Eldahoud v QBE Insurance (Australia) Limited

DETERMINATION OF REVIEW PANEL
CITATION:	Eldahoud v QBE Insurance (Australia) Limited [2025] NSWPICMP 130
CLAIMANT:	Fatemah Eldahoud
INSURER:	QBE Insurance (Australia) Limited
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	John Baker
MEDICAL ASSESSOR:	Surabhi Verma
DATE OF DECISION:	28 February 2025
CATCHWORDS:	MOTOR ACCIDENTS – Review of certificate and reasons of Medical Assessor (MA) who diagnosed the claimant as having post-traumatic stress disorder, major depressive disorder, and somatic symptom disorder with predominantly pain; claimant assessed as having 7% whole person impairment (WPI); claimant injured in an accident 5 August 2019; claimant submitted that when assessing the categories in the psychiatric impairment rating scale (PIRS) the MA did not properly take into account the claimant’s psychiatric disabilities; the insurer submitted that a difference of opinion and interpretation of the intent of the PIRS categories was not an appropriate ground of review and did not evidence an error in the assessment; the Review Panel assessed the claimant and agreed with the diagnoses of the MA but differed in its assessment of the PIRS categories; ultimately also assessed the claimant as having 7% WPI; because of different PIRS assessments the Medical Assessment Certificate was revoked with the Review Panel confirming the claimant was assessed as having 7% WPI.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Review Panel revokes the certificate and reasons of Medical Assessor Rikard-Bell dated 3 May 2023. 2. The Review Panel assesses the claimant as having: (a) post-traumatic stress disorder; (b) major depressive disorder, and (c) somatic symptom disorder with predominantly pain. 3. The Review Panel assesses the claimant as having 7% whole person impairment.

STATEMENT OF REASONS

INTRODUCTION

The claimant has sought a review of a certificate and reasons of Medical Assessor Rikard-Bell (the Medical Assessor) dated 3 May 2023.
The Medical Assessor diagnosed the following psychiatric disorders:
(a) post-traumatic stress disorder, and
(b) chronic pain syndrome with somatic symptom disorder.
The Medical Assessor assessed the claimant as having 7% whole person impairment (WPI).

Bundles of documents

The parties have each presented their respective bundles of documents upon which they rely. The Review Panel have read all the documentation. If a particular document is not referred to by the Review Panel, this does not mean that the Review Panel or a Review 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 Review 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 Review Panel has come to its own conclusion and has taken its own history.

The accident

The accident occurred 5 August 2019 at about 3.00 pm. The claimant was driving a Toyota 4-wheel drive. A car came through an intersection on her left and hit the passenger and front of her car, as variously described, pushing her car across the road. Apparently, the airbags did not deploy.

Claimant’s submissions for review

The claimant disputes the Medical Assessor’s findings and assessments with regard to the psychiatric impairment rating scale (PIRS) Categories with the exception of the category Social and Recreational Activities.
The claimant says the Medical Assessor has made findings that are:
(a)    materially erroneous in relation to his assessment of the claimant’s psychological injuries;
(b)    substantially inconsistent with the preponderance of the claimant’s treating evidence and the medico-legal evidence relied upon by both parties;
(c)    internally inconsistent, and
(d)    without adequate reasons.
The claimant provided the following submissions regarding the Medical Assessor’s PIRS assessment.

Self care and personal hygiene

The claimant submits that the ‘Class 2’ finding is not consistent with the Medical Assessors recorded findings, which, the claimant says demonstrate that she cannot live independently without the regular support of her family members, and which the claimant says is consistent with her contemporaneous post-accident complaints in relation to this. The claimant says the appropriate finding should have been Class 3.

Travel

The claimant says that the Medical Assessor assessed this category as Class 1. The claimant relies on the history reported by the Medical Assessor where it was said the claimant can attend medical appointments close by or shop nearby but for more distant appointments, she has to ask one of her children to drive her. The claimant submits that she falls into Class 2 based on the classification criteria.

Concentration, persistence and pace

The claimant submits that the Medical Assessor’s findings are inconsistent with the preponderance of the claimant’s treating and medico-legal evidence in relation to this category.
The claimant says that the Medical Assessor found that the claimant could use her phone for 30 minutes and could read for 10 minutes but she experienced headaches, pain in her eyes and dizziness which can impact her ability to concentrate. He assessed class 2 on the basis that it was a mild impairment but the claimant says she should have been assessed as category 3 based on the findings of Dr Teoh who said she had poor concentration, lacked motivation and had persistent preoccupation with thoughts.

Social functioning

The Medical Assessor assessed the claimant as being class 2 in this category. The claimant says that the appropriate categorisation was class 3. This is because the claimant’s day-to-day relationships, particularly with her husband are severely strained.

Adaptation/Employability

The claimant says she has not returned to work and cannot return to work and therefore she should be classified as class 5 rather than class 3 as assessed by the Medical Assessor.

