Frith v QBE Insurance (Australia) Limited
[2025] NSWPICMP 617
•18 August 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Frith v QBE Insurance (Australia) Limited [2025] NSWPICMP 617 |
CLAIMANT: | Jennifer Frith |
INSURER: | QBE Insurance (Australia) Limited |
REVIEW PANEL | |
MEMBER: | Alexander Bolton |
MEDICAL ASSESSOR: | John Baker |
MEDICAL ASSESSOR: | Steven Yeates |
DATE OF DECISION: | 18 August 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of threshold injury decision of Medical Assessor (MA); the claimant suffered psychiatric disability in an accident following serious collision; damage to her car; claimant forced to change job locations to avoid driving where the accident occurred; claimant was able to view the imminent high speed impact and feared for her life; Held – Review Panel satisfied that the claimant met criterion A for post-traumatic stress disorder and satisfies the remaining criteria in DSM-5-TR; certificate and reasons of MA revoked. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION 1. The Panel revokes the certificate and reasons of Medical Assessor Verma dated 2. The Panel finds that the claimant has suffered a post-traumatic stress disorder which is a recognised psychiatric illness. 3. The claimant has suffered a non-threshold injury. |
STATEMENT OF REASONS
INTRODUCTION
This is an application by the claimant for review of a certificate and reasons of Medical Assessor Verma (the Medical Assessor) dated 4 March 2024.
There is a dispute between the claimant and the insurer about whether the injury is a threshold injury under Schedule 2, s 2(e) of the Motor Accident Injuries Act 2017 (the Act).
The following injuries were referred by the Personal Injury Commission (Commission) for assessment:
(a) post-traumatic stress disorder.
The Medical Assessor found that the claimant suffered an adjustment disorder with anxious mood and that this is a threshold injury.
Amendment to legislation
The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2023 with various amendments commencing on
1 April 2023. From 1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
For motor accidents occurring on or after 1 April 2023, the entitlement to statutory benefits for a threshold injury have increased from 26 weeks to 52 weeks. The accident the subject of this claim occurred on 28 June 2022.
Accordingly, an injury which does not fall within the definition of a threshold injury (“a non-threshold injury”) means that a claimant has an entitlement to claim damages and, subject to other exclusions, receive statutory entitlements beyond either the 26-week or 52-week limitation period.
LEGISLATIVE BACKGROUND
Jurisdiction
Threshold injury
A threshold injury is defined in s 1.6 of the Act which says;
“1.6 MEANING OF "THRESHOLD INJURY"
(1) For the purposes of this Act, a
"threshold injury" is, subject to this section, one or more of the following--(a) a soft tissue injury,
(b) a psychological or psychiatric injury that is not a recognised psychiatric illness.
In summary, if a person injured in a car accident does not have a recognised psychiatric injury, then the injured person’s statutory benefits cease in accordance with ss 3.11 and 3.28 of the Act. If a person injured in a car accident has a recognised psychiatric injury then that injury will be a non-threshold injury.”
Section 1.6(4) provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury or a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) further defines threshold injury to include “an injury to the spinal nerve root that manifests in neurological signs (other than radiculopathy)” and an acute stress disorder and an adjustment disorder (in terms of psychiatric or psychological injuries).
Section 1.6(5) says that the Motor Accident Guidelines (the Guidelines) may provide for the assessment of whether or not an injury is a threshold injury. Relevantly to the matters in issue in the claimant’s claim, cls 5.10 to 5.12 of the Guidelines are headed “threshold psychological or psychiatric injury assessment” and provides:
“5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5- TR), published by the American Psychiatric Association.
5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury.”
Method of assessment
Part 5 of the Guidelines contain the procedure for assessing whether an injury resulting from the motor accident is a “threshold injury” for the purposes of the Act. In respect of the medical assessment of whether an injury is a threshold injury or not, the Guidelines relevantly provide:
“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.5 Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b) a review of all relevant records available at the assessment
(c) a comprehensive description of the injured person’s current symptoms
(d) a careful and thorough physical and/or psychological examination
(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
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 accident occurred on 28 June 2022, the claimant was the driver of a 2002 model Toyota Echo hatchback and was travelling on her way to work. She was stationary in a line of traffic. The insured driver failed to stop in time and collided with the rear of the claimant’s car, pushing her into the car in front of her, and by way of a second impact.
