claimant had a post-traumatic stress disorder as well as an adjustment disorder with mixed anxiety and depressed mood. Mr Mason was of the view the claimant required psychiatric and psychological counselling, that her condition had stabilised and that she had an impairment to her ability to work.
He assessed her impairment as 18% (17% WPI plus 1% for treatment).
The Panel notes there have been no expert psychiatric or psychological reports served by the insurer.

Other assessments

Medical Assessor Parmegiani assessed the claimant on or about 18 May 2021[18] after an in person examination.
[18] Page 179 of the claimant’s bundle.
The claimant gave a consistent history of the accident and her treatment but said she did not get on with Ms Hill her first psychologist and as a result she switched to

Mr Georginis.
He diagnosed a chronic post-traumatic stress disorder which he assessed at 18% (17% for impairment plus 1% for the effect of treatment).
Medical Assessor Parmegiani assessed the claimant again on 11 October 2021 by way of video-link. At the first assessment he had not been provided with the insurer’s reply. At this assessment he had the insurer’s reply and documentation, and he appears to have addressed the issues raised in the insurer’s submissions in that matter.
The claimant denied any psychiatric diagnosis before the accident and conceded there had been two incidences of domestic violence and that her first marriage disintegrated due to the behaviour of her ex-husband’s brother.
She was said to have appeared well groomed, agitated but pleasant and polite.
Medical Assessor Parmegiani reassessed WPI again finding 18%.

RE-EXAMINATION FINDINGS

General remarks

The claimant attended an in-person medical examination with Medical Assessor Baker on behalf of the Panel.
The clamant was identified by her Medicare Card Number. She did not bring her driver’s license to the assessment and her husband drove her to the assessment. The couple travelled about 60 minutes to attend.
The claimant entered the waiting room unaided and hypervigilant. She was pre-occupied with the new environment. She was greeted and responded in a courteous manner on the third occasion. She was about 15 minutes early for the assessment.
Both BOV and BNP were present in the room during the examination as BNP was not able to settle without the support of her husband. Rapport was difficult to establish and sustain. Progress throughout the re-examination was slow. The claimant had frequent outbursts of anger and fear. She stated her trust in others since the motor accident was damaged. BNP required time to settle. Once settled she was able to report various aspects of her history before and since the motor accident on 15 May 2018. In general, the history provided was consistent with the documented narratives of the motor accident and injuries sustained by all other authors.
While BOV was advised he was there as a support person and was not to participate, as the medical examination progressed and at times due to his wife’s outbursts, he was required to help settle his wife and any comments from him have been noted.

Psychosocial history and pre-accident history

BNP’s early developmental history was confirmed and will not be reiterated in this re-examination. There was nothing of relevance to the re-examination.
The claimant reported no postnatal depression, psychological or psychiatric condition before the motor accident.
BNP lived with her husband Robert, and her son to her first marriage. The claimant reported that she and Robert had no children together. She reported that she had two elder daughters. Each elder daughter was married, and each had two children. The claimant advised that her second daughter’s husband was a commercial lawyer. She reported that her second daughter has a five-month old infant.
The claimant lived in the same house as she had while married to her ex-husband. Her ex-husband was the father of all her children. Prior to the separation and divorce, the claimant reported that her ex-husband’s brother was aggressive towards the claimant’s pregnant sister. There were verbal and physical threats made. The incidents occurred on one or two occasions only. The claimant on one occasion, intervened stepping between the arguing couple. Her ex-husband’s brother then slapped the claimant across the face, possibly twice. The claimant sought safety from her then husband but was offered no support.
The claimant took legal action for her own protection. The claimant was successful in her application of a five-year apprehended violence order (AVO) against her former brother-in-law. This was the catalyst for the divorce. The claimant maintained the house and raised her three children as a single mother until she married Robert. She did not seek psychological or psychiatric services at the time of the divorce. During the time immediately after the events that led up to the AVO, the claimant reported she worked for various employers without impairment. The employers were identified in the claimant’s statement. She was able to form a new relationship with her current husband.
In the claimant’s statement she reports an incident of her husband throwing a water bottle. She suffered a cut to her lip. She attended her doctor. The claimant understood the event as an “accident” caused by her husband as she walked through a room at the time. The claimant did not seek psychological, psychiatric, or legal assistance in relation to this incident. At the time of the re-examination, she stated that the incident had not been an ongoing issue. The incident had not impaired her intimacy with her husband or her capacity to work in his business and did not prevent her from forming new relationships with her grandson, Sebastian, the first-born grandson to her first daughter.
Prior to the motor accident the claimant had injured her left shoulder. She reported that her left shoulder had been treated and she had recovered prior to the motor accident. She had experienced the symptom of pain, however she had not as a result of this pain, experienced anxiety, depressed mood or loss of her capacity to function as a grandmother, fulltime employee for her husband. She reported no incapacity to drive before the accident making 110km round trips to her daughter’s house up to three times each week, as well as frequenting her favourite Neutral Bay cafe, friendship circle, social media network and her favorited European fashion shoe shop in Neutral Bay as well as David Jones with her daughter.
The claimant had been interested in her appearance and had cosmetic treatment of her lips as well as attending salons for coifing of her hair and treatment to her nails. The claimant had completed a Dulux colour course in order for her to work for her husband. She would attend clients’ homes and present paint colours as well as assisting with colour matching and choices regarding the client’s home, ambiance and planned furnishings. BNP reports the family business led by her husband was successful. The claimant also assisted with invoicing, bill payments and payments received from clients prior to the motor accident.

The claimant said she had provided verbal reassurances that when her second daughter was to start her family, she would be able to help with the adjustment to the arrival of a newborn. The claimant stated at the time of the re-examination that she had a responsibility and had made a commitments to help both her daughters’ equally.
The claimant reported that before the accident she was fit and capable of working, supporting her husband’s business as well as supporting her first daughter and her first daughter’s young family. The claimant enjoyed her life and would engage in social events and post them on social media. She enjoyed travel and her marriage to her husband. Her son was a music producer and disc jockey (DJ).

History of the motor accident.