Claimant’s submissions for WPI assessment

On 28 October 2020, the claimant was assessed by Medical Assessor Steiner. He produced a report dated 29 October 2020 saying that the claimant sustained a posterior vitreous detachment of the right eye. He said that this injury was a threshold injury but would be assessed at 5% impairment of the right eye.
Subsequently, the claimant was reviewed by Medical Assessor Wechsler who provided a certificate dated 27 March 2024. He found that there was firm evidence that the claimant had a right posterior vitreous detachment causing a retinal hole requiring treatment in 2013. Following on from this, Medical Assessor Wechsler said that all of the claimant’s vitreoretinal problems were pre-existing and had not been caused or contributed by the whiplash injury from the subject accident on 5 August 2019.
On 2 November 2021, the claimant’s psychological injuries were assessed by Medical Assessor Barrett. She provided a report dated 15 November 2021 and said that the claimant had sustained a non-minor psychological injury. Medical Assessor Barrett confirmed that the claimant had sustained post-traumatic stress disorder as a result of the subject accident.
On 15 October 2020, the claimant’s psychiatric injuries were assessed by Medical Assessor Gliksman. Medical Assessor Gliksman produced a report dated 30 November 2020 saying that the claimant sustained a psychiatric threshold injury.
On 4 January 2021, the insurer lodged a further assessment application in relation to the threshold injury dispute. The basis of the insurer’s application was that there was relevant additional information that would have a material effect on the previous decisions issued by Commission in relation to the non-threshold injury.
The claimant submits that the psychiatric injury suffered by her is such that her WPI assessment is greater than 10%.

Insurer’s submissions on review
Self-care and personal hygiene

Concerning self-care and personal hygiene, the insurer submits the Medical Assessor took a history of the claimant’s level of functioning in respect to self-care and hygiene. The insurer submits that there is no suggestion by the claimant that this is not an accurate history, and that the claimant’s submissions adopt the history. The insurer says that the claimant’s complaint is that this history ‘unequivocally demonstrates’ that she cannot live without support and that this is inconsistent with a finding of a class 2 impairment.
The insurer submits that the Medical Assessor took a detailed history from the claimant and provided reasons for his findings. In doing so, he used his clinical expertise to reach a conclusion as to the class of impairment in respect to self-care and personal hygiene.
The insurer submits that the claimant’s disagreement with the classification based on her own interpretation is not a sufficient basis to establish that it is incorrect in a material respect.

Concentration persistence and pace

The insurer says that the claimant argues that the Medical Assessor’s findings regarding concentration, persistence and pace are inconsistent with the findings of Dr Teoh in his report of 9 March 2021. Dr Teoh had categorised a class 3 impairment, compared to the Medical Assessor’s class 2.
The insurer submits that the classification was available to the Medical Assessor in the exercise of his expertise.
The insurer noted that the Medical Assessor referred to Dr Teoh’s report and commented upon Dr Teoh’s findings in his reasons.
The insurer submits that the difference in opinion between Dr Teoh and the Medical Assessor, noting that Dr Teoh’s report pre-dates the Medical Assessor’s by two years, is not sufficient ground to establish that the report is incorrect in a material respect.

Social functioning

The insurer noted that the claimant submitted that the Medical Assessor’s assessment of a class 2 impairment for social functioning was not appropriate because her day-to-day relationships, especially with her husband, were severely strained.
The insurer says that the history recorded by the Medical Assessor is not disputed. He recorded that the claimant relates well to her husband, however, there has been a lot of stress with her marriage and there is a lot of pressure on the family. The insurer submits that this is consistent with the class 2 adopted by the Medical Assessor. In particular, the insurer notes that the common examples for a class 3 impairment include periods of separation or domestic violence, and the need for community services or others to care for children. The insurer submits that the undisputed history recorded by the Medical Assessor does not demonstrate such a level of impact.

Adaptation / employability

The insurer refers to the claimant’s submission that on the current evidence that the claimant has not returned to work and is totally unfit for work, means that there is little dispute that the circumstances attract a class 5 finding.
The insurer submits that the Medical Assessor turned his mind to the claimant’s employability and found a moderate impairment, namely class 3. The insurer submits that the class 3 was not only available but also appropriate.
The insurer further submitted that even if a higher classification for this category was warranted, and which it disputes, it could not give rise to a material error. Any impairment for adaption / employability would not alter the median class value and therefore would make no material change to the outcome.
The insurer submits, in conclusion, that the history taken by the Medical Assessor has not been disputed. The insurer says that the only matter/s in dispute are the classifications that the Medical Assessor has made in respect to each of the classes of impairment under the PIRS categories.
The insurer submits that the Medical Assessor has used his clinical expertise to reach a conclusion about the class of impairment sustained by the claimant in each of the PIRS categories. The insurer says that those conclusions were open to him, exercising his expertise and judgment.
The insurer submits that the claimant has not identified any matter that is internally inconsistent.
The insurer says that the claimant disagrees with the Medical Assessor’s classification based on her interpretation of the intent of the categories and her interpretation of the evidence. The insurer submits that this is not grounds for reasonable cause to suspect that the assessment was incorrect in a material respect.
The insurer says that the Medical Assessor was entitled to form his own opinions, including his own independent assessment of permanent impairment, based upon the evidence before him at the time of the assessment, his clinical examination and the claimant’s self-reported history: Garcia v Motor Accidents Authority [2009] NSWSC 1056.
The insurer says that the difference in opinion and calculation of impairment between other doctors and the Medical Assessor does not evidence an error in the assessment.

