Collier-Caldwell v Allianz Australia Insurance Limited

DETERMINATION OF REVIEW PANEL
CITATION:	Collier-Caldwell v Allianz Australia Insurance Limited [2025] NSWPICMP 302
CLAIMANT:	Bodee Collier-Caldwell
INSURER:	Allianz Insurance Australia Limited
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	John Baker
MEDICAL ASSESSOR:	Christopher Canaris
DATE OF DECISION:	1 May 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); whole person impairment (WPI) assessment at 4%; claimant witnessed the immediate aftermath of a motorbike accident involving his brother and alleged that he suffered psychiatric disability; claimant suffered unrelated physical disabilities from work incidents; claimant made first complaint about his psychiatric disabilities seven months post-accident; Review Panel accepted this was reasonable; Review Panel concluded that the claimant had suffered post-traumatic stress disorder (PTSD) and was satisfied that this was causally related to the accident; Held – Review Panel assessed WPI at 7%; MAC revoked and new certificate issued.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Panel revokes the certificate and reasons of Medical Assessor Shen dated 8 September 2023. 2. The Panel finds that the claimant has suffered a post-traumatic stress disorder following an accident on 1 May 2021 in which the claimant’s brother was injured and about which the claimant witnessed the immediate aftermath. 3. The Panel finds that the claimant has a whole person impairment of 7%.

STATEMENT OF REASONS

INTRODUCTION

The claimant has sought a review of a certificate and reasons of Medical Assessor Shen (the Medical Assessor) dated 8 September 2023.
The Medical Assessor found the following injuries caused by an accident on 1 May 2021 gave rise to a permanent impairment of 4%:
(a) post-traumatic stress disorder, partial remission, and
(b) persistent depressive disorder, partial remission.
The Medical Assessor assessed whole person impairment (WPI) at 6%. He deducted 4% for pre-existing impairment and then added 2% for treatment effect, leaving a total of 4% WPI.
This is a dispute between the claimant and the insurer about: the degree of permanent impairment under Schedule 2, s 2(a) of the Motor Accident Injuries Act2017 (the Act).

Bundles of documents

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

The accident

The claimant did not see the accident. It involved his brother. The claimant alleges a psychiatric injury when he witnessed the aftermath of a motorbike accident involving his brother. The accident occurred on 1 May 2021. At the time of the accident the claimant was 16 years old.

Claimant’s submissions

The claimant submits that the Medical Assessor incorrectly applied the psychiatric impairment rating scale (PIRS) categories.
The claimant submits that the Medical Assessor incorrectly categorised the following:
(a)    self-care and personal hygiene;
(b)    travel, and
(c)    social functioning.
The claimant submits that he ought to have been placed in the following categories:
(a)    Category 3 to 4 for self-care and personal hygiene;
(b)    Category 3 for travel, and
(c)    Category 3 for social functioning.
Regarding the category of self-care and personal hygiene, the claimant noted that the Medical Assessor recorded the following:
“He said he then became more depressed, and he struggled with sleep, and his appetite had increased, his concentration was worse, he felt more guilty, and he had suicidal plans."
The claimant says that his self-care and personal hygiene should be Category 3 to 4. The claimant submits that he is now a young 18-year-old person who does not shower, does not go to hotels, does not eat properly and struggles to do the groceries.
In terms of travel, the claimant submits that he is no longer working and does not leave the house. He only goes to places with his support person partner. The claimant submits that for the purposes of PIRS classification, he is Category 3.
Regarding social functioning the Medical Assessor noted:
"He doesn’t go out much anymore, including to the pubs and clubs since the subject accident. He said he now just sits in his room to play PlayStation alone."
The claimant highlighted that he is an 18-year-old male who was reported by the Medical Assessor as not having any friends, and who was socially withdrawn.
Also, the claimant submits that the Medical Assessor failed to record what was put to him that he is in an intermittent fleeting relationship with his partner, and they are constantly fighting.
The claimant submits that social functioning should be Category 3 and possibly Category 4.

Insurer’s submissions

The insurer does not agree with the claimant’s submissions but submits that there are material errors in the report of the Medical Assessor and on that basis agreed that a review of his decision was warranted but confirmed that in its submission, WPI would remain below the threshold.
The insurer submits that the Medical Assessor erred in the following areas:
(a)    causation;
(b)    diagnosis;
(c)    the effect of the subsequent back injury;
(d)    in his assessment of the PIRS, he has determined the classes on the basis that the deficit is related to psychological symptoms whereas clearly from the clinical notes, they arose out of the physical injuries subsequently sustained;
(e)    failed to have regard to the psychological sequelae arising out of the subsequent back injury which rendered the claimant unable to work for a period of time, and
(f)    the effects of treatment.

Causation / diagnosis – lack of complaint

The insurer submits that the Medical Assessor failed to address the lack of contemporaneous complaint of a psychological nature to the claimant’s usual general practitioner (GP) despite many attendances post-accident.
The insurer submits that it appreciates that the lack of a contemporaneous report is not determinative of whether the claimant had any specific issues. However, the insurer further submits that the lack of a contemporaneous complaint or even reference to his brother’s motorbike accident is critical in this case, given that there was a subsequent significant incident, namely the work injury to the claimant’s back which the insurer submits, affected his psyche. Regarding this work injury, the insurer says the claimant was employed by Malcolm’s Concreting and in the course of that employment, he sustained a back injury in August 2021 when he was lifting barrows of concrete and felt pain in his lower back.

First records of motorbike accident – Dr Lim at Workers Doctors in Parramatta

The insurer says that the first record relating to the motorbike accident and alleged psychological disorder comes from the notes of Dr Lim at Workers Doctors in Parramatta.
The first contact appears to have been made on 3 November 2021 via telehealth. The insurer says the recorded notes are vague and refer only to a motor bike accident but nothing else.
The insurer queries in its submissions why no explanation has been given about why the claimant who resides in Goulburn and has a GP there, sought treatment from Dr Lim, via telehealth at Parramatta, as opposed to his usual GP (Goulburn Doctors), whom he had been consulting in the intervening period for other issues. The insurer submits that the Medical Assessor did not make this enquiry of the claimant.
The first actual consultation, which was conducted via telehealth, appears to have been on

8 December 2021. The note about this consultation follows;
“Post-traumatic stress disorder (PCL-5: 60)
DOI: 01/05/2021
mother contact insurance stated the claim no is
CTP/ALZ: 75C005880
accepted claim
ongoing issues
coping ok at school
concentration
low mood
ongoing nightmares about his brother
he then woke up and check if his brother is safe in the room
disturbed sleeping
---
refer to Psychologist. Insightful Mind, on 20/12
Dr Dickson review on 05/01/2022”
The insurer says there is no reference to a significant back injury the claimant had sustained which rendered him unable to work and which occurred in August 2021.
The insurer says that there is also no explanation how a diagnosis of post-traumatic stress disorder was made.
There was then a consultation on 5 January 2022 with Dr Dickson, whom the insurer understands is a psychologist, also at the Workers Doctors. The insurer submits that again, without any explanation Dr Dickson diagnosed post-traumatic stress disorder.
The insurer says that the claimant then commenced psychological counselling, with Workers Doctors. From the records, the insurer observed that the claimant appeared to have seen