When asked to recount the accident, the claimant immediately responded with an angry outburst stating, “contamination”. She required reassurance by her husband. She was encouraged to use her psychological skills and breathing techniques to settle. She was asked to explain what the context of the word, “contamination” meant to her. The claimant explained: “It’s the 4 R’s! Every time I’m asked about the crash I Relive, Reply, Repeat and Revisit my losses”.
BNP stated that she suffered from frequent reliving of visual imagery of the oncoming car crashing into her car. She stated she had written everything into her statements. She then stated that having to reply to the same questions over and over caused her to suffer angry outbursts and that she feared she would not be listened to or understood.
Rapport with the patient was rebuilt slowly and the re-examination progressed. The claimant stated that she was unable to resolve the ongoing guilt she experienced with “Seb” at the time of the motor accident. She stated she had become fearful of driving and that her fear included isolating herself from her first and second daughter’s families. The claimant stated she could not travel the necessary distance alone and so she was now unable to form a close relationship with her new grandchild who was five months old. The claimant stated every time she thinks of the motor accident, she had intrusive distressing memories of “Seb” crying. She had told her second daughter she could not drive to visit her new grandchild. This had resulted in repeated angry arguments, each time commenced by the claimant’s second daughter who shamed the claimant with statements like, “You did lots more for your eldest daughter! Now you won’t even visit!” The medical members of the Panel are of the view that this type of angry outburst and avoidance of intrusive distressing memories is clinically well known to be part of post-traumatic stress disorder.
A second attempt was made to obtain more details of the motor accident. BNP spoke about having a car with a bull bar crash into her. She spoke about smoke coming from the engine. She spoke about the safety system of her car failing. She confirmed the prior history that she believed that she and Seb narrowly survived being seriously injured or dying due to the crash.
The claimant explained that the air bags of her car failed to deploy on impact with the other vehicle. She experienced physical injuries to her neck, hands, back, left shoulder and left leg. She reported having been helped from her car. She had at the time of the motor accident placed her “entire focus on Seb”. She said, “children come first” and “I failed to keep Seb safe”. She feared the unknown consequences to Seb and was unable to be reassured he was not harmed in the crash. Medical Assessor Baker noted that the claimant required further time to settle at this point.
The claimant then stated that the accident only happened a short distance from her home. The ambulance and Fire Brigade attended the scene. The police did not attend the scene. Her husband came to the scene of the motor accident. She was asked why she and Seb were not taken to hospital. After settling herself the claimant explained she was dazed by the motor accident. The ambulance officers checked her and Seb, and as she was not in pain at the scene of the motor accident, and Seb was not in pain the ambulance left. Her focus was “on Seb, not herself”. The claimant stated that the ambulance officers, reassured her that Seb was “OK”. She went home as supported by her husband with Seb.

History of symptoms and treatment following the motor accident

The claimant reported the first experience of pain was on the evening of the motor accident. She reported that she was angry that the other driver had driven into her car. She was angry her car was towed and had to be replaced. She described that she commenced experiencing increased anxiety. She described her mood became sad and then depressed. She attended her GP the following day. She began to experience pain constantly.
The claimant’s doctor prescribed her Voltaren Gel for her muscle pain. He referred her to a sports physiotherapist. There were no appointments available to help her. She changed services and received remedial muscular massages with heat pads and topical Voltaren Gel. Investigations showed changes at C6/7 and L4/5 of her spine. She began to experience painful “pins and needles in her hands”. Her pain became more severe and was exacerbated by her depressed mood and anxiety. She was referred to Dr Standen. She was commenced on pain management, but treatment ceased in 2019, “due to the psychiatrist stopping practice” and lack of rapport with the psychologist. The claimant said she was referred to her current psychologist on referral of Dr Standen.
Medical Assessor Baker noted that at this time the claimant required further time to settle. BNP was asked to talk about her mental and behavioural symptoms since the motor accident. The claimant became agitated, frustrated, and angry. She said, “Gratitude!” On settling, the claimant was asked what she meant by the word “Gratitude”. The claimant stated:
“I feel like everything has been taken away from me. I have lost my self-esteem and my self-confidence. I have no interest in leaving the house. My friends on Facebook mock me and write on my page, ‘the queen of Kenthurst does not venture out of her area.’ I’m fearful I will hurt my five month old grandchild. I have no interest in intimacy with my husband. I keep reliving the crash. I’m angry my life has gone! I kick my husband when I have nightmares. No one has got me well.”
The claimant had not received psychiatric treatment since her treating psychiatrist had stopped practice in 2019 although she has had pain management and still sees a psychologist (which the Panel notes is paid for by the relevant insurer in her statutory benefits claim). The diagnosis of post-traumatic stress disorder was made, and her treatment included the commencement of Effexor and psychological counselling. Initial attempts to develop and sustain a treatment relationship with the referred psychologist (Ms Hill) failed. The claimant’s second psychologist (Mr Georginis) was close to the pain physician rooms (Dr Nazha). She organised for the referral for ongoing psychological treatment through the service “Starlight”. Treatment with this psychologist continued. The claimant was avoidant of eye movement desensitisation and reprocessing therapy (EDMR), specific cognitive behavioural therapy (CGT) and other evidence-based psychological treatment to address her depressed mood and anxiety. There has been no referral for outpatient or inpatient psychiatric hospital-based treatment for post-traumatic stress disorder. The Effexor was prescribed by

Dr Basiri.

Chronic primary pain

The claimant stated she was suffering from chronic pain. She stated that her anxiety and depressed mood exacerbated her pain experience. The claimant’s chronic pain is experienced in more than one anatomical region. She reports pain in her shoulder, thigh, neck, and back. She also reported experiencing pain in her hands with the experience of painful pins and needles whilst typing invoices. The claimant described that the chronic pain had, in the past, caused overwhelming emotional distress, however in more recent times the pain had settled but never fully resolved. Whilst the pain experience may have settled in relation to her neck and back, the claimant reported that the painful pins and needles affecting her hands whilst typing persisted.
She stated she was able to lift light objects up to about a one litre of paint in a can. She was able to describe that her chronic primary pain was exacerbated by anxiety and her depressed mood. She did describe that her chronic primary pain interfered with her daily functioning. She had a reduced activity of daily life activities and reduced participation in social roles and work.