Insurer’s submissions for WPI assessment

With respect to the claimant’s psychiatric pre-accident condition, the insurer has raised the following points:
(a)    on 2 February 2016 the claimant consulted with her general practitioner (GP),
Dr Barich with the reason for contact noted as depression and was prescribed Lexapro;
(b)    on 12 July 2016 the claimant again consulted with her GP, Dr Barich due to insomnia and was prescribed Temazpam;
(c)    on 20 January 2017 the claimant consulted with her GP, Dr Barich referring to a knee MRI, right ankle pain, insomnia and depression;
(d)    on 30 May 2017 the claimant consulted with her GP, Dr Barich regarding worries about her abdominal pain with counselling advised, and
(e)    in handwritten consultation notes of Penrith Mall Medical Centre dated
19 February 2019 there is reference to severe anxiety and right knee.

Medical evidence

The Medical Assessor provided a certificate and reasons of 3 May 2023. He diagnosed post-traumatic stress disorder and a chronic pain syndrome with somatic syndrome disorder. He assessed WPI at 7%.
The Medical Assessor concluded that the claimant had developed somatic symptom disorder with widespread pain extending from her eyes with blurred vision, head, neck, shoulders, knees, whole spine, legs and hips which has caused intolerable pain that has not improved. In addition, to the somatic symptom disorder there was post-traumatic stress disorder with some secondary depressive symptoms. The features according to DSM-5 (Diagnostic Statistical Manual of Mental Illnesses – fifth edition) are outlined below:
(a)    a traumatic event (the motor vehicle accident);
(b)    re-experiencing phenomena with nightmares;
(c)    avoidance behaviours avoiding perceived situations of danger, avoidance of driving at night;
(d)    negative cognitions with negative feelings of self and the future, worry about safety of family;
(e)    marked alterations in arousal with hypervigilance and high levels of stress;
(f)    duration of more than one month;
(g)    significant impairment of functioning, and
(h)    not due to substance use or other medical condition.
His PIRS assessment was as follows:

Psychiatric diagnoses

1. Post-Traumatic Stress Disorder

2. Chronic pain syndrome with somatic symptom disorder

Psychiatric treatment

description

Nil

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	2	Ms Eldahoud is able to dress herself, however she is limited. She can groom herself and she can shower herself, however she requires assistance with dressing, certain aspects of showering, cleaning, self-care and she needs to sit on a chair sometimes. Therefore, there is mild impairment of self-care and personal hygiene.
2. Social and Recreational Activities	3	In terms of social and recreational activities, community friends will sometimes visit and Ms Eldahoud will go for a coffee “once in a blue moon.” She does not visit the mosque and she rarely goes out with friends. Therefore, there is moderate impairment of social and recreational activities.
3. Travel	1	In terms of travel, Ms Eldahoud can only travel short distances and there is mild impairment of travel.
4. Social Functioning	2	In terms of social functioning, Ms Eldahoud relates well to her husband, however, there has been a lot of stress with her marriage and there is a lot of pressure on the family. therefore, there is mild impairment of social functioning.
5. Concentration, Persistence and Pace	2	In terms of concentration, Ms Eldahoud can use her phone for 30 minutes and she can read for 10 minutes, however she experiences headaches, pain in her eyes and dizziness which can impact on her ability to concentration. Therefore, there is mild impairment of concentration, persistence and pace.
6. Adaptation	3	In terms of adaptation, Ms Eldahoud has lost interest in working. She was working full-time prior to the accident; however, she is unable to work or contribute. Pain prevents her from being able to work, however she has lost motivation, feels exhausted, tired and her mood is low. Therefore, there is moderate impairment of adaptation.
List classes in ascending order: 1, 2, 2, 2, 3, 3
Median Class Value: 2
Aggregate Score: 13
% Whole Person Impairment: 7%

Medical Assessor Barrett diagnosed the claimant as having a post-traumatic stress disorder and that this was a non-threshold injury.
Her affect was anxious, dysphoric and tearful at times, reactive to the content. She did not smile spontaneously. Her mood was described as more irritable and stressed.
Medical Assessor Barrett concluded that the claimant criteria for post-traumatic stress disorder. She met criteria A, as she was directly exposed to the trauma of the accident. The accident was described by the police as a major crash and the contemporaneous records of the psychologist indicated the claimant responded to the accident with a sense of horror and considered at that time that she could have been killed in the accident. The police records indicate that the speed of the accident caused her to lose control of her car and the car spun which the Medical Assessor said would have added to the anxiety provoking nature of the accident.
The Medical Assessor said that as a result of the accident the claimant then experienced intrusion symptoms, criteria B, with recurrent distressing trauma related dreams, reported at assessment and also contained in the contemporaneous records of the psychologist.
The claimant reported avoidance symptoms, criteria C, avoiding driving for a period and then continuing to avoid driving in situations she considers more dangerous, such as at night.
She had negative alternations in cognition and mood, criteria D, including difficulties recalling parts of the accident, exaggerated negative beliefs about the world with disproportionate fears regarding the safety of her children if they are out and their risks of having an accident, persistent loss of positive emotions, loss of happiness.
She also had hyper-arousal, criteria E, with reports of irritability, sleep disturbance and concentration problems.
Medical Assessor Barrett said that her symptoms had been persistent for more than a month, criteria F, and caused distress, impacting her engagement in social activities and motivation to participate in social and household tasks, criteria G. Her condition is not the result of substances or another medical condition, criteria H.
Thus, Medical Assessor Barrett said that the claimant fulfilled diagnostic criteria for post-traumatic stress disorder.