The claimant subsequently attended Sutherland Hospital Emergency Department where she was investigated and examined. The claimant was not admitted to hospital.
Claimant’s submissions
The claimant submits that the Medical Assessor’s medical assessment is incorrect in a material respect for the following reasons:
(a) failure to use the correct test for post-traumatic stress disorder and arriving at a legally unreasonable determination with respect to criteria A, and
(b) ignored relevant evidence and failed to provide adequate reasons.
Ground 1- failure to use the correct test for post-traumatic stress disorder and arriving at a legally unreasonable determination with respect to criteria A
The claimant submits that the Medical Assessor determined that criteria A was not satisfied because the claimant “did not experience any serious injuries or threatened death”. The claimant says that to that end, the Medical Assessor’s belief that the claimant did not experience any serious or life threatening injuries was based on the fact that she was diagnosed with threshold injuries. The claimant submits that this is not the correct test for criteria A pursuant to the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM 5).
The claimant submits that the Medical Assessor was under an obligation to adhere to the DSM V in her assessment as to whether the claimant suffered a recognised psychiatric illness outside the scope of a threshold injury.
The claimant says that pursuant to the DSM 5, criteria A is satisfied when there is “exposure to actual or threatened death, serious injury, or sexual violence”. Therefore, the claimant submits, she does not need to experience any serious injuries or threatened death, and criteria A is satisfied if the claimant was merely exposed to threatened serious injury.
The claimant says that this is a fundamental distinction which has been misapplied by the Medical Assessor, and she has failed to provide a diagnosis that is in keeping with the DSM V, resulting in an assessment where she has fallen into material error.
In the claimant’s submission, it is clear that criteria A is satisfied. The claimant was driving a small hatchback and came to a standstill behind a line of traffic. The claimant then saw “a red ute driving at a high speed in the rear vision mirror.” The claimant says that she was unable to escape the imminent collision, and the insured vehicle did not stop. The claimant submits that she feared for her life as she saw the insured driver travelling towards her. The claimant says that this was not a minor collision which is confirmed by the shattering of the car rear window and with the claimant’s vehicle being written off for insurance purposes and with glass over the road.
In support of the claimant’s submission, she relies on a report of her psychologist,
Ms Webster, dated 20 July 2023 where it was reported;
“Criteria A refers to the ‘exposure to actual or threatened Death, serious injury, or sexual violence’. When Ms Frith realised she was going to be hit by the red utility, the intensity of the fear was because she felt her life was being threatened. Additionally, she was seriously injured considering that a year after the accident she still suffers with the physical consequences of the accident.”
The claimant submits that the Medical Assessor’s understanding of criteria A was flawed. In the claimant’s submission, it was plainly unreasonable to determine that criteria A was not established given that the claimant had quite obviously been exposed to the fear of imminent serious injury.
Ground 2 – ignored relevant evidence and failed to provide adequate reasons
The claimant submits that because a threshold injury determination was handed down in accordance with the Motor Accident Guidelines does not lead to the conclusion that an individual has not suffered serious injury. The claimant submits that consequently, the Medical Assessor has relied on irrelevant considerations in determining whether the claimant suffered serious injury, which the claimant says in any event was not keeping with the proper test in the DSM 5.
The claimant referred to a comment of the Medical Assessor in disputing a post-traumatic stress disorder diagnosis when she said:
“Also, currently, Ms Frith is working full-time, and hence, there is no ‘clinically significant distress or impairment in social, occupational, or other important areas of functioning’. I have noted some impairment but that is mainly attributed to her back pain, like driving to close distances rather than any psychological symptoms. Ms Frith has been mostly independent in her domestic duties and transportation and only needs the support of her husband because of the chronic pain like, for example, lifting heavy groceries and vacuuming as she is unable to bend because of back pain.”
Following on from this the claimant submits that because an individual works full-time, with restrictions, does not reasonably lead to the conclusion there is no “clinically significant distress or impairment in social, occupational, or other important areas of functioning” (criteria G). The claimant submits that this statement is false and amounts to an erroneous finding in the certificate of the Medical Assessor.
In the claimant’s submission, the subject accident has resulted in enormous distress in which the claimant was forced to change job locations to avoid prolonged periods of driving and in particular, to avoid driving where the accident occurred. The claimant says that this history was provided to the Medical Assessor during the assessment and is evidenced by the report of Ms Webster dated 20 July 2023 such that these “disturbances have caused significant clinical distress, and impaired her socially, occupationally. Ms Frith has had to change location of her job to avoid driving on the Heathcote Road. These disturbances are not attributed to medication or the effects to another substance”.
