Celvavinayagan v Allianz Australia Insurance Limited

DETERMINATION OF REVIEW PANEL
CITATION:	Celvavinayagan v Allianz Australia Insurance Limited [2025] NSWPICMP 697
CLAIMANT:	Selvasundaram Celvavinayagan
INSURER:	Allianz Australia Insurance Limited
REVIEW PANEL
MEMBER:	Belinda Cassidy
MEDICAL ASSESSOR:	Melissa Barrett
MEDICAL ASSESSOR:	Ankur Gupta
DATE OF DECISION:	11 September 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; insurer’s review of Medical Assessment Certificate (MAC) under section 7.26; whole person impairment (WPI) dispute; psychiatric injury; claimant injured in bus accident as bus driver; original medical assessor diagnosed a major depressive disorder with anxious distress and a somatic symptom disorder; claimant had pre accident psychological symptoms; Held – accident could have and did cause or contribute to the development of psychological symptoms; Review Panel diagnosed a somatic symptom disorder and gave reasons for their being no post-traumatic stress disorder and no depressive disorder; psychiatric impairment rating scale (PIRS) does not permit assessment of impairment for a somatic symptom disorder therefore no assessable impairment; MAC revoked.
DETERMINATIONS MADE:	REPLACEMENT CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 The Review Panel: 1. issues this certificate to replace the certificate issued on 9 September 2025 due to typographical errors in the certificate and the statement of reasons; 2. revokes the certificate of Medical Assessor Canaris dated 15 May 2024, and 3. certifies that the injuries sustained by the claimant in the motor accident on 19 October 2022 do not result in a whole person impairment exceeding 10%. A statement setting out the Panel’s reasons for the assessment is included with this certificate.

STATEMENT OF REASONS

INTRODUCTION

Selvasundaram Celvavinayagan was involved in a motor accident on 19 October 2022. He was driving a bus in the course of his employment when a truck failed to give way and collided with the bus.
Mr Celvavinayagan says he injured his cervical spine, lumbar spine, right shoulder, left hand, right hip and right knee in the accident. He also says he developed a psychiatric or psychological injury and made a claim for statutory benefits and then damages against Allianz, the third-party insurer of the vehicle that caused Mr Celvavinayagan’s accident.
A medical dispute about the degree of the claimant’s whole person impairment (WPI) has arisen in connection with the damages claim and the claimant referred that dispute to the Personal Injury Commission (the Commission) for assessment.
On 15 May 2024 Medical Assessor Canaris determined Mr Celvavinayagan did not have a WPI of greater than 10% (8%).
The claimant has lodged an application with the Commission seeking a review of the Medical Assessor’s decision.
On 25 July 2024, Ms Wigan 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

6 March 2025 the President’s delegate convened this Panel to conduct the Review.

LEGISLATIVE FRAMEWORK

General

Mr Celvavinayagan’s claim and entitlements to compensation are governed by the provisions of the Motor Accident Injuries Act 2017 (the MAI Act).
In a claim for lump sum compensation, damages are assessed in accordance with common law principles as modified by the MAI Act. Under Part 4 of the Act, an injured person can make a claim for damages for both certain types of economic (pecuniary) losses and damages for non-economic (or non-pecuniary) loss.
Damages for non-economic loss are limited and restricted by the provisions in 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% whole person impairment (WPI) as a result of the injuries sustained in the accident.
[1] The current maximum as of October 2024 is $654,000.
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.

Dispute Resolution

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 Canaris’, further medical assessments and the review of medical assessments by this Panel[3].
[3] Sections 7.20, 7.24 and 7.26.
Applications for review of a medical assessment are made to the President of the Commission on grounds that the assessment “was incorrect in a material respect” (s 7.26(1)). If the President, or his delegate is satisfied “there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect” then the President arranges for the application to be referred to a review panel consisting of a member of the Commission and two medical assessors (s 7.26(2) and (2B)).
The review is not an appeal looking for error and is not confined to the issues raised in the application (or the reply) but is “a new assessment of all the matters with which the medical assessment is concerned” (s 7.263A).
Rule 128 of the Personal Injury Commission Rules (the Rules) 2021 permits the Panel to determine its own proceedings and the Panel is not bound by the rules of evidence and may inquire into relevant matters as it thinks fit.

Permanent impairment assessment

Permanent impairment is to be assessed in accordance with Chapter 6 of the Motor Accident Guidelines (the Guidelines)[4] which are largely based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides).
[4] Section 7.21. The current version of the Guidelines is Version 9.3.

Guides and Guidelines

The Guidelines include a chapter entitled “Mental and behavioural disorders” and require the assessment to be undertaking in accordance with the psychiatric impairment rating scale (PIRS). The Guidelines also say that the mental and behavioural chapter of the AMA4 Guides are to be used as “background or reference only”[5].
[5] 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)[6].
[6] Clause 6.213 of the Guidelines.
The PIRS provides[7] for the consideration of any psychiatric condition present before the accident in question as follows:
“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.”
[7] Clause 6.218 of the Guidelines.
Clause 6.34 of the Guidelines provides for subsequent conditions and impairments
The PIRS provides in clause 6.219 for six areas of function:
(a)    self-care and personal hygiene;
(b)    social and recreational activities;
(c)    travel;
(d)    social functioning (relationships);
(e)    concentration persistence and pace, and
(f)    adaptation.
The PIRS then provides at 6.220 for five classes with a descriptor for each which is “illustrative rather than literal criteria” 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[8] that is treatment such as medication being consumed to treat the psychiatric condition.
[8] 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 WPI percentage[9].
[9] See clauses 6.225 – 6.228 and table 17.
Of particular relevance to the matters in dispute in this matter:
(a) clause 6.214 says that Impairment due to physical injury is assessed using different criteria outlined in other parts of the Guidelines, and
(b) Clause 6.215 provides that the PIRS must not be used to measure impairment due to somatoform disorders or pain.