Mr Campiciano, Dr Dickson and a P Dekkers.
The insurer noted that the early records made no reference to the back injury the claimant had sustained, and his pain or the effect that this had on his psyche. The insurer submits that it appears these practitioners were not aware of this. The insurer submits that it appears they did not have records from Goulburn Doctors.
The insurer says that the first reference to an injury to the back is entered on

19 January 2022, recording “back pain – bulging disc – physio exercises”.
It is recorded that the claimant was not working at that stage and his apprenticeship discontinued. The insurer submits that it was its understanding that was because of the back problems, and nothing to do with his brother’s motorbike accident. The insurer says that this does not appear to have been appreciated by the psychologist.
The insurer submits that the issues in relation to the claimant’s back were significant and should clearly have been considered in any psychological diagnosis.
The insurer notes a consultation record on 3 February 2022, where it is said that the claimant had been an outgoing/exuberant boy until his brother’s accident. The insurer submits however that when read together with the notes from Goulburn Doctors, it seems clear that the reason for the claimant becoming withdrawn was his significant back problem.
The insurer submits that the psychologists notes, of Workers Doctors, from

14 February 2022 make it clear that the claimant’s issues with returning to school were related to his back.
The insurer further submits that the claimant’s back also affected his ability to concentrate and to work. At the consultation on 14 February 2022, it is also recorded that the claimant was keen on school and that it was easy to make friends. He felt supported by his friends/mates. The main purport of this record, copied below, seems to be predominantly to do with the claimant’s back injury. There is only a small reference to the claimant’s brother who was reported to be “getting better with time”:
“Monday February 14 2022 10:38:46
Psychologist Visit type: Telehealth
video
AHRR 1, Consult 5
Psych Treatment Benefits
Past psychological history - aggravating factors
Diagnosis - relation to the injury
Symptoms - patient experience
Bad back - came on August/ Sept last year Pre accident was fit - was happy -
Was unfit - concreting and hurt back
Hoping for youth worker job - wants to hep when people are hurt
School better now in year 11
Needs to see surgeon before going back to school walking ok - but slow
Went to rugby game - sore after walking alot Wants crutches to go to scool
Very bored -
Plans to go to year 12 Video games -
Does exercices - but back worse now Brother getting better with time
PT states feels ok - and happy. some days energenic
Best mates moved away - but still keen on school. Easy to make friends - feels supported by friends/ mates
Examination/Mental State - presentation
Mood: Anxious Affect: Congruent Insight" OK
ADL's/Psycho Social/RTW - impact on function”

Diagnosis of post-traumatic stress disorder

In this regard, the insurer again submits that there is a significant issue in terms of causation.
The insurer says that it is difficult to conceive how the claimant could suffer from flashbacks or nightmares as alleged or otherwise fulfill the criteria for post-traumatic stress disorder, given that he did not actually witness the accident.
The insurer submits that the alleged psychological symptoms the claimant suffers are a consequence of the back injury and its sequelae, including the effects on the claimant’s capacity to attend to school work and perform activities of daily living and not the motorbike accident.
The insurer submits that the diagnosis of post-traumatic stress disorder must be part of the review.
Concerning the adjustment made by the Medical Assessor for affect of treatment or lack of treatment, the insurer submitted that the Medical Assessor may increase the percentage of WPI by 0% for no or negligible treatment effect, 1% for a mild treatment effect, 2% for a moderate treatment effect or 3% for a full remission. The insurer noted that the claimant reported to the Medical Assessor that he saw a psychologist over a few months or up to a year and found it helpful in reducing his symptoms “a little bit”. The Medical Assessor noted that the insured only had residual symptoms and made an adjustment of 2% for moderate improvement which he considered reasonable.
The insurer, however, submits that the treatment was arguably related to his back and not as a result of psychiatric disability and the accident, in which case there should have been no adjustment for the effect of treatment.
The insurer submits that in any event, the effect of treatment has passed and there should be no adjustment for the effect of treatment.
It is the insurer’s submission that the Panel would not be satisfied that the claimant does have a diagnosable psychiatric illness arising out of his brother’s motorbike accident. The insurer submits however that if such a finding is made, then the finding of WPI must be less than 10% after taking into consideration:
(a)    the pre-existing psychological impairment;
(b)    the subsequent effects of the back injury, and
(c)    the lack of any ongoing treatment effect.
The insurer provided further submissions following receipt of an earning capacity assessment dated 15 June 2024.
The insurer submits that the report should be considered by the Review Panel in making its determination in relation to the Medical Assessors certificate. The insurer submits that significantly, based on that report, it seems that the claimant has no ongoing psychological injury.
During the assessment, the claimant stated that he no longer experiences any psychological difficulties related to the witnessing of his brother’s accident and that he feels he is capable of working eight hours per day five days per week in a suitable role - page 2 and 3 of the report.
The claimant gave a history that symptoms were triggered around one week following the accident. He was angry at the other driver. The claimant confirmed that he was a school student at Goulburn High School at the time of the accident. It was noted that there were a lot of behavioural issues prior to the accident.
The insurer submits that the report reflects the claimant’s own concessions about his psychological status at the time of examination and that this does not support a diagnosis of a recognised psychiatric disorder or any ongoing impairment.
The insurer submits that the claimant has recovered from the effects of this accident and is getting on with his life.

MEDICAL EVIDENCE

The claimant was seen by Medical Assessor Shen who provided a certificate of

8 September 2023.
The Medical Assessor diagnosed a post-traumatic stress disorder in partial remission and a persistent depressive disorder, also in partial remission.
Regarding causation, the Medical Assessor said that there was a plausible mechanism of injury from the circumstances of the subject accident and the development of his psychiatric injuries, and there was a temporal and thematic association with his psychiatric symptoms and the subject accident, such that the nexus between subject accident and psychiatric injury was maintained.
The Medical Assessor’s PIRS assessment was as follows:

Psychiatric diagnoses	1. Post-traumatic stress disorder	2. Persistent depressive disorder
3.	4.
Psychiatric treatment description	Previous psychological therapy