Post-traumatic stress disorder

The claimant said she continues to have distressing re-experiencing of the motor accident. These distressing experiences included visual imagery of the at fault driver crashing into the claimant’s car, the claimant’s car being on the bull bar of the other car; the smoke in her car, hearing Seb screaming, seeing Seb distressed and having the initial thought, “Seb and I could have died!”
The claimant continued to demonstrate deliberate avoidance of reminders likely to produce re-experiencing of the traumatic event. The main behavioural response she would have to being asked to remember the experience was to have an angry outburst such that she did not have to grapple with the content of her distressing thoughts, visual imagery and occasional olfactory smell of the smoke from the engine.
The claimant also reported using avoidance when asked to help her second daughter and her second daughter’s five month-old child. The claimant stated, “Prevention is better than cure”. If I don’t go near them, then I cannot harm the baby”.
The claimant continued to experience persistent perceptions of heightened current threat. The patient used the word “Paranoid”. Medical Assessor Baker notes that the claimant’s use of the word “Paranoid” is the common sense meaning, “unreasonably or obsessively anxious, suspicious, or mistrustful” and did not imply that she was suffering from a psychotic or delusional psychiatric condition.
The claimant responded to the surveillance by the insurer by having her core feature of post-traumatic stress disorder namely, increased fearfulness and avoidance of any activity, event or memory of the motor accident being exacerbated. The claimant isolated herself from her family inside the house and her daughters outside of the house. The claimant reported her exacerbated fear and avoidance had resulted in estrangement from her friendship circle and loss of her social media network on which she relied for business leads. She stated she felt humiliated by the mocking she had experienced on her social media page.
The claimant reported significant impairment in personal, family, social and occupational functioning documented below at the time of this re-examination.
The claimant demonstrated common emotional symptoms associated with, but not core to, posttraumatic stress disorder. These emotional symptoms included shame, guilt, anger and humiliation. All of these emotions were demonstrated by the claimant during the re-examination.

Current and proposed treatment.

The claimant attended her treating medical team regularly. She reported having a good relationship with her pain physician and her psychologist.
The patient brought her pharmacotherapy and prescriptions with her and she showed me original prescriptions of medications. She was asked to separate the medication into her pain medication from her other medication which she was able to do.
Her pain medication was:
(a)   Norflex (orphenadrine) 100mg one tablet twice daily;
(b)   Endep (amitriptyline) 10mg one tablet at night, and
(c)   Paracetamol 665mg two tablets three times daily.
BNP’s psychiatric medication was:
(a)   Effexor (venlafaxine) 75 mg capsule in morning;
(b)   Effexor (venlafaxine) 150 mg capsule in morning;
(c)   Melatonin modified release 5mg one tablet bedtime, and
(d)   Phenergan (promethazine) 10mg tablet one tablet bedtime.
The medical members of the Panel note that Effexor is, in their clinical experience an appropriate evidence-based treatment for post-traumatic stress disorder and that the maximum recommended daily dose is 225 mg daily. In other words the claimant is taking the maximum dose.
The claimant was also aware of the psychological treatment for post-traumatic stress disorder included CBT and EDMR. Since psychiatric treatment ceased in 2019,

BNP mainly used controlled breathing to settle her anxiety. The claimant had not been admitted to a psychiatric hospital and had not received an inpatient or outpatient psychiatric treatment program.

Clinical examination

Chronic primary pain examination

The claimant walked into the examination room unaided and without the need of any device or support. The claimant’s gait appeared unimpeded.
The claimant was too anxious to enter the examination room alone and turned to her husband to follow. Both the claimant and BOV entered the room together. The claimant was offered a choice of between a hard back chair or a soft back chair both with pillows. She selected the soft back chair. She said she used a soft back chair with a pillow as her preferred seating at home. She utilised a pillow for lower back support.
The claimant and her husband were offered water and the claimant asked for a glass less than half full. The clamant did not demonstrate tremor or complain of excessive sensitivity to cold causing pain. The claimant did not complain of painful pins and needles on gripping or raising her left arm with the glass that was closest to her. She was observed to drink water unimpeded. She reported a dry mouth due to anxiety and was courteous, saying thank you. She stated her anxiety symptoms and depressed mood exacerbated her pain.
The claimant readjusted her hair band and her hair before leaving the re-examination. She did not appear to be in pain or restricted in raising her left or right arms above 90 degrees to attend to the back of her head. She did not complain of pain caused by this spontaneous movement.
The claimant did report experiencing pain during the assessment. She reported anxiety and said that thinking about her losses caused her to suffer from a depressed mood. When suffering from her anxiety or depressed mood she reported exacerbation of her pain. On direct enquiry she was asked about her first experience (after the accident) when Seb had been returned to his mother. She stated that she experienced pain. She said when her pain was not able to be rapidly improved, she began to suffer from a depressed mood with anxiety. The claimant explained that at the time of the re-examination her anxiety and depressed mood made her pain worse.
The claimant’s husband, BOV reported (consistently with his statement) that his wife’s anxiety and pain impaired her capacity to work and remain intimate in the relationship.