ASSESSMENT UNDER REVIEW

The Medical Assessor examined the claimant on 15 May 2024 and issued his certificate the same day. Medical Assessor Canaris confirms at [2][10] that he was asked to assess “psychiatric condition – major depressive disorder with anxious distress.”
[10] The numbers in square brackets are a reference to the section number in the Medical Assessor’s reasons.
At [8] – [10], Medical Assessor Canaris records the following history:
(a)    the claimant was 53 years old at the time and a former bus driver;
(b)    the claimant admitted to a previous episode of anxiety and depression 15 years earlier when his wife had issues with her passport while they were travelling. The Medical Assessor referred to insomnia, daytime somnolence, antidepressants and said that he had applied for the disability support pension which the claimant related to the passport incident and said he was normal;
(c)    he said at the time of the accident he was working full time and over time;
(d)    he details his family history and refers to conflict in his home country and his migration to Australia in 1997;
(e)    he says he first worked as a warehouse operator before obtaining a job as a bus driver in 2019;
(f)    he described the accident which occurred while he was at work driving a bus. A truck went through a red light and crashed into his vehicle. He was the only one injured sustaining injuries to his knee, back and left little finger;
(g)    the claimant saw his GP, went back to work for two weeks but then found it very difficult to work and has not worked since;
(h)    the claimant was taking pain killers (Targin and Mobic) but was still in pain. He was also taking 10 mg of an antidepressant Allergan because he is “really struggling mentally”, was distressed about his payments;
(i)    he reported a bad tremor in his right hand, relives the accident, experiences fear when he sees trucks, his sleep is disturbed, and
(j)    he sees a psychologist and psychiatrist once a month and is taking Sertraline (an antidepressant) and Quetiapine at night.
The claimant looked unkempt on the screen, did not look at the screen, pointed to his tremor (which the Medical Assessors notes was not observed later) and the Medical Assessor noted the claimant “minimise[d] the significance of earlier difficulties in his mental health.”
The claimant was asked how he spends his day, and the claimant says he has to use crutches and just sits on his bed. He says he needs help with self-care although no one is at home to help him. He thought he had lost weight as he skips meals saying he has no appetite.
The claimant says he does not go out socially as he cannot walk and that he cannot enjoy functions. He says he goes to his medical appointments by taxi on his own. He has given up his licence because he requires the use of two crutches.
The claimant reported frequent arguments with his wife, confusion, and an inability to watch TV for very long due to eye issues.
Medical Assessor Canaris considered at [18] a post-traumatic stress disorder but discounted it as he considered the severity of the accident did not meet Criterion A in the DSM-5-TR.
Medical Assessor Canaris did diagnose a major depressive disorder with anxious distress and sets out the criteria and how the claimant satisfied them. He also diagnosed a somatic symptom disorder on the basis that the claimant has a number of somatic symptoms which are disrupting his life.
He considered the issue of causation and noted the previous episode of mood disorder which he was of the view had “gone into remission” and that the accident “has played a substantial role in its reemergence albeit with a significant contribution of constitutional vulnerability.”
Medical Assessor Canaris accepted the injury had stabilised and the impairment was permanent.
He assessed the various classes of impairment as follows:
(a)    self-care and personal hygiene                 class 2
(b)    social and recreational activities               class 2
(c)    travel  class 2
(d)    social functioning  class 2
(e)    concentration persistence and pace         class 3
(f)    adaptation  class 3
This resulted in a median of 2 and an aggregate of 14 which resulted in an impairment of 7% to which 1% was added for the effects of treatment.

ISSUES FOR DETERMINATION

Claimant’s submissions[11]

[11] The numbers in square brackets are a reference to the paragraph number in the submissions.

The thrust of the claimant’s argument is found at [6] and at [35] – [47] where he submits that the Medical Assessor has not explained what impairments relate to the somatoform disorder and what relates to the depressive disorder.
The claimant also identifies at [16] – [21] an error in relation to a letter from Dr Jacobi, psychiatrist which the Medical Assessors cites in support of a pre-existing condition, but which was dated 19 August 2023 after the accident.
The claimant is also critical at [22] – [34] of the Medical Assessor’s failure to diagnose a post-traumatic stress disorder noting that the only criteria referred to was criterion A and the claimant relies on the diagnosis of Dr Khan and the CCTV footage from inside the bus.
The claimant submits at [48] – [49] that the Medical Assessor erred in his calculation of a class 2 impairment for self-care and personal hygiene noting that the claimant cannot live independently.
Each of the other grounds are discussed and alternative assessments and classes offered.
The claimant’s original submissions say at [12] that the claimant sustained a “serious psychological condition” which he says at [13] makes him feel defeated and lethargic and that he finds no enjoyment in daily life.
The claimant asserts at [14] that he has no history of mental health issues before the accident.
He says at [15] he is under the regular care of a treating psychologist and psychiatrist.

Insurer’s submissions

The insurer refers at [13] – [16] to cl 6.215 (no impairment due to somatoform disorders), cl 6.217 (clinical judgment is the most important tool and clinical experience is the basis for the diagnosis) and 6.21 (consider the impairment at the time of assessment).
The insurer says there was no clear error by Medical Assessor Canaris [19] in relation to Dr Jacobi’s evidence and even if it was, there is no material impact because Medical Assessor Canaris did not make any deduction for pre-existing impairment [21].
The failure to diagnose a posttraumatic stress disorder is not material to the outcome [32] but the insurer refers to criterion A and suggests this was a matter for clinical judgment by the Medical Assessor.
In relation to the distinction between the depressive disorder symptoms and the somatoform disorder symptoms the insurer says neither party had diagnosed a somatoform disorder and therefore this was not the “battleground” between the parties and the Medical Assessor did not have to distinguish between the two [35] – [38]. In any event the insurer notes at [40] the comments on the claimant’s physical injuries and the restrictions he says they have imposed on the claimant.
In the original submissions lodged by the insurer with the original proceedings, the insurer submits at [2] that the claimant’s expert, Dr Kumagaya is not an authorised health practitioner and that his opinions are inadmissible.
The insurer pointed at [3] to comments about consistency and range of motion assessments.
The insurer says at [4g] that the claimant had pre-existing depression, anxiety, posttraumatic stress disorder and insomnia. The insurer submits that if the accident did cause a psychiatric injury, it is not greater than 10%.
The insurer says Dr Kumagaya reports the claimant could not live alone, could not engage in social and recreational activities and was unable to leave home without a support person or visit unfamiliar areas. The insurer submits:
(a)    at [63] the claimant attended on Dr Bodel on his own without a support person;
(b)    the claimant reported to Dr Kumagaya that his impairments were mainly due to his psychological symptoms whereas he told Dr Jacobi it was his physical symptoms and pain that limited his activities;
(c)    Dr Kumagaya did not refer to the criterion from DSM-5 when diagnosing a major depressive disorder, and
(d)    Dr Kumagaya did not make any deduction for pre-existing impairment

PANEL PROCESS

The Panel issued directions to the parties on 14 March 2025. The Panel noted:
“… the Medical Assessors on the Panel are required, in accordance with the Guidelines, to determine if the claimant has a psychological or psychiatric injury caused by the accident and then make a diagnosis of that injury. The Medical Assessors may, in their clinical judgment, diagnose a condition that is the same as, or different to, the diagnoses of the treating doctors or medico-legal experts or the particular diagnosis that may have been included in the application or reply form.”
The Panel advised the parties we did not have the documents before Medical Assessor Canaris and did not have the CCTV bus footage, and a timetable was set for the production of these and other relevant documents.
The claimant lodged a bundle of documents on 7 April 2025 and the insurer lodged its bundle on 24 April 2025.
The Panel met on 20 May 2025 and reported to the parties on the same day. The Panel confirmed receipt of the bundles of documents and:
(a)    requested a copy of the CCTV footage from inside the bus noting the parties appear to have provided photographs from that footage;
(b)    sought updated clinical notes from the claimant’s GPs and treating specialists, and
(c)    the parties were advised of the re-examination date, 23 July 2025.
On 7 July 2025 the insurer’s legal representative advised that she did not have the CCTV footage nor did the insurer or the claimant’s legal representative. Enquiries were being made with the bus company. The footage has not been provided but the Panel has the photographs taken from the footage. The Panel is of the view that a fair assessment of the dispute can be done without the footage.
The claimant was available for the re-examination on 23 July 2025 but due to technical difficulties the re-examination was abandoned. A fresh date was set for 19 August 2025 and the re-examination proceeded without difficulty.
The Panel met on 5 September 2025 to discuss the Medical Assessors’ clinical findings and to finalise the decision.