There is a report of Dr Tandon, dated 12 November 2019 providing a diagnosis of adjustment disorder and noting her experience of nightmares, poor appetite and hesitation around driving. It was also noted she had seen a psychologist, Dr Onuoha, on a few occasions between October 2019 and February 2020.
There is a certificate of capacity, certificate of fitness, of Dr Barich dated 18 February 2020 listing “emotional post trauma”. He had also listed this on 17 January 2020 and
24 December 2019, 26 November 2019, 29 October 2019 and 27 September 2019.
With the referral from the claimant’s GP Dr Barich to the psychologist Mr Onuoha on
29 October 2019, he noted that the claimant was taking antidepressant Valdoxan, agomelatine 25 mg daily, prescribed on 1 October 2019.
The claimant consulted a psychologist Mr Onuoha. The first session was
27 September 2019, nearly two months after the accident. He recorded, regarding the accident that the claimant said, “I thought I was going to die”, “I get scared of driving. I’m scared for my children. I had bad sleep, wake up with headaches, screaming”, and was noted to cry for the duration of the session and appear agitated. He considered she met criteria for acute stress disorder, post-traumatic stress disorder with unwanted memories of the accident, nightmares, flashbacks, fear on reminder of the event, getting nervous when memories are triggered of the event, avoidance of thinking about the traumatic event, avoidance of reminders of the event such as getting in cars, reduced interest in participating in regular activities, irritability, estrangement from people, difficulty experiencing positive emotion and heightened startle reaction and difficulty with concentration.
At the second session on 5 October 2019, he noted her mood was “sad, anxious, agitated”. She reported poor memory, turning the stove on and forgetting it. There was a further assessment on 22 October 2019 where she was continuing to complain about nightmares of the accident. There was another session on 16 November 2019, followed by a session on
5 December 2019 when she retold the story of the accident during which she was recorded as appearing tearful. There were further sessions on 6 December 2019, 28 January 2020, and 16 March 2020.
There is an Allied Health Recovery Request (AHRR) from the physiotherapist indicating difficulty working due to reduced standing and sitting tolerance, difficulty in doing household chores and only being able to drive 15 to 20 minutes before needing a break initially increasing to 20 minutes at the time of the certificate.
The claimant obtained a report of Dr Teoh, psychiatrist, dated 9 March 2021. He reported a diagnosis of major depressive disorder with 15% WPI. His criteria for the whole person impairment calculation was not clear. There was moderate impairment for social functioning and the relationship with her husband. Adaptation was recorded as moderate impairment and yet it was reported she was fit for suitable duties. The assessment of
Dr Teoh is considerably greater than the other psychiatrists providing their opinions in this claim.
The clinical notes of Dr Walker, psychiatrist, on 10 August 2021 noted prescription of Venlafaxine 75 mg with an increase to 300 mg for anxiety in relation to the motor vehicle accident. On 23 August 2021 due to inability to tolerate Venlafaxine there was a change to Sertraline.
A report of Dr Tandon, psychiatrist, dated November 2019 noted evidence of adjustment disorder with anxiety and depression and “… there was a complex interplay of physical and psychological contributing factors.”
A NSW Ambulance report dated 5 August 2019 indicated there was a motor vehicle accident on 5 August 2019. The Glasgow Coma Scale was noted as 15 and the claimant was able to walk to the ambulance and gait was unaffected.
Records of Penrith Mall Medical Centre on 21 January 2022 noted stress in relation to family overseas.
A report of Dr Dias, occupational physician, dated 13 January 2022 noted chronic symptomatology and disabilities over the previous 2.5 years and the condition was unlikely to alter significantly. Dr Dias found 21% whole person impairment for physical injuries.
The claimant’s GP clinical notes record an entry dated 9 March 2012 when she had very low vitamin D. There is an entry dated 19 February 2019, before the accident, when she had “severe anxiety, easy crying, partner gambling, financially not stable, counselling, in debt”. She did not want an antidepressant, but it was recorded that the claimant might consider counselling. On the next review on 8 March 2019 no further psychiatric symptoms were recorded. She was given a vitamin B12 injection on 29 March 2019. An entry on
6 August 2019 in regard to the subject accident recorded “the Pt shocked in accident”. On
24 September 2019 she was seen and it was reported, “insomnia since and driving phobia, not only when driving but also when passenger, shouting at her daughter or son to drive slowly and carefully and they feel severely exaggerated as not required to do so to them as sensible drivers”. Her appetite was noted to be reduced. There is an entry dated
23 August 2019 “very tired, pain, stiffness and unwell”. There is an entry dated
22 October 2019 “anxiety is apparent, insomnia, illegible word, feels down”. On
22 November 2019 it was noted “still driving phobia, insomnia”. On 10 December 2019 “Pt driving still affected with anxiety”. On 18 February 2020, still severe driving phobia.
A report of Dr Perla, occupational physician, dated 27 April 2021 noted 10% WPI. While Dr Perla is not a psychiatrist, and he acknowledged this, he did record that the claimant reported depression on two occasions, 27 years earlier and eight years earlier from the time of his examination. The claimant informed Dr Perla that she had recovered from those conditions prior to the accident.
Additional GP’s notes date back to 2016. In early 2019 there were consultations for insomnia. There was pain and on 6 August 2019, which was the day after the motor vehicle accident and also on 23 September 2019. On 27 September 2019 there was severe anxiety whilst driving. On 1 October 2019 there was pain and depression. On 15 October 2019 there was ongoing pain and anxiety with continued pain throughout 2019 and 2020. On
7 July 2020 there was depression.
The insurer obtained a report of Dr Jones dated 18 July 2021. He diagnosed post-traumatic stress disorder and 6% WPI. He found moderate impairment for adaptation and mild impairment in other areas with no impairment of self-care and personal hygiene. There was no pre-existing impairment.
Dr Jones reported that the claimant presented at assessment, as consistent with having a probable post-traumatic stress disorder. She had attained some partial remission in this but had residual symptoms of re-experiencing phenomena, generalised hypervigilance and anxiety as well as specific anxiety related to driving and a comorbid depressed mood. She had returned to reasonable functioning in a number of areas and had ongoing physical limitations which were the major limiters of her day-to-day functioning, for example, employment and housework. She had maintained her ability to selfcare, her family relationships, and some friendships. The claimant said that she very much missed working in the family business and lamented that it would be highly beneficial to her mental health if she were able to return there.
The claimant reported that at the time of examination, she was not seeing a psychologist or a psychiatrist and was not taking any regular psychiatric medications. She reported some willingness to attend a psychiatrist if it were to be helpful.