Mental State examination

The claimant presented as a mildly dishevelled woman who was not readily recognisable from the social medial posts forwarded with this re-examination. She had not attended to her appearance before the assessment. Her hair was raised in a simple band gathered at the back of her head. She wore no make-up and had not attended to her fingernails. She stated she no longer used cosmetics or improved her self-image. She stated her self-esteem had been broken by the repeated difficulties she had experienced since the motor accident. She demonstrated courtesy and was polite both on requesting water and whilst drinking. On completing her drink, she said, “I’m useless to my family”.
The claimant had difficulty settling in the assessment room. Her husband was required to enable her to settle on repeated occasions. The claimant would frequently shift from answering specific questions to having angry outbursts. She was asked what she believed was causing her rapid change in emotions. She reported that the main cause of her angry outburst was reliving visual images of the motor accident. She reported reminders of the motor accident led to the intrusive distressing visual images of the at fault driver crashing into her car. She reported having overwhelming emotions of shame and guilt that she could no longer control her angry outbursts. She reported overwhelming fear that she was to blame for “hurting Seb” and that no one listened or understood her. She stated she had been publicly humiliated on her social media page and no amount of reposting could repair the loss of her business network and friendship circle.
The claimant’s re-examination was slowed by the need to repeatedly rebuild rapport after each angry outburst. She was encouraged to use her psychological skills that were taught to her by her psychologist. Controlled breathing helped recompose the claimant. During one angry outburst the claimant demanded to leave the room and pause the re-examination. The door to the assessment room was opened immediately. The claimant was provided the immediate opportunity to leave the room or use her breathing skills to recompose herself. She chose to use her breathing skills to recompose herself and remained in the re-examination room.
The claimant’s angry outburst behaviour was noted by Medical Assessor Baker to be distressing to the claimant’s husband. He said this repeated anger and fear was not present before the motor accident.
The claimant reported unrepairable harm to her friendship circle, business network and second daughter’s relationship. The claimant was fearful of public humiliation and publicly being mocked. She had isolated herself and abandoned EMDR treatment as she feared the shame would never leave. She described humiliation for being “labelled” on her social media page as “the Queen of Kenthurst”. She was permanently estranged from her friendship circle. The claimant stated she could longer trust anyone. She stated she had no libido and had lost all interest in intimacy. She reported violent movements in her sleep in the context of nightmares about the other driver crashing into her car. BOV then reported many episodes of being forcibly kicked by the claimant whilst she still appeared to be asleep to him. The patient’s abnormal sleep movements are clinically known to be associated with intrusive distressing nightmares associated with the content of the traumatic event caused by post-traumatic stress.
The claimant was orientated in time, place and person. She had good capacity to recall what had happened during the motor accident. She reported the reminders caused her irritability and distress. The claimant’s concentration waxed and waned throughout the assessment. She was not able to persist without suffering an angry outburst at a frequency of about once every 15 minutes. She was allowed to progress at a slower pace. She complained that her concentration would fatigue, and she would then have a headache. She reported an angry dysphoric mood. She demonstrated hypervigilance. She reported suicidal thoughts without intent. She was distressed when she explained she could not “trust myself” not to hurt the five month-old infant. She stated she feared another motor accident with the baby in the car. She stated she feared “dropping the baby” and causing unwanted harm. She had chosen to avoid her second daughter and this family. She stated her second daughter was angry with the claimant. The claimant stated, “Prevention is better than cure”. She explained that she preferred to be isolated and alone than to be shamed and left holding the guilt that she had caused harm to the children.

Comments on consistency

The claimant was consistent with her presentation and report of her post-traumatic stress disorder and pain experience. She did not exaggerate or minimise her pain condition. She was frank and open about what had happened between her and her first husband as well as her first husband’s brother. She reported that she had moved on in her life and no longer engaged with this part of her extended family for many years before the motor accident.

The claimant was frank and at times blunt in her presentation of the difficulties she had experienced. She stated that she disliked having the angry outbursts, but she was demoralised and had “suffered enough”.
The claimant was angry and upset by the insurer and the surveillance footage and social media entries. She was able to identify herself in the video footage and confirmed she had responded to it in her statements.

DIAGNOSIS

Preliminary matters

As explained in paragraph [14], cl 6.213 of the Guidelines provides for the assessment of impairment due to mental or behavioural disorders in accordance with the current edition of the DSM or ICD. As the current edition of the ICD is more recent (published in January 2022), the Panel prefers to consider it.
The Panel has also decided to use this publication because:
(a)   both the DSM and ICD provide for a post-traumatic stress disorder diagnosis however there are subtle differences between the two;
(b)   ICD 11 provides for a diagnosis of complex post-traumatic stress disorder which is more useful in dealing with repeated trauma which is relevant in the light of the insurer’s allegation of a pre-existing psychiatric condition caused by more than one domestic incidents, and
(c)   DSM 5 provides for a somatic symptom disorder while ICD 11 provides a new diagnosis of chronic primary pain which includes within its criteria symptoms of anxiety and depression. This diagnosis assists in separating and distinguishing between pain disorders and other psychiatric disorders and provides the best current understanding of the medical conditions in issue in this matter noting cl 6.125 (which excludes pain and somatoform disorders from impairment assessment) and the chronic pain which is a feature of BNP’s current presentation.
Medical Assessors Parmegiani and Jones, as well as Dr Mason, all recognise the diagnosis of post-traumatic stress disorder. The use of DSM 5 criteria confused the claimant’s history because it does not recognise repeated trauma such as domestic violence as a separate condition to single trauma events such as a motor accident. DSM 5 cannot diagnose complex post-traumatic stress disorder and does not list an equivalent diagnostic condition.
In ICD11, complex post-traumatic stress disorder is used in simplifying diagnosis in trauma populations, by recognising the more complex reactions that are typical of individuals exposed to repeated trauma. It explains that whilst repeated trauma may cause complex reactions, not all people exposed to repeated trauma will experience complex post-traumatic stress disorder.

Pre-existing psychiatric condition

It is the clinical judgment of the medical members of the Panel that a review of the documents does not support a diagnosis of complex post-traumatic stress disorder[19] before the accident.
[19] ICD11code 6B41.
The Panel accepts that the claimant had experienced episodes of trauma in her life before the motor accident, however she did not demonstrate any mental and behavioural disorder due to this repeated trauma. For these reasons she does not meet diagnostic criteria for a pre-existing assessable mental and behavioural disorder as defined within the Guidelines.
The pre-existing left shoulder injury and the symptoms of pain BNP experienced was not, before the accident, associated with other impairments and the claimant remained functional in her work, family, social circle, business network and community. The medical members of the Panel are, in their clinical judgment, of the view that the claimant did not have the mental and behavioural disorder of Chronic Primary Pain[20] at the time of the accident, as there is no evidence of any loss of function at the time of the injury.
[20] ICD11 code MG30.0.
In conclusion the Panel finds the claimant did not have evidence to support a pre-existing chronic primary pain syndrome or pre-existing repeated trauma related disorder before the current accident.