REVIEW OF THE EVIDENCE

Claim form and claim documents

The claimant signed and dated the claim form on 25 November 2022[12]. The claimant describes the accident as follows:
“I was driving a bus … I was travelling along the T-way, which runs parallel to Windsor Road when a truck who was turning left from Windsor Road onto Sanctuary Drive collided with the bus I was driving.”
[12] Page 40 of the insurer’s bundle.
The claimant denied any previous motor accident claims and said he was not suffering from a relevant illness or injury at the time of the accident.
The claimant lists his injuries as to his right knee, right arm, shoulder, lower back, neck and left hand. He does not mention any psychological or psychiatric symptoms. He says he was taken to Blacktown Hospital and discharged on 11 November 2022.
The claimant has given several statements. In his first dated 6 December 2022 he says at [8] he speaks good English and does not need a translator.

He said at [10] that before the accident he was healthy, had sinus surgery 20 years previously, had never made a compensation claim and never had any injuries to his knees, back or hand before.
The claimant described at [12] the accident saying the truck struck the bus near his seat and that the bus shook but his right knee hit the dashboard and his back, left hand, right knee and shoulder were injured. He said [13] he did not understand what had happened and “almost blacked out”. He said he got out and spoke with the driver.
The claimant said as the vehicles were blocking the road he did not call an ambulance and he moved the bus out of the way. The windscreen was broken. He said he did not need medical assistance and needed to look after the students on the bus.
The claimant said at [15] that he was given another bus to drive but he only drove as far as Blacktown Station, took some painkillers and waited an hour but was in too much pain to continue with his shift but that he was OK to drive the bus back to the depot.
The claimant told the investigator of his treatment, the investigations he had and that he continued to work. He took pain killers but stopped them on 6 November 2022 due to side effects. On 7 November he said he went to work but got pain in his right knee and back pain “like a knife cutting me” and he could not turn his head. He called the company who told him to go straight to the doctor.
On 10 November 2022 he could not get out of bed even to go to the toilet. He was told to call an ambulance because “I was in a critical condition.”
Mr Celvavinayagan said in his claim form he was taken to Blacktown Hospital and stayed until 11 November 2022. He has been unable to work since. He says he can only walk with crutches and is taking Endone and Targin. He says he has had physiotherapy and now has trouble writing as his right-hand fingers are shaking. He says he has trouble sleeping “and my emotions are in turmoil.”
In the claimant’s second statement dated 7 September 2023 he says he has been unable to work because of his physical injuries and that this is causing issues of worthlessness and stress. His financial state is causing depression and anxiety [9]. He says his pain levels have made it difficult to sleep through the night and he feels defeated and lethargic [10].
Mr Celvavinayagan says he has difficulty enjoying life, refrains from social or recreational activities and avoids communicating with his family. He reports flashbacks at [12] and says his emotional state is getting worse [13]. He denies at [15] any previous psychological condition.
In his third statement dated 25 March 2024 he confirms he has actually suffered from anxiety, depression and insomnia from 2008 to mid 2009. He described the trigger as an incident involving his wife’s passport being mislaid by the Australian High Commission in New Delhi while her Visa was being renewed. It was missing for a few weeks and their trip was prolonged.
He recalls going to a sleep clinic and taking antidepressant medication and says his symptoms resolved completely.
The claimant response at [7] to the records in 2018, 2019 and 2021 reporting stress says at [8] these were minor complaints. The claimant says he did not see a psychologist or have any psychological treatment.
The claimant says he feels depressed and anxious all the time. He is in constant pain and cannot work which makes him feel worthless and frustrated. He sometimes experiences flashbacks. He lacks energy and motivation. He avoids all recreational and social activities and can only leave the house with a support person. He says his poor mental state makes it hard to concentrate of simple tasks.
Photographs have been taken showing the cracked windscreen and the damage to both vehicles.