The claimant submits that the Medical Assessor ignored relevant evidence which led to an erroneous finding that “there is no “clinically significant distress or impairment in social, occupational, or other important areas of functioning”.
The claimant submits that the Medical Assessor has ignored relevant evidence that confirmed criteria G was established as the claimant needed to change jobs so that she could avoid driving on the road where the accident occurred in addition to reducing the amount of time she drove.
The claimant submits that the Medical Assessor overlooked that the claimant changed jobs so that she could avoid driving on the road where the accident occurred.
The claimant submits that post-traumatic stress disorder is a diagnosable psychiatric illness under DSM-5 and is therefore a non-threshold psychological injury in accordance with the definition prescribed the Act.
Insurer’s submissions
The insurer submits that the Medical Assessor directly identified the issue of whether the claimant presented with a post-traumatic stress disorder in light of the report of
Ms Webster dated 20 July 2023. The insurer says that the Medical Assessor then directly engaged with the ultimate dispute between her findings and those of
Ms Webster.
The insurer submits there is no evidence the claimant suffers from a recognised psychiatric illness in accordance with the DSM-5.
The insurer submits the following observations;
(a) For diagnosis of post-traumatic stress disorder, the claimant must have suffered an “exposure to actual or threatened death, serious injury, or sexual violence in one (or more)”. The insurer submits that this is not consistent with the medical evidence. The insurer says that following the accident on 28 June 2022, neither the NSW Ambulance Service nor the NSW Police Service attended the accident scene. The NSW Police recorded the motor accident as a “minor traffic crash” following the claimant’s report on 30 June 2023.
(b) The insurer says that the claimant’s application for personal injury benefits claim form completed on 5 July 2022, with respect to injuries arising out of the subject accident, does not record any shock or psychiatric complaints.
(c) In an Allied Health Recovery Request (AHRR) completed by Mr Rohowyi, physiotherapist on 14 July 2022, the claimant was assessed as being independent with home duties, for example self-care, domestic, caring, and independent within the community for example driving, transport, leisure.
(d) All the AHRRs completed for the purpose of physiotherapy or exercise physiology treatment record no history of any psychiatric complaints.
(e) A referral letter from Dr Cleophas, general practitioner (GP) to Ms Dash, psychologist, dated 31 March 2023, recorded a history of the claimant having “low mood” and being frustrated that her pain levels were not improving.
(f)
The insurer says that the medical evidence does not indicate any impairment in social, occupational, or other significant areas of functioning resulting from the accident. The insurer submits that on the contrary, the certificate of capacity completed by Dr Cleophas on 21 July 2022, assessed the claimant as capable of working eight hours for four days a week, starting from 21 July 2022. Her capacity increased to eight hours for five days a week on 8 February 2023. The insurer then submits that as of
3 May 2023, the claimant resumed full-time work as a high school teacher.
(g)
In an initial psychological/counselling management plan prepared by
Ms Mesuraco, psychologist, on 3 May 2023, a diagnosis of post-traumatic stress disorder was recorded. The insurer says that although the plan refers to the DSM-5 criteria for post-traumatic stress disorder,
Ms Mesuraco did not accurately address each and every criterion outlined in the DSM-5.
(h) On 16 May 2023, the claimant reported to Dr Cole, sport and exercise physician, that she had recently returned from a holiday in Europe. She also reported beginning a new job at a different school, which had been very stressful due to an “increased workload”.
(i) On 28 June 2023, Ms Moubarak, psychologist, and Dr Antoun, general practitioner, expressed the opinion that there was “insufficient evidence to support a PTSD diagnosis” and inconsistent with the claimant’s reported function.
(j) The medical evidence does not include any record of antidepressant medication, suggesting that the claimant was not prescribed any antidepressants.
The insurer submits that the claimant has suffered a threshold injury.
Medical evidence
The Medical Assessor provided a certificate of 4 March 2024. She found that the claimant was suffering from an adjustment disorder with anxious mood and that this was a threshold injury.
The Medical Assessor noted that the claimant reported experiencing pain in her back soon after the accident, which impacted her overall functioning. She also reported feeling anxious at times and with a fluctuating mood. She said she also struggles with occasional anxiety about driving and being in an accident.
