Coban v Insurance Australia Ltd t/as NRMA Insurance

DETERMINATION OF REVIEW PANEL
CITATION:	Coban v Insurance Australia Ltd t/as NRMA Insurance [2025] NSWPICMP 525
CLAIMANT:	Tulin Coban
INSURER:	Insurance Australia Limited t/as NRMA Insurance
REVIEW PANEL
MEMBER:	Belinda Cassidy
MEDICAL ASSESSOR:	Christopher Canaris
MEDICAL ASSESSOR:	Ankur Gupta
DATE OF DECISION:	18 July 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; original assessor diagnosed post-traumatic stress disorder (PTSD) and persistent depressive disorder with a 12% WPI; issues of causation (pre-existing condition) and degree of impairment; re-examination by two assessors; Held – claimant’s diagnosis was major depressive disorder; WPI assessed at 7%; MAC revoked; no issue of principle.
DETERMINATIONS MADE:	Issued under Division 7.5 of the Motor Accident Injuries Act 2017 The Review Panel: 1. Revokes the certificate of Medical Assessor Sidorov dated 17 May 2024. 2. Certifies that the degree of the claimant’s permanent impairment resulting from the injuries caused by the motor accident on 14 September 2020 is 7% which is not greater than 10%.

STATEMENT OF REASONS

INTRODUCTION

Tulin Coban was involved in a motor accident on 14 September 2020. She was in the Sydney Harbour Tunnel when she was hit from behind. Her unrestrained dog was in the car and was thrown forward.
Ms Coban says she injured her neck and back in the accident and developed a psychological injury after the accident. She made a claim for statutory benefits against NRMA, the third-party insurer of the vehicle that hit her vehicle.
A medical dispute about the degree of the claimant’s whole person impairment (WPI) has arisen in connection with that claim and Ms Coban referred that dispute to the Personal Injury Commission (the Commission) for assessment.
On 17 May 2024, Medical Assessor Sidorov determined Ms Coban had a WPI of 12% which is, of course, greater than 10%.
The insurer lodged an application with the Commission seeking a review of the Medical Assessor’s decision. The insurer takes issue with the diagnosis and the class of impairments but not with the issue of causation.
On 18 June 2024, Ms Brittliff 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

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

LEGISLATIVE FRAMEWORK

General

Ms Coban’s claim and her 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% 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 the matter is referred for medical assessment.[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 Sidorov, 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 9.1 which is effective from 1 April 2023.
Due to the nature of the injuries sustained by the claimant, the mental and behavioural chapter of the AMA 4 Guides is relevant.

ASSESSMENT UNDER REVIEW

The Medical Assessor examined the claimant on 7 May 2024 and issued his certificate on

17 May 2025. The Medical Assessor confirms at [2][5] that he was asked to assess a “psychiatric condition – Depressive Disorder.”
[5] The numbers in square brackets are a reference to the section number in the Medical Assessor’s reasons.
At [8] – [10] Medical Assessor Sidorov takes a history from the claimant as follows:
(a)    she developed anxiety in about 2015 or 2016 due to her husband’s incarceration which she said was “not significant and no treatment was required”;
(b)    she was unable to remember the exact date of the accident;
(c)    she was driving in the western distributor taking her dog to the vet;
(d)    she was stationary and was rear-ended. The rear of her car was seriously damaged, and the vehicle was written off;
(e)    she reports she was pushed forward by the impact and her legs were jammed under the dashboard and she feared the loss of her legs;
(f)    her dog (unrestrained) was thrown forward and hit the dashboard;
(g)    she was helped out of the car, a police vehicle that was passing stopped to assist and called an ambulance however she was cleared to go (it was during COVID-19), the tow truck driver removed the car, and she went home in a hire car;
(h)    when she got home, she took herself to St George Hospital due to bruising on her legs, neck and lower back pain and headache;
(i)    she was discharged home with Valium, felt anxiety and shock;
(j)    she attended on her general practitioner(GP), had physiotherapy and hydrotherapy;
(k)    Ms Coban said she developed nightmares about dying and being in the tunnel. She had recurrent, intrusive and distressing memories. Her sleep was disturbed, her mood was unstable, her marriage broke down, she felt depressed more often than not, her self-esteem has been affected;
(l)    she was referred to Dr D’Silva, psychologist but it was unclear whether there had been any improvement, and
(m)     she is taking two or three Valium tablets four to five times a week.
The claimant is reported at [12] to have disturbed sleep from her ongoing neck and lower back pain and that sometimes her neck and back “lock up” and she is unable to move. She also reported migraines with nausea.
The claimant reported being less motivated towards grooming, less motivated to cook and ordered Uber Eats for lunch and dinner, her aunt prompted her to shower who also helped with the housework.
The claimant was able to live independently and care for her child, left home independently but travelled only to her local area and mostly driven there by someone else. She reported having no friends and no motivation to see anyone.
She had no hobbies and described the breakdown of her marriage due to her “unstable and depressed mood.” She reported memory problems, a lack of focus and concentration.
The claimant was asked about previous psychological problems, and she is noted at [16] to have “minimised” their effect saying it was not significant before the accident.
At [18] Medical Assessor Sidorov diagnoses a post-traumatic stress disorder on the basis of a serious motor vehicle accident where she feared death or serious injury and the development of symptoms. He also diagnosed a persistent depressive disorder.
At [19] Medical Assessor Sidorov says the post-traumatic stress disorder and persistent depressive disorder was caused by the accident saying, “there are no other identifiable causes.” While he acknowledged the significant anxiety and depressive past symptoms, “it appears that the severity of these symptoms was less than that following the subject accident."
He considered the impairment permanent and assessed WPI at:
(a)    Self-care and hygiene  class 2;
(b)    Social and recreational  class 3;
(c)    Travel  class 2;
(d)    Social functioning  class 3;
(e)    Concentration persistence and pace        class 3, and
(f)    Adaptation  class 3.
The class scores were 2, 2, 3, 3, 3, 3, giving a median of 3 and an aggregate of 16 which translates to a WPI of 17%.
He considered the impairment assessment present before the accident as:
(a)    Self-care and hygiene  class 1;
(b)    Social and recreational  class 2;
(c)    Travel  class 1;
(d)    Social functioning  class 2;
(e)    Concentration persistence and pace        class 2, and
(f)    Adaptation  class 2.
The class scores were 1, 1, 2, 2, 2, 2, giving a median of 2 and an aggregate of 10 which translates to a 5% WPI.
The 5% was deducted from the 17% leaving a current impairment of 12% which was not adjusted for treatment.