Treating medical records and reports

The insurer summarises the claimant’s pre-accident psychiatric or psychological history as follows:
(a)    March 2008 Mr Celvavinayagan attended his GP regularly for sleep disturbance / insomnia, and symptoms of anxiety and depression. He received regular treatment throughout 2008 and 2009;
(b)    on 12 December 2008: a letter was sent from Royal Prince Alfred Hospital Sleep Disorders Clinic to Dr Jayachandran. Dr Amy McLean noted the claimant was becoming more and more anxious about his sleep, and the claimant felt that was his predominant psychological symptom. She referred the claimant to “one of our insomnia psychologists”;
(c)    17 March 2009: Dr Seelan prepared a report noting the claimant initially developed insomnia in 2001 and had taken occasional sedatives for sleep, but since February 2008 (13 months before the report was written) the claimant had developed severe insomnia following ‘psychological stresses’, and he suffered tiredness and daytime sleepiness. The doctor noted the opinion of the respiratory physician at RPA that insomnia was due to anxiety and depression symptoms and not sleep apnoea. The doctor noted the claimant had been on antidepressant medication since July 2008, but this continued in December 2008 because of adverse effects such as dizziness. The doctor had commenced him on Avanza to treat insomnia and depression;
(d)    14 March 2009: Dr David Luke, psychologist, reported to the GP noted the claimant had been treated for insomnia and symptoms of depression, especially agitation, rumination, flat mood and lack of energy persisted, and he believed the claimant’s medication required review (changed or increased) and possibly referral to a psychiatrist might be warranted;
(e)    29 March 2009: Dr Luke said he believed the claimant’s insomnia was a response to previous traumatic events, as was the claimant’s depression. The claimant had related a number of recent crises surrounding this children’s health which reportedly left him feeling disempowered and anxious, and he was reportedly extremely anxious that his youngest son would develop a disability similar to his second child, and
(f)    7 May 2009: Dr Chara, occupational physician, prepared a report in the context of workplace difficulties, due to the claimant’s propensity to fall asleep whilst operating a forklift. The claimant reported to Dr Chara that since August 2008 his sleep quality had deteriorated markedly, following a visit to India. Dr Chara considered the claimant had a sleep disorder secondary to post-traumatic stress disorder/anxiety with or without depression.
The claimant has attended Civic Park Medical Centre and Parkview Medical Centre where he sees Dr Sivagnanasundram. In a “to whom it may concern” report dated 14 February 2024[13] to an attendance on 11 June 2021 for acute stress and that there was a history of physical conditions including high cholesterol, bulky pancreas, faecal loading and constipation, oesophageal issues, macular degeneration, chronic rhinosinusitis, and reflux (due to pre-accident pain medications).
[13] Page 204 of the claimant’s bundle.
The claimant attended the Emergency department of Blacktown Hospital on 10 November 2022 complaining of worsening paraspinal pain and leg weakness following the car accident. An MRI reported no cord compression or injury, moderate degenerative spondylosis at C5/6 with mild to moderate foraminal stenosis and no lumbosacral fractures.
The claimant was discharged home with Targin and Endone and advised to see his GP or return if there was a worsening of symptoms.
After the accident on 21 December 2022 the claimant consulted Dr Sivagnanasundaram who reported “nil depression, anxiety at this stage …”
Dr Ramachandran, pain physician wrote to Dr Sivagnanasundaram on 8 February 2023[14] there were complaints of pain mainly on the right side and in the neck and low back without any neurological symptoms. The doctor reports significant fear and avoidance and reliance on passive methods to manage pain. The doctor says, “there were no symptoms of active PTSD in today’s consultation.” He recommended recommencing Targin and engaging the claimant with hydrotherapy and physiotherapy in conjunction with this medication.
[14] Page 240 of the claimant’s bundle.
In a report dated 3 April 2023,[15] Dr Ramachandran said the claimant was progressing with hydrotherapy and exercise physiology and the claimant was given education about his medication and reassured there was nothing sinister in his body scan. On 6 July 2023 Dr Ramachandran reported that the claimant was having difficulty with both land-based sessions and hydrotherapy and the claimant was worried about whether there was new pathology in his lower back.
[15] Page 237 of the claimant’s bundle.
Professor Sitharthan, psychiatrist sent a short “to whom it may concern” letter dated 24 May 2023[16] noting he had been referred by the claimant’s GP to assess and assist the claimant. He notes the claimant has due to his injury and ongoing pain consulted a pain physician, orthopaedic surgeon and physiotherapist. He said:
“In my opinion he suffers from major depression and PTSD, complicated by exessive worries about his future, poor sleep, nil appetite, anhedonia and impaired attention and concentration.”
[16] Page 203 of the claimant’s bundle.
Dr Radhakrishnan, rehabilitation physician provided a report to the claimant’s GP dated

12 August 2023 (after a consultation on 7 August 2023)[17]. The claimant was seen by this doctor in the Westmead pain clinical along with a physiotherapist and psychologist.
[17] Page 294 of the claimant’s bundle.
The claimant reported multiple areas of pain including the right shoulder, neck, back, fingers in the left hand, right knee, right ankle, right buttock and a heavy feeling always on the right side.
The doctor has a history of the accident, the claimant getting out of the bus, exchanging details, moving the bus, returning to work after a few days rest and so on. The history continues that the claimant was prescribed pain killers which he took with good effect but on ceasing them had an increase in his pain leading to an attendance at hospital. His right shoulder pain was said to have commenced two months after the accident.
The examination was limited due to “voluntary muscle contractions secondary to pain” and he was “able to move much better when he was engaged in conversation and not paying attention.”
He recommended continued medications, follow up with Dr Ramachandran, further physiotherapy and psychology to increase participation and an MRI of the brain (which the claimant refused).
Dr Jacobi, psychologist provided a report dated 19 August 2023 to the claimant’s GP (page 216). She notes the claimant spoke conversational English but struggled to understand more complex concepts.
He described his accident saying he worked through for two weeks and developed chronic pain in his knee, hand and back. The claimant reported a bad reaction to the pain tablets, deterioration after three weeks and vision problems and since then he has been unable to drive.
He could not work and could not garden and could only mobilise with crutches. He cannot drive because of pain from head and neck and cannot step on the brake due to his knee pain.
He grieves the loss of functioning, ruminates a lot at night and sometimes harbours passive death wishes, He was frustrated at his lack of progress. He has seen many specialists.
He denied anxiety symptoms and said, “if the pain was taken away, I’d be a very happy man.”
Dr Jacobi has a history of the claimant seeing a psychologist 20 years ago in the context of losing travel documents.
He was casually dressed without self-neglect. He had low mood.
She considered a prolonged adjustment disorder in the context of chronic pain. She thought a somatic symptom disorder needed to be considered.
The claimant was referred to Dr Teoh, orthopaedic surgeon who saw the claimant on

13 November 2023 and reported to the claimant’s GP[18]. He referred to the claimant having multiple problems with his right shoulder, right hip, right knee and his hands. He noted the claimant’s restricted range of shoulder motion but said the rotator cuff was intact and remarked the claimant had “non dermatomal and vague numbness in his fingers.” He reviewed an MRI of the shoulder which showed longstanding degeneration and interstitial tearing. He organised for an MRI of the claimant’s cervical spine.
[18] Page 214 of the claimant’s bundle.
On 29 January 2024 Dr Teoh saw the claimant again[19] and said that the MRI of the cervical spine showed a worsening of the claimant’s C6 foraminal stenosis which may be the cause of his symptoms and a referral to Dr Rao was given.
[19] Page 799 of the claimant’s bundle.
Dr Nepal, psychiatrist provided a report to the GP dated 24 May 2024. He notes a diagnosis of adjustment disorder, post-traumatic stress disorder and physical health conditions and chronic pain.
The claimant was distressed, depressed, frustrated with sleep and appetite disturbances and worsening problems with his family.
Medication was adjusted and further review was advised.
Included in the claimant’s updated bundle was a report to Dr Sivagnanasundaram from Dr Nepal. Dr Nepal saw the claimant on 14 June 2024 having previously seen him on 24 May 2024. The claimant was said to have “presented with increasing distress.” The claimant complained of not receiving appropriate support from health and social care providers and he was depressed and sad. The claimant reported increasing quarrels with his wife and family members. His wife was caring for her elderly parents who lived with them and this was also a source of conflict.
The claimant reported difficulty cleaning himself after going to the toilet which distressed him and his chronic pain and inability to walk continued.
The claimant said his sleep was worse because of pain, his weight had decreased to 70kg, his mood was variable and his general interest is much reduced. The claimant reported