At the time of assessment, the Medical Assessor reported that the claimant was future-focused and did not have any persistent low mood, lack of interest in activities or lack of motivation. The Medical Assessor said that the claimant had, however, been experiencing chronic pain, which had impacted her capacity to engage in social activities as previously. She was though, able to go out with her husband and is well-supported by him.
The Medical Assessor considered other possible diagnoses and said;
“Post-Traumatic Stress Disorder
I believe that the diagnosis of Post-Traumatic Stress Disorder is less likely as she does not experience the cardinal symptoms associated with Post-Traumatic Stress Disorder. I have noted that although Ms Frith reports chronic pain from the accident, however, her injury has been diagnosed to be threshold injury and not a serious or life-threatening injury.
Also, currently, Ms Frith is working full-time, and hence, there is no ‘clinically significant distress or impairment in social, occupational, or other important areas of functioning’.
I have noted some impairment but that is mainly attributed to her back pain, like driving to close distances rather than any psychological symptoms. Ms Frith has been mostly independent in her domestic duties and transportation and only needs the support of her husband because of the chronic pain like, for example, lifting heavy groceries and vacuuming as she is unable to bend because of back pain.
During the assessment as well, Ms Frith was future-focused and there were no prominent negative alterations in cognition and mood, which are usually associated with Post-Traumatic Stress Disorder. She is currently pregnant and is future-focused and looking forward to having the baby. She did identify other stressors as not being well supported at her current school as compared to the previous one during the assessment.
Major Depressive Disorder
I believe that the diagnosis of Major Depressive Disorder is less likely as she does not experience the cardinal negative cognitions often associated with depression. She reported her mood being positive overall and has been engaged in full-time employment doing most of the household chores, which she can. There were no themes of helplessness, hopelessness or worthlessness, which are often associated with the diagnosis of Major Depressive Disorder.”
The claimant relied on a report of Ms Webster dated 20 July 2023. She concluded that the claimant’s presentation was consistent with post-traumatic stress disorder based on the symptoms that she had been having. The Medical Assessor though disagreed with the conclusion of Ms Webster as she did not believe that the claimant was “exposed to actual or threatened death, serious injury or sexual violence”. The Medical Assessor said the claimant did experience injury but she did not experience any serious injuries or threatened death to fulfil the diagnostic criteria. The Medical Assessor said that the claimant continued to have chronic pain, but that this did not impact her overall functioning. As the Medical Assessor said, the claimant did have some cross-cutting symptoms of post-traumatic stress disorder, but not enough to diagnose this.
The claimant was assessed as having a threshold physical injury by Medical Assessor Rapaport in his certificate of 15 February 2024. This injury was an L4/L5 disc bulge, noting that she also had an injury to that area in 2019.
Ms Mesuraco, psychologist, provided an initial psychological/counselling management plan dated 3 May 2023. In that plan, a diagnosis of post-traumatic stress disorder was recorded. While the plan referred to the DSM-5 criteria for post- traumatic stress disorder, it did not address every criterion outlined in the DSM-5.
Other reports seen by the Panel relate to the claimant’s physical injuries and AHRR treatment requests.
Sutherland Hospital emergency department notes were attached to the insurer’s bundle of documents but nothing is noted about any psychiatric or psychological complaint. The insurer made no submission about these notes.
Beachside Physiotherapy and Psychology clinical notes have also been attached. These notes relate only to the claimant’s treatment of her physical disabilities. There is a reference on 27 September 2022 about the claimant being away on an eight hour drive and then a comment by the claimant on 4 October 2022 that she was “doing well- but thinks she hasn’t been at school, driving and standing in class that attribute [sic] to this”. There are no direct submissions about this.
A AHRR request for physiotherapy dated 28 July 2022 noted that there was a pre-existing lumbar disc injury and reference to a re-occurrence of lumbar spine radiculopathy.
An MRI lumbar spine request form completed by Dr Cole noted that there was a history of "previous disc injury".
A medical report dated 15 November 2022 from Dr Cole reported that "...she (the claimant) is becoming quite upset that her pain has not improved over the past 5 months." It was reported that the claimant was finding it difficult to drive to work and back each day but there was no reference to this being a psychological problem but rather, to her physical issues.