ISSUES FOR DETERMINATION

Insurer’s submissions

The insurer says the Medical Assessor erred in his assessment of Concentration, Persistence and Pace and also Adaptation, failed to give sufficient reasoning and failed to apply cl 6.217 of the guidelines correctly.
In terms of Concentration, Persistence and Pace the insurer noted the scoring was based on accepting the claimant’s history. The Medical Assessor did not comment on the claimant’s ability to concentrate and persist with the medical examination.
In terms of adaptation, the insurer notes the claimant was not working and was receiving the disability support pension and had lost her job due to COVID-19 not the accident. The insurer says the Medical Assessor did not explain the impact of the claimant’s physical injuries and explain why her inability to work was solely as a result of her psychological injuries.

Claimant’s submissions

The claimant says there is no error and t the Medical Assessor has given his reasons taking into account the clinical examination, the documentation and using his clinical judgment.

Procedural matters

The Panel issued directions to the parties dated 10 March 2025. The Panel noted that the submissions from the parties take issue with the degree of the claimant’s impairment and that there did not appear to be an issue about causation of injury and the existence of a pre-accident condition. The Panel sought clarification of this and issued directions to the parties for bundles of documents.

Responses from the parties

The insurer provided a bundle of documents comprising 222 pages. The insurer also responded to the Panel’s query accepting that the motor accident caused a psychiatric injury resulting in impairment.
The claimant provided a single short “letter” from the claimant’s treating psychologist who expressed the view the claimant had a greater than 10% impairment (with no reasoning or assessment under the psychiatric impairment rating scale (PIRS)) and a covering letter which does not add anything to the Panel’s understanding of the matter.

Preliminary conferences

The Panel met on 13 May 2025 and reported to the parties the same day. The Panel noted:
(a)    the insurer has conceded the claimant sustained some form of psychiatric injury in the accident;
(b)    the Medical Assessors are required to determine if the claimant had a psychiatric injury and diagnose that injury and that they may in their clinical judgment, diagnose a condition that is the same as, or different to, the diagnosis of the original Medical Assessor or 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, and
(c)    the Panel had received the bundles of documents from the parties.
The Panel advised the parties of the re-examination date (24 June 2025 at 11.00am) and directed the claimant to attend.
The claimant responded on 15 May 2025 as follows:
“We are instructed by our client that at paragraph 19 of the certificate dated 17th May 2024 of Dr Sidorov that 'Ms Coban’s post traumatic stress disorder and persistent depressive disorder were caused by the subject accident. Accordingly may you bring this to the attention of the member Ms Cassidy. Our clients instructions are that the re-examination is unneccessary.”
The Panel conferred and responded as follows:
"The Panel confirms receipt of the message from the claimant's solicitor advising of his client's attitude to the re-examinatio. …The Panel is required to undertake an assessment de novo … and has determined that a re-examination is required in order to undertake the assessment de novo. The Panel encourages the claimant to attend the re-examination as arranged."
The Panel received no further communication from the claimant or the insurer.

REVIEW OF THE EVIDENCE

Claim form and claim documents

The claimant was 36 years of age at the time of the accident and will turn 42 later this year. Her claim form was signed and dated 22 October 2020.
The claimant says:
“I was heading north in the tunnel, there was traffic so I was stationary foot on the break when a car from behind slammed in the back of my car very badly, I was in massive shock and couldn’t move/get out of the car for a few minutes. When I got hit from behind, I had my dog in the car as well, she also flew to the front of the car hitting the dashboard on impact.
On impact my whole body flew forward, my neck is still in pain and have been getting regular headaches and dizziness as a result. My lower back is very sore and in constant pain after the accident. My knees hit the bottom of the dashboard, my left knee had lots of bruising.”
The insurer denied liability for ongoing benefits on 20 January 2021 on the basis the claimant’s physical injuries were “minor” injuries. On 6 February 2023 the insurer accepted liability for ongoing benefits.
Dr Nigro completed the first certificate of fitness on 10 November 2020. He said he first saw the claimant on 16 September 2020. His diagnosis is of neck and lumbar muscle spasm, soft tissue injuries. His management plan included Panadol osteo tablets, Voltaren gel, X-rays of neck and back and MRI scans and he had noted the claimant had been to St George Hospital. He said the claimant had no capacity to work.
The claim form was blank in relation to employment but noted the claimant was a hairdresser and receiving jobseeker support.

Treating medical records and reports

Notes have been provided by Premier Health of Kogarah.
At page 89 of the bundle, the claimant’s medications are listed and the Panel notes that Valium was prescribed on 11 December 2019.
The clinical notes commence with an entry on 26 September 2008. There are a handful of entries in 2009, one in March 2009 and then nothing until September 2014.
On 15 and 22 February 2016 the claimant attended on Dr Nigro for lethargy and fatigue and weight gain. The claimant’s mother and sister were said to have a hypothyroid condition. There was a similar complaint made on 9 May 2016. The claimant attended for a long consultation on 7 and 15 November 2017 concerned about pregnancy, contraception and wanting to freeze her eggs. Her husband was in jail in Western Australia with 2.5 more years of a 12 year sentence to be served. A similar consultation occurred on 19 April 2018.
On 3 July 2019 the claimant attended on Dr Nigro having hurt her left ring finger and reporting lethargy and fatigue.
The claimant attended St George Hospital on 19 October 2019[6] with symptoms of anxiety having “recently received bad news regarding her husband and having difficulty eating sleeping and lots of physical symptoms”. Four tablets of Valium (diazepam) were provided which she was advised to take if very anxious.
[6] Page 163 of the insurer’s bundle.
On 11 December 2019 the claimant attended having been to St George Hospital again and been given Valium. Dr Nigro gave her anxiety counselling, controlled breathing and relaxation techniques. He also referred to “treatment options including plan to treat the depression to elevate mood and improve memory in order to be more amenable to psychologist review and cognitive therapies.” He referred the claimant to Dr Deborah Martin, Smith, psychologist for “opinion and management” of “recurrent anxiety”.
The referral to Dr Marin Smtih seeks opinion and management of “recurrent anxiety.”
On 17 August 2020, Dr Nigro undertook a telephone consultation. He records the claimant was not suicidal and again performed anxiety counselling, controlled breathing and relaxation techniques. There was a long discussion regarding treatment options for depression. A Centrelink certificate was given. At the end of a note is “general anxiety disorder, panic disorder, insomnia.”
On 26 August 2020 Dr Nigro referred to the Centrelink Short Service Disability (SSD) certificate which was not filled in correctly and had been rejected. A fresh certificate was generated. The Panel has not been provided with a copy of the Centrelink certificate.
The hospital notes record the claimant presented to emergency after the car accident having been rear ended at 30kmph. They take a history of her self-extricating and having lower back pain and lateral neck pain and Valium 2.5 mgs having been taken at 3.00pm, 5.00pm and 6.30pm due to palpitations.
The hospital records[7] “a history of anxiety since 2006, had previously seen psychiatrist / psychologist but not for years and had no regular medications but Valium PRN from her doctor ‘not needed for months’. She had increasing sense of anxiety while at home today since 12.30pm”.
[7] Page 187 of the insurer’s bundle.
The first attendance at Premier Health was on 16 September 2020, two days after the car accident. Says “no head injury or loss of consciousness”. She reported two days of worse neck and lower back pains with spasm.
On 28 September 2020 the claimant attended for worse lower back pain but the neck was slightly better and there was a bruise on the left knee. There was a conversation about a scar on her chest. On 19 October 2020 there was another telephone consultation with complaints of lower back and neck pain and left knee bruise. There was a further attendance on