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	2	He said he showers every 3 days, which has been the case since three months after the subject accident. He changes his clothes infrequently as well. He said he tries to cook to keep his mind occupied, and he cooks about once a week, usually whatever is on hand. He doesn’t do any cleaning or laundry. He tries to do grocery shopping as much as possible, once a fortnight. As he has sufficient skills to care for himself, albeit with a degree of self-neglect, he has mild impairment.
2. Social and Recreational Activities	3	He said he doesn’t have many friends anymore, as he had been more socially withdrawn after the subject accident. He has only 1-2 friends now, and he is contact once every 1-2 weeks, and he has not seen them since April 2022. He doesn’t go out much anymore, including to the pubs and clubs since the subject accident. He said he now just sit in his room to play PlayStation alone. As he has been socially withdrawn, without any regular outlet, he has moderate impairment.
3. Travel	2	He said he walks, and he has his L’s, and doesn’t drive as he doesn’t feel comfortable
driving, and cannot go into any cars. He can take public transportation, without any issues. As he has been able to use public transportation without issues, but anxious being in cars, he has mild impairment.
4. Social Functioning	2	He said his relationship with his partner has been good, and they don’t fight at all. He doesn’t have any children. He has seven siblings, and he talks to some of them most of the time, nearly every day. His father has passed away, and he talks to his mother quite regularly as well and his relationship with her is good. He said he doesn’t have many friends anymore, as he had been more socially withdrawn after the subject accident. He has only 1-2 friends now, and he is contact once every 1-2 weeks, and he has not seen them since April 2022. As he maintains a good relationship with his family and partner, though he has been more isolated from other social relationships, he has mild impairment.
5. Concentration, Persistence and Pace	2	His energy has been getting better, and he feels like he has a lot of energy, but sometimes he loses energy quickly. He can still walk around. His concentration has been “getting better”, but not back to what it was like prior to the subject accident. He can concentrate on being on the phone assessment. He has been able to read a book, up to half an hour. He was alert and appeared grossly cognitively intact, and was able to sustain his concentration for the duration of the assessment.
As he can maintain his concentration, has been able to concentrate up to half an hour, he has mild impairment.
6. Adaptation	1	He said he was last working May 2023, as a bricklayer for 40 hours a week. He was doing that for three weeks, and he discontinued as he was only paid $13 per hour, which he felt was too low so he ceased it. Prior to that, he was working in tree-lopping for three or four months, and he ceased it as he was getting paid only $15 per hour, and he felt he should have been paid more. He has also worked as a concreter for 3 months or so, until he hurt his back so he ceased attending. As he has been able to work on a full-time basis, he has no impairment, or only minor impairment at most.
List classes in ascending order: 122223
Median Class Value:2
Aggregate Score: 12
% Whole Person Impairment: 6%

Regarding pre-existing impairment, the Medical Assessor said the claimant had a pre-existing depression, ADHD (attention deficit/hyperactivity disorder) and ODD. His PIRS assessment for that was as follows:

Psychiatric diagnoses	1.Depressed mood	2. ADHD
Psychiatric diagnoses	3. ODD	4.

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	2	He was showering every second day, and he was changing his clothes every 1-2 days. He did chores with washing the dishes at home. Given the mild degree of self-neglect, he has mild impairment.
2. Social and Recreational Activities	1	He was playing rugby league, until the subject accident. He had been playing every weekend. He had a few friends, and he would see them every day at school, but not outside of school. He would not do much else outside of school. He was engaged in social activities and friends.
3. Travel	1	He was able to be a passenger in cars without a problem. He was not able to take public transport, or very infrequently, when he would have to travel to Sydney and was not able to be driven by his mother. There were no major deviation from his expected trajectory.
4. Social Functioning	1	He was not in a relationship at the time. He had a reasonable relationship with his mother and his siblings.
5. Concentration, Persistence and Pace	2	He said at the time, his concentration was poor, and he would struggle with his studies; even when he was on Ritalin. As he had issues with this, he likely had mild impairment.
6. Adaptation	2	He was not working, and had behavioural and attendance issues, but he was working his way
towards remaining at school, so he had mild impairment.
List classes in ascending order: 111222
Median Class Value:1.5=2
Aggregate Score: 9
Pre-existing % Whole Person Impairment: 4%

Concerning effects of treatment, the Medical Assessor said as the claimant only had residual symptoms, an adjustment of 2% for moderate improvement was reasonable.
The claimant has provided a report of Dr Abhishek Nagesh dated 14 March 2022 and a supplementary report of the same date with a WPI and PIRS assessment.
No details have been provided of the qualifications of Dr Nagesh.
Dr Nagesh provided the following history, which is not consistent with other medical information and reports;
“HISTORY OF PRESENTING ILLNESS
Bodee is a 16-year-old male about to turn 17 in a week's time, single, living with his mother and, siblings currently starting in Year 11 at Goulburn High School. On review today Bodee alleged that on 01 May 2021 while he was with his mother at Goulburn Doctors his mother received a phone call where a voice message was left informing that his brother Brett had met with a motorbike accident. On hearing this news he panicked and rushed outside the surgery to the nearby street where the accident had happened where he could see a number of ambulances and police officer surrounding the accident site. He rushed to Goldsmith Street where the accident happened, saw his brother bleeding lying on the ground. There were multiple ambulances and police surrounding and the whole area was cordoned off. Seeing this alleged scene where his brother was injured lying on the ground bleeding terrified him. Subsequent to that his brother was airlifted and transferred to a hospital. Bodee alleged that he noticed symptoms after a week of the accident when he started getting messages from his schoolmates asking him questions about the accident which started to make him anxious. The sounds of motorbikes made him anxious, post this alleged accident he started to withdraw, he stopped socialising, he stopped riding motorbikes, he started to feel lethargic, his sleep was affected, he developed nightmares and woke up in the middle of the night with panic attacks. He also alleged having flashbacks, not able to concentrate and he had to pass through the accident spot every day to go to school which made him extremely anxious. He totally lost interest in motorbikes and push bikes and he also stopped playing soccer and lost contact with friends. He started to comfort eat and has gained significant weight since the alleged accident. He also lost energy and motivation and started to lie in bed all day. He stopped going to school for two weeks and the very sight of motorbikes started to make him anxious. He developed mood swings, irritable, guilt feelings that he was responsible for the accident as his brother was coming to see him. Behavioural problems at school started. Because of the above alleged symptoms Bodee was referred to see a psychologist where he has been seeing a psychologist on a weekly basis the frequency of which has been reduced to fortnightly. He currently is not on any antidepressant medication and one has not been prescribed for him. He also has been seeing his GP on a regular basis. He has received supportive psychotherapy, cognitive behaviour therapy and relaxation exercises. With the treatment received so far there has not been any significant improvement in Bodees symptoms and as alleged by him his performance at school has declined, his attention, concentration is quite poor. He is still irritable, anxious. He does not ride push bikes. Since the accident he has become addicted to PlayStation, he has stopped socialising and does not go out much. He is irritable around his siblings, that has affected his relationship with them. He has stopped socialising, he showers only two to three times per week, needs constant prompting. He does not wash himself. He can do a little bit of cooking. He continues to get nightmares, his sleep is poor, his energy levels are poor. He has constant flashbacks of the traumatic scene he witnessed, he is irritable. He is anxious around push bikes and totally avoids them and motorbikes and he avoids totally going past motor vehicle scene. He has lost contact with all his friends. He does not go to weddings or birthday parties or anniversaries. However he has been going to school but struggles to concentrate there and his motivation levels are quite poor and there has been a drop in his grades.”
Dr Nagesh said that in his opinion, the claimant had been suffering from post-traumatic stress disorder since the accident because of the exposure to the alleged accident.
In terms of prognosis Dr Nagesh said that this appeared to be guarded as the claimant’s symptoms had not improved with the treatment received so far.
Dr Nagesh assessed WPI as follows:

“Self Care and Personal Hygiene.