Current diagnosis

ICD11 code 6B40 post-traumatic stress disorder criteria

BNP was exposed to a serious motor accident. The consequences of the motor accident included the claimant witnessing her then three-year-old grandson’s life being threatened by the motor accident. The airbags, the main major safety device in the car that the claimant drove failed, which she perceived to have increased the risk of serious actual harm to herself and her grandson.
The claimant reports all three core elements for the diagnosis of as single trauma event causing post-traumatic stress disorder which are:
(a)   re-experiencing the traumatic event in the present, including visual distressing intrusive memories of the other driver crashing into her car;
(b)   deliberate avoidance of reminders likely to produce re-experiencing of the traumatic event, including avoiding contact with her new grandchild in an attempt to avoid “reminders about the harm she had placed Seb in” when he was three years of age at the time of the motor accident, and
(c)   persistent perceptions of heightened current threat. This was seen as the claimant entered a new environment (the examination room) for the first time. She was observed to be hypervigilant. During the re-examination, the claimant’s behaviour was put to her during the assessment, and she reported, “I was fearful of you!”.
The claimant reports and the statement of others indicate there has been a significant impairment in personal, family, social and occupational functioning, and the other common emotional features of post-traumatic stress disorder such as shame, anger, guilt and humiliation were all reported by the claimant during the course of the re-examination.
The condition diagnosed as post-traumatic stress disorder is to be assessed as part of the impairment assessment. The medication Efexor XR 225mg is an evidence-based treatment for post-traumatic stress disorder and is used in conjunction with EMDR, relaxation techniques and controlled breathing as evidenced-based psychological treatment for the disorder.

ICD11 code MG30.0 Chronic primary pain criteria

Having reviewed the documents from the claimant’s pain specialist and psychologist, and considering the results of the re-examination, it is the clinical judgment of the medical members of the Panel that the best diagnosis to explain the claimant’s current mental and behavioural pain experience is ICD11, code MG30.0, chronic primary pain.
The condition of chronic primary pain is defined as follows:
(a)   chronic pain in one or more anatomical regions that is characterised by significant emotional distress such as anxiety, or depressed mood. The claimant reports pain in four body areas, her shoulder, neck, thigh and back;
(b)   the loss of function in daily life activities and reduced participation in social roles. The reduced ability work activity and business network and her diminished support as a grandmother is documented throughout the claimant’s records after the motor accident;
(c)   chronic primary pain is multifactorial, it has biological, psychological and social factors contributing to the pain syndrome, and
(d)   the diagnosis is independent of identified biological or psychological contributors.
The medical members of the Panel find repeated evidence in the joint bundle that support the ICD11 diagnosis of chronic primary pain. The diagnosis provides a rationale as to the steps the claimant did independently make from initial presentation to the GP the day after the motor accident to help, she sought by being treated by the pain physician and associated psychologist.
The diagnosis of chronic primary pain incorporates the loss of adaptation, social functioning and work capacity. It best defines the observation made by BOV at point 8 of his statement this is wife is, “always anxious, irritable, in constant daily pain and this has impacted both her ability to return to work and our relationship”.

IMPAIRMENT ASSESSMENT

Functioning before the motor accident

Selfcare and personal hygiene

The claimant was independent in her capacity to function. She was able to purchase, carry and organise a large grocery shop alone. She was able to manage her home cleaning, washing, cooking and gardening alone. She was able to maintain her own medical care alone.
It is the clinical judgment of the medical members of the Panel that before the motor accident BNP’s class of functioning was class 1.

Social and recreational activities

The claimant would frequently visit her daughter and grandson to spend time and play. She would also frequently attend David Jones on shopping trips with her daughter. She would share Christmas and New Year’s Eve with her husband and family. She enjoyed visiting her favourite café in Neutral Bay as well as her favourite European fashion shoe shop. She would also share time with her friendship circle.
She had documented many of these activities on her Facebook page. She had enjoyed social media.
It is the clinical judgment of the medical members of the Panel that before the motor accident BNP’s functioning in this area was class 1.

Travel

The claimant was able to travel without impairment both locally and internationally. She was able to drive about 110km per round trip to visit her daughter and grandson. She also was able to visit her second daughter without difficulty before the motor accident.
It is the clinical judgment of the medical members of the Panel that before the motor accident BNP’s class of functioning in the area of travel was class 1.

Social functioning

Before the accident, the claimant’s primary relationship with her husband was mutually enjoyable and intimate. She reported enjoying her marriage and contributing to her family.
The claimant’s relationship with her children was also strong prior to the motor accident. She reported that she had focused on the support of her first daughter’s young children with the expectation of supporting her second daughter’s family when her second daughter began to have children.
The claimant reported having friends with whom she enjoyed group activities and events as documented on Facebook.
It is the clinical judgment of the medical members of the Panel that before the motor accident BNP’s class of functioning was class 1.

Concentration persistence and pace

The claimant was able to participate and perform all the necessary small business administration. She was self-taught by various experiences. She was able to type invoices and organise her colour tool sets required in planning her sessions with prospective clients. She was able to successfully complete the Dulux training required for her to perform these complex tasks alone in the field.
It is the clinical judgment of the medical members of the Panel that before the motor accident BNP’s class of functioning in this area was class 1.

Adaptation

The evidence suggests the claimant was able to perform more than 20 hours per week in her work role. She was contributing to her husband’s business. She contributed specific skills and services to the company that enabled her husband to be more profitable in his role. She was able to be flexible in when she worked, as her work was a combination of home-based work and in the field work. The claimant was able to function as a mother to her son at home and a grandmother to her grandson (Seb).
It is the clinical judgment of the medical members of the Panel that before the motor accident BNP’s class of functioning in adaptation was class 1.