20 November 2020 with similar complaints. A referral to Lifefit Physiotherapy was provided for neck and lower back pains.
The claimant was seen by telehealth on 9 December 2020 and on 7 January 2021 she was spoken to following the MRI of her lumbar and cervical spine. On 28 January 2021 she had lower back and neck pain persisting with paraesthesia worse in the left arm and numbness in her left buttock and a referral to Professor Lubowski (for haemorrhoid treatment) and Professor Davies, neurologist were given.
There are no references for mental health issues at this time.
Dr Nigro wrote to NRMA on 23 July 2021 and responded to a series of questions. He diagnosed neck and back injuries and now depression and post-traumatic stress disorder. He says the claimant first presented with these symptoms on 8 June 2021 mentioning nightmares, flashbacks, insomnia and phobia of driving and a referral was given. He confirms that in 2019 the claimant required treatment for anxiety which had resolved. He said she had no further symptoms until after the car accident.

On 29 August 2023 the claimant was referred to Dr Noore, for recurrent neck and back pains “and associated anxiety.”
Dr Noore, psychiatrist and pain management expert provided a report dated 10 October 2023.[8] The claimant was 39, she had an infant and was recently separated from her partner. She was not working and receiving Centrelink benefits. “She experiences persistent motor vehicle accident-related pain associated with distress and disability”.
[8] Page 221 of the insurer’s review bundle.
He had seen her twice. He has a history of the rear end collision and that she drove her car home.
She complains of neck and back pain which is continuous and worsened by activity. In addition, she had nightmares, flashbacks and panic attacks. Driving was difficult and she was easily triggered.
Dr Noore says the claimant is having regular psychological consultations with Dr D’Silva and she uses Valium for her anxiety (which she has used for a “long time”). Dr Noore diagnosed a post-traumatic stress disorder, impaired function, significant stressors such as marriage breakup and financial stress and gave her advice about ongoing treatment. She was supposed to get back to him.
The insurer has provided allied health recovery request forms completed by Dr D’Silva of Behold Psychology:
(a)    21 May 2021 notes a diagnosis of “chronic adjustment disorder with mixed depressed and anxious mood couple with panic attacks.” Tweleve sessions were recommended to improve and maintain patient functioning, reduce chronicity and support return to work / usual activities;
(b)    13 August 2021, same diagnosis, same symptoms. It was noted “slow recovery due to pain issues and severe psychological symptoms.” The same goal was noted and eight further sessions requested;
(c)    5 November 2021, same diagnosis, similar symptoms with heightened anxiety and panic attacks, gradual progress. Noted that “experiences severe symptoms of anxiety, anger and depression aggravated by pain. A further 12 sessions were requested, and
(d)    1 April 2022, same diagnosis, similar symptoms of anxiety and depression; the goal was to improve her ability to deal with symptoms of pain anger and anxiety through Cognitive Behavioural Therapy. Eight sessions were requested.
The Panel has not been provided with copies of Dr D’Silva’s clinical notes.

Medico-legal reports

Dr Cocks, psychiatrist provided a report to the insurer dated 15 June 2023.
The claimant gave the following history:
(a)    she separated from her husband two months ago having been married for 17 years;
(b)    she lives alone (there is no mention of the claimant’s child Oliver);
(c)    she is unemployed but has formal qualifications as a hairdresser;
(d)    she denied previous mental health difficulties but experienced palpitations and could be overwhelmed with anxiety at times;
(e)    she went to emergency when her husband was arrested, treated with Valium and discharged;
(f)    on the day of the accident, she was unemployed and on jobseeker, her partner was in custody, but she denied psychological distress;
(g)    she was in the Sydney Harbour tunnel with her dog when she was hit from behind;
(h)    her dog was thrown forward and she went into shock;
(i)    she could not open her door, a police officer could not help, and she remained in the car until the tow-truck driver arrived; an ambulance was called but she was not assessed and not taken to hospital;
(j)    she returned home and her health deteriorated, and she started to vomit and experienced palpitations, and
(k)    she went to hospital was assessed and discharged.
The claimant said after the accident she experienced intense neck and lower back pain which has become more intense.
Ms Coban says she has experienced distressing nightmares, dreams about her dog drowning and her life ending. She rarely goes out and has had about 50 sessions from a psychologist, but she has not been referred to a psychiatrist or prescribed medication.
Her libido has been affected, she does not enjoy going to the gym, exercising or going to the beach and she is in constant pain.
Dr Cocks was of the view the claimant met the criterion for post-traumatic stress disorder, and she also met the criteria for a major depressive disorder, and she is now dependent on Benzodiazepines.
He says all of these are not threshold injuries.
He declined to assess impairment on the basis her injuries had not stabilised.