Medical examination
The claimant was examined by Senior Medical Assessor Baker and Medical Assessor Yeates on 9 July 2025. Their examination report follows;
1. Psychosocial history and pre-accident history
Ms Frith was born at the Royal Women’s Hospital in Paddington on 15 July 1986. She was raised with her mother, father, brother, and two sisters. She is the youngest. Her father was an artist who specialised in painting. Ms Frith's mother ran several businesses, including a cleaning and ironing service. The family had enough money, food, clothing and other essentials. The family home was in Randwick and later in Caringbah. Ms Frith was a healthy child and young person. There was no domestic violence in the family, and Ms Frith denied any external physical, sexual, or emotional trauma. Her reflections on her early life are positive, with a wide circle of friends and family, and close relationships with her mother and sisters.
Ms Frith attended Saint Patrick’s in Sutherland Shire and went to a Catholic college for secondary school. She had a circle of friends and no disciplinary issues. She described herself as a slightly above-average student who finished Year 12 in 2004. She began a childcare certificate at TAFE but didn’t enjoy it and switched to studying sport. She obtained a certificate in sports coaching and a diploma in sport development. She then studied physical education teaching at the University of Wollongong between 2008 and 2012. She received some credits for her previous study. She completed the four-year degree in 4½ years and worked concurrently at a physiotherapy practice and in retail at Rebel Sport. She denied any previous WorkCover claims or issues in these positions.
Ms Frith began teaching casually after completing her degree because there were no full-time roles available. She then worked as a PE teacher for one year in London before returning to Australia and securing a position at a school in Beverly Hills. This role was contract work at an intensive English Centre that was affected by the decline in migrant numbers during the pandemic. She also worked in higher and vocational education before taking a job at Elderslie High School as a PE and English teacher, which was her substantive role at the time of the incident. Ms Frith married in 2022 and has an approximately one-year-old son.
Ms Frith received psychological counselling fortnightly or monthly for about a year during her mid-20s, in the context of a relationship breakdown. She described the period as broadly depressive and self-blaming, related to infidelity by her ex-partner. She has never been admitted to a psychiatric hospital and has never experienced suicidal ideation, intent, or made a suicide attempt. There is no history indicating primary psychotic illness or bipolar disorder. There is no family history of major mental illness, addiction, or suicide. Ms Frith engaged in recreational binge drinking as a young woman, but now consumes minimal alcohol. She has never used illicit drugs and does not gamble. There is no forensic history.
2. History of the motor accident
While driving to work around 7:30 am on 28 June 2022 in fine weather, Ms Frith was stationary on Heathcote Road near Voyager Point at Holsworthy. Due to roadworks, there were two lanes on her side and two lanes from the opposite direction. She was stopped in the inside lane at traffic lights and saw a red Toyota Hilux approaching quickly in her rearview mirror. She made several attempts to escape, including moving left, but this was blocked by barricades. Instead, she turned her wheel to the right and was hit from behind at speed, causing her car to spin to the other side of the road and crushing the rear of the vehicle. She was wearing her seatbelt, and the airbags did not deploy. She reported feeling shocked, unable to concentrate, and overwhelmed by comments and suggestions from bystanders. She described experiencing immediate back pain. She looked for her phone but couldn’t find it for a while, then managed to ring her husband and mother. Her clearest memory from the accident was of the vehicle approaching rapidly from behind. She said she saw the other vehicle hit her car whilst she was looking in her rearview mirror. Police and ambulance were not called; instead, Ms Frith was transported by tow truck to a repair shop.
3. History of symptoms and treatment following the motor accident
Ms Frith presented to Sutherland Hospital, where a CT scan of her neck and chest was performed. She was lying in a hospital bed for six hours and was diagnosed with whiplash. She consulted her GP, who referred her to a physiotherapist. Regarding psychological symptoms, Ms Frith said she immediately felt adverse reactions to travelling in cars or similar vehicles to her own. She also reported acute anxiety related to vehicles similar to the one involved in her collision. She had two days off work and then spent the school holidays, which coincided with just after the accident, recovering at home.