Medical examination

The claimant was examined by Senior Medical Assessor Baker and Medical Assessor Verma on 12 February 2025. Their report follows:

Ms Eldahoud was re-examined by Assessors Verma and Baker via telehealth on
12 February 2025. She was accompanied with an Arabic interpreter appointed by the Commission.
Psychosocial History
Ms. Eldahoud is a 62-year-old female who lives with her husband and twin daughters, aged 29, as well as a son who is 31. Her eldest son, who is 34, is married and lives independently in Glenwood Park. She has grandchildren aged 3 and 2. Originally from Syria, Ms. Eldahoud grew up with her three brothers and seven sisters, making her the third of her siblings. She reported, “We are a family and are well connected to each other.” She denied experiencing any traumatic incidents or adverse events and described her school life as “normal like all other children.” After completing Year 12, she undertook two courses: one in typewriting and another in sewing. Ms. Eldahoud stated that it was extremely difficult to find a job. She had an uncle in Australia and immigrated on a visitor visa. After a few years, she worked, learned English, and learned how to drive. She then returned to Syria, met her husband, whom she married, and remained there for a year before returning to Australia once more. She reported that her husband owned a takeaway shop, and she worked with him for a few years before stopping when her children were younger.
Ms. Eldahoud mentioned that she worked in the takeaway shop for about 18 years. In fact, she was working at the same shop at the time of the accident, from 9 a.m. to 8 p.m. every day, five days a week. Ms. Eldahoud recounted that before the accident, her routine included waking up, tidying the plates, starting work at the shop, and doing some prep. She balanced household chores while working at the shop. She described having a positive relationship with her family members and denied any difficulties with her day-to-day functioning or socialising, as well as issues with inattention or concentration. She also noted that she was able to drive without any difficulties. She remembers going shopping with her daughters every Saturday and having lunch with her extended family and friends on Sundays. Ms. Eldahoud denied any history of mental health issues, although she acknowledged some life stressors, stating, “I wouldn’t consider them mental health issues.”
Ms. Eldahoud reported having seen a psychologist before the accident in relation to her husband's gambling. She mentioned attending a few sessions before discontinuing as her husband stopped gambling. Regarding her medical history, she indicated that she had a thyroidectomy about 30 years ago. She also underwent gastric sleeve surgery, stating her weight reduced from about 89 kg to around 80 kg post-surgery. She denied consuming alcohol, using illicit drugs, gambling, or smoking cigarettes. There is a record of her involvement in a motor vehicle accident approximately 21 to 22 years ago, which resulted in physical injury. She experienced pain from that incident, which gradually resolved on its own, allowing her to return to her baseline functioning.
History of Motor Accident: Ms Eldahoud was involved in a motor vehicle accident on 15 August 2019 while driving home from work on Richmond Road. She reported that she had stopped at the traffic light when another vehicle approached from the left side and collided with her car. She speculated that the other driver might have been on his phone and not paying proper attention. Although the airbags did not deploy upon impact, her car was pushed up to three metres from the point of collision. She mentioned that all the other cars stopped, which prevented further collisions. The police and ambulance arrived at the accident site. She noted that the other driver did not exit his vehicle. While she experienced blurry vision, she managed to compose herself. She stated that paramedics checked her blood pressure, but since she was alert, able to walk, and didn’t have any visible physical injuries, she declined to go to the hospital.
History of symptoms and treatment following a motor accident:
Ms Eldahoud reported that she began to experience pain in her “head, upper back, and lower back," and on the night of the accident, she was unable to sleep. She recalls seeing the accident as if it were happening in the present, making her agitated. ~~feel jumpy~~. Additionally, she experienced “unbearable pain” and she consulted her GP on the same day as the accident happened. She noted that “all her days became the same." She remembers being unable to sleep, feeling jumpy, and being “annoying to everyone." Her mood was low due to the intense pain, and it seemed like there was no respite from it. She also had nightmares that impacted her overall sleep quality. Gradually, she became increasingly concerned and fearful about her safety and that of her family members. She felt tense and would grip the handle in the car, fearing that she might have an accident at any moment.
Ms Eldahoud added that she tried to support her husband despite suffering from chronic pain and mental health issues. However, she found it difficult to do so. She mentioned that she would wake up feeling fatigued and lacking energy because of poor sleep since the accident. Additionally, she dealt with headaches, eye pain, and blurry vision. She stated that she could not visit the shop as they had moved to a new home that was a 20-minute drive from the shop. This meant she could not accompany her husband to work in the mornings, as she often woke up too late and was asleep when he routinely left for work most days. She said that sometimes she would still be awake from the night before having not been able to initiate sleep before her husband left for work the following morning. She also continued to experience headaches and blurry vision. She said she experienced this symptom when she was agitated and distressed. Overall, she felt she wasn’t functioning well and couldn’t even go to the shop alone because of the distance. She felt extremely distressed at the thought of travelling by car towards the shop and this caused her to avoid this location.