Other assessments

On 6 May 2022 Medical Assessor Gorman assessed the claimant’s physical injuries to her right knee, left knee and lower back as soft tissue and therefore threshold injuries.
On 17 January 2022, Medical Assessor Verma diagnosed the claimant with a major depressive disorder which was a non-threshold injury.
Medical Assessor Verma had a history of the claimant working as a senior hairdresser 25-30 hours a week before the accident until COVID-19 then her hours dwindled. She had not returned to work since the accident saying she had disc bulges in the neck and back.
The claimant gave a history to Medical Assessor Verma of living with her husband. There was no child of the marriage at that time.
The claimant said she used to watch hair dressing videos, going to the gym, beach, walking and going to cafes to meet up with friends but no longer does this.
She gave a history of the accident and said a tow truck came to tow her car, but she could not open the door to get out. The tow truck driver apparently undid her seat belt and took her to Kings Cross. Ambulance would not “touch her due to fear of contracting COVID”.
The claimant admitted to pre-accident anxiety and said the accident exacerbated her anxiety and that she went to hospital on the night of the accident after having a panic attack. She was prescribed Valium. She described the panic attack as an episode of shivering, palpitations, diarrhoea, feeling cold and shortness of breath. She developed neck and back pain and left leg pain. She experienced dizziness and severe headaches and was unable to drive.
The claimant reported flashbacks and nightmares says she experiences disturbed sleep, has decreased appetite and weight loss which she since put back on because she was not exercising. She stopped going out, stopped working, she would shower and brush her teeth twice a week. She had impaired concentration.
The claimant said she had fallen the week before “after feeling giddy”.
She was having dreams about car accidents and dying.
She attributed most of her symptoms to her pain.
Medical Assessor Verma cites the criteria for major depressive disorder but does not say how the claimant satisfies them. She says, “there is a clear temporal association between the onset of the symptoms” and the accident. She said while there was a history of panic attacks there is no history of persistent symptoms. She says, “she also does not have any other personal factors that could have precipitated her psychological symptoms.”
Medical Assessor Verma says the claimant does not satisfy the criteria for an adjustment disorder as her symptoms are severe enough for a major depressive disorder. She also said there were not enough symptoms for a diagnosis of post-traumatic stress disorder.
The claimant confirmed she had anxiety for 30 years but denied having panic attacks before the accident. She did breathing exercises, but had never needed a psychologist or psychiatrist.

RE-EXAMINATION FINDINGS – MEDICAL ASSESSORS CANARIS AND GUPTA

The following is the report of the re-examination on 24 June 2025 provided by the Medical Assessors.
The re-examination of Ms Coban occurred via Microsoft Teams. A good audiovisual connection was established and maintained throughout the one and a half hour appointment. Ms Coban was at her home in Kogarah. Medical Assessors Canaris and Gupta were in their respective offices.
Ms Coban was pleasant and co-operative throughout the appointment however she became very teary at times during the early part of the appointment and her levels of anxiety and distress increased during the history taking part of the assessment. We were able to continue with the appointment but due to concerns about her mental state we did not push her on some aspects of her history and did not put to her a number of inconsistencies in her history and the medical records.

Psychosocial and pre-accident history

The claimant is a 41-year-old separated disability support pensioner who was involved in a motor accident on 14 September 2020.
At the time in question, she was married and had lost her job as a hairdresser because of COVID-19. She was rather vague saying she had been “working for someone in the City” and had been with them “a few years”. She had stints of working full time then part-time and full-time as she had the flexibility to alternate between five days and four days a week according to what suited her. After COVID-19 hit, she lived off her savings and then applied for and received Jobseeker payments.
Ms Coban was married at the age of 22. About 10 years prior to the accident her husband had been jailed. Ms Coban was also vague about the details of this saying she did not know exactly what he had been jailed for and thought perhaps “maybe he was caught with a little bit of a drug… honestly I can’t recall what happened”.
She said she maintained a long-distance relationship with her partner while striving to pay off their mortgage. At first, he was imprisoned in Perth, and she would travel to see him in prison. He was later transferred to a jail in Sydney, and she subsequently visited him in Windsor and Silverwater. She was unable to visit him in jail during COVID-19 time and then did not visit him at all after the accident until his release. Ms Coban was vague about her husband’s release and the details of their marriage thereafter.
She says they have an infant son born after her accident and after her husband was released. Since their separation she and her husband have equal custody of the boy. She is able to care for the child when she has custody with some assistance from her aunty.
She had been “good – great” before the accident and had “travelled a lot – travelled overseas – I paid off my mortgage”. She denied any history of psychiatric illness and said she had been medically well before the accident. We noted this is not consistent with the documented records but did not press the claimant about this due to her mental state at the time.
She did not drink alcohol, smoke, or use any drugs. She did not gamble. She knew of no family history of psychiatric illness. She denied any history of problems with the law and had no other claims history.
She was born in Australia. Her parents were born in Türkiye. She has an older brother and a younger sister.
She left school halfway through year 11 and embarked on an apprenticeship and has been a hairdresser all her adult life working “mostly for other people”.

History of the motor accident

On the day of the accident, she was,
“Going to a specialist for my dog and I was going on the eastern distributor towards Ryde – my dog was in the back seat – I was in the tunnel and there was some traffic – I was at a standstill – my foot was fully on the brake not moving at all… the car behind me smashed into the back of my car in a very forceful way – I was in major shock when it happened – my dog flew to the front of the dashboard – I literally didn’t know what happened – I felt like I lost my legs – I couldn't feel my legs – I looked down and I saw they were there – I was on the wall side of the tunnel – I couldn't open the door – it was crushed against the door – it was a very horrific accident – my dog pooped everywhere…”
A police officer was by chance escorting a bus full of people for quarantine and “saw I was stuck and he opened the passenger side – I couldn’t move, and I was in shock – he managed to open the passenger door – he said, Are you OK? I couldn’t talk – I didn’t know what was going on…”. A tow truck and “some traffic controlling people” attended. She was taken out of the tunnel by the tow truck driver and an ambulance attended but the paramedics “didn't touch me because it was Covid…”.
We were unable to put to the claimant the details recorded in the hospital notes about the speed of the other car (30 kmph) due to the claimant’s teariness at this stage. She did make it clear her airbags did not deploy and she did not really know what happened other than there was an impact from behind in stationary traffic.