Category 2 mild impairment.
My rationale for this is the individual does not shower on a daily basis. He needs prompting, he is able to do a little bit of cooking however relies on takeaway meals a lot of the time and would need assistance with cooking. However, he needs prompting to have shower as showers only once every two to three days.

Travel

Category 3.
The individual does not have the capacity to travel or drive. It is extremely anxiety provoking. The individual has already stopped riding push bikes and travelling would make him extremely anxious and he would not have the capacity to travel.

Social Functioning

Category 2 mild impairment.
My rationale for this is because of his irritability his relationships with his friends has strained, he continues to argue and have tension within the family with his mother and his siblings and has lost most of his friends.

Social and Recreational Activities

Category 3 moderate impairment.
My rationale for this is the individual leads a life of a recluse, he does struggle to go to school, he does not leave the house much, he struggles with anxiety when he leaves the house. He is socially withdrawn and does not enjoy any sociable activities. He does not go to any birthday parties or social events. He stopped socialising completely with his friends.
Concentration, persistence and pace
Category 3 moderate impairment.
My rationale for this is the individual is unable to concentrate, he struggles to read his class books, finds it difficult to follow complex instructions. He is forgetful most of the time. His attention and concentration are very poor. He struggles to read a book, a newspaper and watch television.
Employment
Category 4 severe impairment.
Cannot work for more than one to two days at a time. Even if he does work he can work less than 20 hours per fortnight and his pace will be reduced and his attendance will be erratic due to his reduced hours.
Listing classes in ascending order:
2, 2, 3, 3, 3, 4 Median class value of 3.
Aggregate score:
4 + 6 = 10
10+ 3 = 13
13+ 4 = 17
Which leads to a whole person impairment of 19%.”

Dr Nagesh provided a supplementary report of 5 July 2022. He said that the claimant’s injuries were stabilised as of 14 March 2021 [sic]. Presumably he meant 14 March 2022 when he assessed the claimant.
Grand Pacific Health medical centre clinical notes indicate the claimant was being treated for anger management and symptoms of ADHD and oppositional defiant disorder (ODD). The claimant was receiving treatment prior to the accident and post-accident there was no mention of any stressor was arising as a result of the accident.
The claimant was noted as presenting with problems of interpersonal conflicts, difficulty concentrating at school, anger, alcohol use and vaping.
The insurer has provided a report of Ms Katie Thomson of Good Rehab dated 15 June 2024. The claimant reported the onset of symptoms around one week following the accident. He had recurrent intrusive memories of the subject accident triggered by seeing a motorbike or the same make and model car that was in the crash. He avoided being in the car, and experienced recurrent nightmares. He blamed the driver for his brother’s injuries, became increasingly angry, lost interest in his usual activities, found it difficult to connect with others, and found it harder to experience positive emotions. He had an increase in frequency of anger outbursts, became hypervigilant, and had issues with concentration and sleep.
The claimant reported that at the time of the accident he was a school student. His records from Goulburn High School showed behavioural issues before the subject accident. He saw a psychologist over a few months, up to a year, and found it helpful in reducing his symptoms. He had not seen a psychiatrist and does not currently engage in any form of treatment. The claimant reported that his symptoms had completely resolved at the time of this report, and that he felt capable of full-time work.
Clinical notes from Workers Doctors show a first consultation on 18 November 2021 but no actual record of what occurred. The first consultation of note was on 8 December 2021 where the claimant complained of ongoing nightmares about his brother and disturbed sleeping.