Current functioning

Selfcare and personal hygiene

The claimant lacked motivation when attempting to cook and was less interested in her garden. The claimant said that she reported she cooked less and was less interested in her food. She told Medical Assessor Baker she did not require prompting to shower. She was observed in the re-examination room to reposition her hair band and lift her arms up to manage her hair unaimed and without distress. She was able to manage her medical regime of pharmacotherapy and psychological skills that had been taught. She acknowledged that she was able to attend the local shops alone and that she was able to buy light shopping. She was able to lift light laundry items into the dryer.
It is the clinical judgment of the medical members of the Panel that the claimant’s post motor accident class of functioning should be assessed as class 1 at the time of the re-examination.
Mental and behavioural functioning due to pain was excluded from PIRS assessment of impairment. The claimant acknowledged that her she would not carry heavy items as this activity would cause pain. She was able to recognise herself in a video alone in a shopping centre purchasing groceries. She reported that her pain resulted in her restricting herself from lifting heavy items of laundry into the dryer. The claimant did not do heavy gardening or cleaning of bathrooms or vacuum the house. The claimant had a cleaner who attended once each month. The above self-care and personal hygiene activities due to pain was not included in the PIRS assessment.

Social and recreational activities

The claimant acknowledged that she had posted on social media including Facebook. She reported that some of the reports were created when she was practicing “Gratitude” to others, whilst others were created before the motor accident. She reported that her capacity to post items was less than before the motor accident. She reported that she was able to make herself comfortable in a soft cushioned chair with a pillow at home. She had lost interest in socialising and preferred to remain isolated and alone. She did socialise with her husband and son in the house over recent months. She would share events such as movies, or television. She was able to engage with social media however she no longer enjoyed this type of social experience.
It is the clinical judgment of the medical members of the Panel that the claimant’s post motor accident class of functioning in this area should be assessed as class 1 at the time of the re-examination.
Mental and behavioural functioning due to pain has been excluded from the PIRS assessment of WPI for this table. The claimant said she would go to her room for quiet time if her pain was more severe. She reported that if her depressed or anxious mood exacerbated her pain, she would isolate herself. The time spent isolated due to pain was not included in the PIRS assessment. There are significant physical limitations due to pain affecting her hands she says were caused by the motor accident which have affected BNP’s participation in previous hobbies or physical activities.

Travel

The clamant was able to identify herself in the surveillance film being alone having driven a car. She was able to identify herself supported by her husband at another time. BNP said that she could travel to the local shops alone. She reported that she could not travel to the city alone or to her daughters’ homes alone as the distance was too far and she had restricted her travel out of fear that she might have another motor accident. She reported that she had been able to travel further afield with the support of her husband as documented in the surveillance material. BNP said she would not have been able to attend this re-examination without the support of her husband as the location was unfamiliar to her and too far from her home.
It is the clinical judgment of the medical members of the Panel that the claimant’s post motor accident class of functioning was class 2, at the time of the re-examination.
Mental and behavioural functioning due to pain has been excluded from the PIRS assessment of impairment. The claimant stated pain did not restrict her capacity to drive or travel locally. She reported pain did not prevent her from travel when supported by her husband.

Social functioning

The claimant reported that her lack of intimacy was caused by her hypervigilance and re-experiencing of the motor accident. She was not expecting her husband to divorce or separate from her. The claimant reported kicking her husband whilst responding to nightmares. She reported that the content of the nightmares involved the motor accident. The claimant’s sleep disturbance caused ongoing fatigue, loss of libido and recurrent unpleasant repeated events of kicking her husband whilst asleep.
The claimant reported that she had increased periods of separation from her daughters and her grandchildren. She stated that she feared injuring the grandchildren. She said the grandchildren reminded her of the motor accident and caused unavoidable outbursts of anger. She was fearful that she would be held responsible for any injury to the children.
The claimant reported that her second daughter was recurrently verbally angry and would humiliate and shame her for not providing the same help to her as the claimant had to the elder daughter prior to the motor accident.
The claimant was estranged from her friendship circle. She had lost interest and had been repeatedly publicly humiliated, shamed and estranged from her friendship circle since the motor accident. The claimant experienced an increased sense of fear and threat. The claimant explained that the “Contamination” had undermined her self-esteem, confidence and capacity to sustain old relationships and form new relationships and friendships outside of her home.
It is the clinical judgment of the medical members of the Panel that the claimant’s post motor accident class of functioning in this area was class 3, at the time of the re-examination.
Mental and behavioural functioning due to pain has been excluded from the PIRS assessment of impairment. The claimant had reported that it was not due to the pain that she had lost all her friendships or not been able to care for the grandchildren.

Concentration persistence and pace

The claimant was observed to have an impaired concentration, slowed pace and lack of persistence in the re-examination. She reported reliving the motor accident, suffering from fear of reminders about the motor accident and becoming fatigued by having to repeatedly resettle herself. Before the motor accident she could successfully complete a Dulux colours course. At the time of this assessment the claimant found it difficult to follow complex instructions as required to successfully complete a new course online. She had stopped organising her colour charts or investigating current fashion or trends online. She did not read more than a few lines of text. Her intrusive post-traumatic stress symptoms impaired her concentration and slowed her pace of progress. She would rapidly fatigue and required extra time to settle, refocus and attempt to continue an allocated task. She could no longer follow a recipe.
It is the clinical judgment of the medical members of the Panel that the claimant’s post motor accident class of functioning in this area should be assessed as class 3, at the time of the re-examination.
Mental and behavioural functioning due to pain has been excluded from the PIRS assessment of WPI. The claimant did not report pain as causing her loss of concentration, persistence and pace in the assessment. She stated that if she was experiencing pain she would go to her room and rest.

Adaptation

The evidence suggests that the claimant was erratic and unable to sustain her business network.
The clamant reports she was unable to adapt to the increased demands of her growing extended family. She felt fear, shame and guilt that she was unable to function as Nana. Her capacity to engage in play with her grandchildren was impaired by the psychological effects of the motor accident. The role of play with Seb and the capacity to provide overnight grandchild care was not impaired by fear, shame, or guilt before the motor accident.
It is the clinical judgment of the medical members of the Panel that the claimant’s post motor accident class of functioning for adaption was class 4, at the time of the re-examination.
Mental and behavioural functioning due to pain has been excluded from the PIRS assessment of WPI. The claimant reported that she could not lift more than a 1l can of paint. The claimant reported at the time of this assessment she could only do about two hours per week of work completing invoices. She reported she developed pain with pins and needles in her hands causing her to restrict her work. The claimant reported she was unable to physically complete these tasks because of her pain.