Ms Eldahoud reported that gradually she began to gain weight after the accident as she was not engaging in many physical activities. She also faced high levels of anxiety with panic attacks, particularly when it came to travelling in a car. She started to avoid situations where she felt threatened and specifically avoided driving at night. Ms Eldahoud reported feelings of helplessness, hopelessness, and worthlessness as she thought she was no longer contributing to the household as she had before the motor accident. She experienced a constant sense of being on edge and was hypervigilant, she would startle easily to unexpected noise. She was referred to see Dr Walker, a psychiatrist, and met with him once a month, commencing soon after the motor accident and continuing to the date of this re-examination. She was trialled on multiple medications but experienced many side effects which disrupted her recovery.
The Medical Assessors note that Ms Eldahoud was trialled on different selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and Moclobemide when she did not respond to SSRIs and SNRIs. She was referred to see a psychologist and attended a few sessions before these sessions were not approved by the insurer. She has only recently started seeing a psychologist again. She was referred to Macquarie University for pain management and was prescribed medications, including Lyrica, but only attended once, as she could not afford the medical fees. She never received a referral for admission to a mental health unit or any recommendations for other forms of biological treatment for her psychological issues symptoms.
For details of any relevant injuries or conditions sustained since the motor accident:
Not applicable.
Current symptoms: Ms Eldahoud reported that she “experiences chronic pain 24 hours a day” and has no respite from it. She reflected that it has significantly impacted her ability to carry out her household chores, go out to socialise, and take walks. She provided examples of how even walking for more than three to four minutes exacerbates the pain. She has gained weight and currently weighs around 90 kg. She mentioned that she is “unable to cope when people are around her as she feels socially anxious.” She remains socially withdrawn and is reclusive. Her mood is generally depressed, and she has thoughts of death, expressing that she would rather “die than live,” however, she denied having any active suicidal ideas, plans, or intent to harm herself, as she views her children and grandchildren as protective factors. She is still able to enjoy the company of her children and grandchildren at the time of this re-examination.
She is also distressed by her inability to lift and play with her grandchildren. Her sleep continues to be poor as she still experiences “neck and back pain.” Additionally, she suffers from pain and muscle cramps, along with a tingling sensation in her foot and has to bang her feet at night.
Current and Proposed Treatment: Ms Eldahoud continues to be engaged with her psychologist and talks to him on the phone frequently. Session times depends on his availability. She said that they are working on “talk therapy.” She also has been seeing Dr Walker and is currently on tablet Endep 25 mg one tablet at night and tablet Valium 2 mg prn for anxiety and sleep. She said that she was suggested to trial Diclofenac for pain, which she did not commence as she was worried about gastric side-effects.
Mental Status Examination
Ms Eldahoud was reviewed and assessed via MS Teams. She was accompanied with the Arabic interpreter. She presented as a 62-year-old female and looked her stated age. She was casually dressed in a t-shirt, and her eyebrows were groomed. She appeared in pain as she positioned herself multiple times during the re-examination. She stood up during the assessment slowly because of pain. She reported her mood to be depressed and sad. Her affect was dysphoric and congruent to the mood she described. Her speech was spontaneous and normal in volume and tone. Ms Eldahoud spoke in English at times, and at times she needed support from the Arabic interpreter. Her thoughts were logical and goal directed. She reported ongoing anhedonia, lack of interest in social activities, nightmares, flashbacks, and avoidance behaviour. There was no evidence of any manic, psychotic or any perceptual abnormalities. She had insight into her condition and her judgment was intact.
Ms Eldahoud was able to focus during the assessment reasonably well, only to be interrupted when she was in pain and had to slowly change her position.
Diagnosis and Reasons
Ms Eldahoud was involved in a motor vehicle accident on 5 August 2090. She reported experiencing both physical and psychological injuries from the motor vehicle accident. At the time of assessment, she presented with symptoms consistent with the diagnosis of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Somatic Symptom Disorder with predominantly pain.
Ms Eldahoud meets DSM-5-TR criteria of major depressive disorder (MDD), she had the following symptoms, depressed mood most of the day, nearly every day, markedly diminished interest or pleasure in almost all activities, insomnia nearly every day, significant weight gain, fatigue or loss of energy almost every day, feelings of worthlessness, and diminished ability to think or concentrate almost every day. These symptoms caused clinically significant distress and impairment in her overall functioning and are not attributable to the physiological effect of her substance or another medical condition.
These symptoms are also not better explained by a Schizoaffective Disorder, Schizophreniform Disorder, Delusional Disorder, or other specified and unspecified schizophrenia spectrum and other Psychotic Disorder.
Ms Eldahoud also reported directly experiencing the motor vehicle accident, which was traumatic and did meet criteria A of DSM-5-TR criteria for Post-Traumatic Stress Disorder. She experiences recurrent involuntarily intrusive distressing memories of the traumatic motor accident, along with recurrent distressing nightmares and dreams in which the content of the motor accident was related to the content of the nightmare and traumatic dreams. She also experienced persistent avoidance of driving and going out in her car along with negative alterations in cognitions and mood. She had markedly diminished interest, persistent negative emotional state of guilt of being in the accident and not being able to help her family and inability to experience positive emotion when with her family. She also experienced marked alterations in arousal and reactivity with hypervigilance, exaggerated startle response and sleep disturbances.