History of symptoms and treatment following the motor accident

Ms Coban took herself to St George Hospital where she waited a few hours as “they waited for me to calm down”. She was told she had whiplash. When she got home, she found significant bruising on top of her thighs because her bottom slid underneath the dashboard.
She had neck pain and back pain and had MRIs which showed up “a few things” and she is “still in pain”. She was vague about the details and claimed pain all over her body.
She has had physiotherapy and hydrotherapy and “just like at home exercises and stuff like that – acupuncture”.
She “can’t do a lot of things anymore – I can't stand too long – I take a lot of Voltaren – I can’t sleep because of the pain – I’m always in pain – I can't exercise how I used to – go for jogs – go to gym – Pilates…I am in pain”.
She did not go back to work (“I wish I could, but I couldn’t – just the pain is constant”).
Her dog was OK after the accident, and did not sustain any obvious injury. However, she had to give her away “because I couldn’t look after her – I couldn’t take her for walks… she wants to play ball – to go for a walk – but I couldn’t look after myself”.
She finds herself “always [thinking] about me and my dog being trapped in that tunnel situation – it was so claustrophobic – I always think about it”. She feels as though she is there “and I feel like I’m there –I wake up sweaty and I feel like I’m there – like I’m in that car and I’m stuck”.
She does not like talking about the event and was very teary at this point as she imparted this history.
Her mood “hasn’t been the best – I feel depressed – I feel low – I feel empty – I feel like my whole life has spiralled… I don’t go anywhere – I don’t feel like I want to see anyone… I don’t feel good about myself – I don’t feel joy”.
She is sad saying, “I can’t move the way I want to, and my mood is horrible, and I don’t feel like a good person because of the pain”. She said, “I don’t feel joy – I feel like a vegetable – like a dead person – it’s a horrible feeling”.
She has panic attacks which she sees as related “mainly to the accident – like when I drive – I’m really scared of driving – I only do it when it’s really necessary – I feel like I can’t trust anyone – I just don’t feel like myself”.
Her sleep is “very broken” and she “might get a few hours with Valium [diazepam]”. She wakes from “just the nightmares – the panic attacks – the sweating – I feel like I’m back in that tunnel – in that car”.
She sees her psychologist, Dr D’Silva, sometimes as often as twice a week and sometimes every fortnight. She did not say when her psychological symptoms started or when she first saw Dr D’Silva. The insurer is no longer paying for her sessions with Dr D’Silva. In her sessions, “We just try to set small goals like meditation and when I have panic attacks how to calm them down naturally – [to deal with] panic attacks – breathing exercises – he encourages me to do some social interactions”.
She takes Valium “4 or 5 times a week – I just can’t sleep and when I have a panic attack, “It calms me down”.
She has never been prescribed an antidepressant although this has been suggested “but I just haven’t been referred to someone to prescribe me that kind of medication – I just don’t feel like I’ve been looked after…”. Her GP Dr Nigro prescribes her Valium on a regular basis. He does not report any concern about the amount or frequency of her consumption of Valium. It was not clear to us why no one had prescribed antidepressants bearing in mind the alleged severity of her symptoms, the longevity of them and the length of time she has been seeing Dr D’Silva without apparently any improvement.

Details of any relevant injuries or conditions sustained since the motor accident

The claimant denied any subsequent injuries or conditions and has had no further accidents. In the time since the accident her husband has been released from a long jail sentence, and she has welcomed a baby into the world.

Current and proposed treatment

Antidepressants had been suggested but not followed through. She has not been referred to a psychiatrist and has had about 40 sessions with Dr D’Silva of which we are aware (although there are no notes from Dr D’Silva).

Mental state examination

She presented as a woman of appearance consistent with her stated age who appeared well groomed.
She provided the history documented above. Her narrative was coherent and consistent, and she focused well over the course of an interview well in excess of one hour. She was teary and distressed in the initial part of the interview (particularly when talking about the accident and her husband) but became more composed as the assessment progressed though overall, she impressed as depleted.
She reiterated over the course of the interview that she felt she had not been looked after by the system and summed up at the end saying, “I just want to be heard” when pressed she would not be more specific.
There was no evidence of psychosis or of cognitive impairment.

Current functioning

She says she has not been back to work “because of pain - my injuries because of the accident” and “because I’m depressed”. She thinks she went onto the disability support pension “maybe six months – maybe a year after the accident – I can’t really remember the time frame – I was on sickness benefit at the start, and it transferred to the disability pension”. The Panel notes that sickness benefits ceased to new entrants in Australia in March 2020 (before the accident) and were phased out completely in September 2020 (around the time of the accident). The records of Dr Nigro suggest benefits were claimed in the month before the accident but there is no evidence of certificates issued after the accident. Ms Coban did not shed any light on this.
She said, “I hardly have showers”. She says she does not look after herself as before. She has an aunty who lives close by who pushes her into the shower. She said, “I just can’t be bothered – everything’s an effort”. She would shower “maybe once a week – maybe once every week and a half”. She would change her clothes with equal frequency. She reported no difficulty with feeding, changing, bathing and dressing Oliver. She does not cook and would mainly snack or get Uber eats though sometimes her aunt cooks for her. Ms Coban says she can order food by herself and will complete her shopping online. She does not cook for herself “because everything’s an effort – I don’t feel like doing it” but did not report difficulty with cooking for Oliver. Her appetite is “very up and down – some days I’ll eat and some days I don’t”. Her weight “fluctuates a lot”. Her aunt cleans for her and from time to time she has a cleaner come and do a deep clean. She does not clean “because it’s just too much effort and honestly, I have so much pain some days I can’t pick up anything from the floor… I’m constantly in pain – constantly…”
We noted in this context that she appeared reasonably groomed with no evidence of malnourishment. We also acknowledge the significant amount of work and effort involved in raising a baby even with help from her aunt and husband. We have also considered the contribution of pain to her limitations in this regard which needed to be excluded from assessment under the PIRS.
She would “hardly” go out saying, “I don’t need to go anywhere” and has no visitors other than her aunt. The Panel noted however regular visits from her aunt and from her partner who would help her look after her son.
She drives “very rarely and it’s just the Woollies at Kogarah which is just two streets away from me”. She nominates her anxiety as the cause saying, “I get panicky – I feel like everybody is going to hit my car – I don’t trust anybody on the road – cars speed past”. She does not go on buses or trains saying, “I don’t want to go on anything that moves”. She last travelled on holiday to Bali in 2017. She also used to travel to Perth to visit her husband in jail before he was transferred to New South Wales.

Her aunt would come over “once a week mainly”. Her parents live overseas as do her brothers and sisters. She is in touch with them “here and there”. She “used to have friends before the accident but because my health had declined, I don’t want to see anyone – I don’t reply to messages – I don’t want to put on a fake happiness”. She is officially still married but her husband wants to divorce. She said, “I kind of blame myself for the separation” what with “angry outbursts at him – zero libido – don't want to go anywhere and he wants to eat…”.
Her husband may now live with his brother, but she was vague about this and at one stage she said they have been separated some four or five years but that appears to be while he was in jail. Oliver was born in late 2023 and she has 50:50 custody of him – she has no difficulty taking him to day care and her husband still comes around regularly and helps out.
She was rather vague as to how she would spend her day. She reported “just a little bit of TV – small naps” and would stay “not long at all” on a TV program spending “maybe half an hour – sometimes less”. She might “read a bit of news” on her phone though she would only have “a quick flick through” saying, “My head is so full of pain – I just don’t have the capacity.”
She is however on top of her finances. She owns her own home and pays the utility bills and rates, sorts out maintenance of the home (but does not do it herself) and attends to payment of childcare and other regular bills.

Comments on consistency

The Panel had reservations about Ms Coban’s inability to provide detail about her husband’s imprisonment, their separation and her care of the baby Oliver.
Her failure to acknowledge her previous episodes of anxiety cannot be easily explained.
These things could not be put to the claimant due to her teariness and increasing anxiety levels and our fear of the re-examination going “off the rails” with the claimant at home and alone.