The psychiatric impairment rating scale assessment table

Psychiatric diagnoses	ICD11 code 6B40 post-traumatic stress disorder
Psychiatric treatment description	The condition diagnosed as ICD11 code 6B40 post-traumatic stress disorder to be assessed as part of the PIRS assessment. The medication Efexor XR 225mg is an evidence-based treatment for post-traumatic stress disorder and is used in conjunction with EMDR, relaxation techniques and controlled breathing as evidenced-based psychological treatment for post-traumatic stress disorder.

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	1	The claimant lacked motivation when attempting to cook and was less interested in her garden. The claimant acknowledged that she cooked less and was less interested in her food. She did not require prompting to shower. She was able to manage her medical regime of pharmacotherapy and psychological skills that had been taught. She was observed in the re-examination room to reposition her hair band and lift her arms up to manage her hair unaimed and without distress. She acknowledged that she was able to attend the local shops alone and that she was able to buy light shopping. She was able to lift light laundry items into the dryer.
2. Social and Recreational Activities	1	The claimant acknowledged that she had listed a number of postings on Facebook. She reported that some of the reports were made when she was practicing “Gratitude”. Others were made prior to the motor accident. She reported that her capacity to post items was less than prior to the motor accident. She reported that she was able to make herself comfortable in a soft cushioned chair with a pillow at home. She had lost interest in socialising and preferred to remain isolated and alone. She did socialise with her husband and son in the house over recent months. She would share events such as movies, or television. She was able to engage with social media however she no longer enjoyed this type of social experience.
3. Travel	2	The claimant was able to identify herself alone having driven a car on surveillance. She was able to identify herself supported by her husband. She reported that she could travel to the local shops alone. She reported that she could not travel to the city alone or to her daughters a home’s alone as the distance was too far and she had restricted her travel out of fear that she might have another motor accident. She reported that she had been able to travel further afield with the support of her husband as documented in the joint bundle. She would not have been able to attend this re-examination without the support of her husband as the location was unfamiliar and too far from her home.
4. Social Functioning	3	The claimant reported that her lack of intimacy was caused by her hypervigilance and re-experiencing of the motor accident. She was not expecting her husband to divorce or separate from her. The claimant reported kicking her husband whilst responding to nightmares. She reported that the content of the nightmares involved the motor accident. The claimant’s sleep disturbance caused ongoing fatigue, loss of libido and recurrent unpleasant repeated events of kicking her husband whilst asleep. The claimant reported that she had increased periods of separation from her daughters and her grandchildren. She stated that she feared injuring the grandchildren. She said the grandchildren reminded her of the motor accident and caused unavoidable outbursts of anger. She was fearful that she would be held responsible for any injury to the children. The claimant reported that her second daughter was recurrently verbally angry and would humiliate and shame her for not providing the same help to her as the claimant had to the elder daughter prior to the motor accident. The claimant was estranged from her friendship circle. She had lost interest and had been repeatedly publicly humiliated, shamed and estranged from her friendship circle since the motor accident. The claimant experienced an increased sense of fear and threat. The claimant explained that the “Contamination” had undermined her self-esteem, confidence and capacity to sustain old relationships and form new relationships and friendships outside of her home.
5. Concentration, Persistence and Pace	3	The claimant was observed to have an impaired concentration, slowed pace and lack of persistence in the re-examination. She reported reliving the motor accident, suffering from fear of reminders about the motor accident and becoming fatigued by having to repeatedly resettle herself. Before the motor accident she could successfully complete a Dulux course. At the time of this assessment the claimant found it difficult to follow complex instructions as required to successfully complete a new course online. She had stopped organising her colour charts or investigating colour fashion or trends online. She did not read more than a few lines of text. Her intrusive post-traumatic stress disorder symptoms impaired her concentration and slowed her pace of progress. She would rapidly fatigue and required extra time to settle, refocus and attempt to continue an allocated task. She could not follow a recipe.
6. Adaptation	4	The claimant was erratic and unable to sustain her business network. She was unable to adapt to the increased demands of her growing extended family. She felt fear, shame and guilt that she was unable to function as Nana. Her capacity to psychologically engage in play with her grandchildren was impaired by the motor accident. The role of play with Seb and the capacity to provide overnight grandchildren care was not impaired by fear, shame, or guilt prior to the motor accident. She would be erratic in providing the same capacity of functioning at the time of this re-examination.
List classes in ascending order: 1, 1, 2, 3, 3, 4
Median Class Value: 3
Aggregate Score: 14 in accordance with table 6.17 this converts to a WPI of 13%

The summary of permanent impairment assessed by the Panel is:
·        Current % permanent impairment  13%
·        Pre-existing/subsequent % permanent impairment          Nil
·        Adjustments % for effects of treatment  Nil
·        Percentage WPI  13%
The Panel is not satisfied BNP had a pre-existing condition at the time of the accident. Whilst the patient may have experienced symptoms, she did not have any diagnosable pre-existing psychiatric condition and therefore no impairment.
The Panel has considered whether the impairment assessment should be adjusted for the effect of treatment. Clause 6.222 of the Guidelines provides that an adjustment may be made if all of the following requirements are met:
(a)   there is research based evidence that the prescribed treatment is effective for the psychiatric condition;
(b)   the treatment has been appropriate and the example is given that medication has been taken in the appropriate dose and duration;
(c)   clinical evidence shows that the treatment has been effective in that the person’s symptoms or functioning has improved, and
(d)   it is the clinical judgment of the Panel that ceasing treatment will cause the symptoms to deteriorate or worsen.
The Panel finds criteria (c) has not been met. BNP continues to experience symptoms from her assessable psychiatric condition at the time of this re-examination. There is therefore no clear clinical evidence that the treatment has been effective.