self-harming ideas and Dr Nepal noted this was an issue with the Tamil community. He advised ongoing psychological support but no change in medication.
In a report dated 18 September 2024, Dr Nepal records the claimant says his physical injuries were more painful because of the cold, so painful he could not leave his room which caused more distress. The claimant said he needs support when going out including to the doctor. He again mentioned being unable to clean up after himself following defecation. He said he needs crutches and cannot walk on his own. Marital counselling was recommended, and medication was adjusted.
A further report dated 11 October 2024 was written after another attendance. The claimant reported fear of driving and anxiety, worsening headaches, relationships at home. He visits his mother in an aged care facility and says he feels better when he leaves his home, but he cannot go there on his own. The claimant reported poor sleep, his weight had dropped to 57kgs his mood was “not happy” and his general interest was low.
The next report from Dr Nepal is dated 23 April 2025 and this refers to a previous appointment on “31/4/25”. The claimant reported his depression had increased but then said he was travelling to Sri Lanka for two weeks to see extended family and friends.
His relationship with his wife had improved but he reported visual disturbance which meant he could no longer watch TV or work on his laptop or computer.
The claimant was seen by Associate Professor Geevasinga on 17 November 2023[20] in respect of any neurological issues in the lower limbs and to consider the claimant’s right-hand tremor. The doctor was of the view there was nothing serious, there was evidence of carpal tunnel syndrome and an intermittent tremor in the right hand. Associate Professor Geevasinga reviewed the claimant’s scans with the claimant. He noted the claimant walked with a limp and that the tremor was intermittent noting it would disappear and reoccur during the re-examination. Power, tone and reflexes of the upper and lower limbs were normal. He considered the gait derangement “out of proportion” to the clinical examination and considered the right-hand tremor was “psychogenic” and not neurological. He also raised a query as to whether “there is a psychological overlap to the majority of his symptoms” and he made no arrangements to see the claimant again.
[20] Page 46 of the insurer’s bundle.
The claimant was seen by Dr Deshpande of the Western Sydney Pain clinic[21] who wrote to Dr Sivagnanasundaram in respect of a review appointment on 11 June 2024. He noted pain conditions had not changed other than worsening during winter. Reference was made to Dr Rajendra and a psychiatrist Dr Mahendra.
[21] Page 64 of the claimant’s additional bundle.
Professor Rajendra saw the claimant on 2 July 2024 and reported to the claimant’s GP. He has a history of:
(a)    the accident, crutches, strong pain medication and exacerbated constipation;
(b)    loss of appetite for 20 years, previous indigestion and a August 2022 endoscopy;
(c)    feelings of bloating, colonoscopy showing haemorrhoids but otherwise normal lower GI tract, and
(d)    high cholesterol.
The claimant was prescribed a medication which he had been provided before the accident.
Professor Rajendra saw the claimant again on 10 September 2024 indicating that the bloating had improved. In a report dated 28 January 2025 the claimant was reported to be somewhat better (in terms of his gastro-intestinal issues) but otherwise the report adds little to the mix.
The claimant uploaded a bundle of updated records on 6 June 2025. Included in this bundle is a report from the Emergency Department of Westmead referring to an attendance on

19 March 2025.
The claimant was seen about longstanding weakness to the right side of his body, chronic right shoulder and neck pain following the current car accident. The claimant had developed sudden worsening of weakness in his right hand and reduced sensation. The clinical examination found improving power and reduced sensation “not following a clear dermatomal distribution.” Reflexes were said to be brisk and neurological examination was otherwise normal.
Mr Celvavinayagan was advised to see his GP later in the week and return to emergency if there was worsening of strength or reduced sensation.
On 24 March 2025 the claimant was referred to Dr Kam for opinion and management of the claimant’s “ongoing neck pain and slight weakness in the right upper limb.” An imaging request of the same date (MRI of the head) refers to a “recent flare up”.
Updated GP records indicate continued complaints of pain with associated depression and anxiety.

Medico-legal reports

Claimant’s reports

The claimant relies on Dr Bodel, orthopaedic surgeon[22] who on 6 April 2023 expressed the view that the claimant has persisting physical injuries “complicated by a very significant psychological disturbance and this affects his perception of” his physical injuries. In a separate report he assessed WPI at 23%.
[22] His older reports are found at page 68, 77, 79 and 81 of the claimant’s initial bundle and there is a final report in the updated bundle.
Dr Bodel provided an update on 19 February 2024 (WPI of 31%) and a further updated report on 22 January 2025 (WPI of 25%).
Dr Kumagaya, psychiatrist ’s report is dated 14 September 2023[23]. He diagnosed a major depressive disorder with anxious distress, had a history of no previous injury or pre-existing condition and that he would need ongoing medical treatment. In a separate report Dr Kumagaya assessed WPI at 24%.
[23] Page 92 of the claimant’s bundle.
Dr Khan, psychiatrist provided a report dated 7 March 2024[24]. He records the claimant’s treatment as involving seeing his GP every week, counselling with a psychologist every four weeks and reports the claimant has had four consultations with a psychiatrist in total. He notes the claimant has seen Professor Sitharthan and been diagnosed with Major Depression and post-traumatic stress disorder and has been prescribed Sertraline, Quetiapine and Amitriptyline.
[24] Page 105 of the claimant’s bundle.
Dr Khan has a record of mental health difficulties emerging in 2009 while on holiday in India. The incident is noted as concerning his wife who lost her passport and travel documents and upon returning to Australia he had some treatment. The clamant was not prescribed medication. The claimant said he had stress from time to time.

Dr Khan diagnosed a major depressive disorder and post-traumatic stress disorder, and he expressed a guarded prognosis. In a separate report he assessed WPI at 22%.
The claimant also relies on a report of Dr Greenberg dated 15 March 2024[25] in respect of the claimant’s gastrointestinal issues. Dr Greenberg had a history of constipation before the accident which was not significant and was controlled by medication. He diagnosed a “gastrointestinal motility disorder” related to the claimant’s consumption of pain killers. He assessed WPI at 3%.
[25] Page 115 of the claimant’s bundle.
The claimant also relies on functional and vocational assessment reports from Dr Ting which the Panel has read and considered.

Insurer’s reports

The insurer relies on medico-legal reports from Dr Shazad, occupational physician dated

9 January 2023[26], Dr Bentivoglio dated 14 May 2024[27] and the Vocational Capacity Centre dated 30 September 2024.
[26] Page 21 of the insurer’s bundle.
[27] Page 27 of the insurer’s bundle.
Dr Shahzad and the Vocational Capacity Centre examiners were of the view the claimant was exaggerating or malingering. Dr Shahzad says the claimant reported his fingers were shaky and he was using crutches. Dr Shahzad said the claimant was able to climb stairs. Mr Celvavinayagan was unable to move his right knee, left hand or neck when under formal examination but demonstrated more movement on informal observation. There were inconsistencies which he thought were “possibly malingering … with underlying non-organic causes.” In answer to the insurer’s questions Dr Shahzad said he thought the claimant had sustained soft tissue injuries which have now subsided.
Dr Bentivoglio considered Mr Celvavinayagan’s complaints and disabilities were not reasonable suggesting there was no abnormality in the little finger (he was wearing a form of splint) saying “there is no way any hand physiotherapist or any hand surgeon would suggest splinting of his little finger in extension 18 months after an injury when there was no fracture”.
He also felt there was no abnormality in the knees identified in the radiology and no reason for the use of crutches. Dr Bentivoglio noted the claimant used crutches but that he did not walk with a limp. Dr Bentivoglio has a history of right shoulder pain developing six months after the accident.
Dr Bentivoglio considered the claimant was fit to work and did not require treatment and:
“From a musculoskeletal point of view, this gentleman is not disabled and would be capable of doing activities of daily living. He does not require any domestic assistance or personal care.”