Ms Eldahoud experienced these symptoms for more than one month, which caused significantly significant distress in social, occupation and other important areas of functioning.
Ms Eldahoud also has been experiencing chronic pain that is distressing and has resulted in significant disruption of her daily life. She has a persistently high level of anxiety about her pain and about the seriousness of her symptoms. She has been experiencing these symptoms for more than six months. Her pain related symptoms were sufficient to met DSM-5-TR criteria for Somatic symptom disorder with predominant pain. The pain Ms Eldahoud experience from all causes was not included in the assessment of permanent psychiatric impairment in compliance with current guidelines.
Causation And Reasons
Ms Eldahoud was independent in her daily functioning and lifestyle before the motor accident. Ms Eldahoud did not have a pre-existing psychological injury or condition. She was able to support her family and work in the family business for many years without impairment before the motor accident.
Ms Eldahoud had sought the advice of a psychologist in relation to her husband’s use of poker machines and gambling behaviour. She attended on a few occasions. Ms Eldahoud with the help of the psychologist developed a management plan which was successful in relation to her husband’s behaviour. She was not psychologically or psychiatrically impaired. She was not exposed to any domestic violence. She reported that she resolved her concerns with her husband and the family business and marriage has remained without any permanent psychiatric impairment before the motor accident. For these reasons the Medical Assessors formed the opinion that the Ms Eldahoud did not have any per-existing condition as defined by current guidelines.
Ms Eldahoud was involved in a motor vehicle accident. She had no other interpersonal, personal, financial or personality vulnerabilities that would have predisposed her to develop these psychiatric symptoms at the time of the motor accident. The Medical Assessors from careful review of the forwarded documentation, and the findings on re-examination confirm that the assessable psychiatric conditions of posttraumatic stress disorder and major depressive disorder are caused by the motor accident. The Medical Assessors were of the opinion that the motor accident did cause the psychological injury as documented.
The Medical Assessors find that the motor accident did also cause somatic symptom disorder with predominant pain. The pain from all causes is not used to measure permanent psychiatric impairment in compliance with current guidelines. For these reasons loss of function due to psychological pain as defined by somatic symptom disorder with predominant pain is not assessed as part of the PIRS assessment of whole person impairment.
The following pain related loss of function was not included in the PIRS assessment:
Self-Care and Personal Hygiene
Ms Eldahoud is supported by her daughter for cleaning and cooking because of chronic pain, Ms Eldahoud experiences when attempting to perform these physically demanding activities. Ms Eldahoud’s impairment in self-care and personal hygiene because of pain was not included when assessing this table of function. Ms Eldahoud used to previously enjoy cooking sweets and tiding the house. She said that she is however now unable to cook and clean because of her predominant pain. She lifted much less grocieries sdue to her predominant pain.
Social and recreational activities
Ms Eldahoud attributed some of her restriction in social and recreational activities to her predominant chronic pain. She said she was restricted in lifting and this made showing affection difficult as her arms were often too painful to be active in lifting or embracing others.
Travel
Ms Eldahoud reported she was able to physically travel to Syria last year to visit her mother.
Social functioning
Ms Eldahoud reported that she was less able to show physical signs of affection due to her predominant chronic pain toward her husband.
Concentration persistence and pace
Ms Eldahoud said that she is also unable to concentrate because of her predominant chronic pain.
Adapation
Ms Eldahoud reported that whilst she “wishes to return to work she was also aware of her disabilities with regard to her ongoing predominant chronic pain”. She explained that her physical pain partly restricted her adaptation in returning to work after the motor accident.
WPI Impairment Assessment PIRS rating form.

Psychiatric diagnoses	1. PTSD	2. Major Depressive Disorder
	Psychiatric treatment description	Yes