CONSIDERATION OF THE ISSUES – PANEL

The Panel met again on 15 July 2025 to discuss the re-examination findings and with a view to finalising the Review and these reasons.
The Panel notes the following about the documentation in this matter:
(a)    there are few documents concerning the mechanism of the accident;
(b)    there are no updated medical records from the claimant’s GP;
(c)    there are no clinical records at all from Dr D’Silva who has apparently seen the claimant 40 or so times, and
(d)    Dr Nigro’s notes include a reference to a Centrelink medical certificate issued before the motor accident, but no copy of that certificate can be found in his clinical notes.
The Panel notes however the insurer’s concession as to the causation of some form of psychological injury and we formed the view at the teleconference on 15 July 2025 that a fair assessment could be undertaken on the material currently available.

Differential diagnosis

The Panel has considered the diagnoses made by other examiners and the treating practitioners:
(a)    Dr D’Silva, psychologist who has seen the claimant about 40 times documented in several certificates of fitness his diagnosis of a chronic adjustment disorder with mixed depressed and anxious mood with panic attacks;
(b)    Dr Noore, psychiatrist and pain specialist diagnosed a post-traumatic stress disorder;
(c)    Dr Cocks (the insurer’s qualified expert) and Medical Assessor Sidorov diagnosed a post-traumatic stress disorder;
(d)    Medical Assessor Sidorov also diagnosed a persistent depressive disorder, and Dr Cocks diagnosed a major depressive disorder as did Medical Assessor Verma, and
(e)    Dr Cocks also diagnosed a dependence on benzodiazepines (Valium).
The Panel notes the recorded history of the accident (30 kmph according to the hospital records) and the absence of airbag deployment. The claimant was not seriously injured in that there were no broken bones or lacerations. Airbags did not deploy and there was no history of broken windows provided. The Panel notes the accident occurred in the Sydney Harbour Tunnel and the claimant’s dog was unrestrained and thrown forward and that these circumstances would have been distressing for the claimant. The Medical Assessors are however, in their clinical judgment, of the view that the accident was not significant enough to comprise a Criterion A event as per the DSM-5-TR which would warrant a diagnosis of post-traumatic stress disorder.
It is the clinical judgment of the Medical Assessors that a diagnosis of a chronic depressive illness is more applicable to Ms Coban’s symptoms particularly in the light of their connection to her chronic pain. The preferred diagnosis of the Medical Assessors is of a chronic major depressive disorder with anxious distress. In terms of the DSM-5-TR criteria, there was evidence of a depressed mood most of the day nearly every day as per the claimant’s subjective report with markedly diminished interest and pleasure in almost all activities again for most of the day nearly every day as per her subjective account. She complained of insomnia daily with fatigue and loss of energy, feelings of worthlessness, and diminished capacity for concentration. In short, she satisfied 7 out of the 9 symptoms listed in Criterion A of which a minimum of 5 were required for the diagnosis. It was evident from her account and from the presentation at interview that her symptoms caused her significant distress and impairment in psychosocial functioning as described in the PIRS below (Criterion B) and that her symptoms were not attributable to the physiological effects of a substance or to another medical condition (Criterion C). There was no evidence of a schizoaffective disorder, schizophrenia, schizophrenia spectrum, or other psychotic disorder (Criterion D) and no evidence of a manic or hypomanic presentation in the past (Criterion E).
The anxious distress specifier captures the reported post-traumatic symptoms of nightmares and the reports of occasional panic attacks. Her depression was moderate to severe in that she had 7 out of the 9 symptoms listed in Criterion A.
It is the clinical judgment of the Medical Assessors that a diagnosis of adjustment disorder would not apply primarily because the raft of symptoms she reports is too severe and pervasive to warrant the diagnosis. Moreover, the presence of symptoms many years after the accident goes against a diagnosis of adjustment disorder.

Causation and reasons

The Panel notes that the insurer has conceded the claimant sustained a psychiatric injury as a result of the accident.
The claimant has a clear and documented history of pre-accident anxiety. According to the hospital notes this began in 2006 and Dr Nigro’s records include a period of symptoms in 2019 associated with her husband’s incarceration. Four weeks before the accident it appears she applied to Centrelink for benefits which may be associated with this anxiety state however in the absence of a copy of that certificate the Panel is reluctant to make a finding that the claimant’s pre-existing anxiety was causing impairment at the time of the accident. However, it is the clinical judgment of the Medical Assessors that the claimant’s generalised anxiety disorder made her more vulnerable to develop another disorder in the face of the stress associated with the accident and her ongoing pain from her physical injuries. The Medical Assessors are of the clinical judgment that her accident-related injury is a separate injury and not an exacerbation or aggravation of any previous condition.
While the Panel considered her husband’s incarceration may have contributed to her pre-accident anxiety, it elicited no evidence from her as to any pre-accident depression nor was any such evidence apparent from the documentation.
The Panel also notes that there was a six-month delay between the accident and the first documented report to Dr Nigro of psychological or psychiatric symptoms. The Medical Assessors are of the view that this supports the diagnosis of a primarily pain related and depressive disorder. This history does not support a diagnosis of a post-traumatic stress disorder as the Medical Assessors are of the view post-traumatic symptoms would have arisen and been reported much earlier if that was the case.

IMPAIRMENT ASSESSMENT - PANEL

Psychiatric impairment rating scale

The Guidelines include a chapter entitled “Mental and behavioural disorders” and require the assessment to be undertaking in accordance with the PIRS. The Guidelines also say that the mental and behavioural chapter of the AMA4 Guides are to be used as “background or reference only”.[9]
[9] Clause 6.203 of the Guidelines.
The PIRS requires a psychiatric diagnosis to be undertaken first in accordance with whatever 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).[10]
[10] Clause 6.213 of the Guidelines.
Clause 6.214 provides that physical injury impairment is assessed using different criteria and at cl 6.215 that the PIRS “must not be used to measure impairment due to somatoform disorders or pain.”
Clause 6.217 requires the PIRS to be used “by a properly trained medical assessor” and that the psychiatrist’s clinical judgment “is the most important tool” and clinical experience is relevant.
The PIRS provides in cl 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 cl 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[11] that is treatment such as medication being consumed to treat the psychiatric condition.
[11] See cls 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.[12]
[12] See cls 6.225 – 6.228 and table 17.

What is the claimant’s impairment?

The Panel adopts the Medical Assessors diagnosis of a chronic major depressive disorder with anxious distress.
The primary stressor for this disorder is the accident and the claimant’s pain associated with her physical injuries. In the light of cl 6.215, the Panel must take care to ensure that we are rating impairment due to psychological or psychiatric symptoms and not due to the claimant’s symptoms of pain.
The standard form required by cl 6.220 which is to be used, is attached to these reasons as a summary of the following detailed findings.