MEDICAL EXAMINATION

The claimant was examined on behalf of the Panel by Medical Assessor Baker on

1 April 2025. His report follows;
Pre-accident history
Mr Collier-Caldwell is a 19-year-old man who is currently supporting himself on Centrelink on jobseeker. He is now with disability employment services and is looking for work in construction. He identifies as a member of the First Nations people. His heritage includes his father who is a Kamilaroi man – his father is from Walgett, and his mother who is from Tharawal. He has two brother and four sisters. He is the third of his siblings.
His parents separated in 2011 in the setting “DV” on the part of his father. He cannot remember many details but said “One thing I did remember from my dad was I was at the footy… my dad had a beer bottle in his hand, and he threw it in the back of me head… there was a trustee and guardian thing about that”.
His father had a problem with alcohol and drugs and his mother’s father died of alcohol poisoning while other relatives had died of emphysema.
His mother may have been on antidepressants.
His father passed when he was 11 years old after a cardiac arrest. He said his father’s death was “especially hard because I never had a father figure to teach me what to do and now, I have my own kid”. He saw his father “in the morgue”. His father was a cabinet maker, and his mother was initially a homemaker who later worked for Neami and then was on Centrelink support before returning to work at a jail as an Aboriginal support officer.
Between the ages of six to eight years, he was in foster care and he and his brother went through several houses, until he and Braith were taken back by their mum. On return to his mother’s home he said, “life was great.” He also said “I loved my dad to bits… I was going to move in with him… I got home from school, and my mum gets a call from Pop say dad has passed away… I didn’t get to see him, but mum said it was horrific”. He said until his return home he was in many foster homes with indigenous and Asian families. He does not know whether he had many placements because he was disruptive or because “no one wanted me”.
During his childhood he was diagnosed with ADHD, ODD and intermittent explosive disorder and is on Ritalin and Catapres. He said, “when I was younger, I was on risperidone.” He stopped his medication since moving away from his mother’s house, to live with his partner and their new baby. He said he feels “different from when I had my meds because when I was on my meds I’d just sit at home and be zombified all day”. His medications had been prescribed by his paediatrician. He feels he is now “controlling it very well”.
He said he was “naughty” at school and “one of the ones who didn’t like school – as they say, school isn't for everyone – I was one of them people”.
At the time of the subject motor accident, he “had just dropped out [of school] to become a concreter”. He then returned to school for a brief period before leaving school permanently.
Before the subject motor accident, he has had surgery for tonsils and had had a broken thumb. He recovered without any problems.
He has a seven-week-old daughter. He has a partner living with him in private rental premises with two bedrooms. His partner is also on Centrelink.
Accident
Mr Collier-Caldwell was 16 years old at the time of the accident. His brother was injured in a motor vehicle accident. His brother was on a motorbike and was T-boned by a car.
He was not a witness to the accident but with his mother was “one of the first people at the scene”. He said after “my mother got a phone call from a lady who was near the scene of the crash – we were not even 100 metres away.”
On arrival, he “saw a lot of blood” and his brother “looked really lifeless”. He was at the scene “for nearly an hour”. The ambulance got there within a few minutes of the accident but took a long time to get his brother comfortable.
The at fault driver was “done for reckless driving” and lost his licence for reckless driving in NSW and then went back to Queensland (he was in NSW on a visit).
His brother was taken to Goulburn Hospital and then airlifted to Liverpool hospital. He does not see much of his brother since the accident although he does talk to him on the phone. He “seems to be going well from what I’ve seen”.
Symptoms and treatment
The accident “has made me look at things from a really different perspective… I didn’t ride motorbikes any more… now you can’t get me near one… the main reason is seeing my brother the way he was and the way he was in hospital – he was on painkillers and in psychosis – that was very eye-opening”
His brother was in hospital some two or three months.
He said, “It all affected me with seeing the way my mother was… I stopped showering… I quit working because I was in the worst mindset – thinking he could die – he was my older brother and my best friend at the time”.
He was “angry at the world – why did it happen to me – my dad passed away when I was 11 – to go from that to losing my brother – I didn’t have any man figures in my life”.
He was “angry – upset – overwhelmed – it was too much with how supportive people tried to be – I went back to school, and everybody was asking me how your brother is…”.
He had May and June off after the accident “because I was away a lot in Liverpool” visiting his brother.
His brother had a compound fracture of his left femur, and his bone was sticking out of his knee as well as broken fingers. He needed a blood transfusion and had four surgeries. He subsequently went through rehab and hydrotherapy. He recalls his brother being psychotic “seeing stuff” and an incident in which he wanted to get up and see his long dead father.
He explained that he had injured his back in August 2021 with two slipped discs and could keep working. He continues at school some six to eight but “ I hated it – I couldn't walk – that was because of my back – but it was good because it got me out of the house and not in my room 24-7 and I was associating with people a little bit more”.
He went onto to do tree lopping after his injured his back improved. He did this job for three months. He was working three days a week because of his back “and I wasn’t on the hard job”.
He then moved away to Minto where he has been for nearly two years. He then worked in scaffolding in a couple of jobs but has not worked since May or June 2024.
He said he did not know quite why he stopped working other than he did not have the motivation “but now I’m getting the motivation back”.
He feels he is “getting better” but “every time I see a bike, I think of what happened… picturing my brother on the ground and seeing his bike all smashed up”. The image ‘doesn’t make me as upset anymore but it obviously makes me upset but I’m starting to think it’s just a memory” and he is less prone to just sit there and dwell on it”.
He “used to have nightmares about it” but these have receded. He did not relive his accident in any other way.
He “used to speak to a psychiatrist and he helped me a lot”. He saw him “twice every month”. He did not prescribe medication and hence was most likely a psychologist who he said was associated with Workers Doctors. He would “just talk on the phone and he would tell me to breathe… Music is my biggest therapy – he’d say go listen to music and he would calm me down”.
He has not seen his psychologist “in ages”.
He had times when his mood would “swing a lot” in that he could be happy one minute and then feeling upset or angry or overwhelmed. He rates his current mood as “actually good – ever since my daughter was born, I’ve has a new mindset that I have to do everything for her.
His sleep is “not very good – I’m always waking up” but could not articulate what woke him. This has continued with the birth of his daughter “but that’s not a worry” and he might “sometimes take up to an hour” to get back to sleep unless he is “really tired”. He could not articulate a specific reason for being wakeful other than feeling he has “opened my eyes too far or if I roll over and check my phone for the time.”
Subsequent physical injuries
The Panel noted his lower back injury at work in 2023.
MENTAL STATE EXAMINATION
Mr Collier-Caldwell was interviewed by Microsoft Teams. He was at his home in Campbelltown. Assessors Canaris and Baker were in their respective offices. A good audiovisual connection was established. He presented as a bespectacled man with dark hair sporting a mullet haircut. He had a light moustache and beard on his chin. He provided the history documented above. His narrative was coherent and consistent. His affect was warm and reactive. No evidence of psychosis or cognitive impairment emerged. He said he lacked motivation and interest in his self-care and person hygiene. He did not have suicidal thoughts or plans. His judgment was normal. He was insightful into his condition.
Current functioning
Mr Collier-Caldwell’s personal hygiene has “gone down a lot” since the accident mainly because he lacks motivation. He would shower “probably twice a week”. He would change his undies daily but short and T-shirt every couple of days. His partner prompts him to change. He would “barely eat” and he would eat only dinner – one meal a day. He explained, “I just don’t get hungry”. He has been gaining weight “even though, “I don’t know how” and had gained a lot before his daughter was born – his weight is now steady.