CONCLUSION

As explained above, the Panel is satisfied that the claimant has, as a result of the motor accident, developed a post-traumatic stress disorder in accordance with ICD11 code 6B40. All of the previous examiners have also found a post-traumatic stress disorder although few have identified whether they have used DSM or ICD criteria.
The table below summarises the previous impairment assessments as a result of the diagnosed disorder.

Category Dr Mason
15 Jun 20 Assessor Parmegiani
22 Oct 21 Assessor Jones
5 Apr 22 Dr Mason
24 Mar 23 Review Panel

Self-care 2 3 1 2 1

Social and recreational activities 3 2 2 3 1

Travel 2 2 2 2 2

Social Functioning 2 2 2 2 3

Concentration, persistence and pace 3 3 2 3 3

Adaptation 3 4 4 4 4

Aggregate score 15 16 13 16 14

The Panel’s assessment of travel and adaption is the same as previous assessments. The main differences between the Panels’ assessment of WPI and prior assessments are addressed as follows:
(a)   self-care and personal hygiene – Medical Assessor Parmegiani had rated this as class 3 and Dr Mason as class 2. The Panel’s rating of class 1 and the exclusion of adjustment disorder to enable the diagnosis of post-traumatic stress disorder to prevail, results in a significant difference;
(b)   social and recreational activities - the Panel’s rating of class 1 was below that of the other examiners. The Panel found the effects of chronic primary pain weighed more heavily on the assessment of impairment than post-traumatic stress disorder for this area of function. As cl 6.215 does not permit the assessment of a pain disorder to be considered, this has resulted in a significant difference from rating of class 2 and 3 to class 1;
(c)   social functioning – the Panel finds the effects of the claimant’s post-traumatic stress disorder has become more prominent since previous assessments and in particular after the arrival of her now five-month-old grandchild. There has also been an increase in fear and poorly controlled angry outbursts damaging her interpersonal relationships. This has caused increased periods of separation from her second daughter and her grandchildren and is as a result of the claimant’s intrusive memories of the accident and her fear of causing future harm. The claimant has been unable to sustain her friendship circle or form new friendships due to her loss of self-esteem and self-confidence. Her shame, humiliation and guilt prevents her function in a social setting and had now become more pronounced in recent times, due to her post-traumatic stress symptoms alone, and
(d)   concentration persistence and pace - the Panel found that the effects of the claimant’s post-traumatic symptoms have again become more prominent in this area. Angry outbursts and fear dominated the re-examination rather than over complaints of pain or restricted movements. The claimant’s ability to concentrate and persist throughout the examination was affected and reported by Medical Assessor Baker.

CONCLUSION

The Panel is satisfied the claimant has a psychiatric condition recognised by the current (11^th edition) International Statistical Classification of Diseases and Related Health Problems, namely a post-traumatic stress disorder.
The Panel is satisfied that this condition is an injury caused by the motor accident on 15 May 2018.
The Panel is further satisfied that this injury has resulted in a permanent impairment which is greater than 10% (13%).
As the Panel has come to a different conclusion to that of Medical Assessor Jones it follows that his certificate must be revoked and a fresh certificate issued.

Event or activity	Claimant’s response
The claimant attended a wedding on 20 May 2018.	The photo depicts a handbag on a table at a wedding. The wedding occurred on 16 July 2017 not 20 May 2018.
The claimant attended a kitchen tea on 28 May 2018.	The claimant attended the kitchen tea which was at her sister’s house, and it was for her niece. She left early and was collected by her husband due to her pain.
The claimant participated in a dress up event on 31 May 2018.	The photo was taken in 2015 and reposted as a thank you to a friend who visited her after the accident.
The claimant travelled to Mykonos in August 2018.	The trip was booked before the accident.
The claimant travelled to Las Vegas in advance of a friend’s wedding in September 2018 and attended a night club.	The trip was booked before the accident, and she spent most of the week in her hotel room. She was in constant pain and could not keep up with the girls.
The claimant attended an event on 11 October 2018 with her hair professionally styled.	The claimant does not recall this.
The claimant hosted and attended a school reunion in October 2018.	The event had been planned for months before it occurred. It was held at her home, and everyone brought food and helped and clean up afterwards. She has declined to attend other events since then.
The claimant went on a boat trip at Barangaroo in October 2018	This was another hens event which she attended with her daughters.
The claimant was dancing on 22 December 2018.	The video is old and was reposted to thank someone.
The claimant attended a rooftop bar in Barangaroo in March 2019.	Not clearly addressed.
The claimant visited a venue in Caulfield North (Victoria) September 2019 and St Kilda in March 2019	The claimant does not know what this is and has not visited Melbourne in over 10 years.
The claimant ate fairy floss on 1 June 2019.	The claimant confirms attending the black-tie charity event with friends and her husband.
The claimant attended a fiftieth birthday costume party on 8 June 2019.	Her husband drove her to this.
The claimant attended a wedding 20 September 2019.	Not addressed.
The claimant travelled to Croatia in January and February 2020	Not addressed.
Lockdown posts March 2020, April 2020.	This was an old video reposted.
The claimant went out with friends December 2020	The photo posted was from 2015. It was reposted to say thank you.
The claimant was photographed with a child in January 2021.	The photo is an old photo posted for self-esteem purposes.
The claimant commented “dressed up nowhere to go” 26 June 2021.	This is an old photo touched up with the use of an app.
The claimant attended a family dinner out in June 2021.	Not addressed.
The claimant commented on having had her hair done.	The claimant accepts during lockdown she purchased a home hair dye kit to support her local hairdresser. She says she cannot physically do her own hair but does not want to cut it.

Category	Dr Mason 15 Jun 20	Assessor Parmegiani 22 Oct 21	Assessor Jones 5 Apr 22	Dr Mason 24 Mar 23	Review Panel
Self-care	2	3	1	2	1
Social and recreational activities	3	2	2	3	1
Travel	2	2	2	2	2
Social Functioning	2	2	2	2	3
Concentration, persistence and pace	3	3	2	3	3
Adaptation	3	4	4	4	4
Aggregate score	15	16	13	16	14

[2023] NSWPICMP 377

2 August 2023