Ms. Frith reported experiencing symptoms of difficulty with driving, accompanied by intense fear, leading her to avoid it whenever possible. She describes herself as hyper-focused and preoccupied with monitoring the actions of vehicles in the rearview mirror. She is easily startled and panics when tailgated or struggles when in traffic. She avoids the road where the accident happened, taking a longer route to reach her workplace. She describes ongoing nightmares and intrusive memories of the accident, along with disturbed sleep. She has gained a significant amount of weight due to both pregnancy and the effects of the accident. She reports persistent background anxiety and reluctance to visit distant relatives. She is particularly distressed by the presence of utility vehicles. She sought treatment from psychologist, Angela Webster, which she has been paying for herself on a monthly basis. She noted that financial constraints prevent her from attending more often and has completed 20 sessions of cognitive behavioural therapy. She has not seen a psychiatrist. She is under the care of her GP, Dr. Vikram Cleophas. Her current medications include Mounjaro 5 mg for weight loss, ondansetron wafers, and rizatriptan for migraines. Apart from migraines, she is medically well. Ms. Frith has not taken any psychotropic medications, such as antidepressants or psychotic drugs.
4. Details of any relevant injuries or conditions sustained since the motor accident
Since the accident, Ms Frith has given birth to a son. Her pregnancy was complicated by pre-eclampsia, and she has returned to work initially one day per week and now two days per week, approximately five months postpartum.
CLINICAL EXAMINATION
5. Mental state examination
The mental state examination showed a woman of Anglo-Saxon descent wearing casual clothes and no makeup. She was generally socially appropriate but appeared reticent. Her mood was low, and her affect was flat, with no spontaneous laughter and several tears when talking about the accident. Her thoughts were reality-oriented, with no signs of psychosis or suicidality, but she was preoccupied with rumination and expressed frustration about driving limitations or intrusive symptoms. Her thought form was normal. Her speech had correct grammar, structure, and syntax, with adequate spontaneous elaboration. Her judgement was not acutely impaired, and there were no perceptual disturbances. Her insight was reasonable.
6. Current functioning
Ms Frith does not shower daily and relies on her husband for household chores and maintenance. She has gained about 13 kg due to a variable appetite and difficulty with physical activity. She reports suffering from frequent nausea caused by migraines. She enjoys spending time with her son but is not involved in other social or recreational activities. Before her accident, she played basketball but has since stopped. She drives alone for up to an hour but avoids the road where the motor accident happened. She continues to drive but finds driving very frightening. She mentions tension in her relationship with her husband because of her reluctance to drive, but she has no plans to separate. She is also very hesitant to visit relatives who live far away, which would require a long drive. She cannot watch action movies and does not watch the news, but she performs her work for her employers with relative satisfaction. She only works more than two days a week occasionally due to psychological symptoms and a return-to-work maternity plan. Her current position is more than an hour's drive from her home.
Determinations
7. Diagnosis
Ms. Frith presents with symptoms and signs consistent with post-traumatic stress disorder. The accident, the details of which are obtained from Ms. Frith’s account and the documentation provided, meets criterion A for post-traumatic stress disorder. Ms. Frith also satisfies the remaining criteria for PTSD as outlined below and identified in the DSM-5, TR. Ms.Frith provided a clear history indicating that she became preoccupied with the terror of the vehicle approaching her from behind before the impact, which later became an intrusive memory. It is more likely than not that Ms. Frith feared for her life during the accident. Since the incident, she has had persistent intrusive memories and distress related to recollections of the event, including encountering similar cars or circumstances while driving. She reported recurrent distressing dreams connected to the accident. She consistently avoids driving on roads where the accident occurred and avoids long drives to visit relatives due to the physiological reactions triggered by these experiences. She feels persistently irritable, which has strained her relationships, and experiences sleep disturbances. There is an impact on her functioning at work, as she is choosing her workplace location based on the amount of driving required.
Post Traumatic Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
This criterion is met as the claimant was the driver in the car which was severely damaged in the motor accident.
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
This criterion is met as the claimant experiences intrusive distressing memories of the other vehicle driving into her car causing the psychological injury from this subject motor accident.
2. Recurrent distressing dreams in which the content and/or affect of the dream are
related to the traumatic event(s).
This criterion is met by the claimant’s report of distressing dreams about the motor accident that disrupt her sleep and cause difficulty in her return to sleep.
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
This criterion is met by the claimant’s increased anxiety when she experiences external cues such driving near the road of the motor accident as well as internal cues when thinking about how to avoid using the road where the motor accident happens.
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
2. Avoidance of or efforts to avoid external reminders (people, places, conversations,
activities, objects, situations) that arouse distressing memories, thoughts, or feelings
about or closely associated with the traumatic event(s).