He has not been out at all in the last three months saying, “I just don’t like people”. He has “tried to” go out with his partner “but it’s too hard – I just get overwhelmed with too many people in one place”. He said, “I think I didn’t like much noise”. His partner would go out on her own and he would be happy to sit at home on his game. Occasionally his aunty or his mother would come over and say hello to his baby daughter. He would then “try to” spend time with them but most of the time he said, “I’m in my room by myself”. Before the accident, he was “a social butterfly” and had no difficulties with crowds. He was not sure what brought about the change other than that he perceived people differently and he “didn’t want be known as Braith’s little brother”. He used to go to all the NRL games and had a member’s ticket – he is still a member, but his mum pays for his membership – he went to the Anzac game last year because his dad had a rooster’s coffin which was the only game he went to last year. He went with family – he would not have gone by himself. He has a hobby fishing – he has not gone for over two years “because I can’t catch any fish”. His mother would “force” him to go to cultural events including smoking ceremonies and yarning events which he might attend “once every year” in NAIDOC week. He would not go if not pushed by his mother.
He does not drive. He has learners permit but has been disqualified for one year after being caught driving by himself in April last year. He had his L’s for two years before that and was “very comfortable” driving and comfortably catches public transport although this could be inconvenient.
Mr Collier-Caldwell’s has known his partner since school. She is not indigenous. She had been a supervisor at a deli in Coles but stopped when they left Goulburn. She stopped working because of “her mental health… she’s got bipolar” and is on medication for this. He said, “her bipolar disorder is very well controlled.”
His concentration is “all over the place” since he stopped taking his medication. He said he was “on point when I used to take my medications”. He said of his meds, “I want to get back on them, but I didn’t want to at the same time”. He has never been much of a reader but can stay “all day” with something like the footy but gets bored with the news and would change it to something else. He does not watch any series saying, “I never really get into them – I only like a certain type of movie like the Fast and the Furious…” His partner manages the finances and does the budgeting. He does not spend money on himself. He plays a range of computer games – Rainbow Six Siege and another game called Fortnite and UFC. He plays solo and can stay with a game for “hours”. He said, “it’s about the only thing I can keep my concentration on.”
In June 2024, he had been working some 38 to 40 hours per week on a casual basis. He is thinking of getting back into scaffolding – he would like to work full-time. He has been applying for jobs. He has only started looking about three weeks ago. He had not looked for work till recently because of “loss of motivation” adding that “all the jobs were just too far away on the train.” He mows the lawn where he lives.
Consistency
There was no inconsistency in Mr Collier-Caldwell’s presentation. He provided information in a simple straight forward manner. He was able to report how he felt before and whilst supporting his brother through his hospital stay. He provided a frank update about how his relationship had changed since he had moved with his partner. He was able to report how he felt about his baby girl and his partner since the birth of his first child.
Documentation
The Panel noted the submissions on behalf of Mr Collier-Caldwell in relation to PIRS categories applied by Assessor Shen. also noted the contention on the behalf of the claimant that in accordance with the definition of posttraumatic stress disorder in DSM, remission of the condition was not possible and that consequently the diagnosis of posttraumatic stress disorder partial remission was incorrect. The Panel was unable to find such an assertion on perusal of DSM-5-TR. The Medical Assessors noted their clinical experience in encountering many individuals over the years that suffer from posttraumatic stress disorder and may have symptoms that wax and wane with the person being able to clinically present with full or partially remitted symptoms at the time of re-examination. The Panel notes that since the motor accident the claimant had met DSM-5-TR criteria for posttraumatic stress disorder in that he described the minimum necessary symptoms and criteria as defined by and compliant with DSM-5-TR F43.10 posttraumatic stress disorder.
The Panel noted the insurer’s submissions which accept that there had been errors in Assessor Shen’s assessment of whole person impairment while maintaining that his ratings were in any case too high. It also contends that the claimant did not satisfy the diagnostic criteria for a psychiatric disorder while noting an apparent lack of reference to psychological issues in the claimant dealing with his then GPs, Goulburn Doctors pointing out that the claimant began to consult with Workers Doctors until 3 November 2021. It also contends that Assessor Shen had not given due consideration to psychological sequelae arising from the subsequent workplace back injury. The insurer also submits, “it is difficult to conceive how the Claimant could suffer from flashbacks or nightmares as alleged or otherwise fulfil the criteria for PTSD, given that he did not actually witness the accident” (Comment: The Panel has addressed this issue in its determinations).
The Panel noted the certificate of Assessor Shen dated 4 September 2023 determining that the claimant’s injury comprising posttraumatic stress disorder and persistent depressive disorder with both in partial remission gave rise to a permanent impairment of 4%. Assessor Shen rated the claimant as Class 1 for adaptation and Class 2 for self-care and personal hygiene, travel, social functioning, and Class 2 concentration, persistence, and pace resulting in a 6% whole person impairment rating but with a 4% deduction for pre-existing impairment with Class 1 for social and recreational activities, travel, and social functioning, and Class 2 for self-care and personal hygiene, concentration, persistence, and pace and adaptation yielding an impairment of 2%. Assessor Shen then made a 2% adjustment for treatment effects yielding a final whole person impairment of 4%.
The Panel noted the application for personal injury benefits.
The Panel noted sundry certificates of capacity “Psychological injury after being informed of his brother [being] involved in a MBA”.
The Panel noted the records of Goulburn Doctors which refer to his workplace back injury. These, however, refer to diagnoses of ADHD/ODD [oppositional defiant disorder]/intermittent explosive disorder for which he was on Ritalin 80 mg daily and Catapres 300 mg at night.
The Panel noted the records of Grand Pacific Health as at 7 November 2023. This appears to relate to Headspace attendances on 22 March 2021, 8 April 2021 giving rise to a mental health treatment plan, and 22 June 2021 (a mental health support consultation). He was said to need anger management. At his June consultation, he was not interested in the session, and said that he only wanted help in leaving school because he was not enjoying attendance which she reported to be his major stressor. There is a reference to ADHD, ODD, and intermittent explosive disorder for which he was medicated. Significant events/trauma comprise being placed in foster care at the age of six, his father’s passing when he was 11 years old, a trauma at the age of six years that he did not want to disclose, and the family history with AOD (alcohol and other drugs) being portrayed as “a curse”. There was no reference to the subject accident. There was a reference to regular conflicts with students and teachers, dislike of school, and alcohol use but with his strong relationship with his mother portrayed as a protective factor.
The Panel noted records of Workers Doctors which refer to psychological issues including psychologist consultations over 8 December 2021 to 15 March 2022. There are references to a diagnosis of “PTSD” as well as to his back problem. There are references to his having gone back to school, to be feeling better psychologically, and to his brother’s condition improving. The last entry notes that he is still going to school, getting stronger, sleeping better, and hanging out with new people and supportive friends although pain is a presence in his life.
There were two allied health recovery requests dated 10 February 2022 and 16 May 2022. These provide a diagnosis of posttraumatic stress disorder referencing DSM-5-TR criteria while noting PCL 5 scores of 55 and 49 respectively. A screenshot is appended:
The Panel noted the report of Dr Abhishek Nagesh, IME psychiatrist, dated 14 March 2022 and her supplementary report of 5 July 2022. Dr Nagesh diagnosed posttraumatic stress disorder with a whole person impairment rating of 19% with Class 2 for self-care and personal hygiene and social and recreational activities, Class 3 for travel and concentration, persistence, and pace, and Class 4 for employment (adaptation). Dr Nagesh made no deduction for pre-existing impairment or adjustment for treatment effects noting that he had “no pre-existing history”. The Panel noted the insurer’s critique of Dr Nagesh’s assessment of whole person impairment as outlined in its certificate of determination in an internal review citing reports of his psychologist.
The Panel noted a letter from Associate Professor Andrew McDonald, paediatrician, to the claimant’s mother dated 2 February 2022 which while addressing his lower back pain also note considerable weight gain as well as his need for Ritalin and Catapres for his attention deficit disorder and oppositional defiant disorder. There is no mention of the subject motor vehicle accident. The Panel noted earlier correspondence (2013) in relation to these issues and he is noted to have challenging and unpredictable behaviour.
The Panel noted supplementary submissions from the insurer Referring to an Earning Capacity Assessment by Good Rehab dated 15 June 2024. His reluctance to engage with the assessment with several non-attendances was noted. In relation to activities of daily living, the following was noted:
Additionally, no issues were reported in relation to concentration/attention, short-term/working memory, ability to multitask, ability to learn new material, ability to retain and recall information, ability to problem solve, sequencing, and emotional self-regulation. The remainder of the report deals with potential suitable employment. The insurer contends that this report supports the claimant having no psychological injury.
The Panel noted documentation from Family and Community Services in relation to the claimant and his brother as well as his siblings which corroborate his history of having been placed in care, of the children living in an overcrowded situation with poor hygiene, and assertions of domestic violence on the part of the claimant’s father. The children were placed in care. There was considerable additional documentation in relation to subsequent short-term placements. Suffice it to say that there was considerable evidence of exposure to violence and physical/emotional deprivation complicated by subsequent short-term placements apparently relating to carers circumstances changing. However, Bodee and Braith were permanently restored to their mother in 2013 while other children remained in the care of kin.
The Panel noted school reports in 2013 from Cecil Hills Public School. A snapshot is
included:
Determinations
Diagnosis
His presentation is consistent with a diagnosis of posttraumatic stress disorder. In terms of DSM-5-TR criteria, the Panel noted that while the claimant had not witnessed the accident, he arrived at the scene very shortly afterwards and saw his brother seriously injured. Bearing in mind submissions from the insurer, the Panel noted that the claimant’s description of the scene was very much in keeping with a Criterion A event as per the DSM-5-TR. He subsequently saw his brother in hospital seriously unwell and presumably delirious or psychotic as he put it which would have presented an added layer of trauma. He subsequently reported recurrent, intrusive, and distressing recall of the accident in the form of distressing thoughts recall of the accident when he sees a bike as well as nightmares although these have receded (Criterion B). There was evidence of persistent avoidance of stimuli associated with the traumatic event manifest in his avoidance of school and people because he did not want to be asked about the accident or his brother (Criterion C). There was further evidence of negative alterations in cognitions and mood manifested in his social withdrawal and markedly diminished interest and participation in activities he once enjoyed (Criterion D). There was evidence also of alterations in arousal and reactivity manifest in ongoing sleep disturbance which had preceded the birth of his daughter (Criterion E). In relation to Criterion E, the Panel noted his problems with concentration but considered that these were more likely to relate to his pre-existing ADHD. His symptoms had been present at varying degrees of intensity since May 2021 (Criterion F), had caused them clinically significant distress and psychosocial impairment as manifested in his social withdrawal and retreat from activities he once enjoyed (Criterion G), and were not attributable to the physiological effects of a substance or to another medical condition (Criterion H).
The Panel noted references throughout the documentation to prior diagnosis of ADHD and ODD. It considered that there was ample justification from the documentation on hand and from his current presentation to warrant a diagnosis of ADHD but did not consider that there was adequate evidence to warrant a current diagnosis of ODD. In clinical practice both ADHD and ODD may become less clinically severe with increasing age of the diagnosed person. This is clinically apparent at the re-examination with him reporting a change in his world view since the motor accident and birth of his infant daughter.
Causation
Mr Collier-Caldwell’s post-traumatic stress disorder arose following the motor accident. While the Panel noted that post-traumatic symptoms were not reported until later following the accident and that the claimant had sustained a lower back injury at work, Mr Collier-Caldwell’s back injury did not cause his post-traumatic stress disorder. His post-traumatic stress disorder symptoms have content related specifically to the subject motor vehicle accident. The horror of seeing his brother with an open leg bone fracture protruding from his skin, ambulance officer taking a long time and his brother developing a psychosis from his motor accident injuries whilst in hospital qualified him for a Criterion A stressor as defined by DSM-5-TR for post-traumatic stress disorder caused by the motor accident. The Panel further noted that the relatively short gap between the subject motor accident and reportage of psychological symptoms was not unusual in routine clinical presentations for this disorder.
His ADHD was pre-existing. There was no evidence that it had been exacerbated by the subject motor vehicle accident.
Permanency of impairment
Given the passage of in excess of 3.5 years since the subject accident, the Panel concluded that his level of impairment was permanent and that it was unlikely to change substantially or by more than 3% over the next year.
Whole Person Impairment
In relation to the PIRS, the Panel noted the following:
Self-care and personal hygiene:
The Panel obtained the following history:
His personal hygiene has “gone down a lot” since the accident mainly because he lacks motivation. He would shower “probably twice a week”. He would change his undies daily but short and T-shirt every couple of days. His partner prompts him to change. He would “barely eat” and he would eat only dinner. He explained, “I just don’t get hungry”. He has been gaining weight “even though I don’t know how” and had gained a lot before his daughter was born – his weight is now steady.
This equated to Class 3 impairment in this category.
Social and recreational activities
The Panel obtained the following history:
He has not been out at all in the last three months saying, “I just don’t like people”. He has “tried to” go out with his partner “but it’s too hard – I just get overwhelmed with too many people in one place”. He said, “I think I didn’t like much noise”. His partner would go out on her own and he would be happy to sit at home on his game. Occasionally his aunty or his mother would come over and say hello to his little one. He would then “try to” spend time with them “but most of the time I’m in my room by myself”. Before the accident, he was “a social butterfly” and had no difficulties with crowds. He was not sure what brought about the change other than that he perceived people differently and he “didn’t want be known as Braith’s little brother”. He used to go to all the NRL games and had a member’s ticket – he is still a member, but his mum pays for This – he went to the Anzac game last year because his dad had a rooster’s coffin which was the only game he went to last year. He went with family – he would not have gone by himself. He has a hobby fishing – he has not gone for over two years “because I can’t catch any fish”. His mother would “force” him to go to cultural events including smoking ceremonies and yarning events which he might attend “once every year” in NAIDOC. He would not go if not pushed by his mother.
This equated to Class 3 impairment in this category.
Travel
The Panel obtained the following history:
He does not drive. He has a learner’s permit but has been disqualified for one year after being caught driving by himself in April last year. He had his Ls for two years before that and was “very comfortable” driving and comfortably catches public transport although his could be inconvenient.
This equated to Class 1 impairment in this category.
Social functioning
The Panel obtained the following history:
His concentration is “all over the place” since he stopped taking his medication but was “on point when I used to take my medications”. He said of his meds, “I want to get back on them, but I didn’t want to at the same time”. He has never been much of a reader but can stay “all day” with something like the footy but gets bored with the news and would change it to something else. He does not watch any series saying, “I never really get into them – I only like a certain type of movie like the Fast and the Furious…”. His partner manages the finances and does the budgeting. He does not spend money on himself. He plays a range of computer games – Rainbow and Siege and another game called Fortnight and UFC. He plays solo and can stay with a game for “hours”. He said, “About the only thing I can keep my concentration on”.
The Panel noted his capacity for hyperfocus in certain settings characteristic of ADHD. His functioning in this category equated to Class 3.
Adaptation
The Panel obtained the following history:
In June 2024, he had been working some 38 to 40 hours per week on a casual basis. He is thinking of getting back into scaffolding – he would like to work full-time. He has been applying for jobs. He has only started looking about three weeks ago. He had not looked for work till recently because of “loss of motivation” adding that “all the jobs were just too far away on the train”. He mows the lawn where he lives.
This equated to Class 2 impairment in this category.
Median and aggregate impairment
His impairments in ascending order are 1, 2, 2, 2, 3, and 3 with a median impairment of 2 and an aggregate of 13 equating to a whole person impairment of 7%
Pre-Existing Impairment
The Panel estimated his pre-existing impairment from the documentation on hand. It considered that he had Class 1 in all categories except concentration, persistence, and pace which was Class 2 yielding a median score of 1 and aggregate of 7 equating to 0% whole person impairment
Treatment Effects
There was no evidence of any current treatment effect.
Final Whole Person Impairment
His final whole person impairment is 7%.