Other assessments

Medical Assessor Home determined on 22 April 2024 that the claimant sustained soft tissue injuries to his neck, lower back, right shoulder, right knee and left finger. He assessed WPI at 4%. Medical Assessor Home records instances of inconsistency and says he could not rely on range of motion measurements as a result.
Medical Assessor Garvey assessed the claimant’s gastrointestinal issues noting a 10 – 15-year history of recurring constipation and the claimant’s allegation that his constipation has dramatically worsened since the accident. He referred to the Medical Assessment Guidelines and notes there is no assessable impairment for constipation.

RE-EXAMINATION FINDINGS – MEDICAL ASSESSORS BARRETT AND GUPTA

The claimant was assessed on 19 August 2025 by MS Teams. He was located at his lawyer’s office and there was excellent internet connection throughout the re-examination. Mr Celvavinayagan was assessed unaccompanied in the presence of an interpreter who was present for the duration of the assessment.

Introduction.

Mr Celvavinayagan is a 54-year-old man who lives in a home in Sydney with his wife, three adult children and parents-in-law. He says he is supported by Workers Compensation payments.

Personal history.

Mr Celvavinayagan was born in Sri Lanka. He reported normal birth and achievements of milestones. He was the youngest of five siblings. He reported a happy childhood. He completed high school as an average student.
However, the civil war began in Sri Lanka when he was about 15-years-old. As a young adult, he was detained many times by Sri Lankan forces over political issues, which caused him to flee within the country. His community supported him over a period of five to six years, before he fled to India, where he applied for a refugee visa. He came to Australia at 25-years-old in about 1997 or 1998.
He met his wife in about 2000, as an arranged marriage. They have three young adult children.
He denied any previous personal injury claims. He denies any forensic history.
He is a former smoker, who quit in his mid 20’s. He used alcohol occasionally at social gatherings and at parties. He denied any other substance use history.
He denied any family history of psychiatric illness.
He reported a history of high cholesterol treated with medication. He had difficulties with his sleep 15 or 20 years ago. He says his GP prescribed medication and his insomnia resolved.
He described becoming “really upset” in about 2008 or 2009 when he travelled in India with his family and his wife’s passport was lost. He reported that when they got the passport back, he was, “completely OK”. The panel put to him that this account was inconsistent with the documentation, which indicated a maintenance of symptoms persisting after his return to Australia, for which he attended his GP and then was referred to, and attended upon, a psychologist. Despite the question being rephrased to him in multiple different ways, he maintained that his symptoms resolved in India when the passport was returned. He denied any other psychiatric episodes.
Prior to the accident, he was living with his wife and children. He did some cleaning, shopping and lawnmowing. He prepared simple meals, noodles or a sandwich. He showered daily. He enjoyed time with his family, attending the temple, restaurants and going on holidays. He denied any relationship difficulties. After arrival in Australia, he had worked as a storeman in a warehouse. He had began working as a bus driver in 2019.

History of the motor accident.

The subject accident occurred on 19 October 2022. He was driving a bus, traveling through an intersection on a green light. A truck disobeyed a red light and collided with the front driver’s side corner of the bus. He reported that he felt “so shocked”. He asked the children on the bus to get off and catch another bus. He got off and exchanged details with the at-fault driver, who apologised. He contacted the bus company control centre and asked for them to send another bus. He then began driving the second bus but, he reported that he, “couldn’t handle it”, as he was suffering a severe headache. He took some paracetamol and drove to the bus depot, where he left work and drove to his GP.
He attended Blacktown Hospital more than two weeks after the accident.

History Of Symptoms Following the Motor Accident.

Physical Symptoms

Mr Celvavinayagan reported injuries to his right knee, back, right side of his neck and left hand. Initially he said his pain was at a severity of 5/10, and now it has increased to a severity of 8/10, on a scale from 1 to 10 where 10 is the most severe. In addition, he complained of a tremor in his right hand.
He reported physical restrictions due to pain, including to bending and turning. He says he cannot cook because pain restricts him from lifting. He cannot clean because of pain. He says he uses crutches or a walking stick to aid walking and in the shower due to pain and tremor. He was given the sticks by his physiotherapist with advice to use them briefly, but he has continued to use them.
He continued to drive the bus for work for two weeks after the accident, then stopped because of pain saying that at “one stage couldn’t get out of bed”. He has continued to be restricted from driving which he says is due to an inability to turn his neck and knee pain impacting his ability to use the brake.
He relayed that his doctors have diagnosed a “nerve issue” in his neck. He attended a pain clinic at Westmead hospital in 2023, but his care was then moved to a private clinic, where he was given an injection. He takes an opioid analgesic, Targin twice daily, Mobic at night but not daily and Panadol Osteo, and he says he takes eight tablets a day. He says that doctors have told him that he may need surgery. He continues to attend physiotherapy, once a week, which is helpful, “a little bit move”.

Psychiatric Symptoms

Mr Celvavinayagan reported that he is depressed, explaining, “I’m trapped inside the house – feel like I’m in prison”. He is restricted by the suspension of his driver’s license two years ago and the need to use a walking stick to go out, because he does not feel confident without it.
He described constipation as a side effect of opioid analgesia, for which he takes a laxative, and so he wears nappies when he goes out which he reports as embarrassing and “traumatically effecting my mental health”.
He worries about his future, “No hope about future”, triggering suicidal ideation due to, “living like this”. He did not report any plan or intent to act on the thoughts, adding, “but can’t be like this forever”. His sleep is impacted by occasional nightmares and dreams about the accident. His mood is still reactive and can lift if he meets friends.
He has been referred to a psychiatrist who he sees once a month. For about one year he has been prescribed Sertraline but was unsure if he uses 50mg or 100mg daily, Nortriptyline two at night, and Quetiapine, but he was not sure of the dose. His psychiatrist has recommended dose increases but he has been reluctant to do so. He has been seeing a psychologist since the motor accident, who gives advice.