Category	Class	Reason for Decision
1. Self-Care and Personal Hygiene	2	Ms Eldahoud reported that she was able to give verbal instructions to her daughter in relation to tasks she asked her daughter to do in the family home. She showers once a week as she lacks energy. She also brushes her teeth irregularly. She is interested and able to change into clean clothes daily. She would skip meals if she was not hungry. She said that she also enjoyed going out for shopping and groceries, she now lacks energy and this restricts her interest in grocery shopping. Ms Eldahoud’s assessable psychological symptoms were assessed as Class 2 mild impariment of function.
2. Social and Recreational Activities	2	Ms Eldahoud’s children and grandchildren frequently visit her and she enjoys spending socialising and recreating with them. She said she was interested in her grandchildren. She said she was less interested in socialising with her friends, who would visit her in her home. She is also able to “go out with friends when they have time.” She said the opportunity to socialise with friends during the day was restricted by her friends all working.. Ms Eldahoud’s reported feeling anxious if she has to go out when in large groups or with people she was unfamiliar she would avoid going out to larger venues or events, however she is able to socialize when her friends visit her in her home. Ms Eldahoud’s assessable psychological symptoms were assessed as Class 2 mild impariment of function.
3. Travel	2	Ms Eldahoud reported that she leaves her home to attend medical appointments including physiotherapy and osteopathic appointments. She said that she is also able to go out for shopping malls that are familiar to her. She was able to drive in her local region. She is unable to drive long distances as she would become too anxious. During 2024, she travelled to Syria with support from her extended family to visit her ailing mother. She said she was familiar with the travel route and she remained with her mother for a month before returning home. Ms Eldahoud’s assessable psychological symptoms were aassessed as Class 2 mild impariment of function.
4. Social Functioning	2	Ms Eldahoud reported that there was tension in her relationship with her husband. She said her husband does not understand her predicament with regards to her psychological injury sustained in the motor accident. She feels guilty about not being able to help her husband with his business which he is now managing alone. She said that her husband now sleeps in a different room as they are no longer intimate however they have not separated since the accident and she had no expectation of future separation, estrangement or divorce. Ms Eldahoud daughters have been very encouraging and supportive of her. Her grandchildren visit her on the weekends which makes her feel very happy. She reported that she misses her grandchildren when they are not around and wishes to spend some more time with them. Ms Eldahoud’s assessable psychological symptoms were assessed as Class 2 mild impairment of function.
5. Concentration, Persistence and Pace	2	Ms Eldahoud reported that she is unable to focus and concentrate. She said that she can only read for up to 10 minutes and then becomes distracted. She said that she can watch a movie for a maximum of 10 to 15 minutes. She is able to use social media for up to 15 minutes before becoming distracted. Ms Eldahoud’s assessable psychological symptoms were assessed as Class 2 mild impairment of function.
6. Adaptation	4	Ms Eldahoud has severe impairment in the area of adaptation and could not work for more than 1 or 2 days at the time and less than 20 hours per fortnight in a lesser role due to her assessable psychological symptoms which caused her to be too erratic and unable to attend her employment due to her avoidance and inability to manage her psychological distress when thinking about her workplace. She reported that she would become too frustrated and have angry outbursts when thinking about her frequent customers, she feared she would cause further harm and so avoided her husband’s business. Ms Eldahoud’s assessable psychological symptoms were assessed as Class 4 severe impairment of function.
List classes in ascending order: 2, 2, 2, 2, 2, 4
Median Class Value: 2
Aggregate Score: 14
% Whole Person Impairment: 7%

*%WPI ^{= Percentage Whole Person Impairment}
Whole person impairment is assessed as 7% WPI.
Pre-existing condition
There is no apportionment for any pre-existing injuries. The adjustment for pre-existing conditions was assessed as 0% WPI.
There was no adjustment for treatment effects as the withdrawal of treatment due to significant side-effects had not altered the assessment of whole person impairment.
The adjustment for treatment effects was assess as 0% WPI.
The certificate by Assessor Christopher Rikard Bell dated 3 May 2023. I have noted the diagnosis of Post-Traumatic Stress Disorder and chronic pain syndrome with Somatic Symptom Disorder. I have noted that Assessor Bell concluded that her WPI was 7%. Our assessment differed in the areas of social and recreational activities.
Social and recreational activities: Ms Eldahoud is able to engage in social activities with her family members including her grandchildren and her friends. She is able to go out for grocery shopping which she enjoyed doing previously. The impairment arising from being unable to cook and tidy at the house which she enjoyed doing previously is because of chronic pain rather than psychological symptoms.
Travel: Ms Eldahoud reported that she is unable to drive long distances because of ongoing anxiety and hence we have marked that as mild impairment.
Adaptation: Ms Eldahoud has severe impairment in the area of adaptation and possibly cannot work for more than 1 or 2 days at the time and less than 20 hours per fortnight because of ongoing chronic pain, lack of motivation, low mood, exhaustion and impairment in her attention and concentration

The Review Panel adopts the report and findings of Senior Medical Assessor Baker and Medical Assessor Verma.

Conclusion

While the Medical Assessor and the Review Panel have both assessed the claimant as having a WPI of 7%, the assessment of the Review Panel differed from that of the Medical Assessor in the area of social and recreational activities, travel and adaptation. Because of this, the certificate and reasons of the Medical Assessor must be revoked and replaced with a new certificate of this Review Panel.
The Review Panel assesses the claimant as having:
(a)    post-traumatic stress disorder;
(b)    major depressive disorder, and
(c)    somatic symptom disorder with predominantly pain.
The review panel assesses the claimant as having 7% WPI.

Determination

The Review Panel revokes the certificate and reasons of Medical Assessor Rikard-Bell dated 3 May 2023.
The Review Panel assesses the claimant as having:
(a)    post-traumatic stress disorder;
(b)    major depressive disorder, and
(c)    somatic symptom disorder with predominantly pain.
The Review Panel assesses the claimant as having 7% WPI.

[2025] NSWPICMP 130

28 February 2025