Self-care and personal hygiene

Table 6.11 of the PIRS provides the following classes of impairment:
(a)    Class 1 - No deficit, or minor deficit attributable to normal variation in the general population.
(b)    Class 2 - Mild impairment. Able to live independently and look after self adequately, although may look unkempt occasionally. Sometimes misses a meal or relies on takeaway food.
(c)    Class 3 - Moderate impairment. Cannot live independently without regular support. Needs prompting to shower daily and wear clean clothes. Cannot prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) 2–3 times per week to ensure minimum level of hygiene and nutrition.
(d)    Class 4 - Severe impairment. Needs supervised residential care. If unsupervised, may accidentally or purposefully hurt self.
(e)    Class 5 - Totally impaired. Needs assistance with basic functions, such as feeding and toileting.
Medical Assessor Sidorov rated the claimant as having a mild impairment (class 2).

Ms Coban clearly does not fit Class 4 (as she is able to live alone with her child) or Class 5.
Ms Coban said, “I hardly have showers”. She says she does not look after herself as before. She has an aunty who lives close by who pushes her into the shower. She said, “I just can’t be bothered – everything’s an effort”. She reports she would shower “maybe once a week – maybe once every week and a half”. She states she would change her clothes with equal frequency. She does not cook for herself and would mainly snack or get Uber eats though sometimes her aunt cooks for her and she might order snacks through online shopping. She does not cook “because everything’s an effort – I don’t feel like doing it”. Her appetite is “very up and down – some days I’ll eat and some days I don’t”. Her weight “fluctuates a lot”. Her aunt cleans for her and from time to time she has a cleaner come and do a deep clean. She does not clean “because it’s just too much effort and honestly, I have so much pain some days I can’t pick up anything from the floor… I’m constantly in pain – constantly…”.
The Medical Assessors observed that the claimant appeared reasonably well groomed with no evidence of malnourishment and has had no trouble providing for her child albeit with assistance. The Medical Assessors have also considered the significant contribution of pain from the claimant’s physical injuries to her limitations in this regard which needed to be excluded from assessment under the PIRS (cl 6.215). It is the clinical judgment of the medical members of the Panel that the claimant has only a mild impairment (class 2) due to her psychiatric disorder.

Social and recreational activities

Table 6.12 of the PIRS provides impairment classes as follows:
(a)    Class 1 - No deficit or minor deficit attributable to normal variation in the general population. Able to go out regularly to cinemas, restaurants or other recreational venues. Belongs to clubs or associations and is actively involved with these.
(b)    Class 2 - Mild impairment. Able to occasionally go out to social events without needing a support person, but does not become actively involved; for example, in dancing, cheering favourite team.
(c)    Class 3 - Moderate impairment. Rarely goes to social events, and mostly when prompted by family or close friend. Unable to go out without a support person. Not actively involved, remains quiet and withdrawn.
(d)    Class 4 - Severe impairment. Never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or the garden when others visit family or flatmate.
(e)    Class 5 - Totally impaired. Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.
Medical Assessor Sidorov, the only other examiner to rate impairment, classified the claimant as having a class 3 impairment. The Medical Assessors on the Panel are of the view there is no evidence to support a class 4 or 5 impairment as the claimant is able to go out and is able to live with her child and receive visits from her aunt.
The claimant reported that since the accident, she would “hardly” go out saying, “I don’t need to go anywhere” and has no visitors other than her aunt. The Panel noted however regular visits from her aunt and from her partner who would help her look after her son. Again, the Panel has had to consider the significant contribution of the claimant’s physical symptoms and her complaints of pain to her ability to function in this area. It is the clinical judgment of the medical members of the Panel that the claimant has a moderate impairment (class 3) due to her psychiatric disorder.

Travel

For the functional area of travel, table 6.13 of the PIRS provides as follows:
(a)    Class 1 - No deficit, or minor deficit attributable to normal variation in the general population. Able to travel to new environments without supervision.
(b)    Class 2 - Mild impairment. Able to travel without support person, but only in a familiar area such as local shops or visiting a neighbour.
(c)    Class 3 - Moderate impairment. Unable to travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment.
(d)    Class 4 - Severe impairment. Finds it extremely uncomfortable to leave own residence even with a trusted person.
(e)    Class 5 - Totally impaired. Cannot be left unsupervised, even at home. May require two or more persons to supervise when travelling.
The Panel notes that Medical Assessor Sidorov found the claimant had a class 2 mild impairment. It is the clinical judgment of the Medical Assessors that the claimant does not have a severe or total impairment to travel.
She says she drives “very rarely and it’s just the Woollies at Kogarah which is just 2 streets away from me”. She nominates her anxiety saying, “I get panicky – I feel like everybody is going to hit my car – I don’t trust anybody on the road – cars speed past”. She does not go on buses or trains saying, “I don’t want to go on anything that moves”. The Panel notes she last travelled on holiday to Bali in 2017 but appears to have travelled to Perth to visit her husband while he was in jail. Ms Coban told the Medical Assessors she can drive on her own (without support) and she takes her son to day care. It is the clinical judgment of the Medical Assessors that the claimant has a mild impairment to her ability to travel as a result of her psychological disorder (class 2).

Social functioning

At table 6.14 of the Guidelines, the five classes of impairment are set out as follows:
(a)    Class 1 - No deficit, or minor deficit attributable to normal variation in the general population. No difficulty in forming and sustaining relationships; for example, a partner or close friendships lasting years.
(b)    Class 2 - Mild impairment. Existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.
(c)    Class 3 - Moderate impairment. Previously established relationships severely strained; evidenced, for example, by periods of separation or domestic violence. Partner, relatives or community services looking after children.
(d)    Class 4 - Severe impairment. Unable to form or sustain long-term relationships. Pre-existing relationships ended; for example, lost partner, close friends. Unable to care for dependants; for example, own children, elderly parent.
(e)    Class 5 - Totally impaired. Unable to function within society. Living away from populated areas, actively avoids social contact.
The Panel notes that Medical Assessor Sidorov found the claimant had a class 3 impairment. The Panel is of the view that neither class 1 or class 5 are applicable to the claimant on the basis of her history and her reported current functioning.
The claimant said that her aunt would come over “once a week mainly”. Her parents live overseas as do her brothers and sisters but she is in touch with them “here and there”. She “used to have friends before the accident but because my health had declined, I don’t want to see anyone – I don’t reply to messages – I don’t want to put on a fake happiness”. She is officially still married but her husband wants to divorce. She said, “I kind of blame myself for the separation” what with “angry outbursts at him – zero libido – don't want to go anywhere and he wants to eat…”. Ms Coban and her husband are separated but she has 50:50 custody of her son. She is able to care for him half of the time and take him to day care and her husband still comes around and helps out even when he has custody. While it is the clinical judgment of the Medical Assessors that there is a significant contribution to this area of functionality due to the claimant’s chronic pain symptoms, the Medical Assessors accept the claimant’s history that the breakdown of the relationship was caused in part by the claimant’s psychological symptoms and equates this to a moderate (class 3) impairment.