Current functioning

Mr Celvavinayagan described needing full assistance, even with wiping himself after toileting and serving a meal due to the physical restrictions. He spends his day in a chair, need a pillow to support his neck due to pain. He reported, “My wife busy, I’m by myself”. As a result, he described feeling lonely, “like a torture”, “mentally upset – loneliness, anxiety, because trapped in the house”. He watches television but cannot do so for long due to pain in both eyes, blurred vision and “stabbing pain”. If someone takes him to the temple, he will go. He does not join his family in celebrations of religious festivals, because he cannot drive and does not want to be seen walking with a walking stick and does not want to need to ask for help in front of others. He reports some strain in his relationship with his family because of his reliance upon them for help. He travelled to Sri Lanka in 2025, alone, using a wheelchair, to see old friends. Whilst he did not enjoy the trip he said “because I’m a disabled person”, he did experience some relief from worries. He had travelled to today’s assessment at his lawyer’s office, alone, by taxi.
The Panel raised with him the GP entry of 5 February 2024, which certified him fit for light duties in a desk role and raised the possibility of a translator role. He responded that the insurer had refused for him to help him with this.

Mental state examination.

Mr Celvavinayagan was assessed via videoconferencing.
He presented as a casually dressed man of stated age. He had a walking stick in his right hand. He wore a fabric mask, pulled down over his chin, and explained that he wore a mask to avoid infection, as he perceived himself more at risk, “because I can’t handle if get infection” and due to concerns that antibiotics could interact with his other medications. He sat with his eyes squinted, appearing anguished or in a grimace, but he relayed the details of the motor accident in a calm and indifferent manner.
His speech was normal in rate, volume and rhythm. He utilised the interpreter where appropriate throughout the re-examination.
His mood was depressed and anxious. His affect appeared incongruent and somewhat indifferent.
He was preoccupied with his experience of pain, tremor and restricted movements. He said often for example, “Main thing is the pain; if get rid of pain, can get to the next level”, and, “If I get rid of the pain, should be ok”. He repeatedly referred to himself as a “disabled person”. Apart from this, there were no delusions, no formal thought disorder nor perceptual abnormalities.
He acknowledged suicidal ideation, “can’t be like this forever”, but denied plan or intent. He did not express any risk to others.
He is complying with seeing a psychiatrist and psychologist and taking psychotropic medications.

REVIEW PANEL DELIBERATIONS

Causation of injury

The Panel is required to determine in accordance with clause 2(2) of Schedule 2 to the MAI Act the degree of the claimant’s whole person impairment resulting from the motor accident. This requires the Panel to make a finding about causation of injury before assessing impairment.
Clause 6.6 of the Guidelines provides a two-fold test of causation:
(a) a medical decision about whether the accident could have caused or contributed to the injury, and
(b) a non-medical informed decision about whether the accident did cause or contribute to the injury.
The Panel notes the circumstances of the motor accident that is an intersection collision between the bus the claimant was driving and a truck coming through a red light. The Panel has seen the photographs of the damage done to the bus. The Medical Assessors have considered the physical injuries sustained by the claimant. While Medical Assessor Home had concerns about the claimant’s consistency he was satisfied that the claimant sustained injuries to his neck, back, right shoulder, right knee and left little finger and that those injuries resulted in some permanent impairment.
Having considered the mechanism of the accident and the injuries sustained, the Medical Assessors are satisfied that the accident could have caused or contributed to the development of psychological or psychiatric symptoms.
The Panel notes that the claimant did not immediately complain of psychological or psychiatric symptoms but that these symptoms emerged over time as the claimant’s symptoms from his physical injuries persisted. The Panel is of the view that the accident did cause or contribute to the claimant’s development of psychological symptoms and a psychiatric disorder.

Diagnosis of injury

The Panel considered that Mr Celvavinayagan’s account of his past psychiatric history was inconsistent with the available records and these inconsistencies were not resolved by his responses when put to him by the Medical Assessors.
The Panel has considered the findings of Medical Assessor Home, who wrote:
“He presented to the assessment with two Canadian crutches with an unusual stiff-legged right leg gait. He walks on the heel of his right foot …
Mr Celvavinayagan was inconsistent in his clinical presentation with regard to spinal motion and knee motion. The inconsistencies were brought to the attention of the claimant. The inconsistencies did not improve on retesting. The lack of measurable wasting in the right lower extremity is inconsistent with a reported history of relative disuse since soon after the accident. The claimant could not provide explanation for retained muscle tone in the right upper and lower extremity”.
The Panel also note that the emergency department records from Blacktown Hospital[28] noted inconsistencies in the claimant’s presentation reporting:
“findings not consistent given injury was over 3 weeks ago
note that patient can flex knee and move right arm during normal conversation.”
[28] Page 269 of the claimant’s bundle.
The Panel also considers the report of Dr Radhakrishnan, treating rehabilitation physician[29] who observed that his examination was limited due to “voluntary muscle contractions secondary to pain” and he was “able to move much better when he was engaged in conversation and not paying attention.”
[29] Page 294 of the claimant’s bundle.
The Panel considered the report of Associate Professor Geevasinga dated 17 November 2023[30] who reported that the claimant walked with a limp and that his tremor was intermittent noting it would disappear and reoccur during the re-examination. Power, tone and reflexes of the upper and lower limbs were normal. The Panel notes Medical Assessor Canaris made a similar observation about the claimant’s tremor. Associate Professor Geevasinga considered the gait derangement “out of proportion” to the clinical examination and considered the right-hand tremor was “psychogenic” and not neurological.
[30] Page 46 of the claimant’s bundle.
The Panel does not propose to express a view regarding whether Mr Celvavinayagan’s reported physical symptoms are under conscious control. If the Medical Assessors on the Panel accept that Mr Celvavinayagan is genuinely experiencing pain, tremor and physical restrictions, then it is the clinical judgment of the Medical Assessors that the most appropriate diagnosis is a Somatic Symptom Disorder. Mr Celvavinayagan fulfils the DSM 5 criteria as follows:
(a)    Criterion A – one or more somatic symptoms that are distressing or result in significant disruption of daily life. Mr Celvavinayagan has somatic symptoms, pain, tremor and restricted movements, which are distressing to him and cause disruption to his activities of daily living and social life;
(b)    Criterion B – excessive thoughts, feelings or behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of three: disproportionate and persistent thoughts about the seriousness of symptoms; persistently high level of anxiety and excessive time and energy devoted to the symptoms. Mr Celvavinayagan has excessive thoughts about his symptoms and health concerns perceiving himself as “disabled” and at increased risk of serious illness, feeling distress about his pain and hopelessness about the future prospects of resolution of pain and behaviours (avoidance of activities which he reports will cause pain without assistance, including personal hygiene tasks, use of aids such as walking stick and wheelchair), and
(c)    Criterion C - his symptoms have persisted for more than 6 months.
The Panel note the claimant’s treating psychiatrist and psychologist both diagnosed

post-traumatic stress disorder. It is the clinical judgment of the Medical Assessors that the claimant does not satisfy the criterion for a Post Traumatic Stress Disorder for the following reasons:
(a)    Criterion A issues- while there was an intersection collision and an apparent breach of the road rules by the truck, damage was done to the vehicles and the bus driver’s window was smashed, the Medical Assessors note that emergency services were not called to the scene and Mr Celvavinayagan was able to self-extricate, exchange details with the other driver, call the bus company, attend to the children on the bus, drive to the depot and then to his GP, and he subsequently returned to work. and the Panel does not accept that he was exposed to actual or threatened death or serious injury;
(b)    Criterion B issues - the Medical Assessors’ findings on mental state examination, including the absence of distress or arousal when recalling the accident, is not consistent with the findings expected in PTSD. Although he reports some nightmares, nightmares are not pathognomonic of PTSD and can be present in a variety of diagnoses and in normal people, and
(c)
Criterion C issues - after the accident he resumed work and continued to drive a bus for two weeks before he was prevented from continuing to drive by physical symptoms, rather than anxious avoidance. The reason for cessation of driving was relayed to the panel at assessment and is consistent with the claimant’s statement of 6 December 2022 and in the supplementary statement dated