This criterion is met as the claimant continues to avoid Heathcote road and prefers to drive a longer distance to not travel on the road where the motor accident happened.
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
This criterion is met by the claimant reporting persistent inability to experience happiness and loving feelings with members of her family and husband.
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
This criterion is met as the claimant reports increased irritability towards her husband since the motor accident.
3. Hypervigilance.
This criterion is met by the claimant reporting hypervigilance whilst driving.
4. Exaggerated startle response.
This criterion is met by the claimant reporting she would startle if she became too close to other traffic whilst traveling in a car as a driver or passenger.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
This criterion is met by the claimant reporting poor quality sleep and fatigue with unrefreshing sleep most night because she cannot stay asleep.
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
This criterion is met as the date of the motor accident was in June 2022.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
This criterion is met as the claimant reported clinically significant distress whilst driving to school as well as reduced occupation capacity with her not being able to work more than 2 days each week due to the persistent psychological symptoms caused by the motor accident.
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
This criterion is met as the claimant does not have a substance use disorder or physiological effects of a substance, medication or alcohol.
For the above reasons the claimant meets the definition for DSM-5-TR F43.1 posttraumatic stress disorder. This diagnosed condition best defines the claimant’s psychological injury caused by the subject motor accident.
Review Panel Deliberations
The Panel considered the available evidence, as well as Ms Frith’s history and examination. The panel was satisfied, based on the reasoning elaborated above on the balance of probabilities, that Ms Frith suffered from post-traumatic stress disorder, a diagnosable psychiatric condition in the DSM-5. As such, the panel was also satisfied that Ms Frith sustained a non-threshold injury in the subject accident, as per the definition in the Act.
Conclusion
Ms Frith has sustained a non-threshold injury - DSM-5-TR F43.1 post-traumatic stress disorder.
The Panel met on 23 July 2025 to discuss the Medical Assessors findings on examination. The legal Member of this Panel did not participate in the medical examination but prior to the Panel meeting on 23 July 2025, the legal Member had the benefit of reading and considering the Medical Assessors examination report. On
23 July 2025 the Panel met and discussed the examination findings and the issues going to causation and assessment of a threshold injury. It is from this teleconference of the Panel that the Panel has agreed and reached its conclusion and determination.
The Panel adopts the report and findings of Senior Medical Assessor Baker and Medical Assessor Yeates.
Causation/reasons
Before the accident, the claimant did receive psychological counselling on either a fortnightly or monthly basis for about a year during her mid 20s. This was consequent upon a relationship breakdown. Following on from that however the claimant has never been admitted to a psychiatric hospital, has never experienced suicidal ideation, intent nor has she made a suicide attempt. There is no history indicating a primary psychotic illness or bipolar disorder. The Panel is satisfied that at the time of the accident the claimant was not suffering from a pre-existing psychiatric complaint or disorder.
On the balance of probabilities, be said that the claimant suffered a recognisable psychiatric injury has a result of the accident? The reasons discussed above, in the report of the Medical Assessors, the Panel does find that this can be answered in the affirmative.
Would the impairment have occurred, if not for the accident? The panel is satisfied that the accident and impact has had a more than negligible effect on the claimant’s psychiatric condition suffered by her doctor the time of the accident her driving activities were not restricted and caused no distress following accident, the claimant does curtail her driving due to anxieties arising from this period if at all possible she avoids the scene of the accident.
The claimant could see the imminent occurrence of a collision in her rearview mirror her car was damaged in the accident to a considerable degree as evidenced by photographs provided to the Panel in the claimant’s bundle of documents.
The Panel has discussed in its medical examination report that it is satisfied the claimant has suffered from post-traumatic stress disorder which is a diagnosable psychiatric condition in the DSM-5. The Panel does not need to repeat the criteria discussed by its in its deliberations in its medical examination report.
Conclusion
The claimant has suffered a post-traumatic stress disorder arising out of the accident on 28 June 2022. This is a psychiatric injury that is a recognised psychiatric illness.
This is a non-threshold injury.
Determination
The Panel revokes the certificate and reasons of Medical Assessor Verma dated
4 March 2024.
The Panel finds that the claimant has suffered a post-traumatic stress disorder which is a recognised psychiatric illness.
The claimant has suffered a non-threshold injury.
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