Concentration, persistence and pace

Table 6.15 of the PIRS provides as follows:
(a)    Class 1 - No deficit, or minor deficit attributable to normal variation in the general population. Able to operate at previous educational level; for example, pass a TAFE or university course within normal timeframe.
(b)    Class 2 - Mild impairment. Can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for up to 30 minutes, for example, then feels fatigued or develops headache.
(c)    Class 3 - Moderate impairment. Unable to read more than newspaper articles. Finds it difficult to follow complex instructions; for example, operating manuals, building plans, make significant repairs to motor vehicle, type detailed documents, follow a pattern for making clothes, tapestry or knitting.
(d)    Class 4 - Severe impairment. Can only read a few lines before losing concentration. Difficulties following simple instructions. Concentration deficits obvious even during brief conversation. Unable to live alone, or needs regular assistance from relatives or community services.
(e)    Class 5 - Totally impaired. Needs constant supervision and assistance within an institutional setting.
The Panel notes that Medical Assessor Sidorov assessed the claimant with a class 3 impairment.
The Medical Assessors reported that the claimant would spend her day with “just a little bit of TV – small naps” and would stay “not long at all” on a TV program spending “maybe half an hour – sometimes less”. She might “read a bit of news” on her phone though she would only have “a quick flick through” saying, “My head is so full – I just don’t have the capacity”. She is on top of her finances. The Medical Assessors also noted her capacity to maintain focus over the course of an interview which lasted around 1.5 hours. The claimant has a child and is able to look after that child independently 50% of the time. The Panel also notes the claimant’s report of significant physical symptoms which allegedly impair her functionality in this area. It is the clinical judgment of the Medical Assessors that a mild (class 2) impairment in this category is appropriate in respect of the claimant’s psychiatric disorder.

Adaptation

Table 6.16 of the Guidelines provides the following classes of impairment for the area of adaptation:
(a)    Class 1 - No deficit, or minor deficit attributable to normal variation in the general population. Able to work full time. Duties and performance are consistent with injured person’s education and training. The injured person is able to cope with the normal demands of the job.
(b)    Class 2 - Mild impairment. Able to work full time in a different environment. The duties require comparable skill and intellect. Can work in the same position, but no more than 20 hours per week; for example, no longer happy to work with specific persons, work in a specific location due to travel required.
(c)    Class 3 - Moderate impairment. Cannot work at all in same position as previously. Can perform less than 20 hours per week in a different position, which requires less skill or is qualitatively different; for example, less stressful.
(d)    Class 4 - Severe impairment. Cannot work more than one or two days at a time, less than 20 hours per fortnight. Pace is reduced, attendance is erratic.
(e)    Class 5 - Totally impaired. Cannot work at all.
The Panel notes that, according to the history given to Medical Assessors Canaris and Gupta, the claimant was not working at the time of the accident due to the pandemic. Clause 6.221 of the Guidelines provides:
“Where adaptation cannot be assessed by reference to work or a work-like setting, consideration must be given to the injured person's usual pre-injury roles and functions such as caring for others, housekeeping, managing personal/family finances, voluntary work, education/study or the discharge of other obligations and responsibilities.”
Medical Assessor Sidorov had found a class 3 impairment. The claimant reported that she has not been back to work “because of pain - my injuries because of the accident and because I’m depressed – I don’t want to see anyone – I don’t want to interact with anyone – I can't stand on my feet – mentally I just can’t”. She went onto the disability support pension “maybe 6 months – maybe a year after the accident – I can’t really remember the time frame – I was on sickness benefit, and it transferred to the disability pension”.
The Panel noted that Ms Coban was not working at the time of the accident although she attributed this to the pandemic. It further noted the considerable contribution of pain to her impairment in this category which has to be excluded from consideration under the PIRS. The Panel has also had to consider the claimant’s parental responsibilities and the shared custody arrangements in place with her husband. The claimant reported being on top of the family finances and being able to care for her infant child. It is the clinical judgment of the Medical Assessors that the claimant has a mild impairment in this area due to her psychiatric disorder (class 2 impairment).

Psychiatric impairment rating scale

Listed in ascending order, the classes of impairment are 2, 2, 2, 2, 3 and 3. This produces a median class value of 2 and an aggregate score of 14.
Using the conversion table (table 6.17 in the Guidelines), this produces a WPI of 7%.

Pre-existing or subsequent impairment

While there was evidence of a pre-existing anxiety condition, there was no evidence provided to suggest any pre-existing impairment.

The claimant did not indicate any post-accident subsequent event or condition and consequently there is no subsequent impairment to be consiered.

Effects of treatment

The Panel made no adjustment for the effect of treatment as there was no evidence that the 40 or so sessions with Dr D’Silva has had any significant impact on her level of impairment and the claimant is not currently taking any medication for her depressive disorder. She continues to take Valium which she took before the accident.

CONCLUSION

Taking into account all of the above, the Panel is satisfied that the degree of Ms Coban’s impairment resulting from the injury caused by the accident is not greater than 10%.
As the Panel has come to a different conclusion to Medical Assessor Sidorov it follows that his certificate should be revoked, and a fresh certificate must be issued.

ATTACHMENT A – PIRS SUMMARY FORM CL 6.220

Psychiatric diagnoses	Chronic major depressive disorder with anxious distress
Psychiatric treatment description	She has seen a psychologist and takes Diazepam (Valium) for panic attacks.

Category	Class	Reason for Decision
1. Self-Care and Personal Hygiene	2	See paragraphs 165 – 168
2. Social and Recreational Activities	3	See paragraphs 169 – 172
3. Travel	2	See paragraphs 172 – 174
4. Social Functioning	3	See paragraphs 175 – 177
5. Concentration, Persistence and Pace	2	See paragraphs 178 – 180
6. Adaptation	2	See paragraphs 181 - 184
List classes in ascending order: 2, 2, 2, 2, 3, 3
Median Class Value: 2
Aggregate Score: 14
% Whole Person Impairment: 7%

[2025] NSWPICMP 525

18 July 2025