7 September 2023 in which he wrote, “I have been unable to return to work in any capacity since 7 November 2022, due to the ongoing negative consequences of my physical injuries”. This is also consistent with the reason for cessation of driving recorded by the treating psychiatrist, Dr Jacobi, in her letter of 19 August 2023, “He can’t drive as he experiences pain from head movements and can’t step on the break (sic) due to his knee pain”.

The Medical Assessors considered whether an additional diagnosis of Adjustment Disorder, or Major Depressive Disorder or Persistent Depressive Disorder was appropriate, given the claimant’s reported mood symptoms. However, the symptoms of Somatic Symptom Disorder include thoughts, feelings and behaviours, encompassing both negative cognitions and negative emotions and better explain the totality of his experienced symptoms.
At the re-examination the Medical Assessors specifically explored this issue, and the claimant clearly indicated that his pain, and secondary pain related restrictions, are the primary cause of his distress, negative thoughts and feelings, such that if his pain resolved, his mood symptoms would also resolve. This is consistent with the account he gave to the treating psychiatrist, Dr Jacobi, who recorded in a letter dated 19 August 2023, “If the pain was taken away, ‘I’d be a very happy man’”. He reported clearly that he is emotionally impacted by his physical restrictions, “I’m trapped inside the house – feel like I’m in prison”. Further, his restrictions in performing activities of daily living were reported as secondary to pain and restricted movement. He thus did not report a loss of motivation to engage socially or in activities of daily living, which would be a core feature of a mood disorder. He did not report physiological symptoms of a mood disorder, noting that his sleep was predominantly impacted by pain and his appetite impacted by the side effects of analgesics. Further, he does report some reactivity of mood, such as when with friends. His thoughts of futility and negative thoughts were in relation to disproportionate and persistent thoughts about the seriousness of his condition, such as his stated belief that he is disabled and that he would be more susceptible to infection. These thoughts are part of the core features of Somatic Symptom Disorder, rather than self-critical thoughts about past, present and future which are a feature of mood disorders.
The Medical Assessors note that in excluding an additional diagnosis we have formed a different view to that of Medical Assessor Canaris but consider that this is likely due to Medical Assessor Canaris not having access to Medical Assessor Home’s certificate at the time of his assessment. While both parties have relied on medico-legal reports addressing the claimant’s physical injuries, Medical Assessor Home, as an independent decision-maker

IMPAIRMENT ASSESSMENT – THE PANEL

Preliminary matters

The Medical Assessors are of the view that, in accordance with cl 6.19 of the Guidelines, the claimant’s mental health state is static and Mr Celvavinayagan’s condition has stabilised, and it is appropriate to assess the degree of his impairment.
Clause 6.21 of the Guidelines requires the Panel to consider the impairment as it is at the time of the assessment, or in this case at the time of the re-examination.

The separation of physical impairments from psychiatric impairments and pain

Clause 6.36 of the Guidelines provides that impairment resulting from physical injuries must be assessed separately from any impairment resulting from any psychiatric or psychological injury. This also reflects s 7.21(3) of the MAI Act which prevents the combination of a physical impairment with a psychiatric disorder to overcome the 10% threshold.
Clause 6.38 of the Guidelines provides that a separate allowance for permanent impairment due to pain is not to be assessed and that each chapter of the AMA 4 Guides “includes an allowance for associated pain in the impairment percentages.” In other words, the impairment percentages for various physical conditions includes an allowance for pain that accompanies the condition. Clause 6.38 is important in the light of the Medical Assessors’ diagnosis of a Somatic Symptom Disorder which is a psychiatric condition but one which is dependent on the presence of symptoms of illness or injury including pain symptoms.

The assessment of mental and behavioural disorders

Clause 6.35 of the Guidelines provides that psychiatric impairment is assessed in accordance with the Mental and behavioural disorders part of the Guidelines commencing at cl 6.201.
Clause 6.202 of the Guidelines recognises that the Mental and Behavioural chapter (Chapter 14) of the AMA 4 Guides does not allocate percentages for psychiatric impairment. Clause 6.203 therefore requires the assessment of a psychiatric impairment to be undertaken in accordance with the Psychiatric Impairment Rating Scale (PIRS) and that the AMA 4 Guides are “for background or reference [use] only.”
As a first step in the assessment process, cl 6.213 of the Guidelines requires impairment for a mental and behavioural disorder to be attributable to a disorder recognised in the current edition of the DSM or the International Statistical Classification of Diseases and Related Health Problems. The Medical Assessors have diagnosed Mr Celvavinayagan with a Somatic Symptom Disorder which is recognised in the current edition of the DSM that is the fifth Edition (text revision) version (DSM-5-TR).
Clause 6.215 of the Guidelines states that “the PIRS must not be used to measure impairment due to somatoform disorders or pain”.
It is the clinical judgment of the Medical Assessors that Mr Celvavinayagan’s psychiatric or psychological symptoms are best explained by the diagnosis of Somatic Symptom Disorder. It therefore follows that the claimant’s impairment resulting from that disorder cannot be assessed using the PIRS.

CONCLUSION – THE PANEL

The Panel finds that the claimant has no assessable impairment under the PIRS arising from the Somatic Symptom Disorder. The Panel is of the view that there is no provision in the Guides or the Guidelines which permits the assessment of impairment resulting from this disorder other than the PIRS. The degree of the claimant’s WPI resulting from his psychiatric or psychological injury must therefore be assessed at 0%.
While Medical Assessor Canaris diagnosed a Somatic Symptom Disorder, he also diagnosed a Major Depressive Disorder (with anxious distress) and found the degree of the claimant’s WPI was 8%.
As the Panel has excluded the alternate diagnosis of Major Depressive Disorder and found a Somatic Symptom Disorder only, it follows that Medical Assessor Canaris’ certificate must be revoked.

[2025] NSWPICMP 697

11 September 2025