The Panel adopts the findings of Medical Assessor Baker.

CAUSATION/REASONS

The issue of causation has already been dealt with by Senior Medical Assessor Baker. However, the insurer has made submissions identifying why, in its view, the claimant’s psychiatric disability does not arise from the accident, which the claimant did not see, although he did witness the immediate aftermath.
The Panel is mindful that there was no contemporaneous complaint of psychiatric disability following the accident until 8 December 2021. A review of the GP consultation notes, as the insurer has submitted, shows;
(a)    The first medical consultation after the motorbike accident involving the claimant’s brother was on 27 September 2021. That was in relation to right back pain. The insurer says that it is apparent from other notes that the claimant sustained injury to his back whilst involved in heavy labouring in the course of some employment in about August 2021.
(b)    There is no reference in the note of 27 September 2021 to the brother's motorbike accident or any psychological issues.
(c)    It is recorded that the claimant has a history of ADHD/ODD/Intermittent Explosive Disorder and that he had been prescribed Ritalin and Catapress.
(d)
There are clinical notes from consultations at Goulburn Doctors on

14 October 2021, 28 January 2022, 7 and 10 February 2022. These entries are in relation to the back injuries, without reference to the motorbike accident or any psychological issues as a result. On 28 January 2022 there is reference to the claimant sleeping most of the day and that he had given up sport as a result of his back problems.
(e)    On 28 January 2022 the claimant presented to Canberra Hospital with his mother. The mother reported that the claimant had a history of a bulging disc and provided information that for the last week prior, the claimant had experienced difficulty walking due to pain and weakness in both legs as well as pins and needles radiating down to both feet. The claimant was able to mobilise. It was reported that he had experienced back pain for four to six months. The notes record that the claimant had seen a physiotherapist, but he did not complete the prescribed exercises. He was using Ibuprofen and Paracetamol daily. The claimant’s GP had referred him for an urgent MRI, however he was unable to afford the cost of this and so had presented to the Emergency Department in the hope that it would be funded by the hospital. On examination, there was numbness around the calves. The treating doctor at the hospital recommended that the claimant undertake physiotherapy, they were not able to fund the MRI. The claimant was diagnosed with generalised back pain. The claimant and his mother left the hospital on the same day following these discussions.
(f)    There is a letter to the claimant's mother from Associate Professor McDonald, paediatrician, from 2 February 2022 referring to the claimant’s back problems. There is also reference to his ADHD. Again, there is no history of the motorbike accident or any psychological symptoms as a result.
(g)    On 7 February 2022, it is recorded in the Goulburn Doctors’ records that the claimant had been unable to go to school due to his back pain. He was referred to Dr Mobbs, neurosurgeon
(h)    There is an MRI report of the lumbar spine dated 8 February 2022, which refers to a disc protrusion and annular tear at L4/5 and a broad based disc protrusion at L5/S1.
The insurer submitted that specific regard should be given to the letters of referral from Goulburn Doctors to Dr Bandi of the neurosurgery department at Canberra Hospital, and

Dr Mobbs, neurosurgeon at Bowral, both dated 10 February 2022. These letters contain the following information:
"I seek your opinion regarding back pain with radiculopathy for 4 months.
His symptoms became worse day by day and affecting his study and daily activities."
The Panel observes that there is no reference given to any psychological condition or the motorbike accident of the claimant’s brother. Arguably though, a psychiatric impairment would not necessarily be notable for a condition involving the claimants spine.”
The first recording of a diagnosis of post-traumatic stress disorder seems to be an entry of

8 December 2021 when the claimant consulted Dr Lim at Workers Doctors. No reason has been provided why the claimant attended this GP at Parramatta when he resided at Goulburn.
The claimant has experienced other substantial events before the accident involving his brother. This includes being in the care of foster families with his brother between the ages of 6-8 years, being subjected to domestic violence by his father, experiencing the death of his father when he was 11 years old and dealing with ADHD, ODD and intermittent explosive disorder.
The claimant says that he has problems with concentration however, it seems that he is able to play video games uninterrupted and without difficulty.
Notwithstanding the above, the Panel is satisfied that the claimants diagnosis of post- traumatic stress disorder arises from the accident because he experienced the horror of seeing his brother with an open leg bone fracture protruding from his skin, an ambulance officer taking a long time dealing with his brother and his injuries and his brother developing a psychosis from his motor accident injuries whilst in hospital. It is the opinion of the Panel that this qualified him for a Criterion A stressor as defined by DSM-5-TR for post-traumatic stress disorder caused by the motor accident. He suffered nightmares (Criterion B). There was evidence of persistent avoidance of stimuli associated with the traumatic event manifest in his avoidance of school and people because he did not want to be asked about the accident or his brother (Criterion C). There was evidence of negative alterations in cognitions and mood manifested in his social withdrawal and markedly diminished interest and participation in activities he once enjoyed, as reported clinically by the claimant (Criterion D). There was evidence also of alterations in arousal and reactivity manifest in ongoing sleep disturbance which had preceded the birth of his daughter (Criterion E). As noted by Senior Medical Assessor Baker concerning Criterion E, the claimant had problems with concentration but it was considered that this was more likely to relate to his pre-existing ADHD. His symptoms had been present at varying degrees of intensity since May 2021 (Criterion F), had caused him clinically significant distress and psychosocial impairment as manifested in his social withdrawal and retreat from activities he once enjoyed (Criterion G), and were not attributable to the physiological effects of a substance or to another medical condition (Criterion H).
The Panel further notes the relatively short gap between the subject accident on 1 May 2021 and reporting of psychological symptoms in December 2021 which is not unusual in routine clinical presentations for this disorder.
The claimant’s ADHD was pre-existing. There was no evidence that it had been exacerbated by the subject motor vehicle accident nor that it has made his diagnosis following the accident of post-traumatic stress disorder worse.
The Panel is satisfied that on the balance of probabilities, as a result of the aftermath of the accident which the claimant attended, that he has suffered post-traumatic stress disorder.
The claimant did not make any specific complaint about psychiatric disability for several months after the accident however, this is not unusual. The claimant may have had a pre-existing condition, but this was independent of the diagnosis of post-traumatic stress disorder which was not made worse by that pre-existing condition of ADHD.

CONCLUSION

Medical Assessor Shen found that the claimant had a permanent impairment assessment of 4% with respect to a diagnosis of post-traumatic stress disorder in partial remission and persistent depressive disorder, also in partial remission.
Medical Assessor Shen was satisfied that the claimant's psychiatric disabilities arose from the accident involving the claimant's brother and about which the claimant saw the aftermath.
The Panel is satisfied that the claimant suffered post-traumatic stress disorder but is not satisfied that he suffered a persistent depressive disorder. Given this finding, the Panel revokes the certificate of Medical Assessor Shen.

DETERMINATION

The Panel revokes the certificate and reasons of Medical Assessor Shen dated

8 September 2023.
The Panel finds that the claimant has suffered a post-traumatic stress disorder following an accident on 1 May 2021 in which the claimant’s brother was injured and about which the claimant witnessed the immediate aftermath.
The Panel finds that the claimant has a WPI of 7%.

[2025] NSWPICMP 302

1 May 2025